Missouri fails again on every smoking-related health issue, according to a yearly report from the American Lung Association.

The state is one of five (the others are Alabama, Mississippi, South Carolina, Virginia and West Virginia) to receive "F" grades in every category: cigarette taxes, tobacco prevention funding, smoke-free laws and insurance coverage to help people quit smoking.

Missouri has received failing grades four years in a row. Illinois scored a "D" for taxes, "F" on tobacco prevention funding, "A" for smoke-free air and an "F" for coverage of cessation programs.

Missouri is considered one of the friendliest states for smokers with the country's lowest tax rate at 17 cents a pack. There is no statewide indoor smoking ban, although several municipalities including St. Louis have passed smoke-free ordinances in recent years.

More than 21 percent of Missouri's adults are smokers. The state invests 53 cents per smoker on tobacco control programming. The Centers for Disease Control and Prevention recommends that states spend $10.53 per smoker.

Illinois' tax per pack is 98 cents and the adult smoking rate is 16.9 percent. Smoking is banned in the state's workplaces, bars, restaurants and casinos.

Smoking causes or contributes to the deaths of nearly 10,000 Missourians and costs the state $4.7 billion each year, according to the lung association's report.