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Wyoming State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Wyoming. To address this enormous toll, the American Lung Association in Wyoming calls for the following three actions to be taken by our elected officials:
1. Increase tobacco taxes;
2. Adopt a statewide, comprehensive smokefree law; and
3. Maintain funding for tobacco prevention and cessation programs.

In 2016, Wyoming had a short legislative session focused almost exclusively on crafting the two year state budget for 2016 and 2017. Funding for tobacco prevention and cessation programs in Wyoming decreased slightly compared to the last two year state budget for 2014 and 2015 going from $4.6 million to $4.2 million per year. However, Wyoming remains one of only a handful of states that fund tobacco prevention and cessation programs at over 50 percent of the level recommended by the Centers for Disease Control and Prevention.

In past legislative sessions, the Wyoming Legislature has considered, but rejected legislation to increase Wyoming's excise tax on tobacco products, which stands at a meager 60 cents per pack currently. Raising Wyoming's cigarette tax by $1.25 per pack would raise over $50 million per two year period (biennium). This new revenue may become attractive to legislators who are looking for ways to compensate for lost revenue from a struggling minerals industry. The American Lung Association in Wyoming will be supporting increasing tobacco taxes in 2017 to reduce youth initiation and supports some of the new revenue being used to fund tobacco prevention and cessation programs as well.

Wyoming Facts

Economic Cost Due to Smoking: $257,674,019
Adult Smoking Rate: 19.10%
Adult Tobacco Use Rate: 25.50%
High School Smoking Rate: 15.70%
High School Tobacco Use Rate: 38.40%
Middle School Smoking Rate: 5.40%
Smoking Attributable Deaths: 800

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the Wyoming 2013 Youth Risk Behavior Surveillance System.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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Wyoming State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Wyoming. To address this enormous toll, the American Lung Association in Wyoming calls for the following actions to be taken by our elected officials:
1. Support and implement a $1.00 increase in the tobacco tax;
2. Increase/maintain funding for tobacco prevention and cessation programs; and
3. Adopt a statewide, comprehensive smokefree law.

Budget and revenue shortfalls once again forced the Wyoming legislature to make difficult decisions. Despite the best efforts of public health advocates, the legislature cut a total of $2.1 million in tobacco prevention and cessation dollars over the fiscal year 2018 and fiscal year 2019 biennium. This reduction eliminated the Quitline-Quitnet, an online and telephone resource to assist people to eliminate their tobacco addiction.

An increase in the tobacco tax was proposed during the 2017 legislative session. Unfortunately, the increase was only 30 cents, which would not be large enough to yield the reduction in youth and adult smoking that the American Lung Association in Wyoming supports. The legislation gained some traction, but was ultimately not passed.

In December 2017, the Joint Revenue committee in the Wyoming legislature voted 8-7 to introduce a $1.00 increase in the state's tobacco tax, with an equal tax applied to all other tobacco products during the 2018 legislative session. This increase would be expected to generate approximately $22 million in new revenue. The American Lung Association in Wyoming will support this proposal and work to see that a portion of the new revenue is dedicated to support tobacco prevention and cessation programs.

Wyoming Facts

Economic Cost Due to Smoking: $257,674,019
Adult Smoking Rate: 18.90%
Adult Tobacco Use Rate: 25.60%
High School Smoking Rate: 15.70%
High School Tobacco Use Rate: 38.40%
Middle School Smoking Rate: 5.40%
Smoking Attributable Deaths: 800

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the Wyoming 2013 Youth Risk Behavior Surveillance System.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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Wisconsin State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Wisconsin. To address this enormous toll, the American Lung Association in Wisconsin calls for the following actions to be taken by our elected officials:
1. Pass legislation that places ALL tobacco products behind the counter or in a locked cabinet;
2. Lay the groundwork for future passage of Tobacco 21 legislation; and
3. Pass legislation requiring all school districts to have a comprehensive e-cigarette policy that prohibits use on school grounds.

Wisconsin's biennial budget was finally passed more than two months late in 2017, which meant meaningful work on moving tobacco control policies forward was delayed. The budget itself contained good and bad elements for tobacco control – on a positive note, funding for the Wisconsin Tobacco Prevention and Control program was maintained with no cuts, but for the third time, the legislature refused to include a tax increase for little cigars, which would have brought the tax on them up to par with cigarettes. This is due to the very strong anti-tax mentality that presently exists in the legislature.

While progress might be stalled on the state level, local activity continued at a brisk pace as city and county officials passed ordinances to add e-cigarettes to their smokefree air ordinances and school boards adopted policies prohibiting e-cigarette use on school grounds. On the smokefree outdoor air front, tobacco and smokefree (including e-cigarettes) parks are starting to gain acceptance and become more prevalent.

In August, the Wisconsin Department of Health and Family Services released its findings from the Youth Tobacco Survey, demonstrating a continued drop in youth smoking rates. Middle and high school smoking rates are at historic lows, 1.3 percent and 8.1 percent respectively. However, use of e-cigarettes by youth is skyrocketing, from 7.9 percent to 13.3 percent in Wisconsin's high schools. The influence and appeal of candy and fruit flavors is unquestionable – 89.9 percent of high schoolers "think they probably would not, or definitely would not try an e-cigarette if it did not have any flavor such as mint, candy, fruit or chocolate."

Clearly the impact flavorings have on youth is huge, which makes it even more important that these products not be easily accessible to anyone under age 18. Retail assessments conducted throughout the state in 2017 have documented their placement alongside candy and snacks where they are easily stolen, and even very young children can "browse" them.

