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State of Tobacco Control 2019

Federal Minimum Age of Sale for Tobacco Products

In March 2015, the National Academy of Medicine (formerly the Institute of Medicine) issued a report looking at the impact increasing the age of sale for tobacco products could have on youth tobacco use rates. The report concluded that increasing the age of sale for tobacco products to 21 nationwide could prevent 223,000 deaths among people born between 2000 and 2019, including 50,000 fewer dying from lung cancer, the nation’s leading cancer killer.1

A grade was awarded in this category based on whether the federal government had increased the age of sale for tobacco products to 21. The letter grade received deductions based on if groups, like active duty military, were exempted from the age of sale of 21. The federal government would receive an automatic F grade if some tobacco products, such as e-cigarettes were exempted from the age of sale increase, preemption on state or local governments from raising the age of sale was imposed or the age of sale was 19 or 20 years old.

Grade breaks down as follows:
A = age of sale for all tobacco products is 21 years of age with no exceptions;
B = age of sale for all tobacco products is 21 years of age, but certain groups, such as active duty military are exempted;
F = age of sale for tobacco products is below 21 years of age, some tobacco products are exempted from the age of sale to 21 increase or preemption on state or local governments concerning tobacco sales age increases is imposed.


    Did You Know?

    1. More than 31% of high school students in the U.S. use at least one tobacco product, including e-cigarettes, according to the 2019 National Youth Tobacco Survey.
    2. 12.4% of middle school students use at least one tobacco product, including e-cigarettes, according to the 2019 National Youth Tobacco Survey.
    3. From 2017 to 2019, high school e-cigarette use increased by 135% and middle school e-cigarette use increased by close to 212% according to data from CDC's 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 $1.81 per pack.
    10. One state – Connecticut – provides no state funding at all for tobacco prevention programs.
    11. Three states – Alaska, California and Maine – are funding their tobacco control programs close to CDC-recommended levels (in Fiscal Year 2020).
    12. Illinois was the only state to increase its cigarette tax by a significant amount in 2019.
    13. No state approved a comprehensive smokefree workplace law in 2019.
    14. Twelve 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 $2.14 per smoker in the state.
    16. Thirteen states passed legislation increasing its minimum sales age for tobacco products to 21 in 2019 prior to the federal Tobacco 21 law passing.
    17. Nineteen states and the District of Columbia approved Tobacco 21 laws prior to the federal Tobacco 21 law passing.
    18. Nationwide, the Medicaid program spends more than $39.6 billion in healthcare costs for smoking-related diseases each year – more than 15.2% 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, close to 1,600 kids under 18 try their first cigarette and close to 200 kids become new, regular smokers.
    24. Each day, close to 1,400 kids try their first cigar. On average, more than 56 kids try their first cigar every hour in the United States – equaling about 493,000 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 2018.
    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% 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. A 2019 study found patients in Medicaid expansion states that had a cessation medication ordered, had a 65% higher change of quitting.
    32. In 2019, two states, Idaho and Maine implemented Medicaid expansion, providing more smokers with access to tobacco cessation treatments.
    33. Uninsured Americans smoke at a rate more than two times higher than people with private insurance.
    34. An estimated one-third of Americans living in public housing smoke.
    35. Persons with mental health conditions make up 22% of the population, but consume close to 36% of all cigarettes in the U.S.
    36. Native Americans and Alaska Natives have the highest commercial tobacco smoking rates among any racial/ethnic group.
    37. Massachusetts became the first state to prohibit the sale of all flavored tobacco products in 2019.
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