American Lung Association Issues 18th ‘State of Tobacco Control’ Report—Federal Government Falls Far Short, Earns as Many Fs as A Grades

Facing youth vaping epidemic, federal, state and local governments have opportunity to pass strong tobacco control policies, prioritize public health over the tobacco industry and improve grades

The American Lung Association’s 2020 “State of Tobacco Control” report finds that the federal government can do more to address the youth vaping epidemic and prevent tobacco use. The report grades state and federal governments’ efforts in 2019 to implement proven tobacco control policies and identifies opportunities in 2020 to improve grades and the policies they reflect. In this year’s report, the federal government earned as many Fs as As, and inadequate federal action on tobacco control means state governments must fill the void to end the youth vaping epidemic.

Tobacco use causes an estimated 480,000 deaths every year, and 31.2% of high school students used at least one tobacco product in 2019, up from 27.1% in 2018. Congress took the first step to protect public health at the end of 2019 by passing legislation to increase the tobacco sales age to 21 nationwide. However, the federal government failed to protect youth. Flavored tobacco products cause kids to become hooked, and now more than 1 in 4 teens (27.5%) are vaping, a staggering 135% increase over the past two years. On January 2, 2020, the Trump Administration announced new federal guidance on flavored e-cigarette products, but unfortunately it allows thousands of flavored e-cigarettes to remain on the market. This is a reversal of a prior announcement that they would “clear the markets” of all flavored e-cigarettes.

“In 2020, the American Lung Association urges the federal government to implement proven tobacco control policies and help us end the youth vaping epidemic,” said American Lung Association National President and CEO Harold P. Wimmer. “While the American Lung Association recognizes the federal government with an A grade for passage of a strong federal Tobacco 21 law, it also earns an F for its failure to comprehensively oversee tobacco products. Without meaningful actions by the federal government, the health and the future of our nation’s children are being compromised.”

Federal Grades Overview

“State of Tobacco Control” 2020 grades the federal government in five areas:

  • Federal Government Regulation of Tobacco Products (2020 grade – F)
  • Federal Coverage of Quit Smoking Treatments (2020 grade – D)
  • Level of Federal Tobacco Taxes (2020 grade – F)
  • Federal Mass Media Campaigns to Prevent and Reduce Tobacco Use (2020 grade – A)
  • New Category: Federal Minimum Age of Sale for Tobacco Products to 21 (2020 grade – A)

As a result of successful lawsuits filed by the American Lung Association and public health partners, the Trump Administration will be required to finalize graphic warning labels on all cigarette packs by March 15, 2020. Most cigars and other tobacco products, including e-cigarettes, will also have to submit premarket applications by May 12, 2020, to remain on the U.S. market. FDA’s enforcement of the premarket application deadline will be critical to protecting youth.

“The American Lung Association urges the FDA to remove all tobacco products – especially flavored tobacco products – that may remain on store shelves and in online stores illegally after May 2020,” said Wimmer.

The American Lung Association also urges Congress to pass H.R. 2339/S. 3174, legislation that would eliminate all flavored tobacco products, including menthol cigarettes from the marketplace. Additionally, increased funding for the Centers for Disease Control and Prevention’s Office on Smoking and Health is needed to help states combat the youth e-cigarette epidemic and to further strengthen its “Tips From Former Smokers” Campaign.

State Grades Overview

“State of Tobacco Control” 2020 grades states and the District of Columbia in five areas that have been proven to prevent and reduce tobacco use and save lives:

  1. Funding for State Tobacco Prevention Programs – 43 states and Washington, D.C., received F grades in this grading category
  2. Strength of Smokefree Workplace Laws – 23 states and Washington, D.C., received A grades in this category
  3. Level of State Tobacco Taxes – 35 states received F grades in this category
  4. Coverage and Access to Services to Quit Tobacco – 39 states and Washington, D.C., received a C grade or worse in this grading category
  5. State Minimum Age of Sale for Tobacco Products to 21 – 13 states passed laws increasing their tobacco sales age to 21 in 2019; 19 states and Washington, D.C., took this action prior to the federal law passing.

In this year’s report, no state or the District of Columbia earned an A grade in every category, but the top five were California, Washington, D.C., Maine, New York and Vermont. Maine showed marked improvement in its grades this year. The states earning the worst grades (all Fs) are Alabama, Mississippi and North Carolina.

Massachusetts took an historic step as the first state to prohibit sales of all flavored tobacco products, including menthol cigarettes in November 2019. The Lung Association urges more states to follow Massachusetts’ lead and pass comprehensive laws eliminating flavored tobacco products in 2020.

“Parents across the U.S. want to end youth vaping. We’ve made historic progress with the federal Tobacco 21 law, but there is still more work to be done if we want everyone to be protected,” Wimmer said. “In 2020, our elected leaders have the power to pass strong policies to stop the youth e-cigarette epidemic in its tracks and make an immeasurable impact on the lives and health of future generations.”

To learn more about this year’s “State of Tobacco Control” grades, visit

For media interested in speaking with an expert about lung health, tobacco use and tobacco policies, contact Stephanie Goldina at [email protected] or 312-801-7629.

For more information, contact:

Elizabeth Cook
[email protected]

Asthma Basics Workshop - National
, | Apr 17, 2024
Asthma Basics Workshop - National
, | May 07, 2024