While the American Lung Association in Wisconsin will continue to work with local tobacco control coalitions to strengthen community tobacco control ordinances, the most sweeping progress is still made at the state level. The Lung Association will focus on passing legislation that requires that ALL tobacco sales be clerk assisted, continue to educate lawmakers and the public on the health benefits of raising the legal sales age for tobacco to 21 and fight for strong clean air policies, both indoors and out.

Wisconsin Facts

Economic Cost Due to Smoking: $2,663,227,988
Adult Smoking Rate: 17.10%
Adult Tobacco Use Rate: 19.90%
High School Smoking Rate: 8.10%
High School Tobacco Use Rate: 12.50%
Middle School Smoking Rate: 1.30%
Smoking Attributable Deaths: 7,850

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use and middle school smoking rates are taken from the 2016 Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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Wisconsin State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Wisconsin. To address this enormous toll, the American Lung Association in Wisconsin calls for the following three actions to be taken by our elected officials:
1. Prevent funding cuts to the statewide Tobacco Prevention and Control Program (TPCP);
2. Enact legislation that would require all sales of tobacco products and e-cigarettes to be clerk assisted; and
3. Continue to pass local ordinances that include e-cigarettes in those communities' comprehensive smokefree air laws, setting the groundwork for future state policy.

The American Lung Association in Wisconsin's chief accomplishment in 2016 was defeating a very bad e-cigarette bill that would not only have carved out a special exemption for the use of e-cigarettes in public places, but also would have prohibited local governments from enacting ordinances that aren't in strict compliance with state law. Passage of this law would ultimately have struck down numerous local ordinances that presently include e-cigarette use in their smokefree air policies.

While this effort was going on, the Lung Association continued to support strong local ordinances prohibiting the use of e-cigarettes in public places, in preparation for the day when Wisconsin is in the position to add them to its statewide smokefree air law.

Wisconsin also recently launched a new statewide tobacco control coalition which will provide leadership, direction and training/technical assistance for present and future tobacco control work and its partners.

Wisconsin's 2016 Youth Tobacco Survey demonstrates that Wisconsin is following the national trend of reducing cigarette smoking by high school and middle school students, but also shows an alarming increase in the use of other tobacco products (OTPs) - flavored cigars, smokeless tobacco - and e-cigarettes. Middle and high school cigarette smoking rates are presently 1.3 percent and 8.1 percent respectively, down from 2014, however use of e-cigarettes has risen to 2.6 percent and 13.3 percent respectively since 2014 - more than double their previous rates. The new survey results also show an increase in the use of flavored cigars and smokeless tobacco.

Wisconsin can greatly reduce kids' use of flavored tobacco products and e-cigarettes by enacting laws that treat these products the same as cigarettes. While the federal deeming regulation addresses product manufacturing, the rules are silent on issues such as flavorings, licensing, placement and other areas.

In Wisconsin, opportunities exist to address some of those gaps by moving OTPs and e-cigarettes behind counters or in locked cabinets, and creating greater equity in pricing. Presently, OTPs are taxed much lower than cigarettes - e-cigarettes are not taxed at all -- giving them a marked price advantage in addition to their "kid friendly" candy and fruit flavorings. Other equity issues that need to be addressed in 2017 include licensing requirements and free sampling laws.

Wisconsin Facts

Economic Cost Due to Smoking: $2,663,227,988
Adult Smoking Rate: 17.30%
Adult Tobacco Use Rate: 20.20%
High School Smoking Rate: 8.10%
High School Tobacco Use Rate: 12.50%
Middle School Smoking Rate: 1.30%
Smoking Attributable Deaths: 7,850

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use and middle school smoking rates are taken from the 2015 Wisconsin Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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West Virginia State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in West Virginia. To address this enormous toll, the American Lung Association in West Virginia calls for the following actions to be taken by our elected officials:
1. Restoration of West Virginia state funding for tobacco prevention and cessation;
2. Protect clean indoor air regulations as they currently exist throughout the state; and
3. Increase tobacco excise tax to be in line with the national average.

During the 2017 Legislative Session, three different attempts to preempt clean indoor air regulations in the state were fought off. Luckily, none of the bills made it past the first committee.

A bill introduced by Senator Stollings, to raise the minimum tobacco sales age to 21, failed in the Senate Health committee.

Other bills that failed, were an attempt to pass a bill that would not allow drivers to smoke in a motor vehicle if they had a passenger under the age of 16 with them; and legislation that would have allowed employers, such as health care providers, to not hire smokers. Neither of these bills made it out of the Senate Health Committee, their committee of origin.

Most alarmingly, in order to cut West Virginia spending by more than $100 million for the 2017-18 budget, legislators completely defunded the state Division of Tobacco Prevention. This move effectively eliminated all West Virginia state tobacco cessation and prevention efforts – even though the federal Centers for Disease Control and Prevention for years has cited the state for spending only a fraction of the amount it needs to spend to effectively combat tobacco-related illnesses. This is particularly disappointing given West Virginia has one of the highest smoking rates in the country, which costs the state over $1 billion in healthcare costs and lost productivity each year.

In 2018, new leadership and direction for the Coalition for Tobacco Free West Virginia will be needed – with an emphasis on information sharing, collaboration throughout the state and local support. A strong state coalition will be necessary to help sustain/reinstate tobacco control funding and programs. This can be done by making the coalition more representative of the community, which can hopefully help develop more public support for the services provided by the state Division of Tobacco Prevention. The coalition will also need to expose the tobacco industry's deceptive, predatory, and deadly practices by developing more effective methods to counter their strategies.

