The American Lung Association's "State of Tobacco Control" 2019 is a report card that evaluates state and federal tobacco control policies by comparing them against targets based on the most current, recognized criteria for effective tobacco control measures, and translating each state and the federal government’s relative progress into a letter grade of "A" through "F." A grade of "A" is assigned for excellent tobacco control policies while an "F" indicates inadequate policies. The principal reference for all state tobacco control laws is the American Lung Association’s State Legislated Actions on Tobacco Issues on-line database, available at www.lung.org/slati. The American Lung Association has published this comprehensive summary of state tobacco control laws since 1988. Data for the state cessation section is taken from the American Lung Association’s State Cessation Coverage database, available at http://www.lungusa2.org/cessation2.
In response to new data and information, the American Lung Association periodically reviews the methodology for the State of Tobacco Control report and revises the methodology for state grading categories if necessary to update the report to use the most current evidence and best practices. Because of the revisions to the state grading methodology in "State of Tobacco Control" 2015, state grades from "State of Tobacco Control" 2019 cannot be directly compared to grades from "State of Tobacco Control" 2014 or earlier reports.
Calculation of State Grades
State level tobacco control policies are graded in five key areas: tobacco prevention and cessation funding, smokefree air laws, state tobacco excise taxes, access to tobacco cessation treatments and services and laws to increase the tobacco sales age to 21. The sources for the targets and the basis of the evaluation criteria are described below.
- Tobacco Prevention and Cessation Funding
- Smokefree Air Laws
- State Tobacco Excise Taxes
- Access to Cessation Services
- Tobacco 21 Laws
State Statistics Used in the Report
Adult smoking and tobacco use rates are taken from the CDC's 2017 Behavioral Risk Factor Surveillance System. Adult tobacco use includes having used cigarettes, smokeless tobacco, or electronic cigarettes on one or more of the past 30 days.
High school smoking and tobacco use, and middle school smoking rates are taken from CDC's 2017 Youth Risk Behavior Survey, state youth tobacco surveys or other state-based surveys that measure youth smoking or tobacco use rates. High school tobacco use includes having used cigarettes, cigars, smokeless tobacco, or electronic vapor products on one or more of the past 30 days for most states. In states where the tobacco products covered by the survey used are different, a sentence has been added to the state-specific footnotes on each state page describing the tobacco products included.
Health impact and economic information is taken from CDC's 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.
State-by-state tobacco-related revenue data (revenue from state tobacco settlement payments and tobacco taxes) is obtained from the Campaign for Tobacco-Free Kids.