A new study finds that Missouri and Kansas are among the worst states in using tobacco settlement proceeds to prevent smoking, despite recommendations from federal health officials.

The Kansas City Star reports that Missouri allotted $48,500 in its current fiscal year for tobacco prevention programs, even though it received $259 million in tobacco taxes and from tobacco companies.

A December report by Campaign for Tobacco-Free Kids and the American Heart Association shows that Missouri’s spending amounts to a fraction of a percent of the $72.9 million the Centers for Disease Control recommended.

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

The report comes on the 20th anniversary of a landmark settlement between major tobacco companies and 46 states that mandated the tobacco companies to compensate states for tobacco-related health care costs.