States that have the highest rates of lung cancer, chronic obstructive pulmonary disease (COPD) and heart disease are the same ones that have less-restrictive smoking laws, according to a new report.

On Monday, Healthnews published a review of data on the health conditions and linked them to the leniency and strictness of state smoking laws. The weaker the laws, for the most part, the worse the health outcomes, the article said.

Kentucky and West Virginia, where there aren’t any smoking laws (including ventilation policies), have the most cases of lung cancer. Reporters said the correlation shows there’s a possible link between the lack of restrictions and higher lung cancer rates. 

Four out of five states with the highest lung cancer rates — Kentucky, West Virginia, Missouri, and Tennessee — have 50% more smokers than the rest of the country. The area is also called “Tobacco Nation,” according to the article.

Maine, which has the strictest smoking ban, still has the third highest lung cancer rate in the country, the data showed. The team explored that correlation and cited Food and Drug Administration data showing that the state has a higher rate of tobacco use among high school students.

West Virginia, Kentucky and Mississippi, which have no smoking rules, have the highest prevalence of COPD in the country. States that have a partial or full smoking ban had a consistently lower average COPD prevalence. 

The article also linked smoking policy strength with heart disease rates. States with the least-restrictive smoking policies — Alabama, Oklahoma and Mississippi — had the highest rates of death from heart disease. 

“The Healthnews analysis shows that states with the highest lung cancer, heart disease and COPD rates are attributed to weaker local policies on tobacco prevention and cessation. This highlights the critical role robust smoking laws play in reducing the prevalence of these diseases,” authors of the report wrote.

The news comes as a study published Feb. 4 in Scientific Reports finds that niacin intake was linked to COPD prevalence in US adults. That is, people with the highest intake of the vitamin had the lowest odds for COPD — something researchers would like to see investigated more.