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Federal Grades | State of Tobacco Control

State of Tobacco Control 2018
 
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UNITED STATES

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  • F

    Food and Drug Administration Regulation of Tobacco Products

  • D

    Cessation Coverage

  • F

    Tobacco Taxes

  • A

    Mass Media Campaigns

The American Lung Association has identified four key actions that federal policymakers must take in 2019 that will ultimately eliminate the death and disease caused by tobacco use:

  1. FDA must release both a proposed and final rule, eliminating all flavored tobacco products from the marketplace, including menthol cigarettes, flavored cigars and e-cigarettes;
  2. Clarify and ensure that all tobacco users have access to a comprehensive tobacco cessation benefit without barriers and cost-sharing;
  3. Ensure the Centers for Disease Control and Prevention’s (CDC) Tips from Former Smokers Campaign and the Food and Drug Administration’s (FDA) Real Cost Campaign continue; and
  4. Pass legislation raising the minimum of age of sale for all tobacco products to 21.
Additional Information

Food and Drug Administration Regulation of Tobacco Products

  • Implementation of Rule Asserting Authority over all Tobacco Products: Rule Partially Implemented
  • Product Standards for Tobacco Products: Product standard to reduce cancer-causing chemical in smokeless tobacco proposed
  • Graphic cigarette warning labels: No warning labels re-proposed or finalized
  • TPSAC Menthol Report Implementation: No product standard on menthol cigarettes proposed or finalized
  • Funding for FDA Center for Tobacco Products: No FY2019 budget in place currently
Overall Grade: F

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Cessation Coverage

  • Medicaid Coverage: Partially Required
  • Medicare Coverage: Partially Covered
  • TRICARE Coverage: Covered
  • Federal Employee Health Benefits Coverage: Covered
  • State Health Insurance Exchanges: Partially Required
Overall Grade: D

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Thumbs down for the federal government for undermining healthcare access to comprehensive tobacco cessation coverage.

Tobacco Taxes

Cigarette Tax:

  • Tax rate per pack of 20: $1.01

Other Tobacco Product Taxes:

  • Little Cigars: Equalized: Yes; Weight-Based: Yes
  • Large Cigars: Equalized: No; Weight-Based: No
  • Smokeless Tobacco: Equalized: No; Weight- Based: Yes
  • Pipe/RYO Tobacco: Equalized: No; Weight- Based: Yes
  • Dissolvable Tobacco: Equalized: No; Weight- Based: Yes
Overall Grade: F

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Mass Media Campaigns

Tips from Former Smokers Media Campaign:

  • Reach: Meets Target
  • Duration: Under Target
  • Frequency: Meets Target
  • Promotion of Services: Meets Target

FDA "Real Costs" Media Campaign:

  • Reach: Meets Target
  • Duration: Meets Target
  • Frequency: Meets Target
  • Promotion of Services: Under Target
Overall Grade: A

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Food and Drug Administration Regulation of Tobacco Products Food and Drug Administration Regulation of Tobacco Products
Overall Grade: F

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  • Implementation of Rule Asserting Authority over all Tobacco Products: Rule Partially Implemented
  • Product Standards for Tobacco Products: Product standard to reduce cancer-causing chemical in smokeless tobacco proposed
  • Graphic cigarette warning labels: No warning labels re-proposed or finalized
  • TPSAC Menthol Report Implementation: No product standard on menthol cigarettes proposed or finalized
  • Funding for FDA Center for Tobacco Products: No FY2019 budget in place currently
Cessation Coverage Cessation Coverage
Overall Grade: D

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  • Medicaid Coverage: Partially Required
  • Medicare Coverage: Partially Covered
  • TRICARE Coverage: Covered
  • Federal Employee Health Benefits Coverage: Covered
  • State Health Insurance Exchanges: Partially Required

Thumbs down for the federal government for undermining healthcare access to comprehensive tobacco cessation coverage.

Tobacco Taxes Tobacco Taxes
Overall Grade: F

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Cigarette Tax:

  • Tax rate per pack of 20: $1.01

Other Tobacco Product Taxes:

  • Little Cigars: Equalized: Yes; Weight-Based: Yes
  • Large Cigars: Equalized: No; Weight-Based: No
  • Smokeless Tobacco: Equalized: No; Weight- Based: Yes
  • Pipe/RYO Tobacco: Equalized: No; Weight- Based: Yes
  • Dissolvable Tobacco: Equalized: No; Weight- Based: Yes
Mass Media Campaigns Mass Media Campaigns
Overall Grade: A

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Tips from Former Smokers Media Campaign:

  • Reach: Meets Target
  • Duration: Under Target
  • Frequency: Meets Target
  • Promotion of Services: Meets Target

FDA "Real Costs" Media Campaign:

  • Reach: Meets Target
  • Duration: Meets Target
  • Frequency: Meets Target
  • Promotion of Services: Under Target

Did You Know?

