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Lung Association Report: Federal and State Leaders Failing to Prevent Tobacco-Related Disease and Death

(January 25, 2017)

Tobacco use is the leading preventable cause of death in the U.S. The word "preventable" is important, because we know how to prevent tobacco use and help current smokers quit. However, our new 2017 "State of Tobacco Control" report shows that states and the federal government are failing to both implement lifesaving laws and policies proven to be effective at reducing tobacco use, and protect Americans from exposure to harmful secondhand smoke.

Our 15th annual "State of Tobacco Control" report grades the states and the federal government on key actions that are proven to reduce tobacco's deadly toll. The report shows that while some key actions were taken at the federal and state levels to prevent and reduce tobacco use in 2016, much more must be done. This year's report was also expanded to include a grade for "Tobacco 21" laws. Raising the minimum age of sale for tobacco products to 21 or "Tobacco 21" is proven to reduce tobacco use by young people.

Federal actions
The federal government's grades were decidedly mixed this year. On the plus side was the long-awaited release of the U.S. Food and Drug Administration (FDA)'s final rule giving FDA oversight over all tobacco products including e-cigarettes and cigars was released. However, this was offset by the failure to require graphic warning labels on cigarettes and failure to move forward on issuing a rule to end the sale of menthol cigarettes nationwide. This lack of action resulted in a final grade of "F" for FDA Regulation of Tobacco Products for the federal government.

Other federal grades include a "C" for Federal Coverage of Cessation Treatments, and an "F" for the low level of federal tobacco taxes. Ironically, the area where the federal government scored best – a "B" for Mass Media Campaigns – is in danger as members of the House of Representatives have proposed eliminating funding for the Tips from Former Smokers media campaign, which has been found highly effective at motivating smokers to quit.

See all the Federal grades.

Although not part of the grading process, the federal government took an important step forward when the U.S. Department of Housing and Urban Development issued a final rule that will protect two million residents, including 760,000 children, from the harms of secondhand smoke by making all public housing in the U.S. smokefree. These safeguards will be in effect by August 2018 unless they are undermined by the Trump Administration.

State actions
Much like the federal government, state grades reflect a mix of successes and failures. The report notes that 22 states have yet to pass comprehensive smokefree laws that eliminate smoking in virtually all workplaces and public spaces to protect against the harms of secondhand smoke. In fact, progress on smokefree laws has completely stalled with no states passing comprehensive smokefree laws since 2012.

Close to 95 percent of smokers try their first cigarette before the age of 21, and increasing the minimum sales age of tobacco products to 21 will significantly reduce youth tobacco use, and save thousands of lives nationwide. With "Tobacco 21" laws becoming an important new tool for legislators, a state grade was added to the report this year for states passing Tobacco 21 laws. In 2016, California and the District of Columbia joined Hawaii, which was the first state to pass a Tobacco 21 law in 2015.
Other state grades show that states are largely failing to do what's needed to prevent and reduce tobacco use:

  • Only three states – California, Pennsylvania and West Virginia – increased cigarette taxes by significant enough amounts to reduce smoking rates in 2016.  Higher cigarette taxes are proven to reduce smoking, especially among youth.
  • Alaska and North Dakota are the only two states funding their tobacco prevention programs at or above the level recommended by the Centers for Disease Control and Prevention.
  • Eight state Medicaid programs – California, Connecticut, Indiana, Maine, Massachusetts, Missouri, North Dakota and Ohio – cover a comprehensive tobacco cessation benefit to help smokers quit, including all seven FDA-approved medications and three forms of counseling for Medicaid enrollees. In 2016, Missouri became the first state Medicaid program to have no barriers to accessing quit smoking coverage.

How did your state rate? Check out state grades.

We can and must do better!
A report card should always include how to improve performance, and according to "State of Tobacco Control," America can do better.

  • The Trump Administration must implement all aspects of the FDA's Tobacco Control Act, and ensure that the 36 million Americans who smoke have access to all proven quit smoking treatments without barriers.
  • Congress must not weaken FDA's authority over all tobacco products, continue to fund CDC's Tips media campaign, fund state tobacco quitlines, increase federal tobacco taxes – on all tobacco products and pass legislation increasing the age of sale for tobacco products to 21.
  • States must pass comprehensive smokefree air laws and "Tobacco 21" laws, increase tobacco taxes, fund tobacco prevention programs, and improve access to quit smoking services.

The American Lung Association also pledges to do its part by working to defend the gains that have been made to combat tobacco use. The Lung Association will continue to push federal and state leaders to enact policies that will save lives - funding tobacco prevention programs, helping smokers quit and protecting everyone from secondhand smoke.

We can't do it alone! Learn what you can do to help us eliminate tobacco-caused death and disease in America.

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