Annual tobacco report assigns grades to state and federal government efforts to implement proven tobacco control policies, save lives

The American Lung Association’s 16th annual “State of Tobacco Control” report shows that much more needs to be done by states and the federal government to reduce tobacco use. According to the report both adult and youth smoking rates have declined nationally, but not everyone in America has benefited equally from this progress. Tobacco prevention and cessation efforts must be focused on states and populations with high rates of tobacco use.

The “State of Tobacco Control” report, released annually, grades state and federal government policies to prevent and reduce tobacco use. This year’s report shows that some key actions were taken at the federal and state levels to prevent and reduce tobacco use in 2017, but the grades earned demonstrate there remains a lot of room for improvement. In particular, much more must be done to implement proven policies that will reduce tobacco use among youth and vulnerable Americans who continue to be targeted by the tobacco industry.

“Despite our progress, tobacco use remains the nation’s leading preventable cause of death and disease. It’s no mystery how to end the tobacco epidemic – enact proven-effective policies,” said American Lung Association National President and CEO Harold P. Wimmer. “All Americans deserve the opportunity to live a healthy life, free of the devastating effects of tobacco use. Our leaders must put proven tobacco control strategies to work in all communities, especially for our nation”s youth and people who use tobacco at high levels.”

Due to the effective policies called for in “State of Tobacco Control,” adult and youth cigarette smoking rates are at historically low levels. Overall, 16.4 percent of adults or about 39 million people in the United States in 2016 smoked cigarettes. However, significant disparities remain, highlighting the uneven progress in states where policies to prevent and reduce tobacco use need to be implemented or improved. Populations with high tobacco use rates and therefore at greatest risk for tobacco-caused death and disease include people living in public housing, individuals living with a behavioral health or substance use disorder, American Indians and Alaska Natives, low-income Americans and people who lack healthcare coverage or get healthcare coverage through Medicaid.

“The bottom line is that more must be done, and the federal and state governments must take the steps to support the health of all Americans,” Wimmer said. “We know what works, we just need the political will to make it a reality. Not doing so puts people’s lungs and ultimately lives at risk, which is simply unacceptable.”

Steps Backward at the Federal Level
The U.S. Food and Drug Administration (FDA) significantly weakened its “deeming” rule, which gave FDA’s Center for Tobacco Products authority over e-cigarettes, cigars, hookah and other previously unregulated tobacco products. In July, FDA announced it would delay full implementation of the rule by more than four years. This earned the federal government an “F” grade for FDA regulation of tobacco products this year.

The federal grade for Mass Media Campaigns increased to an “A” grade this year because the Centers for Disease Control and Prevention’s Tips from Former Smokers campaign was on the air for more than six months. Ideally, this highly effective media campaign should be on the air year-round. The other federal grades for Cessation Coverage and Tobacco Taxes did not change.

Despite threats, key quit smoking policies required in the Affordable Care Act remain in effect. Under the law, Medicaid expansion plans and most private insurance plans are required to cover a comprehensive quit smoking benefit that includes all seven FDA-approved tobacco cessation medications and all three forms of counseling without cost-sharing or prior authorization.

The 2018 “State of Tobacco Control” highlights that low-income Americans are at a greater risk for tobacco-related death and disease, a group that includes those who live in public housing. The U.S. Department of Housing and Urban Development has taken the important step of proceeding with its rule requiring all federally-owned public housing to implement smokefree policies by July 31, 2018. The rule will protect nearly 716,000 children and more than 320,000 senior citizens from secondhand smoke exposure in their own homes, as well as prompt many of the estimated 300,000 smokers living in public housing to make a quit attempt.

Some Progress in Unexpected Places at the State Level, but Lots of Room for Improvement
Overall, state grades in “State of Tobacco Control” 2018 remain poor, but there was some progress in 2017 in unusual places.

Access to Quit Smoking Treatments
Kentucky and South Carolina each have smoking rates that are higher than the national average, but both took significant steps to address the issue in 2017 by providing comprehensive access to quit smoking treatments for low-income populations. South Carolina’s Medicaid program now covers all seven FDA-approved quit smoking medications without the copays that can discourage smokers from using these medications during their quit attempts, earning them one of only a few “A” grades in this category. A new Kentucky law passed in 2017 dramatically expands comprehensive quit smoking coverage to smokers with both private insurance and those who are covered by Medicaid increasing the state’s grade in this category to a “C” from an “F”.

Nine states now have a comprehensive tobacco cessation benefit for all Medicaid enrollees, covering all seven tobacco cessation medications and all three forms of counseling to help smokers quit. This is a key way to reduce disparities in tobacco use as data show Medicaid enrollees smoke at a rate almost three times as high as those with private insurance.

Tobacco Prevention Funding
Revenue from tobacco settlement payments and tobacco taxes should be used to fund tobacco prevention and cessation programs to have an even greater impact on reducing tobacco-related disparities. These programs should focus on reaching priority populations, especially those with higher smoking rates.

In fiscal year 2017/2018, Indiana, North Carolina and Tennessee all saw $1 million or more increases in funding for their state prevention programs. California also saw a massive $250 million increase in funding due to the $2.00 tobacco tax increase approved by voters in November 2016, earning them a rare “A” grade in this category. However, a number of states also had setbacks on funding for their tobacco prevention and quit smoking programs, including West Virginia which zeroed out all its state funding, and Texas, which cut its meager funding investment nearly in half. The total amount spent by states on tobacco prevention and cessation is $729.1 million, less than three cents per dollar of the $27.5 billion states collect from tobacco settlement payments and tobacco taxes.

Tobacco 21 Laws
2017 saw significant progress at the state and local level on laws to increase the tobacco sales age to 21. Three states – New Jersey, Oregon and Maine – and many local communities passed laws raising the minimum age of sale for all tobacco products to 21. This earned New Jersey and Oregon “A” grades in “State of Tobacco Control” 2018, and once the state’s law is implemented will improve Maine’s grade, too. This brings the national total to five states that have taken this important step to reduce youth tobacco initiation and save lives.

Smokefree Laws and Policies
For the fifth year in a row, no state passed comprehensive smokefree laws, leaving 22 states without statewide laws that protect everyone in all public places and workplaces from the dangers of secondhand smoke. Progress was made at the local level, including in Louisiana and Texas where two big cities – Baton Rouge, Louisiana and Fort Worth, Texas approved comprehensive smokefree laws.

Tobacco Taxes
Significantly increasing tobacco taxes is one of the most effective ways to prevent tobacco use among youth. Bringing parity to – or equalizing – tobacco taxes across all products, including cigars, little cigars and roll-your-own tobacco, eliminates the financial incentive for people to switch to a different product, encouraging people to quit tobacco entirely. Unfortunately, there was little progress at the state level on this front in 2017 with three states passing small tobacco tax increases. The average state cigarette tax is now $1.72 – with Connecticut and New York having the highest cigarette taxes ($4.35) and Missouri having the lowest ($0.17).

“In 2018, the American Lung Association will be working to defend the gains that have been made to combat tobacco use and we will push federal and state leaders to summon the courage to enact policies that will save lives – funding tobacco prevention programs, helping smokers quit and protecting everyone from secondhand smoke,” Wimmer said.

To learn more about federal and state grades from this year’s “State of Tobacco Control” report, visit Lung.org/sotc. For media interested in speaking with an expert about lung health, tobacco use and tobacco policies, contact Gregg Tubbs at Media@Lung.org or 202-715-3469.