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Wyoming State Highlights Select a different state

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 calls for the following actions to be taken by Wyoming's elected officials:

  1. Increase tobacco taxes by a $1.00 or more per pack;
  2. Maintain funding for tobacco prevention and cessation programs; and
  3. Pass additional local or state legislation eliminating smoking in public places and workplaces.
During the short 2018 legislative session focused on the two-year state budget, the Joint Revenue Interim Committee sponsored House Bill 43 which would increase taxes on cigarettes and other tobacco products by varying amounts, including a $1.00 per pack increase on cigarettes. Unfortunately, the House of Representatives decided not to introduce the legislation, effectively killing any chance of increasing tobacco taxes during the 2018 session.

Funding for tobacco prevention and cessation programs also took a reduction in the fiscal year 2019 and 2020 two-year budget with about a $1.4 million reduction over the two years or $700,000 each year. Funding that previously came from the state general fund was redirected to suicide prevention.

Wyoming's cigarette tax remains one of the lowest in the nation at $0.60 per pack. The American Lung Association in Wyoming will continue working with partners to support increases in tobacco taxes and additional appropriations for tobacco prevention and cessation programs. The Lung Association will also support any efforts to pass local or statewide smokefree workplace laws in Wyoming

Wyoming Facts

Economic Cost Due to Smoking: $257,674,019
Adult Smoking Rate: 18.70%
Adult Tobacco Use Rate: 28.10%
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 2017 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 Select a different state

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 calls for the following actions to be taken by Wisconsin's elected officials:

  1. Protect and increase funding for the Tobacco Prevention and Control Program;
  2. Equalize the tax on little cigars (brown cigarettes) with regular cigarettes; and
  3. Pass legislation that places ALL tobacco products behind the counter or in a locked cabinet.
Meaningful tobacco control policy advancement continued to be stymied on the state level in 2018. Assembly Bill 159, a bill that would have required all Wisconsin schools to adopt a strong policy prohibiting e-cigarette use on school property passed the Assembly Committee on Education, 14-1 but then was denied a full floor vote in the Assembly.

Even more disappointing, Senate Bill 307/Assembly Bill 225, which would have required all tobacco products to be placed behind the counter or in a locked cabinet, did not pass. The bill had strong, bi-partisan co-sponsorship in both house and overwhelming support from numerous statewide health organizations. After a hearing before the Senate Committee on Agriculture, Small Business, and Tourism, it was passed 9-0 and moved to the Senate floor where it passed on a voice vote. The Assembly Committee on State Affairs also held a public hearing where numerous individuals testified in support and none against, but then stalled. Subsequently, the bill did not advance before the end of the session.

Work continued on the local level with several major e-cigarette victories in 2018. The City of Milwaukee passed an ordinance that prohibits the use of e-cigarettes anywhere that smoking isn't allowed. That city was joined by the cities of Oak Creek, Beaver Dam, Neenah and Grant County. Other communities, such as Appleton and Juneau made advances in clean outdoor air by passing laws limiting the use of cigarettes, e-cigarettes and other tobacco products in parks and recreational areas.

Due to the skyrocketing rise in e-cigarette and other tobacco products use, particularly flavored products, Wisconsin has created an awareness campaign aimed at parents, Tobacco is Changing, with a tagline that says, "Tobacco is Changing, parents. We've got to keep up." The campaign includes paid advertising and on-line videos, social media and a website that familiarizes parents and adults with the new products and the issues surrounding them, provides opportunities to take action, and connects viewers with resources available through the state Tobacco Prevention and Control Program.

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 continue to focus on passing legislation that requires that ALL tobacco sales be clerk assisted, create tax parity between cigarettes and little cigars and advocate to increase funding for the state Tobacco Prevention and Control Program. The Lung Association hopes that new governor Tony Evers and the legislature can work together to make positive advancements in tobacco control in 2019

Wisconsin Facts

Economic Cost Due to Smoking: $2,663,227,988
Adult Smoking Rate: 16.00%
Adult Tobacco Use Rate: 20.90%
High School Smoking Rate: 7.80%
High School Tobacco Use Rate: 17.30%
Middle School Smoking Rate: 1.30%
Smoking Attributable Deaths: 7,850

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use rates are taken from the 2017 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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West Virginia State Highlights Select a different state

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 calls for the following actions to be taken by West Virginia's elected officials:

  1. Restoration of West Virginia state funding for tobacco prevention and cessation;
  2. Protect smokefree air regulations as they currently exist throughout the state; and
  3. Increase the age of sale for all tobacco products to 21.
During the 2018 legislative session, tobacco prevention and control funding failed to be restored. The House of Delegates had proposed funding for tobacco education in the state budget that was presented to the House Finance committee. However, after Governor Justice announced a 5 percent salary increase for teachers and all state employees, the tobacco prevention and control funding was deleted from the budget.

The Senate Finance Committee Chairman announced, while discussing the Senate budget in committee, that an agreement had been reached and that no amendments to the budget would be offered, and in return, he would support future funding be restored for tobacco control.

A bill introduced by Senator Stollings, to increase the age of sale for tobacco products to 21, stalled in the Senate Judiciary Committee. In the House, a bill was similarly introduced by Representative Rowe to raise the legal age of sale for tobacco products to 21 but failed to move forward in the House Health and Human Resources Committee.

The Board of Health in Hancock County took a deeply disappointing action in 2018 amending its Clean Indoor Air regulation to allow smoking at casinos and gaming sections of local video lottery cafes. This will once again expose thousands of workers and patrons to toxic secondhand smoke. The Lung Association discourages other counties from following Hancock's bad example.

New leadership and direction from the Coalition for Tobacco Free West Virginia (CTFWV) has placed an emphasis on the need for shared information, collaboration throughout the state, and building local support.

