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State of Tobacco Control 2018State of Tobacco Control 2018State of Tobacco Control 2018

Federal Highlights

The American Lung Association has identified four key actions that federal policymakers must take in 2018 that will ultimately eliminate the death and disease caused by tobacco use:

  1. Allow the U.S. Food and Drug Administration (FDA) to fully implement the Tobacco Control Act without political interference from the tobacco industry and its champions in Congress;
  2. Clarify and ensure that all smokers 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.

The federal government remains uniquely positioned to significantly improve the health of Americans by strengthening and implementing federal tobacco control policies. However, the lack of political will and significant power the tobacco industry still asserts in Washington makes significant movement on these policy fronts unlikely. 

In July, FDA announced it would significantly delay the deadline for newly-regulated tobacco products to submit tobacco product applications required under the May 2016 deeming rule. FDA pushed the dates back to 2021 for newly-regulated combustible products, such as cigars and hookah, and 2022 for non-combustible tobacco products, such e-cigarettes. This will allow all newly-regulated tobacco products on the market as of August 8, 2016, including all tobacco products with kid-friendly flavors, to stay on the market for years. FDA also announced their intent to seek public comment on reducing the level of nicotine in cigarettes to non-addictive levels. 

Once again, leaders in the House of Representatives attached two policy riders to proposed Appropriations bills in 2017. The first would block implementation and enforcement of the entire deeming rule because certain cigars—including those that cost as little as $1.00—are now under FDA’s authority. The second would grandfather all newly deemed products—thereby taking away and guaranteeing that flavored e-cigarettes that appeal to kids and that contain dangerous chemicals like diacetyl—remain on the market indefinitely. The fate of these policy riders will not be settled until Congress finalizes its fiscal year 2018 funding bills.

The CDC’s Tips from Former Smokers Campaign marked the sixth year of its highly successful and cost-effective mass media campaign—despite efforts by some in Congress to eliminate it by slashing funding to CDC’s Office on Smoking and Health. The Tips Campaign has prompted 500,000 Americans to quit smoking for good, and millions more to make a serious quit attempt. The effectiveness and return on investment of this program demonstrate why it is so important to continue “Tips” moving forward. 

Over a decade ago, the Lung Association and five of our partners were granted intervenor status in a federal lawsuit filed by the Department of Justice against the major tobacco companies, which ultimately found the companies guilty of civil racketeering. After more than a decade of delay, the tobacco industry was forced to start running corrective statements in newspapers and on TV starting in November 2017.

In November, legislation was introduced in the Senate and the House that would increase the minimum age of sale for all tobacco products to 21. 

Looking ahead – on July 31, 2018, the rule that requires all Department of Housing and Urban Development (HUD) public housing to go smokefree will take effect – protecting two million Americans from the dangers of secondhand smoke. It also provides an opportunity to assist the more than 300,000 smokers living in public housing with help to quit smoking for good.

United States Facts

Economic Costs Due to Smoking:


Adult Smoking Rate:


Adult Tobacco Use Rate:


High School Smoking Rate:


High School Tobacco Use Rate:


Middle School Smoking Rate:


Middle School Tobacco Use Rate:


Smoking Attributable Deaths per Year:


Smoking Attributable Lung Cancer Deaths per Year:


Smoking Attributable Respiratory Disease Deaths per Year:


Adult smoking and tobacco use rates are taken from the 2016 National Health Interview Survey. High school and middle school smoking and tobacco use rates are taken from the 2016 National 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.

    Did You Know?

    1. More than 1 in 5 high school students in the U.S. use at least one tobacco product, including e-cigarettes, according to the 2016 National Youth Tobacco Survey.
    2. 7.2 percent of middle school students use at least one tobacco product, including e-cigarettes, according to the 2016 National Youth Tobacco Survey.
    3. A 2014 article in the Journal of the American Medical Association found that about 8 million lives have been saved through tobacco control efforts since 1964, including 800,000 lung cancer deaths between 1975 and 2000.
    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. Connecticut and New York have the highest cigarette taxes in the country at $4.35 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 $1.72 per pack.
    10. Ten states have taxes on other tobacco products equivalent to their state's cigarette taxes.
    11. Alaska is the only state that is funding their tobacco control programs at or above the CDC-recommended level (in Fiscal Year 2018).
    12. Three states increased their cigarette taxes in 2017.
    13. No state approved a comprehensive smokefree workplace law in 2017.
    14. 9 states – California, Connecticut, Indiana, Kentucky, Maine, Massachusetts, Missouri, Ohio 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 $2.10 per smoker in the state.
    16. Maine, New Jersey and Oregon passed legislation increasing their minimum sales ages for tobacco products to 21 in 2017.
    17. Five states and over 280 communities in 18 different states have passed Tobacco 21 laws.
    18. Nationwide, the Medicaid program spends more than $22 billion in healthcare costs for smoking-related diseases each year – more than 11 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. 42 states and Washington D.C. 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 they get from tobacco settlement payments and tobacco taxes to fight tobacco use.
    23. Each day, more than 2,300 kids under 18 try their first cigarette and close to 400 kids become new, regular smokers.
    24. Each day, close to 1,900 kids try their first cigar. On average, close to 80 kids try their first cigar every hour in the United States – equaling close to 690,000 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 $22 million dollars per day marketing their products in 2015.
    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 2012 study of Massachusetts' comprehensive Medicaid quit smoking benefit found that Massachusetts saved $3 for every $1 spent helping smokers quit in just over a year.
    31. In 2017, Kentucky and South Carolina made major improvements to their quit smoking coverage for Medicaid enrollees and others.
    32. Uninsured Americans smoke at a rate two times higher than people with private insurance.
    33. An estimated one third of Americans living in public housing smoke.
    34. One study found persons with behavioral health and substance abuse disorders consume about 40 percent of the cigarettes sold in the U.S.
    35. Native Americans and Alaska Natives have the highest smoking rates among any racial/ethnic group.
    Get more facts »

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