West Virginia Facts

Economic Cost Due to Smoking: $1,008,474,499
Adult Smoking Rate: 24.80%
Adult Tobacco Use Rate: 31.30%
High School Smoking Rate: 16.20%
High School Tobacco Use Rate: 40.80%
Middle School Smoking Rate: 4.60%
Smoking Attributable Deaths: 4,280

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school and middle school smoking rates are taken from the 2015 Youth Tobacco Survey. High school tobacco use rate is taken from the 2015 Youth Risk Behavior Surveillance System.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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West Virginia State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in West Virginia. To address this enormous toll, the American Lung Association in West Virginia calls for the following three actions to be taken by our elected officials:
1. Increase the excise tax on cigarettes by $1.00 per pack;
2. Support comprehensive clean indoor air laws at the regional level; and
3. Secure tobacco prevention and cessation funding from the general budget.

During the 2016 legislative session, after a delayed budget and long battle, a 65-cent cigarette tax increase was approved by the state legislature. This was the first increase in West Virginia's cigarette tax since 2003, and was a step forward to reduce tobacco use in the state. However, it was disappointing to the American Lung Association in West Virginia that state leaders missed an opportunity to achieve far greater public health benefits by increasing the tobacco tax by at least $1.00 per pack and dedicating a portion of the revenue to programs to prevent kids from smoking and help smokers quit. Other tobacco products such as cigars, snuff and chewing tobacco also will see a small jump in the excise tax with the rate going from 7 percent to 12 percent of the wholesale price. In addition, the legislature recognized the emerging threat of electronic cigarettes by placing a 7.5 cent per milliliter tax on the liquid nicotine in the products.

Through local boards of health, counties in West Virginia have added protections for workers from secondhand smoke and its health effects. Over 50 percent of West Virginia's population is protected by local smokefree regulations from exposure to secondhand smoke in public places and workplaces, including restaurants and bars.
A couple of county boards of health have amended their smokefree regulations this year:
* Mercer County strengthened its smokefree regulation by adding electronic smoking devices to it, and is considering making their existing smokefree regulation comprehensive.
* Monongalia County further clarified the definition of smoking in its regulation to make clear its intent to prohibit the use of e-cigarettes and removed the exemption for hookah bar and bingo operations.

The American Lung Association in West Virginia will continue to educate lawmakers on the ongoing fight against tobacco. Our goal is to build champions within the legislature and a groundswell of advocates to advance our goals: a long overdue increase in the cigarette tax, parity between taxes on cigarettes and other tobacco products, comprehensive local clean indoor air laws and funding to prevent our youth from starting to smoke as well as helping individuals who want to quit to do so.

West Virginia Facts

Economic Cost Due to Smoking: $1,008,474,499
Adult Smoking Rate: 25.70%
Adult Tobacco Use Rate: 32.80%
High School Smoking Rate: 16.20%
High School Tobacco Use Rate: 40.80%
Middle School Smoking Rate: 4.60%
Smoking Attributable Deaths: 4,280

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school and middle school smoking rates are taken from the 2015 Youth Tobacco Survey. High school tobacco use rate is taken from the 2015 Youth Risk Behavior Surveillance System.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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Washington State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Washington. To address this enormous toll, the American Lung Association in Washington calls for the following three actions to be taken by our elected officials:
1. Raise the legal age of sale for tobacco products to 21;
2. Increase funding for comprehensive tobacco prevention and control programs; and
3. Tax electronic smoking devices to reduce youth use and fund tobacco prevention programs.

Washington's legislative bodies continue to struggle with budget challenges, in particular finding solutions to adequately fund education due to a court ruling finding the state negligent in providing adequate funding. The budget shortfalls continue to be an obstacle in securing adequate program funding for tobacco prevention efforts and cessation support.

Working together with coalition partners, the American Lung Association in Washington supported and celebrated the passage of Senate Bill 6328, "Concerning vapor products in respect to youth substance use prevention," during the 1st special legislative session in 2016. Advocates fought diligently to get the best possible bill to protect Washington's youth. The bill establishes important youth access protections for electronic cigarettes and provides more meaningful enforcement and penalties for those selling both tobacco products and electronic cigarettes to kids. The bill raised tobacco licensing fees and doubles fines for violations of tobacco sales laws. It also requires electronic cigarette retailers and other entities to get licenses. It was the first increase in 23 years to tobacco product licensing fees and penalties, and the dollars raised will pay for tobacco and e-cigarette enforcement, prevention and education efforts.

Bills were introduced to raise the age of sale for cigarettes to 21 in both the House and the Senate. Despite broad support for this legislation, neither bill moved to the floors for a vote.

Prior to the 2017 legislative session, a growing and strong coalition worked to provide strong support for another run to raise the legal age of sale for tobacco products to 21. Washington's Attorney General, Bob Ferguson, is a strong supporter of the policy as is Washington's Secretary of Health, John Weisman. Building on the support from the 2016 session, the Lung Association will again work to pass this legislation.

The American Lung in Washington will also continue to seek opportunities to secure funding for tobacco prevention programs and cessation support.

Washington Facts

Economic Cost Due to Smoking: $2,811,911,987
Adult Smoking Rate: 15.00%
Adult Tobacco Use Rate: 17.40%
High School Smoking Rate: 7.90%
High School Tobacco Use Rate: N/A
Middle School Smoking Rate: 4.00%
Smoking Attributable Deaths: 8,290

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school (10th grade only) and Middle school (8th grade only) smoking rates are taken from the 2014 Washington State Healthy Youth Survey. A current high school tobacco use rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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Washington State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Washington. To address this enormous toll, the American Lung Association in Washington calls for the following actions to be taken by our elected officials:
1. Raise the minimum legal sale age for tobacco products to 21 years of age;
2. Increase funding for tobacco prevention and cessation programs; and
3. Maintain the comprehensive smokefree air law.