The Lung Association is working on bi-partisan sponsorship of a Tobacco 21 bill to introduce during the 2019 legislative session. Findings from a representative survey of over 3,000 West Virginian voters who voted in the 2016 election indicate that almost two thirds (63.2%) favor raising the legal sales age for tobacco products from 18 to 21. Additionally, the survey found that the majority of both Democrats and Republicans support Tobacco 21. Only about 1 in 7 West Virginia voters strongly oppose raising the legal sales age for tobacco products.

The American Lung Association in West Virginia will continue to educate lawmakers in the ongoing fight against tobacco. Our goal is to identify champions within the legislator and continue to build a strong state coalition to advance our advocacy goals, including restoration of West Virginia state funding for tobacco prevention and cessation, protection of smokefree indoor air regulations, and increasing the age of sale for all tobacco products to 21

West Virginia Facts

Economic Cost Due to Smoking: $1,008,474,499
Adult Smoking Rate: 26.00%
Adult Tobacco Use Rate: 35.00%
High School Smoking Rate: 10.30%
High School Tobacco Use Rate: 26.60%
Middle School Smoking Rate: 4.50%
Smoking Attributable Deaths: 4,280

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school and middle school smoking rates are taken from the 2017 Youth Tobacco Survey. High school tobacco use rate is taken from the 2017 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 Select a different state

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 calls for the following actions to be taken by Washington's elected officials:

  1. Increase funding for tobacco prevention and cessations programs;
  2. Raise the sales age to 21 for tobacco products; and
  3. Defend smokefree workplace laws.
Three bills were introduced in the legislature to raise the legal age of sale for tobacco products to 21 (House Bill 1054, Senate Bill 5025 and Senate Bill 6048). House Bill 1054 was legislation requested by the state Attorney General and the Department of Health.

During the 2017 legislative session, House Bill 1054 had passed out of both the House Committee on Health Care and Wellness and the House Finance Committee. At the beginning of the 2018 regular session, by resolution, the legislation was retained in the Rules Committee, and referred to the Finance committee, where it was again passed out of the committee. On March 7, 2018, the bill was debated on the House Floor with very passionate floor speeches on tobacco and the effect tobacco has had on members' families and friends. The bill passed the House with bipartisan support with 63 yes votes and 35 no votes. Unfortunately, the 2018 session ended before the bill could begin its process through the Senate.

House Bill 1919 would establish licensing for cigar lounges and retail tobacconist shops. This legislation saw no activity during the 2018 session.

The spending authority for Washington's Youth Tobacco & Vapor Products Prevention Account was reduced by $1.6 million by the legislature. Despite this, funding for tobacco prevention and cessation in fiscal year 2019 was roughly the same as the previous year at about $1.5 million. However, this small amount of state funding is wholly inadequate for the task of effectively preventing and reducing tobacco use.

The American Lung Association in Washington will continue to work with stakeholders and engaged grassroot supporters to advocate for policies to reduce tobacco use and its health impact on Washington residents. Building on our momentum from the 2018 legislative session, the Lung Association will continue to support Tobacco 21 and use the increased awareness of tobacco to provide the foundation to increase appropriations for tobacco prevention programs

Washington Facts

Economic Cost Due to Smoking: $2,811,911,987
Adult Smoking Rate: 13.50%
Adult Tobacco Use Rate: 17.90%
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 2017 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 Select a different state

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 calls for the following actions to be taken by Virginia's 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 2018 legislative session, a bill for Medicaid Expansion was introduced. This legislation passed and was signed by the Governor. With the implementation of this legislation an additional 400,000 people will be eligible for Medicaid in Virginia. Expansion will provide critical treatment and services to this newly covered population, including preventive services such as tobacco cessation and lung cancer screening. This legislation implements in January 2019.

Multiple bills to prohibit tobacco products in schools, including on school grounds and to strengthen the state's Clean Indoor Air Act were also introduced in the state House of Representatives and Senate. Current law prohibits smoking in some public places but allows separately-ventilated smoking rooms in restaurants and bars, and completely leaves out workplaces that are not open to the public. Unfortunately, all bills were left in their respective legislative committees and died.

Funding for tobacco prevention and cessation programs in Virginia increased by about $2 million in fiscal year 2019 from the previous fiscal year. Unfortunately, this is likely to be an increase only for this year as the increase was due to a one-time settlement of a dispute with tobacco companies over a portion of tobacco Master Settlement Agreement payments.

In 2019, priorities for the American Lung Association in Virginia will include working to ensure prevention and cessation programs are funded at a minimum at historic levels, a significant 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: 16.40%
Adult Tobacco Use Rate: 21.50%
High School Smoking Rate: 6.50%
High School Tobacco Use Rate: 16.30%
Middle School Smoking Rate: 2.40%
Smoking Attributable Deaths: 10,310

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2017 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the Virginia 2017 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 Select a different state

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 calls for the following actions to be taken by Vermont's elected officials:

  1. Enact legislation to raise the retail sales age of tobacco products to 21;
  2. Maintain past additional $1 million increase in tobacco control program funding; and
  3. Implement an excise tax on electronic cigarettes equal to cigarettes and other tobacco products.
The 2018 session of the Vermont legislature ended with a significant tobacco win with $1 million from a one-time tobacco Master Settlement Agreement payment that Vermont received in April due to settlement of a dispute over a portion of past MSA payments with tobacco companies being added to the fiscal year 2019 budget bill for the state's tobacco control program. This is the first increase to the tobacco control budget in ten years and the American Lung Association in Vermont and partners will look to sustain this increase in 2019.

