The recently released 22nd annual "State of Tobacco Control" report is not just about the data; it’s a call to action. In evaluating state and federal government tobacco control laws and policies, the report grades states on those policies, A through F. The report serves as a blueprint for what our political leaders need to do to eliminate the death and disease caused by tobacco use. One of the states that continually struggles to put in place laws and fund programs to prevent and reduce tobacco use is West Virginia, resulting in a high population of tobacco users. There are many steps West Virginia could take to help reduce tobacco use, but the most urgent is increasing funding for prevention and education programs. We spoke with Dr. Robert Herron, a general thoracic surgeon practicing in Wheeling, West Virginia about his thoughts on this year’s report and what he sees in practice. 

Understanding the Tobacco Problem

Tobacco remains the leading cause of preventable death and disease in America, killing 480,000 people each year. In addition, 16 million Americans live with a tobacco-related disease. “I deal with lung diseases like lung cancer, emphysema, collapsed lungs, tumors of the lung and lung infections. For many of the patients I see their lung issues are largely driven by previous smoking exposure, both first and secondhand,” Dr. Herron explained.


According to the CDC’s 2022 National Health Interview Survey, the decline in adult cigarette rates has stalled. Not surprisingly, the increase in tobacco use in 2022 was driven by a rise in e-cigarette use. The largest consumer group was adults 18 to 24 years of age, with 65.5% of e-cigarette users in this age group being first time tobacco users.

“Unfortunately, for the past couple of years, according to the CDC, we've had a high rate of adult smokers, around 21% or one in five adults in West Virginia smoke. But even more alarming is that more than one in four, or 27% of high school age kids in our state used tobacco, which is the highest in the country” Dr. Herron continued. Indeed, the State of Tobacco Control found that West Virginia has the highest rate of adult smokers and one of the highest high school tobacco use rates in the nation.

As a thoracic surgeon, Dr. Herron sees younger patients suffering from lung complications more frequently. “I have maybe two to four cases a month where a young person who either smokes or vapes comes in with a spontaneous pneumothorax (or a collapsed lung). This means the lung has become diseased, so it collapses which requires surgery. The weak tobacco policies in West Virginia, which were highlighted in the State of Tobacco Control, have led to more tobacco use and tobacco-related disease. So, we’re starting to see more young people who vape who have the same health problems as those who smoke.”

The Importance of Cessation and Education

On the positive side, nine states increased funding for tobacco prevention programs by at least $1 million from the previous year, but many others are still lacking in this area, including West Virginia. This is of particular concern for Dr. Herron, who is very focused on trying to figure out ways to help his patients quit tobacco use. “Here at Wheeling Hospital, we have lots of resources, including a lung cancer screening program and, as part of that, we also give our patients access to tobacco cessation resources. Our programs to help people end their tobacco addiction have strategies to help them either get started quitting or explore other options if they've previously tried to quit but were unsuccessful. I have had several patients who have been successful with the help of these programs,” he said.

“I am so proud to be from West Virginia, but I think sometimes we are at a disadvantage because there are a lot of lower income communities that unfortunately receive fewer resources and less education about the dangers of tobacco. I think more access and widespread education, especially for tobacco cessation as well as why not to pick it up in the first place is important. State and government funding for those programs, even in schools, would be huge.”

It was a disappointing year for passage of state and local policies to prevent and reduce tobacco use in 2023. Though smoking is not allowed in many indoor areas in cities, many more rural areas do not have these laws. “For the county that I live in, there are laws that prohibit people from smoking indoors but that does not hold true for all counties and other parts of the state, and it should,” Dr. Herron said.

To further prevent youth from starting to use tobacco or switching products, the Lung Association continues to suggest the use of evidenced-based polices to reduce youth tobacco use such as increasing the cigarette tax and equalizing the rates across all tobacco products, including e-cigarettes.

Menthol Is Still a Problem

Despite having the menthol cigarette and flavored cigar rules under review for over four months now, the White House has yet to finalize these life-saving rules. This is a particular problem for places like West Virginia where youth use tobacco at high rates. “The main issue with the flavorings, even menthol, is that it attracts more kids. And once they start, the addictive properties make it very hard to quit,” Dr. Herron commented.

Help us encourage the White House to step up and address some of these issues.

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If you are ready to begin your quit journey, you can learn more about our Freedom From Smoking program on our website Lung.org/FFS or by calling 1-800-LUNG-USA.
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