Washington's 2017 legislative session was the longest session in history as three full special sessions were called. The largest task before the legislature was funding basic education to meet the State Supreme Court's ruling on the McCleary court case. The political divisions within the legislature provided additional challenges. This was also reflected in the small numbers of bills that were sent to the Governor for signature.

House Bill 1054 and Senate Bill 5024 proposed raising the minimum legal sale age for tobacco products to 21 years. After a successful hearing in the House, the bill moved to the House Rules committee where it remained throughout the session. The Senate version of the bill was referred to the Senate Commerce/Labor/Sports committee and didn't receive a hearing. This legislation has a large coalition supporting and lobbying for its passage. The legislation was requested by the State Attorney General and the Department of Health.

With the legislature facing budget challenges, the lost revenue resulting from this bill was one of the consistent and convincing arguments for proponents. The Governor's budget proposed $15.9 million for the estimated revenue loss.

Securing additional funding for tobacco prevention and cessation remains a priority goal for the American Lung Association in Washington. While no additional cuts were made to the state program, no additional funding was secured either leaving Washington with a meager $1.4 million in state funding for tobacco prevention and cessation.

Once again, legislation was introduced to establish special licensing for cigar lounges and retail tobacconist shops. House Bill 1919 was referred to the House Health Care and Wellness committee; it did not receive a hearing.

The American Lung Association in Washington will continue its support of policies to reduce the harmful effects of tobacco on Washingtonians. The coalition working on Tobacco 21 continues to grow. The coalition is focusing efforts on engaging youth in supporting and lobbying for this legislation. With additional grassroots support, the American Lung Association in Washington hopes to join together with the other states who have already passed Tobacco 21 laws.

Washington Facts

Economic Cost Due to Smoking: $2,811,911,987
Adult Smoking Rate: 13.90%
Adult Tobacco Use Rate: 16.40%
High School Smoking Rate: 6.30%
High School Tobacco Use Rate: N/A
Middle School Smoking Rate: 3.10%
Smoking Attributable Deaths: 8,290

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school (10th grade only) and middle school (8th grade only) smoking rates are taken from the 2016 Washington State Healthy Youth Survey. A current high school tobacco use rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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Virginia State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Virginia. To address this enormous toll, the American Lung Association in Virginia calls for the following actions to be taken by our elected officials:
1. Increase the cigarette excise tax by at least $1.00 per pack;
2. Create parity between taxes on cigarettes and other tobacco products; and
3. Fund tobacco prevention and cessation programs at the Centers for Disease Control and Prevention (CDC)-recommended level.

In the 2017 legislative session, a bill was introduced which would allow all localities to impose a cigarette tax by removing the requirement that only those localities that had such authority prior to 1977 are eligible. The bill would have set a maximum rate on the cigarette tax imposed by counties of five cents per pack or the amount levied under state law, whichever is greater. The bill was left in the Senate Finance Committee.

Bills to authorize any county to impose a tax on cigarettes were also introduced in the House and state Senate. Again, both were left in their respective Finance Committees and died.

The American Lung Association in Virginia led efforts to urge the Pharmacy and Therapeutics Committee to give a favorable review for Medicaid coverage of benefits consistent with CDC recommendations and Virginia law, including FDA-approved pharmacotherapy products.

Several bills dealing with electronic cigarettes were also introduced in 2017, including a bill that would authorize cities and towns and certain counties to impose a tax on vapor products. The state tax rate is $0.05 per fluid milliliter of consumable vapor product and 10 percent of the retail price for electronic cigarettes or similar products or devices. The bill required revenues from the state tax on vapor products to be deposited into the Virginia Tobacco Settlement Fund. The bill was left in the Finance Committee and died at the end of the session.

In 2018, priorities for the American Lung Association in Virginia will include working to ensure prevention and cessation programs are funded, an increase in the cigarette excise tax, and parity between taxes on cigarettes and other tobacco products.

Virginia Facts

Economic Cost Due to Smoking: $3,113,009,298
Adult Smoking Rate: 15.30%
Adult Tobacco Use Rate: 18.00%
High School Smoking Rate: 8.20%
High School Tobacco Use Rate: 22.70%
Middle School Smoking Rate: 1.60%
Smoking Attributable Deaths: 10,310

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the Virginia 2015 Youth Risk Behavior Surveillance System.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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Virginia State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Virginia. To address this enormous toll, the American Lung Association in Virginia calls for the following three actions to be taken by our elected officials:
1. Increase the cigarette excise tax by at least $1.00 per pack;
2. Create parity between taxes on cigarettes and other tobacco products; and
3. Fund tobacco prevention and cessation programs at the Centers for Disease Control and Prevention (CDC)-recommended level.

In the 2016 legislative session, a bill to increase the state cigarette tax rate from $0.30 per pack to $1.50 per pack, the cigarette excise tax on roll-your-own tobacco from 10 percent of the manufacturer's sales price to 50 percent, and the tax rate on certain other tobacco products by the same percentage was introduced in the state House of Representatives. Ten percent of revenue on the three taxes would have been used by the Virginia Department of Health for tobacco cessation and prevention, and the remainder would have been deposited in the Virginia Health Care Fund. Unfortunately, the bill was left in the Finance Committee, and Virginia's cigarette tax remained the second lowest in the country.

Bills to authorize any county to impose a tax on cigarettes were also introduced in the House and state Senate. Again, both were left in their respective Finance Committees and died.

