Last week, the American Lung Association released its annual State of Tobacco Control report, and its findings for New Hampshire are sorely disappointing.

The report, an annual survey of policies to prevent or reduce tobacco use, assigns letter grades to states and the federal government on their effectiveness in implementing those policies. In the five tobacco control policy areas it tracks for the states, New Hampshire graded out with D’s in two — strength of smoke-free workplace laws and access to tobacco cessation services. In the other three, the state hit bottom with F’s for tobacco prevention funding, level of state tobacco taxes and laws to increase the tobacco sales age to 21.

Regionally, New Hampshire’s report card was the worst in New England; its grades bettered only one of Rhode Island’s, in the minimum sales age category. As for the trendline, the Lung Association noted, upon releasing the report, that “in 2019 New Hampshire had little to no progress on its efforts to reduce and prevent tobacco use, including e-cigarettes.”

Often, proposals to control tobacco use through spending on programs, raising the minimum age and increasing tobacco taxes run smack into the long-held aversion in New Hampshire to government spending, limiting individual behavior and raising taxes. There’s a place for those concerns in a number of contexts, but this is not one of them. In the press release accompanying the report, Lance Boucher, a Lung Association official, emphasized the urgency of the need for more state involvement. “In New Hampshire,” he stated, “our high school tobacco use rates remain at 30.3 percent — the highest in the Northeast, and higher than the national average” and added that tobacco use is a serious addiction that the state needs to address.

Yes, it can be argued in the Live Free or Die state that people should be able to smoke or use tobacco products on their own volition. But their freedom limits that of the rest of us, as their tobacco use can expose others to unwanted risk of secondhand exposure if not adequately regulated, and their costs become everyone’s cost, shared by the additional burden on the health-care system.

Particularly scandalous has been the woeful level of state funding of tobacco prevention and cessation programs. According to the nonprofit Campaign for Tobacco-Free Kids, New Hampshire’s FY 2020 tobacco prevention spending of $360,000 will be dwarfed by tobacco industry marketing in the state, which the campaign estimates to have been $84.5 million in 2018 (the most recent year for which such information is available). Even with an additional $1.8 million of federal funding, prevention program spending for New Hampshire will be a mere 2.6 percent of what’s estimated the tobacco industry will spend and only 13.2 percent of the level of spending for tobacco control programs recommended for New Hampshire by the federal Centers for Disease Control and Prevention.

Meanwhile, the Lung Association estimates the state’s tobacco-related revenue from taxes and the multi-state tobacco litigation settlement — which New Hampshire has shamefully redirected entirely to its general fund — to be more than $245 million.

The Lung Association’s report did note favorably the progress by New Hampshire since the prior year’s report in legislation to restrict e-cigarette use in public spaces. Otherwise, the association describes its report as a roadmap for how New Hampshire can “achieve lasting reduction in tobacco-related death and disease” and with respect to the disturbing rate of high school tobacco use is concerned the state “may have lost an opportunity to make the current generation of kids the first tobacco-free generation.” New Hampshire would do well to find ways to follow the roadmap more closely.