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State of Tobacco Control 2019

Tobacco Control Milestones

Date Subject

  • 2020

    The U.S. Surgeon General released a new report entitled "Smoking Cessation: A Report of the Surgeon General." This report made a number of important conclusions about quitting smoking and the benefits of doing so. These included that insurance coverage that provides access to quit smoking treatments without barriers and other public policies such as increasing the price of cigarettes, adopting smokefree air policies, maintaining comprehensive statewide tobacco control programs, requiring graphic warning labels and implementing mass media campaigns, are proven to increase cessation rates.

  • 2020

    The Food and Drug Administration (FDA) released guidance on flavored e-cigarettes that will do little to protect youth. The guidance allows menthol-flavored Juul and thousands of flavors of e-cigarettes sold in vape shops to remain on the market. This was a reversal from the Administration’s announcement in September 2019 that they would clear the market of all flavored e-cigarettes to deal with the youth vaping epidemic.

  • 2019

    In December Congress approved and the President signed legislation raising the tobacco sales age to 21 across the country. Nineteen states and DC had passed state tobacco 21 laws prior to the national law passing in December.

  • 2019

    On August 15, FDA issued a proposed rule requiring graphic warning labels on cigarettes as required by a March 2019 U.S. District Court order. This action is a result of a court case brought by the American Lung Association and its partners.

  • 2019

    The Lung Association and our partners were victorious in a lawsuit against the Food and Drug Administration, with a federal judge ruling that FDA’s 2017 delay in the deeming rule gave "manufacturers responsible for the public harm a holiday from meeting the obligations of the law."

  • 2018

    U.S. Surgeon General Jerome Adams issued an advisory on the e-cigarette epidemic among youth. This was in response to the staggering increase among youth e-cigarette use – from 2017 to 2018. Results from the 2018 National Youth Tobacco Survey released in November found that e-cigarette use rose by 78 percent among high school students and close to 50 percent among middle school students.

  • 2018

    The American Lung Association and several of its health partners filed a lawsuit in federal court challenging a U.S. Food and Drug Administration (FDA) decision to delay the deeming rule in 2017, which allowed electronic cigarettes and cigars – including candy-flavored products that appeal to kids – to stay on the market for years without being reviewed by the agency.

  • 2018

    The U.S. Department of Housing and Urban Development implemented its final rule requiring all public housing agencies to have smokefree policies for all residential units and common areas in place. The rule will protect close to 2 million Americans, including 690,000 children, from exposure to secondhand smoke in their homes.

  • 2017

    The U.S. Food and Drug Administration (FDA) announced multi-year delays to major parts of its 2016 "deeming" rule asserting authority of all tobacco products, including e-cigarettes, cigars and hookah tobacco. FDA also announced its intention to reduce nicotine in cigarettes to non-addictive levels over an undetermined time period.

  • 2017

    After many years of delay, tobacco companies began running "corrective statements" in print newspaper and on TV in 2017 and 2018 related to their 50-year campaign of deception and fraud about the dangers of smoking and exposure to secondhand smoke. The statements were originally ordered by Judge Kessler as part of her 2006 decision in the 1999 Department of Justice lawsuit against the tobacco companies where they were found guilty of civil racketeering charges.

  • 2016

    The U.S. Food and Drug Administration (FDA) issued a final rule in May 2016 that gives the agency oversight authority over all tobacco products, including cigars, hookah and e-cigarettes. This allows FDA to restrict sales of these products to youth, prohibit flavors and take other actions to protect public health.

  • 2016

    The U.S. Surgeon General issued a report entitled "E-Cigarette Use Among Youth and Young Adults," which looked at the real and potential dangers e-cigarettes pose to kids. Major conclusions include that e-cigarette use among youth has become a public health concern; e-cigarette aerosol is not safe and can contain harmful and potentially harmful constituents.

  • 2015

    The Institute of Medicine released a new report entitled, "Health Implications of Raising the Minimum Age for purchasing Tobacco Products." The report found that raising the minimum age for legal purchase of tobacco products to at least 21 years old will significantly reduce youth smoking initiation and rates. Subsequently, Hawaii became the first state to raise the minimum sales age for tobacco products to 21.

  • 2014

    Major parts of the Patient Protection and Affordable Care Act were implemented as of January 1, including new health insurance options and requirements that most private health plans must cover preventive services, including a comprehensive quit smoking benefit. Another key component implemented was Medicaid expansion, which provides a comprehensive quit smoking benefit to millions of low-income Americans.

  • 2014

    U.S. Surgeon General released a new report entitled "Surgeon General's Report on Smoking & Health 50th Anniversary 1964-2014" that documents the progress that has been made on reducing tobacco use over the past 50 years, and provides an update on the health effects of tobacco use and exposure to secondhand smoke.