The American Lung Association in Virginia led efforts to urge the Pharmacy and Therapeutics Committee to give a favorable review for Medicaid coverage of benefits consistent with CDC recommendations and Virginia law, including FDA-approved pharmacotherapy products,

Several bills dealing with electronic cigarettes were also introduced in 2016, including a bill in the House that would have established a state tax on electronic cigarettes, and a bill in the Senate that would have expanded the definition of "smoking" in the Virginia Indoor Clean Air Act to include electronic cigarettes. The House bill was ultimately stricken from the docket by the Finance Committee, and Senate bill was passed by and died in the Local Government Committee.

In 2017, priorities for the American Lung Association in Virginia will include working to ensure prevention and cessation programs are funded, an increase in the cigarette excise tax, and parity between taxes on cigarettes and other tobacco products.

Virginia Facts

Economic Cost Due to Smoking: $3,113,009,298
Adult Smoking Rate: 16.50%
Adult Tobacco Use Rate: 19.50%
High School Smoking Rate: 8.20%
High School Tobacco Use Rate: 22.70%
Middle School Smoking Rate: 1.60%
Smoking Attributable Deaths: 10,310

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the Virginia 2015 Youth Risk Behavior Surveillance System.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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Vermont State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Vermont. To address this enormous toll, the American Lung Association in Vermont calls for the following three actions to be taken by our elected officials:
1. Increase fiscal year 2018 funding for Vermont's comprehensive tobacco control program to $5.6 million;
2. Dedicate a percentage of annual tobacco tax revenue to sustain Vermont's efforts to prevent and reduce tobacco use; and
3. Raise the legal age for sale of tobacco products to 21.

After a complicated journey in the Vermont Legislature, the Governor signed into law a bill that eliminates the use of electronic cigarettes where smoking is prohibited, including in vehicles with children in car seats. The law was effective July 1, 2016.

For a second year, the Governor proposed to cut most of the budget for the state's Tobacco Evaluation and Review Board which oversees the independent evaluation of the tobacco control program. In 2015, the Lung Association and partners fought hard to restore the funding. In 2016, we lost the battle. The cut to the board's funding threatens the future of the board and ultimately, the effectiveness of the comprehensive tobacco control program.

The good news is that the fiscal year 2017 budget bill included language for "the Secretaries of Administration and Human Services, the Tobacco Evaluation and Review Board, and participating stakeholders to develop an action plan for tobacco program funding at a level necessary to maintain the gains made in preventing and reducing tobacco use that have been accomplished since their inception."

Rep. George Till, a physician, sponsored a bill to raise the legal age for sale of tobacco products to 21. The bill passed the House after a full day of debate. It contained several provisions of concern: 1) a graduated increase of the legal age over three years, 2) a corresponding cigarette tax of $.13 per pack each year, 3) an exemption for active duty military, and 4) an increase of the penalty for misrepresentation of age from $25 to $200. The bill died in the Senate but generated a lot of discussion about the state's effort to prevent and reduce tobacco use and provided a platform for strong legislation in 2017.

The American Lung Association in Vermont will continue to work with coalition partners, the American Heart Association and the American Cancer Society Cancer Action Network to advance tobacco control efforts and protect Vermont's tobacco control program and smokefree policies against rollbacks. We will continue to educate policy makers, business leaders and the media of the importance of Lung Association goals to reduce tobacco use and protect public health.

Vermont Facts

Economic Cost Due to Smoking: $348,112,248
Adult Smoking Rate: 16.00%
Adult Tobacco Use Rate: 18.00%
High School Smoking Rate: 10.80%
High School Tobacco Use Rate: 24.70%
Middle School Smoking Rate: 2.00%
Smoking Attributable Deaths: 960

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the Vermont 2015 Youth Risk Behavior Surveillance System. Results are rounded to the nearest whole number.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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Vermont State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Vermont. To address this enormous toll, the American Lung Association in Vermont calls for the following actions to be taken by our elected officials:
1. Increase fiscal year 2019 funding for Vermont's comprehensive tobacco control program to $3.8 million;
2. Raise the legal age for sale of tobacco products to 21; and
3. Require landlords to disclose smoking policies in building to prospective renters.

2017 marks the least productive year in Vermont's Legislature in the fight against tobacco use. It's the first time in years that a significant tobacco control bill was not passed. In addition, the Governor proposed to cut most of the budget for the Tobacco Evaluation and Review Board which oversees the independent evaluation of the tobacco control program. The final fiscal year 2018 budget included no appropriation for the Board. This cut threatens the future of the Board and ultimately, the effectiveness of the comprehensive tobacco control program.

The Coalition for a Tobacco Free Vermont ran a comprehensive campaign in support of a Senate bill to raise the legal age of the sale of tobacco to 21. In spite of the backing of the Majority Leader and a 5-0 vote from the Senate Health and Welfare Committee, the bill failed 13-16 on the Senate floor. While this was a loss for champion legislators and advocates, it was more of a loss for Vermont teens and young adults. Ninety-five percent of adults started smoking by the age of 21 and half of them became regular smokers by their 19th birthday. Lawmakers missed an opportunity to pass a measure to help to protect Vermont's youth from a lifetime of addiction to tobacco.

Fortunately, the state health department, working with local tobacco control and prevention grantees, is addressing the smoking rate among young adults through the Vermont Tobacco-Free Colleges Initiative. Eighteen percent of Vermonters between the ages of 18 and 24 smoke. By the fall of 2019, the percent of college students covered by a tobacco-free college campus policy will increase from 34 percent to 76 percent, thanks to a resolution passed by the Vermont State College Chancellors. The resolution commits to making all five Vermont State College campuses tobacco-free by the fall of 2019.

The American Lung Association in Vermont will continue to work with coalition partners, the American Heart Association, and the American Cancer Society Cancer Action Network to advance tobacco control efforts and protect Vermont's tobacco control program. The Lung Association will continue to educate policy makers, business leaders and the media about the importance of raising the age of tobacco sales to 21 as well as other Lung Association goals to reduce tobacco use and protect public health.