The Vermont Department of Health will use most of the one-time appropriation to enhance mass-reach health communication interventions. These interventions will include a multi-media campaign to encourage adult cessation, misperceptions of the harm of JUUL and other electronic nicotine devices focused on youth and a new campaign based on formative research targeting women who smoke during pregnancy. Reducing smoking during pregnancy is a high priority for the state given the rate of smoking during pregnancy in Vermont is twice the national average.

The American Lung Association in Vermont will continue to work with our coalition partners including the American Heart Association, American Cancer Society Cancer Action Network and others to advance tobacco control and prevention efforts. As the legislature begins its work in 2019 we will continue to grow our coalition to educate policy makers, business leaders and the media of the importance of the American Lung Association's goals to reduce tobacco use and protect public health. A renewed effort by the Lung Association and partners to increase the minimum legal age of sale for tobacco products to 21 is likely in 2019

Vermont Facts

Economic Cost Due to Smoking: $348,112,248
Adult Smoking Rate: 15.80%
Adult Tobacco Use Rate: 19.50%
High School Smoking Rate: 9.30%
High School Tobacco Use Rate: 18.90%
Middle School Smoking Rate: 2.00%
Smoking Attributable Deaths: 960

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use rates are taken from the 2017 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the Vermont 2017 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 Select a different state

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 2018, 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.

House bill 324 was approved by the legislature and signed into law during the 2018 legislative session, which added e-cigarettes and hookah to the definition of smoking in Utah's Clean Indoor Air Act and made a number of changes to state and municipal licensing requirements for retailers of tobacco products.

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 2019. The program is funded by a combination of tobacco Master Settlement Agreement dollars and tobacco tax revenue.

In November 2018, Utah voters approved an initiative supported by the Lung Association expanding the Medicaid program in the state. Once implemented, this will potentially give a lower income population that smokes at higher rates than the general population access to at least some tobacco cessation treatments and services at low or no cost.

In 2019, the American Lung Association in Utah will continue pushing to increase the sales age for tobacco products to 21, and to maintain or increase funding for the Utah Tobacco Prevention and Control Program

Utah Facts

Economic Cost Due to Smoking: $542,335,526
Adult Smoking Rate: 8.90%
Adult Tobacco Use Rate: 14.00%
High School Smoking Rate: 3.80%
High School Tobacco Use Rate: 9.70%
Middle School Smoking Rate: N/A
Smoking Attributable Deaths: 1,340

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use rates are taken from the 2017 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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Texas State Highlights Select a different state

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 calls for the following actions to be taken by Texas' elected officials:

  1. Restore funding for tobacco prevention and cessation programs that was significantly cut in 2017;
  2. Continue to pass comprehensive local smokefree ordinances to builds towards a statewide smokefree law; and
  3. Increase the minimum 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.

The Texas Legislature only meets in odd numbered years, so in 2018 the American Lung Association in Texas and its partners in the Smokefree Texas coalition worked in communities around the state to pass local smokefree ordinances. Fort Worth implemented its local smokefree law in March 2018 becoming the last major city in Texas to prohibit smoking in virtually all public places and workplaces. Texas currently has 104 cities with comprehensive smokefree ordinances protecting more than 12.5 million citizens from the harmful effects of secondhand smoke.

State funding for Texas' tobacco prevention program in the Texas Department of State Health Services was severely cut in the two-year state budget approved in 2017, leaving only $4.2 million in funding to prevent and reduce tobacco use across the entire state in fiscal year 2019.

Moving forward in 2019, the Lung Association will work with its partners to once again pursue an increase in the minimum legal sales age of tobacco products to 21. In 2017 this bill passed an initial House Committee but failed to get additional committee hearings. The Lung Association will also work to restore funding to the Tobacco Education and Enforcement Fund that was cut during the 2017 legislative session

Texas Facts

Economic Cost Due to Smoking: $8,855,602,443
Adult Smoking Rate: 15.70%
Adult Tobacco Use Rate: 20.90%
High School Smoking Rate: 7.40%
High School Tobacco Use Rate: 16.80%
Middle School Smoking Rate: 2.40%
Smoking Attributable Deaths: 28,030

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use rates are taken from the 2017 Youth Risk Behavior Surveillance System. Middle school (8th grade only) smoking rates are taken from the 2016 Texas School 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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Tennessee State Highlights Select a different state

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 calls for the following actions to be taken by Tennessee's elected officials:

  1. Restore funding in the 2019-2020 budget for statewide tobacco control programs
  2. Support legislation to remove local preemption language for smokefree laws; and
  3. Build momentum on the importance of raising the retail sales age of tobacco products to 21 years old.
Unfortunately, during the 2018 legislative session, state funding for tobacco education programs within the Tennessee Department of Health was stripped from the state budget. Tobacco Master Settlement Agreement funds were deleted from the program and diverted to non-tobacco related projects. Restoring funding in the 2019-2020 budget for statewide tobacco control will be a top priority.

While efforts to remove preemption of local smokefree ordinances in Tennessee failed in 2018, the American Lung Association in Tennessee and our health advocate partners will work to further engage with the Tobacco Free Tennessee Coalition in a broad education effort about county and municipal government support for local options. With a newly-elected governor, and likely changes in legislative leadership positions, a strong strategic public education campaign will be critical.

As Medicaid expansion in Tennessee continues to evolve, the Lung Association will be actively engaged in the process to minimize barriers to tobacco cessation-related coverages.

Also, in 2018 the University of Tennessee Knoxville joined the University of Tennessee Chattanooga and the University of Tennessee Health Science Center in Memphis in going smokefree in all locations on campus. UT Knoxville's policy includes cigarettes, vapes and e-cigarettes.

