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Kansas City, Mo. — A new study finds that Missouri and Kansas are spending only a fraction of their tobacco settlement proceeds on smoking cessation efforts, despite recommendations from federal health officials.

Missouri is the worst among states that spent any money on tobacco prevention programs, amounting to a fraction of a percent of the $72 million that the Centers for Disease Control recommended, The Kansas City Star reported.

A December report by Campaign for Tobacco-Free Kids and the American Heart Association shows that Missouri allocated $48,500 for tobacco prevention programs in its current fiscal year, even though it received $259 million in tobacco taxes from tobacco companies. The report estimates that the tobacco industry spends $364.9 million in marketing its products in Missouri each year.

Kansas fared only marginally better. It ranked 41st among the 50 states and the District of Columbia by spending $847,041.

The report comes on the 20th anniversary of a landmark 1998 settlement between major tobacco companies and 46 states that claimed tobacco products were a public health hazard and required the companies to compensate the states for tobacco-related health care costs.

Tobacco companies were required to make annual payments to each state in perpetuity; through 2018, those payments totaled $126.6 billion, according to data published by the National Association of Attorneys General.

States had pledged to use most of that money, as well as taxes on tobacco products, to offset public health costs created by tobacco use, as well as to devote funding to smoking cessation programs.

But less than 3 percent of those funds actually go to those programs. A Campaign for Tobacco-Free Kids report found that states will receive $27.3 billion in settlement funds and tobacco taxes this year but spend $665 million on smoking prevention and cessation programs.

“This year’s report finds that, once again, most states get a failing grade and are spending a small fraction of their tobacco revenues to fight tobacco use and the enormous public health problems it causes,” the report said.

The report illustrates nearly 21 percent of adults in Missouri smoke and annual public costs associated with smoking exceed $3 billion. It also shows 17.4 percent of adults in Kansas smoke and that public cost figure is around $1.12 billion.