In this Aug. 3, 2010, file photo, boxes of cigarettes are posed in a Brunswick. Credit: Pat Wellenbach / AP

Maine has the highest rate of smokers in New England and among the highest rates of new lung cancer diagnoses in the country, according to a new American Lung Association report.

That comes as Maine and most other New England states have moved in recent years to crack down on smoking rates.

Maine has the seventh-highest rate of new lung cancer diagnoses, with 72.4 diagnoses per 100,000 people, according to the association’s 2020 State of Lung Cancer report. The highest rate was in Kentucky (91.4), while the lowest was in Utah (26.3).

The report also showed that Maine has high rates of tobacco use, especially compared with its New England neighbors. Nearly 18 percent of Mainers smoke, compared with 15.5 percent nationally, the 19th-highest smoking rate in the country. West Virginia had the highest rate (25.3 percent), while Utah had the lowest (9 percent).

In 2017, Maine lawmakers raised the age to buy tobacco products from 18 to 21 beginning in 2018, overriding a veto from former Republican Gov. Paul LePage. Massachusetts followed Maine in raising the age to 21 in beginning in 2019.

It was followed by Vermont and Connecticut also in 2019 and New Hampshire in September, leaving Rhode Island as the only New England state to keep its minimum age at 18.

President Donald Trump signed legislation raising the minimum age to purchase tobacco products to 21 nationwide in December 2019 — at the time, 19 states had already made the change.

More than 95 percent of smokers start before age 21, according to Preventing Tobacco Addiction Foundation.

All of the other New England states had lower rates: 12.2 percent of Connecticut residents smoke, 13.4 percent of Massachusetts residents, 13.7 percent of Vermonters, 14.6 percent of Rhode Islanders and 15.6 of New Hampshire residents.

Maine also had the worst lung cancer numbers among all of its New England neighbors. Connecticut had 60 cases per 100,000, Vermont 61.3, Massachusetts 62, New Hampshire 64 and Rhode Island 69.8.

The report found that the rate of new lung cancer cases among Native Americans in Maine was especially high (84.5 per 100,000), more than double the national rate for Native Americans.

There were glimmers of hope for Maine in the report: it ranked ninth out of 49 states for surgery as part of the first course of treatment. Doctors usually perform surgery first if the cancer is diagnosed early before it has spread — those who receive such treatment have higher survival rates.

Maine also had the fourth-lowest rate of patients who received no treatment for lung cancer, with 9.6 percent cases going without treatment, compared with 15.2 percent nationally.

The association said Maine should increase screenings for residents at high risk of lung cancer, which it said would allow for earlier treatment.

It also recommended that the state institute a higher tax on tobacco products — it had previously given the state a C rating for its tax rates on such items. The current tax rate in Maine for all tobacco products is 43 percent of the wholesale sales price.