The American Lung Association in Tennessee will continue to work with our many health coalition partners and others and will work to grow and activate our grassroots network statewide, to advance tobacco control and prevention initiatives at the state and local levels. As the legislature begins its work in 2019, the Lung Association will continue our efforts to educate policy makers, business leaders and the media on the importance of the Lung Association's goals to reduce tobacco use and protect public health

Tennessee Facts

Economic Cost Due to Smoking: $2,672,824,085
Adult Smoking Rate: 22.60%
Adult Tobacco Use Rate: 29.30%
High School Smoking Rate: 9.40%
High School Tobacco Use Rate: 20.30%
Middle School Smoking Rate: N/A
Smoking Attributable Deaths: 11,380

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use rates are taken from the 2017 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 Select a different state

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 calls for the following actions to be taken by South Dakota's elected officials:

  1. Increase the tax on cigarettes and other tobacco products by $1.00 or more per pack;
  2. Raise the age of sale for all tobacco products to 21 years old; and
  3. Fully fund South Dakota's tobacco control program.
The South Dakota Department of Health along with national, state and local partners continue to work together on the 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 clients, pregnant women, people with mental illness and substance use disorders, spit tobacco users, youth and young adults.

South Dakota placed a tobacco tax increase on the fall ballot by collecting over 19,000 signatures in support of the ballot initiative. Measure 25 would have increased the state tax on tobacco products by $1.00 per pack of 20 cigarettes along with the tax on other types of tobacco products such as cigars, roll-your-own, and chewing tobacco from the current rate of 35 percent of the wholesale price to 55 percent.

The measure would have created a postsecondary technical institute fund for the purposes of lowering student tuition and providing financial support to state postsecondary technical institutes. Under current law, the first $30 million of tobacco tax collected annually goes to the general fund, the next $5 million into the tobacco prevention and reduction fund. This measure would require the next $20 million to be deposited into the technical institute fund. Unfortunately, the ballot measure was not approved by South Dakota voters with the tobacco industry spending over $6 million to defeat the measure. The last increase in tobacco tax in South Dakota was in 2006, which was also a $1.00 increase done by a statewide ballot initiative.

The coalition 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: 19.30%
Adult Tobacco Use Rate: 24.80%
High School Smoking Rate: 10.10%
High School Tobacco Use Rate: 30.30%
Middle School Smoking Rate: 2.00%
Smoking Attributable Deaths: 1,250

Adult smoking and tobacco use data come from CDC's 2017 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 2017 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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South Carolina State Highlights Select a different state

Tobacco use remains the leading cause of preventable death and disease in the United States and in South Carolina. To address this enormous toll, the American Lung Association calls for the following three actions to be taken by South Carolina's elected officials:

  1. Increase the price of tobacco products to reduce tobacco use among youth and adults;
  2. Increase the number of comprehensive local smokefree air laws; and
  3. Increase funding for the state's tobacco prevention program.
South Carolina has completed its first year of full tobacco cessation coverage for Medicaid beneficiaries. In July 2017, the South Carolina Department of Health and Human Services (SC DHHS) enhanced tobacco cessation coverage for full-benefit Medicaid beneficiaries to align with recommendations from the Centers for Disease Control and Prevention and the American Lung Association. SC DHHS and the SC Department of Health and Environmental Control (DHEC) worked together to craft a plan to benefit both fee-for-service and managed care Medicaid benefits. The American Lung Association produced a case study and webinar detailing the South Carolina success.

The American Lung Association in South Carolina and partners in the South Carolina Tobacco-Free Collaborative continue to support passage of smokefree air ordinances at the local level. The state has 65 local comprehensive smokefree air ordinances covering about 40 percent of the state's population. State funding for DHEC's Tobacco Prevention and Control programs remained at $5 million for fiscal year 2019. Tobacco industry supporters tried to attach an amendment to preempt local governments from regulating tobacco products in any form to the state budget bill toward the end of the 2018 session of the legislature, but it failed to gain traction. The Lung Association opposes tobacco industry attempts to preempt local elected officials from passing tobacco use prevention laws and policies..

The Lung Association is part of a growing number of organizations under the umbrella of the South Carolina Tobacco-Free Collaborative to urge consideration of a significant increase in the state's 57-cent cigarette tax with comparable increases for other tobacco products. Significant increases in the price of cigarettes result in reductions in smoking especially among youth. The South Carolina 2017 Youth Tobacco Survey found that 1 out of 4 high school students currently use some form of tobacco. For the first time, current e-cigarette use (13%) surpassed conventional cigarette smoking (12%). In addition, current smokeless tobacco use has dramatically increased among females (6%). For middle school students 1 out of 10 currently use some form of tobacco. Current e-cigarette use (6%) nearly doubles conventional cigarette smoking (3%).

The American Lung Association in South Carolina will continue to advocate for comprehensive smokefree air ordinances, increased tobacco taxes and increased funding for the state tobacco prevention program

South Carolina Facts

Economic Cost Due to Smoking: $1,906,984,487
Adult Smoking Rate: 18.80%
Adult Tobacco Use Rate: 24.00%
High School Smoking Rate: 10.00%
High School Tobacco Use Rate: 21.60%
Middle School Smoking Rate: 3.20%
Smoking Attributable Deaths: 7,230

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2017 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the 2017 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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Rhode Island State Highlights Select a different state

Tobacco use remains the leading cause of preventable death and disease in the United States and in Rhode Island. To address this enormous toll, the American Lung Association calls for the following actions to be taken by Rhode Island's elected officials:

  1. Raise the minimum age of sale for tobacco products from 18 to 21;
  2. Increase funding to the Rhode Island Department of Health's tobacco control program; and
  3. Increase the number of local ordinances that license and/or limit the sale or use of tobacco products.
The 2018 Rhode Island legislative session included the passage of legislation that adds ENDS (electronic nicotine delivery systems) devices to the Rhode Island Public Health and Workplace Safety Act that prohibits smoking in most public places and workplaces statewide. Unfortunately, the legislation also included a provision that allows for bars/lounges where e-cigarettes can be used indoors if they meet a certain threshold of e-cigarette sales. During the legislative consideration of this measure, the American Lung Association in Rhode Island and other public health and governmental organizations expressed concerns with this provision. However, the provision was retained and the bill became law taking effect on January 1, 2019.

