Massachusetts continues to score well on several tobacco control policies but spends far less than recommended on programs that help people quit smoking, a new report from the American Lung Association shows.

The group’s 2026 State of Tobacco Control report, released early Wednesday, reviews state and federal laws that reduce tobacco use. Massachusetts earned top grades for banning flavored tobacco products and keeping most workplaces smokefree. The state received a failing grade, however, for funding tobacco prevention programs.

The report was released after major changes at the federal level weakened tobacco control efforts nationwide. Those changes increased the importance of state action.

Tobacco use remains the leading cause of preventable death in the United States. Smoking-related illnesses kill more than 9,300 Massachusetts residents each year, the report says.

Massachusetts received an “A” for smokefree workplace laws. Smoking is prohibited in offices, restaurants, and bars, with limited exceptions for certain cigar and smoking bars. The state also earned an “A” for ending the sale of flavored tobacco products, including menthol cigarettes and flavored e-cigarettes.

The state earned a “B” for tobacco taxes. Massachusetts taxes cigarettes at $3.51 per pack — one of the highest rates in the country, but not high enough, according to the American Lung Association.

Massachusetts received a “C” for access to quit-smoking services. Medicaid covers smoking cessation treatments, including counseling and medications approved by the federal Food and Drug Administration, such as nicotine patches, nicotine gum, and prescription drugs. Some barriers remain, including annual limits on the number of covered quit attempts, caps on counseling sessions, prior authorization requirements for FDA-approved cessation medications, and copay or cost-sharing requirements that vary by insurance plan.

The state received an “F” for funding tobacco prevention and cessation programs. Massachusetts spends about $13 million per year on tobacco control, which equals 19.5 percent of the level recommended by the federal Centers for Disease Control and Prevention. The state collects more than $551 million annually from tobacco taxes and settlement payments.

Daniel Fitzgerald, director of advocacy for the American Lung Association in Massachusetts, said the funding gap is more serious now because federal tobacco protections were rolled back in 2025.

Several federal actions reduced tobacco control efforts last year. The Trump administration eliminated most staff at the Centers for Disease Control’s Office on Smoking and Health, the federal agency responsible for national anti-smoking education and support for state programs. That move ended the “Tips from Former Smokers” media campaign, which helped more than one million people quit smoking.

Staffing cuts also hit the Food and Drug Administration’s Center for Tobacco Products, reducing enforcement and oversight. Federal grant funding for state tobacco prevention programs was delayed for months, forcing some states to cut back quitline services.

The Food and Drug Administration also authorized new nicotine products for sale in 2025, including menthol e-cigarettes and flavored nicotine pouches. The agency created a faster review process for additional nicotine products, increasing access to items that appeal to younger users.

“Now more than ever, states need to ramp up their tobacco prevention efforts even more to protect residents from disease and addiction caused by tobacco use,” Fitzgerald said.

Federal grades in the report reflect those changes. The federal government received a “D” for regulating tobacco products, a “D” for covering quit-smoking treatments, and an “F” for tobacco taxes. National anti-smoking media efforts were graded as incomplete.

The report warns that weaker federal enforcement has coincided with increased use by youths of e-cigarettes and nicotine pouches.

Massachusetts continues to outperform most states on tobacco regulation. The Lung Association says higher funding is needed to maintain progress.

Fitzgerald says he wants lawmakers to increase prevention spending, raise the tax on cigarettes from $3.51 to at least $4.51 per pack, and avoid weakening existing smoke-free laws.

Opponents of tobacco control laws often cite personal liberty and concerns about higher taxes and business regulations. Supporters argue the policies protect public health and reduce long-term costs tied to taxpayer-funded health care.

A press spokesman for the federal Centers for Disease Control and Prevention could not be reached for comment on Tuesday.