The news is better for Ohio County, which got an "A" in the report. Hancock County failed with an "F."

“We're looking at, how can we have a healthier population? Tobacco is the number one preventable cause of death," said Wheeling-Ohio County Health Director Dr. William Mercer. "We have one of the highest rates of smoking and using tobacco."

Mercer said even in a county that got a top grade, there's room for improvement.

"My prediction is if you look at a couple years from now, I think everything's going to be 100 percent smoke-free."

Ohio County isn't truly smoke-free, because the Clean Indoor Air Act exempts casinos and gaming rooms. Still, Mercer hopes Ohio County can set an example for other counties that aren’t getting top marks.

In Hancock County, health officials said they are doing everything they can for tobacco control.

"We are following the rules that we set and the rules the state's set for no smoking policy. That's all we can do,” said Ed Huff of the Hancock County Board of Health.

Mercer wants to see the state increase its cigarette tax, which he said is currently one of the lowest in the country. He would like the extra tax money to go toward smoking prevention.