Other tobacco-related bills that were introduced, but not passed included: adding sales and use taxes to ENDS products and little cigars and raising the minimum age of sale for tobacco products from 18 to 21.

On the local level, there were numerous victories. Cranston, East Greenwich and Pawtucket strengthened their existing outdoor smokefree ordinances by including ENDS products. Woonsocket and West Warwick enacted restrictions on product placement. West Warwick also strengthened their local tobacco retail ordinance by substantially increasing their annual tobacco licensing fee. But Rhode Island also saw our fair share of challenges which the Lung Association and other partners aided in. There were several proposed rollbacks to pre-existing tobacco ordinances in Central Falls that were successfully defended. This included enforcement of their tobacco retail license as well as their flavored tobacco ordinance. Barrington is fighting a lawsuit to defend being able to locally raise the minimum tobacco sales age to 21. Johnston and Middletown are also fighting lawsuits to continue enforcing local tobacco licensing.

On January 1, 2018, state legislation that added ENDS devices to the Smoke-Free Schools Laws took effect. With a strong partnership and funding from CVS Health, Tobacco Free Rhode Island (a grant administered through the Lung Association) printed and distributed updated outdoor signage to every public, private and charter, elementary, middle and high school in Rhode Island.

The American Lung Association in Rhode Island will build on positive hearings in 2018 and support legislation that raises the age of sale for tobacco products to 21; increases funding for the state's tobacco control program; and strengthens local tobacco control regulations. Strong public support exists for these measures, which the Lung Association will seek to publicize and leverage with legislators and policy makers

Rhode Island Facts

Economic Cost Due to Smoking: $639,604,224
Adult Smoking Rate: 14.90%
Adult Tobacco Use Rate: 19.20%
High School Smoking Rate: 6.10%
High School Tobacco Use Rate: 25.90%
Middle School Smoking Rate: 1.90%
Smoking Attributable Deaths: 1,780

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2017 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the Rhode Island 2017 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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Pennsylvania State Highlights Select a different state

Tobacco use remains the leading cause of preventable death and disease in the United States and in Pennsylvania. To address this enormous toll, the American Lung Association calls for the following actions to be taken by Pennsylvania's elected officials:

  1. Increase the age of sale for all tobacco products to age 21;
  2. Fund tobacco prevention and cessation programs at the Centers for Disease Control and Prevention (CDC)-recommended level; and
  3. Closing loopholes in Pennsylvania's Clean Indoor Air Act and make all public places and workplaces smokefree.
During the 2018 legislative session, the Pennsylvania budget passed with $15.539 million being allocated for the Pennsylvania Tobacco Prevention and Control program. The previous year saw these funds borrowed against to fill the budget gap by selling the rights to part of the state's future annual tobacco Master Settlement Agreement (MSA) payments for a lump sum payment up front. While Governor Wolf's budget allocated what remained from the annual MSA payment towards the Commonwealth's tobacco prevention and cessation programs, the funds still stand at risk of not being appropriated to these lifesaving services in the future.

Alarmingly, an amendment attached to the state budget bill eliminated the city of Philadelphia's ability to pass additional regulations on tobacco sales, giving the state legislature preemptive control. While this will not impact ordinances and regulations adopted prior to implementation, any pending or future legislation, such as a proposed flavored tobacco ordinance, will be prevented from moving forward.

Despite a strong grassroots effort, including a youth-driven campaign, while the 2017 session had introduced a Tobacco 21 co-sponsor memo in the state Senate, that legislation stalled, and a bill was not introduced in the 2018 legislative session.

Findings from a representative survey of over 3,000 Pennsylvania voters who voted in the 2016 election indicate that more than two thirds (68.4%) favor raising the legal sales age for tobacco products from 18 to 21. The majority of both current and former smokers favor Tobacco 21. Additionally, over 72 percent of Democrats and over 67 percent of Republicans support the change. Only about 1 in 10 Pennsylvania voters strongly oppose raising the legal sales age for tobacco products.

The strategic plan for Pennsylvania's Tobacco Prevention and Control Program 2018-2022 was introduced and implemented. Serving as a roadmap for the next five years to decrease tobacco-related morbidity, mortality, and economic costs in Pennsylvania, the strategic plan outlines a framework to inform program goals and activities specific to tobacco control policy priorities throughout the Commonwealth.

The American Lung Association in Pennsylvania will continue to educate lawmakers on the ongoing fight against tobacco. Our goal is to identify champions within the legislature and mobilize advocates to advance our advocacy goals, including increasing the age of sale for all tobacco products to 21, increasing funding for tobacco prevention and control programs, and putting in place legislation to make all workplaces smokefree

Pennsylvania Facts

Economic Cost Due to Smoking: $6,383,194,368
Adult Smoking Rate: 18.70%
Adult Tobacco Use Rate: 23.00%
High School Smoking Rate: 8.70%
High School Tobacco Use Rate: 18.70%
Middle School Smoking Rate: 1.30%
Smoking Attributable Deaths: 22,010

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use rates are taken from the 2017 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the 2015 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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Oregon State Highlights Select a different state

Tobacco use remains the leading cause of preventable death and disease in the United States and in Oregon. To address this enormous toll, the American Lung Association calls for the following actions to be taken by Oregon's elected officials:

  1. Increasing funding for Oregon's Tobacco Prevention and Education program;
  2. Defending Oregon's Indoor Clean Air Act; and
  3. Increasing tobacco taxes by a significant amount.
The 2018 legislative session was a short session for Oregon's legislators. The compressed time frame limits the numbers of bills that are debated and passed.

