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Researchers considered factors including funding for preventative programs, smoke-free air laws and tobacco taxes. They gave Texas a letter grade of an "F" in all of those categories.
JoAnna Strother is with the American Lung Association. She says they recommend Texas raise its cigarette tax by at least $1 per pack.
"So tobacco taxes really are an effective way across the board to help people quit, not start, and of course, raise revenue for the state," Strother says.
Texas also received failing marks across the board last year. But researchers only consider policies at the state and federal level. Many cities, including Houston, have local ordinances in place which prohibit smoking in public places. Still, Strother says the state needs to issue legislation to protect all Texans from secondhand smoke exposure.
"Even though these ordinances aren't taken into account for this report, there's huge support for smoke-free air laws," she says.
We reached out to the Texas Department of State Health Services, but they declined to comment.