The American Lung Association's "State of Tobacco Control 2016" sounds the alarm about the troubling increase of youth tobacco use in our nation. While significant progress has been made in reducing youth cigarette smoking—an almost 42 percent decline in high school smoking rates since 2011—youth use of other tobacco products, including e-cigarettes and hookah, is skyrocketing.
Now, nearly one in four high school students (24.6%) in the United States use at least one tobacco product, and more than 50 percent of these youth that use tobacco products report using two or more tobacco products.1 This startlingly high rate of youth tobacco use is likely to have far-reaching consequences for our nation's health. Youth who use more than one tobacco product are at greater risk for becoming addicted to nicotine and may be more likely to continue to use tobacco products as adults.2 Beyond addiction alone, tobacco products and nicotine have a negative impact on adolescent brain development according to the U.S. Surgeon General.
Despite an almost 42 percent decline in high school smoking rates since 2011, youth use of other tobacco products, including e-cigarettes and hookah, is skyrocketing. Now, nearly one in four high school students use at least one tobacco product.3
"State of Tobacco Control 2016" finds that the significant increase in the use of some tobacco products threatens to undermine the United States' overall progress in the fight against tobacco-caused death and disease. By fully implementing the policies called for in "State of Tobacco Control 2016" our nation can reverse this troubling trend and make significant strides towards eliminating tobacco-caused death and disease in the United States.
Tobacco now kills 480,000 Americans a year and another 16 million Americans are living with a tobacco-caused disease. Economic costs due to smoking in the U.S. are now estimated to be more than $289 billion, including both direct medical costs and lost productivity.4
Updated: Three Bold Goals to End Tobacco-Caused Death and Disease
In 2014, in recognition of the 50th anniversary of the first Surgeon General's report on smoking and health in 1964, the American Lung Association and its partners called for three bold goals to end tobacco-caused death and disease including the call to reduce adult smoking rates to less than 10 percent by 2024.
However, in light of the troubling findings that one in four of our nation's youth is using at least one tobacco product, including e-cigarettes, our organizations have updated the first bold goal to reflect the urgent need to reduce overall tobacco use rates, in all communities and priority populations, in order to ultimately eliminate the death and disease caused by tobacco use.
- Reduce rates of smoking and other tobacco use to less than 10 percent for all communities by 2024;
- Protect all Americans from secondhand smoke by 2019; and
- Ultimately eliminate the death and disease caused by tobacco use.
The 14th annual American Lung Association "State of Tobacco Control" report evaluates states and the federal government on the tobacco control laws and policies necessary to save lives and achieve these updated bold goals. This includes tobacco prevention and cessation funding, programs and insurance coverage; smokefree workplace laws; increased tobacco taxes; and aggressive implementation of the U.S. Food and Drug Administration's (FDA) Family Smoking Prevention and Tobacco Control Act. The report assigns grades based on tobacco control laws and regulations in effect as of January 2016. The federal government, all 50 state governments and the District of Columbia are graded to determine if their laws and policies are adequately protecting citizens from the enormous toll tobacco use takes on lives and the economy.
In July 2015, a study published in the American Journal of Public Health found that localities with less educated and low-income residents were less likely to have comprehensive smokefree laws protecting workers and the public from the dangers of secondhand smoke. This study underscores the urgent need for states and localities to pass comprehensive smokefree laws now and certainly no later than 2019.
States Make Notable Progress on Tobacco Taxes This Year; Falter in Other Areas
While some notable progress on tobacco taxes was made in 2015, "State of Tobacco Control 2016" finds that the federal and state governments are not acting quickly or aggressively enough to meet the three bold goals called for by the American Lung Association and its partners. Indeed, it became clear that the tobacco industry continues to hold considerable influence with Congress. In 2015, the House of Representatives attempted to weaken FDA's authority over e-cigarettes and cigars.
State Trends: The Return of Tobacco Tax Increases
- Tobacco tax increases returned to the agenda for many states this year, in a positive development from previous years. In total, eight states—Alabama, Connecticut, Kansas, Louisiana, Nevada, Ohio, Rhode Island and Vermont—increased cigarette taxes. This increased the nationwide state cigarette tax average from $1.54 to $1.60 per pack.
- Kansas, Louisiana and the District of Columbia also established new taxes on electronic cigarettes, joining Minnesota and North Carolina who already tax e-cigarettes.