Several bills were introduced during the 2018 legislative session that would have weakened Oregon's Indoor Clean Air Act, and many of these were targeted and designed to allow the public use of marijuana. House Bill 4110 would have allowed sampling at newly licensed marijuana fairs. This legislation thankfully didn't receive a hearing. The City of Portland has established an office to explore opportunities to expand opportunities for marijuana use. The American Lung Association in Oregon expects to see continued attacks on clean indoor air laws related to allowing marijuana use indoors during the 2019 legislative session.

Oregon's Tobacco Prevention and Education Program (TPEP) received a one-time funding allocation of $3 million from a budget reconciliation in fiscal year 2019 bringing total funding for the program to a little over $10 million. This is an increase from $8.15 million in fiscal year 2018. This will allow the program to enhance technical assistance contracts and expand evaluation support and communications.

The American Lung Association in Oregon will continue to work with partners and the main state tobacco coalition, Oregon Partners for Tobacco Prevention to support policies to prevent and reduce tobacco use. This includes pushing for a significant increase in Oregon's tobacco taxes, which remain significantly lower than most of its neighboring states

Oregon Facts

Economic Cost Due to Smoking: $1,547,762,592
Adult Smoking Rate: 16.10%
Adult Tobacco Use Rate: 20.90%
High School Smoking Rate: 7.70%
High School Tobacco Use Rate: 18.90%
Middle School Smoking Rate: 3.00%
Smoking Attributable Deaths: 5,470

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school (11th grade only) smoking and tobacco use and middle school (8th grade only) smoking rates are taken from the 2017 Oregon Healthy Teens Survey. High school tobacco use includes cigarettes, cigars, smokeless tobacco, and electronic vapor products, as well as hookah, making it incomparable to other states.

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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Oklahoma State Highlights Select a different state

Tobacco use remains the leading cause of preventable death and disease in the United States and in Oklahoma. To address this enormous toll, the American Lung Association calls for the following actions to be taken by Oklahoma's elected officials:

  1. Maintain dedicated funding for tobacco prevention and cessation programs;
  2. Pass a comprehensive statewide smokefree law that protects all workers and patrons from secondhand smoke; and
  3. Increase the minimum age of sale for tobacco products to 21.
During the 2018 legislative session, the American Lung Association in Oklahoma along with our partners worked to pass House Bill 1010, which included an increase in the price of cigarettes by $1.50 per pack. The final version of the bill included a $1.00 increase in the cigarette tax, which was passed by the legislature and enacted by Gov. Mary Fallin. This is a big victory for the Lung Association and its public health partners in Oklahoma and should spark significant declines especially in youth smoking rates and initiation. After the 2018 legislative session, an attempt was made by anti-tax organizations to repeal the tax package that included the cigarette tax increase by ballot measure in November 2018, but thankfully the effort to put it on the ballot did not succeed. An increase in price provides big benefits to the state, including preventing nearly 30,000 Oklahoma kids from starting to smoke, prompting nearly as many adults to quit and preventing approximately 10,200 tobacco-related deaths.

Dedicated funding from the tobacco Master Settlement Agreement (MSA) for the Oklahoma Tobacco Settlement Endowment Trust (TSET) remained intact for fiscal year 2019, despite several attempts during the 2018 legislative session to divert funding. Oklahoma voters made a wise decision by putting 75 percent of MSA payments each year into TSET, and the Lung Association will oppose any attempts to raid these funds by the legislature.

Program initiatives of TSET and the Oklahoma Department of Health to prevent and reduce tobacco use include the Oklahoma Tobacco Helpline at 1-800-QUIT-NOW, cessation systems grants, community grants covering over 85 percent of the state's population, funding for tribal nations and other priority populations and statewide media campaigns intended to change the social norms related to tobacco use.

Oklahoma remains one of 22 states that still does not have a comprehensive statewide smokefree law. In 2019, the American Lung Association in Oklahoma, along with public health partners, will continue to raise public awareness regarding the need for a comprehensive statewide smokefree law. The Lung Association will also continue to protect funding for TSET and the Oklahoma Department of Health

Oklahoma Facts

Economic Cost Due to Smoking: $1,622,429,589
Adult Smoking Rate: 20.10%
Adult Tobacco Use Rate: 28.60%
High School Smoking Rate: 12.50%
High School Tobacco Use Rate: 25.60%
Middle School Smoking Rate: 4.10%
Smoking Attributable Deaths: 7,490

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2017 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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Ohio State Highlights Select a different state

Tobacco use remains the leading cause of preventable death and disease in the United States and in Ohio. To address this enormous toll, the American Lung Association calls for the following actions to be taken by Ohio's elected officials:

  1. Pass laws to increase the minimum age of sale for tobacco products to 21 at the local or state level;
  2. Match the tax on non-cigarette forms of tobacco like spit tobacco, cigars and hookah to the cigarette tax; and
  3. Increase funding for tobacco prevention and cessation programs to 15 percent of the Centers for Disease Control and Prevention's recommendation for Ohio.
2019 brings change to Ohio State government. Governor Kasich was term limited and we have a new administration in the governor's office. The American Lung Association in Ohio will work with the new administration in hopes that they will be supportive of tobacco control efforts. Governor Kasich was supportive of increasing the tax on cigarettes and other tobacco products, however, he was unable to get his proposal through the legislature. The Ohio Legislature remains conservative and resistant to tax increases and government mandates, which makes any effort to increase taxes difficult.

