CHICAGO | January 25, 2022
The American Lung Association’s 20th annual “State of Tobacco Control” report reveals significant progress in the work to end tobacco use, but products like e-cigarettes and other flavored tobacco products create concern for losing another generation to nicotine addiction. While the adult smoking rate has declined from 21.6% in 2003 to 14.0% in 2019, close to 4.5 million youth used tobacco products in 2020 and more than two million high school and middle school students who reported using e-cigarettes in 2021.
The “State of Tobacco Control” report evaluates state and federal policies on actions taken to eliminate tobacco use, the nation’s leading cause of preventable death. The report recommends proven-effective tobacco control laws and policies to save lives. The 2022 “State of Tobacco Control” reveals that the country has made substantial progress advancing the state tobacco control policies over the past 20 years, including more comprehensive smokefree laws, increased tobacco taxes and more Americans with access to treatments to help them quit smoking through state Medicaid programs.
“Unfortunately, our progress on tobacco control policy has not been equal. We continue to see the unequal burden of tobacco use in communities experiencing health disparities,” said Harold Wimmer, President and CEO of the American Lung Association. “Menthol cigarettes remain a key factor for tobacco-related death and disease in Black communities, with close to 81% of Black Americans who smoke using them. Ending the sale of flavored tobacco products, including menthol cigarettes and flavored cigars, will not only help end the youth vaping epidemic, but will also help address the disproportionate impact of menthol cigarettes and flavored cigars on Black and Brown communities.”
While there have been significant smoking reductions across all populations, smoking remains particularly high among Indigenous Peoples (Native Americans and Alaskan Natives) at 20.9%, and Lesbian, Gay and Bisexual adults at 19.2%.
Over the past 20 years, new products like e-cigarettes have emerged and little cigars have become more popular, which threaten the progress made. These new products are using fruit, candy, mint and menthol flavors to addict a new generation to tobacco. Ending the sale of all flavored tobacco products, including menthol cigarettes, flavored cigars and flavored e-cigarettes, has never been more important to build upon the progress in reducing tobacco use.
Federal Grades Overview
“State of Tobacco Control” 2022 grades the federal government in five areas:
- Federal Government Regulation of Tobacco Products (2022 grade – “D”)
- Federal Coverage of Quit Smoking Treatments (2022 grade – “D”)
- Level of Federal Tobacco Taxes (2022 grade – “F”)
- Federal Mass Media Campaigns to Prevent and Reduce Tobacco Use (2022 grade – “A”)
- Federal Minimum Age of Sale for Tobacco Products to 21 (2022 grade – “Incomplete”)
When “State of Tobacco Control” began, the U.S. Food and Drug Administration (FDA) did not have authority over the manufacturing, marketing and sales of tobacco products. In 2009, FDA gained that authority, but has made uneven progress on providing real oversight of tobacco products since then. In 2021, the FDA had two opportunities to make significant progress on reducing tobacco use.
On April 29, 2021, the FDA announced its intention to issue proposed rules by April 2022 to remove menthol cigarettes and most flavored cigars from the marketplace. The Lung Association urges the FDA to expedite both proposing and finalizing these historic rules.
In 2021, the FDA had the opportunity to remove e-cigarettes and other tobacco products from the market that did not meet its public health standard through its pre-market tobacco authorization (PMTA) authority under the Family Smoking Prevention and Tobacco Control Act. FDA was under a court-ordered deadline of September 9, 2021 to review millions of PMTAs submitted by e-cigarettes and other tobacco product companies in 2020. While FDA issued marketing denial orders to 323 companies, it has yet to take action on most e-cigarette products with the highest market share, including Juul, or any menthol e-cigarettes. It also granted a marketing order for a high-nicotine Vuse e-cigarette.
FDA is also more than 18 months overdue in publishing the final Tobacco 21 regulations as required by statute, which is why it earns an “incomplete.”
State Grades Overview
“State of Tobacco Control” 2022 grades states and the District of Columbia in five areas that have been proven to prevent and reduce tobacco use and save lives:
- Ending the sale of all flavored tobacco products – 45 states and Washington, D.C., received “F” grades in this new grading category in 2022
- Funding for State Tobacco Prevention Programs – 40 states and Washington, D.C., received “F” grades in 2022
- Strength of Smokefree Workplace Laws – 23 states and Washington, D.C. received “A” grades in 2022
- Level of State Tobacco Taxes – 32 states received “F” grades in 2022
- Coverage and Access to Services to Quit Tobacco – 24 states received a “D” grade or worse in 2022
In the past 20 years, states have made a significant impact on proven tobacco control measures, including:
- Smokefree Laws: In 2003 only two states had comprehensive smokefree laws, and today, 28 states have these laws protecting their residents from secondhand smoke. However, since 2012 progress has stalled.
- Tobacco Taxes: The average state cigarette tax increased from $0.62 in January 2003 to $1.91 in January 2022.
- Medicaid Programs Coverage of Tobacco Cessation: In 2008, the report first tracked state Medicaid programs’ coverage of tobacco cessation treatments. At that time, 20 state Medicaid programs covered all 7 FDA-approved quit smoking medications. In 2022, 43 state Medicaid programs provide that coverage.
The pandemic’s impact on tobacco use is still being assessed. According to a Federal Trade Commission report in 2020, cigarette sales increased for the first time in 20 years. It is unclear if this signals higher adult smoking rates, or existing smokers smoking more cigarettes.
“In 2022, the country needs to redouble its efforts to pass the proven policies called for in ‘State of Tobacco Control’ to help end tobacco use. We can’t afford to wait 20 more years and allow another generation to suffer from tobacco-caused addiction, disease and death. This will require a rededication at the federal, state and local levels to save lives,” said Wimmer.
To learn more about this year’s “State of Tobacco Control” grades, visit Lung.org/sotc. For media interested in speaking with an expert about lung health, tobacco use and tobacco policies, contact Jill Dale at [email protected] or 312-940-7001.
The American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease through education, advocacy and research. The work of the American Lung Association is focused on four strategic imperatives: to defeat lung cancer; to champion clean air for all; to improve the quality of life for those with lung disease and their families; and to create a tobacco-free future. For more information about the American Lung Association, which has a 4-star rating from Charity Navigator and is a Platinum-Level GuideStar Member, call 1-800-LUNGUSA (1-800-586-4872) or visit: Lung.org. To support the work of the American Lung Association, find a local event at Lung.org/events.
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