FLORENCE — Alabama didn’t pass a single course on its report card from the American Lung Association.

The report card was released last week as part of the American Lung Association’s State of Tobacco Control 2013 analysis, which graded each state on its tobacco regulations in four main areas: tobacco prevention and control funding, smoke-free air ordinances, cigarette taxes and cessation coverage.

Alabama received an F in all four categories. But the state isn’t alone in its struggles to deal with the health impact of smoking. All 50 states received at least one F from the American Lung Association. Mississippi, Missouri, Kentucky, South Carolina, North Carolina, Virginia and West Virginia also received Fs in all four categories.

Melanie Dickens, area tobacco prevention and control coordinator for the Alabama Department of Public Health, said such reports are both a blessing and a curse for her efforts to curb tobacco use.

“They help us know where we need to work, but they hinder us because we aren’t able to get out all the information about the progress we are making,” Dickens said. “And we are taking steps in the right direction.”

Dickens pointed out that in 2011 Alabama was honored by the group, Americans for Non-Smokers Rights, for passing the greatest number of local smoke-free laws that year. Alabama tied with California in 2011 with four new municipal indoor smoking ordinances.

Locally, Florence is the only Shoals’ town with smoking restrictions on the books.

The city passed its ordinance in 2009 prohibiting tobacco use in buildings, vehicles and on property owned or operated by the city. The ordinance also forced restaurants and bars to declare either smoking or nonsmoking, eliminating special sections for patrons wanting to smoke.

In December, Sheffield voted 4-2 against a smoking ordinance that would have banned smoking in most public places. Sheffield Mayor Ian Sanford said Tuesday his opposition to the ordinance is based on his pro-business stance.

“Businesses should maintain the right to determine what is best for them, especially the small business person,” Sanford said. “As I’ve stated before, if the state of Alabama adopts this, then we will do our best to enforce it.”

The smoke-free air section of the report card looks only at statewide smoking restrictions and doesn’t reflect any municipal smoking bans, which hurts Alabama’s rankings.

“Alabama has made great strides in protecting people from secondhand smoke by passing strong, local smoke-free ordinances,” the report states.

Smoking is restricted statewide at government work sites, schools, childcare facilities, retail store and recreational facilities.

The report notes Alabama allocates just $275,000 in state funds to tobacco prevention and control. The federal tobacco control program funnels about $3 million into the state. With those two programs combined, Alabama falls well short of the $56.7 million the Center for Disease Control said is needed.

Mary Lynn Jackson, a registered respiratory therapist and cessation educator, said nicotine addiction is one of the hardest habits to break. She said while teaching cessation courses, it wasn’t uncommon for the majority of participants to quit the course before completion.

“The majority of patients are not ready to quit,” Jackson said. “They know they need to quit and that it will be better for them to quit, but it is a hard thing.”

Jackson said it is her opinion that prevention efforts need to focus on younger children.

“It seems logical to me to key in on ways to prevent it,” she said. “It is easier to quit smoking if you’ve never started.”

Partially to blame for the lack of funding is the state’s low tax on packs of cigarettes. Alabama’s 42½ cents per pack tax is the fifth lowest in the nation.

During the 2012 legislative session, a bill that would increase the cigarette tax by $1 to help fund the state’s Medicaid program failed.

Dickens said research shows a higher cigarette tax is the top deterrent to youth smoking.