A new study has revealed the current state of affairs when it comes to cancer and smoking – a third of all cancer deaths are caused by smoking in men and almost a quarter in women.

More than 167,000 deaths in the U.S. were attributable to cancer in 2014 and despite this almost, 4 million Americans still light up cigarettes on a regular basis.

The study, conducted by researchers at the American Cancer Society, looked at 12 types of cancer that are commonly caused through smoking including lung, pancreas, liver and stomach. They analyzed smoking rates in statistics from the national database and estimated the number of deaths attributed to smoking. The researchers, however, did not take into account other tobacco-related deaths such as cigars, e-cigarettes and inhalation of second-hand smoke.

The study looked at regional smoking-related cancer deaths and found the top five worst states to be Arkansas, Tennessee, Louisiana, Kentucky, and West Virginia. The percentage of smoking-related cancer deaths was nearly 40 percent in the South for men while for women the worst state was Kentucky.

The reasoning behind the South’s higher levels could be down to the states’ historic smoking prevalence together with lax tobacco controls and cheaper cigarette prices. The researchers believe tightening up controls in each state will help go towards deterring people from lighting up.

“Increasing tobacco control funding, implementing innovative new strategies, and strengthening tobacco control policies and programs, federally and in all states and localities, might further increase smoking cessation, decrease initiation, and reduce the future burden of smoking-related cancers,” stated the study.

Details of the study were published in the journal JAMA Internal Medicine.