States most impacted by tobacco use often do the least to reduce the toll of smoking, according to an analysis by USA Today. Kentucky, Tennessee, Missouri, West Virginia and Mississippi are doing the worst job in terms of tobacco control, the newspaper found.

USA Today found big tobacco-growing states, including Kentucky, Georgia and Tennessee, have the poorest and sickest residents, but spend less than one-fifth of the federal government’s recommended minimum for tobacco education and enforcement.

States hardest hit by tobacco use are the least likely to restrict smoking in restaurants and workplaces, the analysis found. These states impose penalties of $100 or less on businesses that sell tobacco to children, compared with $10,000 in states with the most aggressive enforcement.

Tobacco taxes in states with the most smokers are 60 cents or less, compared with $4.35 in New York and $3.75 in Rhode Island, the newspaper found.

USA Today created two scores for states. States’ “impact score” combined youth and adult smoking rates with public perception about the risks of smoking. States’ “aggressiveness score” combined cigarette taxes, smoking bans, how state spending compares with federal recommendations, ad restrictions, and penalties on cigarette sales to young people.

The states that scored high on aggressiveness and low on tobacco impact included Hawaii, New York and Utah. States scoring low on aggressiveness and high on tobacco impact included Kentucky, Tennessee, Missouri, West Virginia and Mississippi.

According to Brian King, a Deputy Director in the Centers for Disease Control and Prevention’s Office of Smoking and Health, the most effective ways to reduce smoking are to regulate it, increase cigarette taxes, run powerful anti-tobacco campaigns and adequately fund tobacco control efforts. He notes that government anti-smoking efforts are “outgunned” by the tobacco industry, which spends about $1 million an hour advertising tobacco.