NEW YORK - Most states have failed to pay for tobacco-prevention programs and protect people from second-hand smoke despite receiving billions of dollars in settlement money to take such measures, a report says.

The American Lung Association's report, released Tuesday, gave 38 states grades of F for failing to fund tobacco prevention and control programs. Thirty-five states received Fs for their smoke-free air laws.

The annual report also found that 23 states received failing marks because of their inability to keep tobacco out of the hands of minors.

"How many more preventable deaths must occur and how many more children must become addicted to cigarettes before we say enough?" ALA chief executive John L. Kirkwood said.

North Dakota was among the states that got failing grades in spending on prevention, on laws to protect people from secondhand smoke, and on measures to stop children from smoking. The state got a D grade on cigarette taxes.

Some bright spots

The report said there were some bright spots. Fifteen states received grades of A in at least one of the four categories, and five states - California, Connecticut, Delaware, Maine and Rhode Island - got As in two categories. New York was the only state to receive As in as many as three areas.

The American Lung Association says that 440,000 people die each year from tobacco-related illnesses, while smoking costs the United States about $75 billion in direct medical costs and $82 billion in lost productivity each year.

• On the Net: American Lung Association: http://www.lungusa.org/