- Vermont was the only state to increase some of its taxes on other tobacco products this year.
- Four states—Florida, Montana, Ohio and Oklahoma – significantly increased their funding for tobacco prevention and cessation programs for fiscal year 2016. Meanwhile, three states – Connecticut, Delaware and Illinois—went in the wrong direction significantly decreasing funding for these vital programs to prevent and reduce tobacco use.
- Once again, no state passed a comprehensive statewide smokefree law, but progress continued at the local level:
- The City of New Orleans passed a comprehensive smokefree law, becoming the first city in the U.S. to pass a law that makes casinos smokefree and also prohibits the use of e-cigarettes.
- Four states—Delaware, Hawaii, Maine and Oregon—also passed laws to add e-cigarettes to their statewide smokefree laws, prohibiting their use in places smoking is also prohibited.
- There are still only three states that cover a comprehensive tobacco cessation benefit for all Medicaid enrollees: Connecticut, Massachusetts and Indiana. Many states still need to make significant progress in this area by covering all seven FDA-approved smoking cessation medications and individual, group and phone counseling, and providing this coverage to all Medicaid enrollees. There were some positive developments for tobacco cessation in private health insurance: more state health insurance commissioners proactively engaged with informing consumers about access to comprehensive tobacco cessation benefits.
- Find out if your state made the grade this year.
- The federal government earned an "I" for FDA Regulation of Tobacco Products. As of January 31, 2016, the Obama Administration had not yet given the U.S. Food and Drug Administration (FDA) oversight authority over all tobacco products including cigars, e-cigarettes, little cigars and hookah (commonly referred to as the deeming rule). The grade of "I" for Incomplete for FDA Regulation of Tobacco Products is assigned because the final rule is expected at any time.
- In June 2015, the House of Representatives Committee on Appropriations moved to weaken FDA's authority over unregulated tobacco products – including e-cigarettes and cigars – by including a policy rider in its appropriations bill for FDA that would grandfather in all unregulated tobacco products. The House Committee also cut funding by 50 percent to the Centers for Disease Control and Prevention (CDC)'s Office on Smoking and Health. The final spending bill approved in December 2015 did not weaken FDA's authority and it restored funding for the Office of Smoking and Health at CDC.
- The CDC's Office of Smoking and Health and the FDA's Center for Tobacco Products continued their highly successful mass media campaigns aimed at encouraging smokers to quit and discouraging youth from beginning tobacco use.
- The U.S. Preventive Services Task Force (USPSTF) issued its updated clinical guidelines for tobacco cessation. Tobacco cessation continues to earn an "A" grade, which requires almost all private insurance plans to cover tobacco cessation treatments as a preventive service. The USPSTF further strengthened its recommendation by clarifying that tobacco cessation must include medications AND counseling, and by stating there is not nearly enough evidence for clinicians to recommend Electronic Nicotine Delivery Systems (ENDS) products, which includes e-cigarettes, to patients who want to quit smoking.
- Two bills were introduced to close federal tobacco tax loopholes and increase the overall tobacco tax, but neither became law.
- In a victory for public health, the final Trans Pacific Partnership trade agreement between the U.S. and 11 other countries was amended to prohibit tobacco companies from using the agreement to challenge laws and regulations to reduce tobacco use.
- See the federal government's grades.
The three bold goals called for by the American Lung Association and its partners will only be met if federal, state and local policymakers muster the political will to stand up to the tobacco industry and implement the lifesaving measures to prevent and reduce tobacco use called for in "State of Tobacco Control 2016."
In November 2015, the U.S. Department of Housing and Urban Development (HUD) released a proposed rule that would make all publically-owned housing smokefree. The Lung Association recognized this proposal as a significant step forward and in its comments, called on HUD to make all federally-subsidized housing smokefree.
- Centers for Disease Control and Prevention. Tobacco Use Among Middle and High School Students—United States, 2011–2014. Morbidity and Mortality Weekly Report, 2015;64(14):381–5.
- Centers for Disease Control and Prevention. Tobacco Use Among Middle and High School Students—United States, 2013. Morbidity and Mortality Weekly Report, 2014;63(45):1021–6.
- Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey Raw Data, 2014. Analysis performed by the American Lung Association Research and Health Education Division using SPSS software.
- U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. 2014.