Vermont Facts

Economic Cost Due to Smoking: $348,112,248
Adult Smoking Rate: 17.00%
Adult Tobacco Use Rate: 18.70%
High School Smoking Rate: 10.80%
High School Tobacco Use Rate: 24.70%
Middle School Smoking Rate: 2.00%
Smoking Attributable Deaths: 960

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the Vermont 2015 Youth Risk Behavior Surveillance System. Results are rounded to the nearest whole number.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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Utah State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Utah. To address this enormous toll, the American Lung Association in Utah calls for the following actions to be taken by our elected officials:
1. Maintain or increase funding for state's tobacco prevention and control program;
2. Increase the minimum legal sales age for tobacco products to 21; and
3. Raise Utah's tobacco tax to encourage an even further reduction in tobacco use.

In 2017, the American Lung Association in Utah supported legislation that would have increased the age to legally purchase tobacco products to 21 years of age from age 19 currently. Although the legislation did not make it out committee, legislators were educated on the issue for when the bill is introduced in future legislative sessions.

The Lung Association also opposed a bill introduced in the state House of Representatives that would have removed a sunset clause for several exemptions in Utah's Clean Indoor Air Act that prohibited smoking in virtually all public places and workplaces. The bill did pass the first committee in the House, but luckily did not advance any further.

Funding for the Utah Tobacco Prevention and Control Program at the state Department of Health was again maintained at about the same level as previous years in fiscal year 2018. The program is funded by a combination of tobacco Master Settlement Agreement dollars and tobacco tax revenue.

In 2018, the American Lung Association in Utah will continue pushing to increase the sales age for tobacco products to 21, and to maintain or even increase funding for the Utah Tobacco Prevention and Control Program.

Utah Facts

Economic Cost Due to Smoking: $542,335,526
Adult Smoking Rate: 8.80%
Adult Tobacco Use Rate: 11.10%
High School Smoking Rate: 4.40%
High School Tobacco Use Rate: N/A
Middle School Smoking Rate: N/A
Smoking Attributable Deaths: 1,340

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking rate is taken from the 2013 Youth Risk Behavior Surveillance System. Current high school tobacco use and middle school smoking rates are not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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Utah State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Utah. To address this enormous toll, the American Lung Association in Utah calls for the following three actions to be taken by our elected officials:
1. Maintain or increase funding for state's tobacco prevention and control program;
2. Increase the minimum legal sales age for tobacco products to 21; and
3. Raise Utah's tobacco tax to encourage an even further reduction in tobacco use.

The American Lung Association in Utah along with our partners at the Coalition for a Tobacco-Free Utah provide leadership and guidance for public policy efforts to continue the state's success in reducing the impact of tobacco among Utahans. Together with our partners, the Lung Association works to ensure tobacco control and prevention remains a priority for state legislators and local decision makers.

In 2016, the American Lung Association in Utah supported legislation that would have increased the legal age of sale for tobacco products to 21 years old from age 19 currently. Although the legislation did not make it out of the House Revenue and Taxation Committee, legislators were educated on the issue for when the bill is introduced in future legislative sessions.

Additionally the Lung Association supported legislation that would have eliminated smoking rooms at the Salt Lake City International Airport. The bill was defeated, however the city agreed not to include smoking rooms in its new replacement terminal eliminating secondhand smoke exposure for workers and travelers.

Funding for the Utah Tobacco Prevention and Control Program at the state Department of Health was again maintained at about the same level as previous years in fiscal year 2017. The program is funded by a combination of tobacco Master Settlement Agreement dollars and tobacco tax revenue.

In 2017, the American Lung Association in Utah will continue pushing to increase the sales age for tobacco products to 21, and to maintain or even increase funding for the Utah Tobacco Prevention and Control Program.

Utah Facts

Economic Cost Due to Smoking: $542,335,526
Adult Smoking Rate: 9.10%
Adult Tobacco Use Rate: 11.10%
High School Smoking Rate: 4.40%
High School Tobacco Use Rate: N/A
Middle School Smoking Rate: N/A
Smoking Attributable Deaths: 1,340

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking rate is taken from the 2013 Youth Risk Behavior Surveillance System. Current high school tobacco use and middle school smoking rates are not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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Texas State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Texas. To address this enormous toll, the American Lung Association in Texas calls for the following three actions to be taken by our elected officials:
1. Maintain or increase funding for tobacco prevention and cessation programs;
2. Continue to pass comprehensive local smokefree ordinances to build towards a statewide smokefree law; and
3. Increase the minimum legal sales age for tobacco products to 21.

The American Lung Association in Texas along with our partners at Smoke-Free Texas provides leadership and guidance for public policy efforts to continue the state's success in reducing the impact of tobacco among Texans. Together with our partners, the American Lung Association in Texas works to ensure tobacco control and prevention remains a priority for state legislators and local decision makers.

There was no state legislative session in Texas in 2016, however, significant progress was made on passing local smokefree ordinances. Since January 2016, seven local smokefree ordinances have been passed, including the cities of Mesquite and Mission. Texas now has 52 cities with local smokefree ordinances that protect 9.8 million people from secondhand smoke in virtually all public places and workplaces. Efforts continue in the city of Fort Worth, Texas as well, which is the largest city in Texas that remains without a comprehensive smokefree ordinance.

Funding for tobacco prevention and cessation programs remained at $10.223 million as appropriated in the two-year state budget passed in 2015.

Moving forward in 2017, the American Lung Association in Texas and its partners will work to raise the minimum sales age for tobacco products to 21 as well as protect existing funding for tobacco prevention and cessation programs.