  1. More than 27 percent of high school students in the U.S. use at least one tobacco product, including e-cigarettes, according to the 2018 National Youth Tobacco Survey.
  2. 7.2 percent of middle school students use at least one tobacco product, including e-cigarettes, according to the 2018 National Youth Tobacco Survey.
  3. From 2017 to 2018, high school e-cigarette use increased by 78 percent and middle school e-cigarette use increased by close to 50 percent in the 2018 National Youth Tobacco Survey.
  4. Smoking is the number one preventable cause of death in the U.S., killing over 480,000 people per year.
  5. Secondhand smoke kills more than 41,000 people in the U.S. each year.
  6. 28 states and Washington D.C. have passed laws making virtually all public places and workplaces, including restaurants and bars smokefree.
  7. The District of Columbia has the highest cigarette tax in the country at $4.50 per pack.
  8. Missouri has the lowest cigarette tax in the country at 17 cents per pack.
  9. The average of all states plus the District of Columbia's cigarette taxes are $1.78 per pack.
  10. Three states – Connecticut, Tennessee and West Virginia – spend no state dollars at all tobacco prevention programs.
  11. No state is funding its tobacco control programs at or above the CDC-recommended level (in Fiscal Year 2019).
  12. Kentucky, Oklahoma and the District of Columbia increased their cigarette taxes in 2018.
  13. No state approved a comprehensive smokefree workplace law in 2018.
  14. 12 states – California, Colorado, Connecticut, Indiana, Kansas, Kentucky, Maine, Massachusetts, Missouri, Ohio, Oregon and South Carolina– offer a comprehensive cessation benefit to tobacco users on Medicaid.
  15. Each of the 50 states and the District of Columbia provide tobacco quitlines, a phone number for quit smoking phone counseling. The median amount states invest in quitlines is $2.21 per smoker in the state.
  16. Massachusetts passed legislation increasing its minimum sales age for tobacco products to 21 in 2018.
  17. Six states, the District of Columbia and over 350 communities have passed Tobacco 21 laws.
  18. Nationwide, the Medicaid program spends more than $39.6 billion in healthcare costs for smoking-related diseases each year – more than 15.2 percent of total Medicaid spending.
  19. In 2009, the American Lung Association played a key role in the passage of the Family Smoking Prevention and Tobacco Control Act, which gives the U.S. Food and Drug Administration authority over tobacco products.
  20. The American Lung Association played a key role in airplanes becoming smokefree in the 1990s.
  21. 43 states and the District of Columbia spend less than half of what the CDC recommends on their state tobacco prevention programs.
  22. States spend less than three cents of every dollar of the $27.3 billion they get from tobacco settlement payments and tobacco taxes to fight tobacco use.
  23. Each day, more than 2,000 kids under 18 try their first cigarette and more than 300 kids become new, regular smokers.
  24. Each day, more than 1,900 kids try their first cigar. On average, more than 80 kids try their first cigar every hour in the United States – equaling about 712,000 every year.
  25. Smoking costs the U.S. economy over $332 billion in direct health care costs and lost productivity every year.
  26. The five largest cigarette companies spent over $23 million dollars per day marketing their products in 2016.
  27. Secondhand smoke causes $5.6 billion in lost productivity in the U.S. each year.
  28. Smoking rates are over twice as high for Medicaid recipients compared to those with private insurance.
  29. A 2013 study of California's tobacco prevention program shows that the state saved $55 in healthcare costs for every $1 invested from 1989 to 2008.
  30. A 2017 study found that states which expanded Medicaid had a 36 percent increase in the number of tobacco cessation medication prescriptions relative to the states that did not expand Medicaid. This means more quit attempts with proven cessation treatments are being made. 
  31. In 2018, three states, Idaho, Nebraska and Utah, voted to expand their Medicaid coverage, providing more smokers with access to tobacco cessation treatments.
  32. Uninsured Americans smoke at a rate more than two times higher than people with private insurance.
  33. An estimated one-third of Americans living in public housing smoke.
  34. Persons with mental illness consume close to 40 percent of all cigarettes in the U.S.
  35. Native Americans and Alaska Natives have the highest smoking rates among any racial/ethnic group.
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