While increasing the taxes on cigarettes may not be likely to happen in 2019, the Lung Association will continue to work with our partners to call for parity for taxes on non-cigarette forms of tobacco like spit tobacco, cigars, and e-cigarettes. These tobacco products attract younger, more price sensitive consumers and raising taxes on these products to achieve parity with cigarette taxes can prevent some kids from becoming addicted in the first place.

We also will advocate for an increase in funding for tobacco control and prevention programs. Ohio is currently spending just 11 percent of what is recommended by the Centers for Disease Control for a state of our size. Increasing spending to 15 percent of the CDC recommendation would mean a reasonable increase by about $5.2 million a year. The state is currently experiencing a budget surplus, so the argument can be made that now is the time to invest in the health of our residents.

The Lung Association worked with coalitions and other interested parties around the state to help move their cities closer to passing laws to increase the minimum sales age for tobacco products to 21 often referred to as Tobacco 21 laws. In December of 2018, Cincinnati, one of the largest cities in Ohio, became the 17th community in Ohio to pass a Tobacco 21 law. Fourteen other cities, such as Dayton and Toledo are currently working towards enacting their own local Tobacco 21 ordinances in 2019.

As we look to 2019, the American Lung Association in Ohio will continue to work with a broad coalition of stakeholders to increase funding for evidence-based tobacco prevention and cessation programs and pass Tobacco 21 laws in additional cities across Ohio

Ohio Facts

Economic Cost Due to Smoking: $5,647,310,236
Adult Smoking Rate: 21.10%
Adult Tobacco Use Rate: 26.90%
High School Smoking Rate: 8.40%
High School Tobacco Use Rate: N/A
Middle School Smoking Rate: 1.00%
Smoking Attributable Deaths: 20,180

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school and middle school smoking rates are taken from the 2017 Youth Tobacco 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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North Dakota State Highlights Select a different state

Tobacco use remains the leading cause of preventable death and disease in the United States and in North Dakota. To address this enormous toll, the American Lung Association calls for the following actions to be taken by North Dakota's elected officials:

  1. Raise the state tobacco tax currently at 44 cents per pack; and
  2. Raise the sales age for all tobacco products to 21 years old.
There was no state legislative session in North Dakota during 2018. Funding for the state's tobacco control program in fiscal year 2019 remained almost identical to fiscal year 2018 under the two-year state budget approved in 2017. However, due to the elimination of the North Dakota Center for Tobacco Prevention and Control Policy in 2017 by the legislature, funding remains over $3 million dollars below previous levels.

North Dakota has the fourth lowest cigarette tax in the country at 44 cents per pack, a lower tax on cigarettes than several tobacco-growing states. The tax has not been raised since 1993. This low tax significantly hinders efforts in North Dakota to reduce tobacco use among youth.

The American Lung Association in North Dakota will continue its work in 2019 to educate both state and local decision makers about the benefits of a higher tobacco tax and increasing the sales age for tobacco products to 21

North Dakota Facts

Economic Cost Due to Smoking: $325,798,988
Adult Smoking Rate: 18.30%
Adult Tobacco Use Rate: 24.60%
High School Smoking Rate: 9.00%
High School Tobacco Use Rate: 28.80%
Middle School Smoking Rate: 2.40%
Smoking Attributable Deaths: 980

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school and middle school smoking rates are taken from the 2017 Youth Tobacco Survey. High school tobacco use rate is taken from the 2017 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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North Carolina State Highlights Select a different state

Tobacco use remains the leading cause of preventable death and disease in the United States and in North Carolina. To address this enormous toll, the American Lung Association calls for the following actions to be taken by North Carolina's elected officials:

  1. Restore funding for tobacco use prevention and cessation programs, including QuitlineNC;
  2. Increase the state cigarette tax to the national average of $1.78 per pack; and
  3. Resist attempts to weaken the smokefree restaurants and bars law and expand the law to include all public places and private worksites.
There was good news for the state's tobacco use prevention and cessation programs in the 2018 session of the General Assembly. Advocates under the banner of the North Carolina Alliance for Health lead a successful campaign that increased state funding to over $2.8 million. While funding levels remain far from the $17.3 million the tobacco use prevention and cessation programs received in 2011 and before, these new dollars give a boost to QuitlineNC and youth prevention programs that are greatly challenged to meet the needs of a growing state with minimal resources. The American Lung Association in North Carolina is grateful that funding for these important programs is moving in a positive direction and urges this trend to continue.

The bad news is that in the final hours of budget negotiations, tobacco industry allies successfully attached a provision to the state budget reducing state tobacco taxes by 50 percent for any product included in a modified risk tobacco product order issued by the Secretary of the U.S. Department of Health and Human Services. That was an unfortunate move for North Carolina. The state has the fifth lowest cigarette tax in the country at 45 cents per pack. The national average for state taxes is $1.78 per pack. Despite an increasing population with ever-increasing health needs, state leaders have repeatedly overlooked a tobacco tax increase as a source of funds to meet these challenges and reduce smoking rates. A move in the right direction would be to increase North Carolina's cigarette tax by a $1.00 or more per pack to reduce both youth and adult smoking rates.

The American Lung Association in North Carolina will continue to partner with the North Carolina Alliance for Health as it defends against any threats or attempts to weaken the smokefree restaurants and bars law and seeks options for strengthening protections for nonsmokers. Price increases of $1.00 per pack or more have repeatedly been shown to reduce youth and adult smoking rates. The Lung Association in North Carolina, along with other partners, will also continue to advocate for increased funding for tobacco use prevention programs and for QuitlineNC

North Carolina Facts

Economic Cost Due to Smoking: $3,809,676,476
Adult Smoking Rate: 17.20%
Adult Tobacco Use Rate: 22.60%
High School Smoking Rate: 8.90%
High School Tobacco Use Rate: 28.80%
Middle School Smoking Rate: 2.50%
Smoking Attributable Deaths: 14,220

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use and middle school smoking rates are taken from the 2017 Youth Tobacco Survey. High school tobacco use includes cigarettes, cigars, smokeless tobacco, and electronic vapor products, as well as pipes, bidis, roll-your-own cigarettes, hookah, snus, dissolvable tobacco products, and clove cigars, making it incomparable to other states.