Texas Facts

Economic Cost Due to Smoking: $8,855,602,443
Adult Smoking Rate: 15.20%
Adult Tobacco Use Rate: 17.70%
High School Smoking Rate: 14.10%
High School Tobacco Use Rate: N/A
Middle School Smoking Rate: N/A
Smoking Attributable Deaths: 28,030

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking rate is taken from the 2013 Youth Risk Behavior Surveillance System. A current high school tobacco use and middle school smoking rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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Texas State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Texas. To address this enormous toll, the American Lung Association in Texas calls for the following actions to be taken by our elected officials:
1. Restore funding for tobacco prevention and cessation programs that was significantly cut in years 2018 and 2019;
2. Continue to pass comprehensive local smokefree ordinances to builds towards a statewide smokefree law; and
3. Increasing the minimum legal sales age for tobacco products to 21.

The American Lung Association in Texas along with our partners at Smoke-Free Texas provides leadership and guidance for public policy efforts to continue the state's success in reducing the impact of tobacco among Texans. Together with our partners, the American Lung Association in Texas works to ensure tobacco control and prevention remains a priority for state legislators and local decision makers.

During the 2017 legislative session, the American Lung Association along with our partners of the Texas 21 Coalition supported legislation increasing the minimum age of sale for tobacco products to 21 years old. House Bill 190 passed the House Committee on Public Health but failed to get additional committee hearings. On the local level, the city of San Antonio was considering passage of a local Tobacco 21 ordinance when this report went to press.

The Lung Association in partnership with the Texas Cancer Partnership coalition worked to extend the sunset review date for the Cancer Prevention & Research Institute of Texas (CPRIT) by two years. This allows the agency to fully invest $3 billion in cancer prevention programs and research.

Significant progress continued to be made in 2017 on passing smokefree ordinances at the local level. Fort Worth, the largest metro area in Texas without a comprehensive smokefree ordinance previously, passed an ordinance that prohibits smoking in virtually all public places and workplaces in December 2017. This was a multi-year effort by tobacco control advocates, including the Lung Association, and a significant step forward. Another large city, Arlington, also passed a mostly comprehensive smokefree law in 2017, but disappointingly included exemptions for e-cigarettes and bingo halls. Texas currently has 88 cities that have passed comprehensive smokefree ordinances protecting more than 12.4 million citizens from the harmful effects of secondhand smoke.

The Texas Legislature only meets in odd numbered years, so moving forward in 2018, the Lung Association and its partners in the Smoke-Free Texas coalition will work in communities around the state to pass, and in some cases strengthen existing, local smokefree ordinances. The Lung Association will also look for opportunities to advance Tobacco 21 at the local level in Texas.

Texas Facts

Economic Cost Due to Smoking: $8,855,602,443
Adult Smoking Rate: 14.30%
Adult Tobacco Use Rate: 17.20%
High School Smoking Rate: 7.80%
High School Tobacco Use Rate: N/A
Middle School Smoking Rate: 2.40%
Smoking Attributable Deaths: 28,030

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school (11th grade only) and middle school (8th grade only) smoking rates are taken from the 2016 Texas School Survey. A current high school tobacco use rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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Tennessee State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Tennessee. To address this enormous toll, the American Lung Association in Tennessee calls for the following actions to be taken by our elected officials:
1. Increase the tobacco tax by $1.00 per pack or more;
2. Repeal preemption to allow local communities to pass stronger smokefree ordinances; and
3. Pass legislation to make tobacco cessation medications and counseling covered under Medicaid barrier free.

Unfortunately, the 2017 legislative session saw few victories against tobacco. The city of Cookeville was given the authority by the state legislature to prohibit smoking at Dogwood Park. Also, public universities in Tennessee were given the authority to create their own tobacco use policies. There were two bills that sought to give local governments more power regarding tobacco, both received broad support and were sent to a summer study committee in hopes of combining the two. No other tobacco bills were heard before committees in 2017.

The American Lung Association in Tennessee with partners is working to raise the price of cigarettes by $1.00 per pack or more, repeal preemption to allow local communities to pass stronger smokefree laws and pass legislation or regulations making all U.S. Food and Drug Administration and U.S. Preventive Services Task Force approved tobacco cessation interventions covered by Medicaid with no barriers. This is being accomplished by mobilizing grassroots support across the state and strengthening our state tobacco control coalition to include more organizations. Tennessee began restructuring and recruitment of the coalition with a planning committee to set goals in October 2017.

Tennessee Facts

Economic Cost Due to Smoking: $2,672,824,085
Adult Smoking Rate: 22.10%
Adult Tobacco Use Rate: 26.80%
High School Smoking Rate: 11.50%
High School Tobacco Use Rate: 31.90%
Middle School Smoking Rate: N/A
Smoking Attributable Deaths: 11,380

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. A current middle school smoking rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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Tennessee State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in Tennessee. To address this enormous toll, the American Lung Association in Tennessee calls for the following three actions to be taken by our elected officials:
1. Repeal preemption as it relates to smokefree air laws in public places;
2. Increase the tobacco tax by $1.00 per pack; and
3. Increase the age of sale for tobacco products to 21.

It was a disappointing 2016 legislative session in Tennessee related to tobacco control policy. There was a Tobacco 21 bill filed by Representative Ramsey in the House that would not have even been heard in committee had it not been for the State Health Commissioner Dreyzehner testifying on behalf of it.

Preemption continues to be a barrier in passing any effective or strong smokefree laws in the state. The state of Tennessee passed legislation in 1994 giving complete control over tobacco regulation to the state. Protecting tobacco farmers in Tennessee was a large part of the rationale behind tobacco preemption at the time this legislation was passed.

