Hawaii is one of just four states to make progress in overall efforts to curb tobacco-related illnesses, according to a new report by the American Lung Association.

The nonprofit’s State of Tobacco Control 2012 report monitors progress on tobacco control policies and grades states on how well they do to protect the public.

Hawaii received an A grade for smoke-free air in 2011, as it did 2010; an A for its cigarette tax, the same as the previous year; and a B for spending on tobacco prevention and control, up from a C in 2010. It did receive a D for cessation coverage — programs to help smokers quit — but that was up from an F in 2010.

"Hawaii is one of very few states that accepted its responsibility in 2011 to enact much-needed laws and policies and provided funding for programs that save lives and reduce tobacco-related disease," the association said in a press release.

An estimated 1,163 annual deaths in Hawaii are attributed to tobacco use, which results in $686.8 million in health costs and lost productivity, the association said.

To improve cessation coverage, the state must ensure access to counseling for the state’s large Medicaid population as well as remove regulatory barriers that cause delays in coverage, said Debbie Odo, the organization’s tobacco control manager in Hawaii.

"We want everyone to have access to cessation services and medication," she said. "We are doing well, but there is still work to be done in Hawaii to fight the leading cause of preventable death."

The high school smoking rate in the islands is 15.2 percent, followed by an adult smoking rate of 14.5 percent and a middle school rate of 4.9 percent.

"The smoking rate went up because we lost tobacco-prevention funding in 2009," Odo said. Those funds dropped to 6.5 percent from 12.5 percent of tobacco settlement funds to help ease the state budget deficit.

A measure to restrict tobacco advertising failed in the state Legislature last year. But Hawaii did implement a 20-cent cigarette tax increase in July, to $3.20 per pack — the fourth-highest rate in the nation — as a result of previous legislation.

In its 10th annual report, all 50 states and the District of Columbia were graded on the four major policies proved to save lives and reduce health costs.

States that received all F’s were Alabama, Mississippi, Missouri, South Carolina, Virginia and West Virginia. Aside from Hawaii, the states with passing grades were Delaware, Maine and Oklahoma. There were no straight A’s.

State laws are measured against the best in the nation or by goals set by federal agencies such as the Centers for Disease Control and Prevention.