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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New York State Highlights Select a different state

Tobacco use remains the leading cause of preventable death and disease in the United States and in New York. To address this enormous toll, the American Lung Association in New York calls for the following actions to be taken by our elected officials:

  1. Raise the age of sale for tobacco products to 21;
  2. Increase funding to New York's Tobacco Control Program; and
  3. License and tax electronic cigarettes in New York.
2018 was a year of incremental progress for tobacco control in New York State. Tobacco 21 continued to have momentum at the state level, with the Senate voting Tobacco 21 out of the Senate Health committee, and the Assembly moving the bill through the Health and Codes Committee. Due to the volume of legislation at the end of the legislative session, the bill was not voted on by the full Assembly. However, the American Lung Association in New York expects the bill to move in 2019. On the budget side, this year the Lung Association saw a small increase in funding for tobacco control to $39.9 million, but no new taxes on tobacco products, including on electronic cigarettes, were enacted.

There continued to be significant progress on the local level for Tobacco 21 legislation. The Lung Association saw a number of counties pass Tobacco 21 in 2018, including Westchester and Suffolk counties. In fact, more than 75 percent of New Yorkers are now covered by local laws restricting the sale of tobacco to youth. This is a significant jump from the just over 55 percent of New Yorkers who were covered at the end of 2017. In addition, the smokefree public housing rule by the Department of Housing and Urban Development will protect 200, 000 New York families from secondhand smoke.

It is imperative that New York begin to counter the stagnation of funding that has plagued the tobacco control program for a number of years. Lack of funding has had a direct impact on the ability to fight the disparities in tobacco use that continue to exist in areas across our state. Increased funding will allow for interventions targeted to the specific populations that have smoking rates that are double or triple the rest of the population.

New York must also ensure that we see a bill passed that prohibits the sale of tobacco products to those under 21. Additionally, New York must continue to pursue legislation which would license and tax the sale of electronic cigarettes at the state level. Currently e-cigarette retailers are not subject to licensing or taxation. The American Lung Association in New York believes that New York must increase the cost of e-cigarettes to continue to reduce youth tobacco use. Taxing and licensing e-cigarettes would also provide revenue to the state. New York has a long history of leading on tobacco control efforts, it is time for decision-makers to take decisive action to save lives

New York Facts

Economic Cost Due to Smoking: $10,389,849,268
Adult Smoking Rate: 14.10%
Adult Tobacco Use Rate: 17.70%
High School Smoking Rate: 5.50%
High School Tobacco Use Rate: 19.30%
Middle School Smoking Rate: 1.20%
Smoking Attributable Deaths: 28,170

Adult smoking and tobacco use data come from CDC's 2017 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use rates are taken from the 2017 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the New York 2014 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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New Mexico State Highlights Select a different state

Tobacco use remains the leading cause of preventable death and disease in the United States and in New Mexico. To address this enormous toll, the American Lung Association calls for the following actions to be taken by New Mexico's elected officials:

  1. Raise the tax on cigarettes by $1.50 per pack and on other tobacco products including snuff, chew and cigarillos;
  2. Maintain or increase funding for state's tobacco prevention and control program; and
  3. Protect New Mexicans from secondhand smoke, including in multi-unit housing.
The American Lung Association in New Mexico provides leadership in convening partners and guiding public policy efforts to continue the state's success in reducing the impact of tobacco among New Mexicans. 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 2018, the Lung Association's focus was to continue to educate legislators, legislative staff, and the general public about smoking and the importance of providing tobacco cessation programs for adults and youth, and the dangers of secondhand smoke. During the legislative session the Lung Association along with our partners were unsuccessful in an effort to raise the state's cigarette tax by $1.50 per pack and impose an equivalent tax on other tobacco products including cigars, smokeless tobacco and electronic cigarettes. The legislation would have generated $43 million in new revenue for the state of New Mexico.

On a more positive note, funding for the New Mexico Tobacco Use Prevention and Control program was maintained at $5.68 million in fiscal year 2019, the same level as last year.

The American Lung Association in New Mexico's Smoke-Free at Home NM program provides education and support to property managers and owners on the economic and health benefits of implementing smoke-free policies in multi-unit housing. In 2018, the Lung Association continues to help public, affordable, and market rate housing implement smokefree policies building on our efforts from previous years. Smoke-Free at Home NM certified 8 properties representing approximately 1,471 residents as smokefree, while an additional 21 properties implemented our Thinking About Quitting workshops helping smokers who were interested in quitting seek to do so.

Moving forward in 2019, the American Lung Association in New Mexico will once again make it a priority to educate our legislature and communities about the dangers of tobacco use and the importance of a well-funded tobacco prevention and cessation program. Additionally, we will be working on raising the excise tax on tobacco products. With a new Governor recently taking office, the Lung Association hopes a cigarette tax increase will be able to gain more traction in 2019. The Lung Association will also continue to focus on creating smokefree multi-unit housing. It is our goal to provide all New Mexicans with a safe and healthy living environment, free from the dangers of secondhand smoke

New Mexico Facts

Economic Cost Due to Smoking: $843,869,235
Adult Smoking Rate: 17.50%
Adult Tobacco Use Rate: 22.50%
High School Smoking Rate: 10.60%
High School Tobacco Use Rate: 31.90%
Middle School Smoking Rate: N/A
Smoking Attributable Deaths: 2,630

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 2017 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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