Numerous health based tobacco coalition partners feel the time is ripe to fight tobacco preemption in Tennessee. There is a strong will for increased local control at our legislature as evidenced by increased de-annexation legislation in the last 2 years. There was also laws passed that allowed for exemptions to allow Ascend Amphitheater in Nashville and a major aquatic center in Kingsport to go smokefree. This began to set the stage for the possibility to challenge preemption in the state of Tennessee. The Lung Association and our partner organizations began to meet with state and local officials to gain support for a bill in 2017 that would repeal preemption in the state and give local control to communities to allow them to pass stronger smokefree laws.

In the meantime, on a local level there was positive voluntary smokefree movement in Chattanooga with an alliance of a number of mayors from the area who promoted smokefree parks and public places in their communities. A billboard and social media campaign launched the initiative and gained much earned media. In addition, Memphis and Kingsport worked on voluntary smokefree parks and public places as well and gained a lot of momentum and earned media in those communities.

Another major area of concern was the allotment of tobacco Master Settlement Agreement money to tobacco control and cessation programs for three years runs out in 2016, and no legislation to continue this funding was approved.

Overall, Tennessee legislators have much work to do to protect the people in the state from secondhand smoke, preventing kids from ever starting to smoke, and helping those who want to quit.

Tennessee Facts

Economic Cost Due to Smoking: $2,672,824,085
Adult Smoking Rate: 21.90%
Adult Tobacco Use Rate: 26.50%
High School Smoking Rate: 11.50%
High School Tobacco Use Rate: 31.90%
Middle School Smoking Rate: N/A
Smoking Attributable Deaths: 11,380

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. A current middle school smoking rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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South Dakota State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in South Dakota. To address this enormous toll, the American Lung Association in South Dakota calls for the following three actions to be taken by our elected officials:
1. Ensure the full $5 million in dedicated tobacco tax revenue is allocated to tobacco prevention programs;
2. Protect South Dakota's comprehensive smokefree workplace law; and
3. Increase the tax on cigarettes and other tobacco products.

The South Dakota Department of Health along with national, state, and local partners continue to work together on a five-year tobacco strategic plan. The four goal areas of the plan include: preventing initiation of tobacco use, promoting quitting among adults and youth, eliminating exposure to secondhand smoke and identifying and eliminating tobacco-related disparities among population groups. Priority populations have been identified to include: American Indians, Medicaid enrollees, pregnant women, people with mental illness and substance use disorders, spit tobacco users, youth and young adults.

State funding for the state's tobacco prevention and control program remained at $4.5 million in fiscal year 2015, the same level as the past several years. When combined with federal funding this level is close to half of the level recommended by the Centers for Disease Control and Prevention (CDC).

South Dakota has a well-funded quitline compared to other states, but coverage of treatments to help smokers quit under the state Medicaid program is one of the least comprehensive in the country leading to the F grade for Access to Cessation Treatments.

Sioux Falls was one of the sites for the launch of FDA's "The Real Cost" campaign targeting youth ages 12-17, at risk of smokeless tobacco use. In 2016, the campaign expanded to have a presence during games in Minor League Baseball including both the Sioux City Explorers and the Sioux Falls Canaries.

The coalition in South Dakota has strong roots in working together to support tobacco control best practices and will continue to work in 2017 to assure funding for the state tobacco control program is not reduced any further and promote increasing funding to the CDC-recommended level. Other priorities include protecting the comprehensive statewide smokefree law and education toward increasing the tobacco tax in the future.

South Dakota Facts

Economic Cost Due to Smoking: $373,112,273
Adult Smoking Rate: 20.10%
Adult Tobacco Use Rate: 25.00%
High School Smoking Rate: 10.10%
High School Tobacco Use Rate: 30.30%
Middle School Smoking Rate: N/A
Smoking Attributable Deaths: 1,250

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. A current middle school smoking rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


To Get Involved, Contact:

South Dakota State Highlights

Tobacco use remains the leading cause of preventable death and disease in the United States and in South Dakota. To address this enormous toll, the American Lung Association in South Dakota calls for the following actions to be taken by our elected officials:
1. Increase the tax on cigarettes and other tobacco products;
2. Raise the age of sale for all tobacco products to 21 years old; and
3. Protect South Dakota's comprehensive smokefree workplace law.

The South Dakota Department of Health along with national, state, and local partners continue to work together on implementation of the five-year tobacco strategic plan. The four goal areas of the plan include: preventing initiation of tobacco use, promoting quitting among adults and youth, eliminating exposure to secondhand smoke and identifying and eliminating tobacco-related disparities among population groups. Priority populations include: American Indians, Medicaid enrollees, pregnant women, people with mental illness and substance use disorders, spit tobacco users, and youth and young adults.

During the 2017 legislative session, the Speaker of the House of Representatives submitted a proposal to the Secretary of State that would increase the tobacco tax by $1.00 per pack via a ballot initiative with part of the revenues dedicated to lower technical school tuition and provide scholarships along with funding tobacco prevention and awareness programs. If the adequate number of signatures are collected, the question of raising the tobacco tax will be on the ballot in November 2018.

The coalition in South Dakota, including the American Lung Association in South Dakota, has strong roots across the state and is working together to support tobacco control best practices and continues to work together to implement the strategic plan to reduce the harm from tobacco in South Dakota.

South Dakota Facts

Economic Cost Due to Smoking: $373,112,273
Adult Smoking Rate: 18.10%
Adult Tobacco Use Rate: 22.60%
High School Smoking Rate: 10.10%
High School Tobacco Use Rate: 30.30%
Middle School Smoking Rate: 2.80%
Smoking Attributable Deaths: 1,250

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the 2016 Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.


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