BISMARCK, N.D. - North Dakota ranks among the top 10 healthiest states, but could rank even healthier if there weren't so many young people smoking, health experts say.

The state still leads the nation in high schoolers smoking, said Kathleen Mangskau, administrator of the state tobacco prevention and control project. North Dakota improved from 12th healthiest on UnitedHealth's 2002 list to ninth healthiest this year, in part because the 2001 score was much worse in total number of smokers. In 2001 UnitedHealth listed North Dakota as one of four states with the biggest health declines since 1990. UnitedHealth said North Dakota's adult smoking rate was the sixth best in the country in 1990, when 26.4 percent of adults smoked. Even though the smoking rate decreased to 23.2 percent in 2001, the state hadn't kept pace with the rest of the country and was ranked only 24th last year. Now UnitedHealth's 2002 report said the state's adult smoking rate of 22.1 percent puts it at 13th best in the smoking category. Just over 35 percent of North Dakota students in grades 9-12 smoked last year, Mangskau said, citing a biennial youth risk behavior. And though still highest in the country, that's an improvement. ''We have seen a slight downward trend,'' she said, noting the 1999 survey showing that 41 percent of high schoolers smoked. Mangskau said the notable thing about North Dakota's adult smoking rate is how little it has changed in recent years. ''We haven't gotten worse. We haven't gotten better,'' she said. "That shows we need to work to get people to quit.'' A few months ago, the state finished distributing $4.7 million to the state's 28 local health units to use in tobacco prevention and cessation programs, Mangskau said. That's from the state's share of the national tobacco settlement, she said. Mangskau said it's too early for those programs to have results. One reason is that the state has a marked shortage of ''stop smoking'' programs. Just over 35 percent of North Dakota students in grades 9-12 smoked last year, said an official, citing a biennial youth risk behavior. And though still highest in the country, that's an improvement.

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