FAYETTEVILLE, Ark. (KNWA/KFTA) — According to the World Health Organization, 22.3% of the global population uses tobacco.

The website niceRX.com recently conducted a study to determine which U.S. states have the highest smoking rates and the most deaths caused by smoking, and The Natural State ranked poorly in both categories. Arkansas came in tied for 6th in highest smoking rate at 20.2%, and it had the 3rd-most smoking deaths per capita.

West Virginia had the highest smoking rate at 23.8%, followed by Kentucky, Louisiana, Ohio and Mississippi. Arkansas and Alabama tied for 6th place. Massachusetts, California and Utah had the lowest rates.

West Virginia also had the highest total of smoking-related deaths per capita, with 241 per 100,000 people in 2019. Kentucky was second (197) and Arkansas was third (192). Colorado, Alaska and Utah had the fewest smoking-related deaths per 100,000 people. West Virginia had over six times as many smoking deaths per capita as Utah in 2019.

The United States had the 31st-most smoking deaths per capita when compared to other countries around the world. Serbia, Bulgaria and Montenegro had the most.

The full results of the report are available here.