  • 2014

    FDA launches its public education campaign, "The Real Cost" aimed at preventing youth ages 12-17, including priority populations from starting to use tobacco products.

  • 2014

    The U.S. Centers for Disease Control and Prevention updates its Best Practices for Comprehensive Tobacco Control Programs refining the evidence-based recommendations for effective tobacco control programs run by states to prevent and reduce tobacco use.

  • 2012

    The U.S. Surgeon General released a new Surgeon General's report on youth and young adult tobacco use entitled, "Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General."

  • 2012

    The Centers for Disease Control and Prevention launches the first ever federal government paid media advertising campaign encouraging people to quit smoking, Tips from Former Smokers, which features real people living with diseases caused by smoking.

  • 2012

    North Dakota approves a comprehensive smokefree law by ballot initiative becoming the 28th smokefree state.

  • 2010

    President Obama signs the Patient Protection and Affordable Care Act into law. The law includes important provisions that will expand tobacco cessation benefits and establishes the Prevention and Public Health Fund, which provides funds to prevent and reduce tobacco use.

  • 2010

    Youth access and marketing restrictions on tobacco products take effect and cigarette companies are prohibited from using "light", "low" and other misleading health descriptors.

  • 2010

    The U.S. Surgeon General releases the 30th Surgeon General's report on tobacco entitled, "How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease."

  • 2009

    President Obama signs legislation granting the U.S. Food and Drug Administration regulatory authority over tobacco products. Tobacco products are now no longer exempt from basic oversight.

  • 2008

    The American Lung Association launches its State Tobacco Cessation Coverage Database, which tracks what each state covers to help smokers quit. This database, available at is the only comprehensive, up-to-date source for information on coverage of cessation treatments for Medicaid recipients, state employees, and laws requiring private health insurance plans to cover quit smoking treatments.

  • 2008

    The U.S. Public Health Service releases an important update to its Guideline on Treating Tobacco Use and Dependence. This guideline contains recommendations for doctors on how to help their patients quit using tobacco, and recommends the use of 7 medications and 3 types of counseling to help people quit.

  • 2006

    Judge Kessler releases her final ruling in the U.S. Department of Justice's federal suit against the tobacco companies. She finds that the tobacco industry had lied for 50 years and deceived the American public on health issues and marketing to children.

  • 2006

    The Surgeon General releases The Health Consequences of Involuntary Exposure to Tobacco Smoke. The report said unequivocally that the "debate is over" – secondhand smoke in any form at any level is harmful to health.

  • 2005

    After over a year of court proceedings in the U.S. Department of Justice's suit against the tobacco companies, the Department announced that it was reducing the amount of remedies it was seeking in the case by billions of dollars. Six major public health groups, including the American Lung Association, intervene in the lawsuit to advocate for stricter remedies to preclude future tobacco industry wrongdoings.

  • 2004

    The United States signs the Framework Convention on Tobacco Control Treaty, which is the world's first tobacco control treaty and establishes international guidelines for countries to implement and control tobacco use and addiction. The treaty has not yet been sent to the U.S. Senate for ratification.

  • 2002

    The American Lung Association releases the first edition of the State of Tobacco Control report. This report, available at, tracks progress on key tobacco control policies at the state and later the federal level and assigns grades to state laws and regulations. It is released annually in January.

  • 2002

    The result of advocacy work led by the American Lung Association, Delaware's statewide smokefree law goes into effect. Delaware was the first state in four years to pass a smokefree law, and this event was the catalyst for many other states to go smokefree in the 2000's.

  • 2000

    The U.S. Supreme Court rules in a 5-4 decision that the U.S. Food and Drug Administration could not assert authority over tobacco products without being given the power to do so by Congress. Efforts turn to Congress to pass legislation.

  • 1999

    The U.S. Centers for Disease Control and Prevention releases the first edition of Best Practices for Comprehensive Tobacco Control Programs. This document details how state tobacco control programs should be structured to best prevent smoking and help smokers quit. It also recommends minimum funding levels at which each state can best run these programs.

  • 1999

    The U.S. Department of Justice announces it is suing the tobacco industry under the RICO statute – the same statute used to prosecute the Mob – claiming the tobacco industry engaged in a "coordinated campaign of fraud and deceit."

  • 1998

    Attorneys General from 46 states and the tobacco industry reach the landmark Master Settlement Agreement to reimburse state government for tobacco-related health care costs. The billions of dollars were supposed to be used to prevent smoking and help people quit, unfortunately states have used the majority of this money for other, unrelated purposes.

  • 1998

    California becomes the first state in the nation to eliminate smoking in bars. This law, along with the law eliminating smoking in restaurants and most other public places, makes California the first state to pass a comprehensive statewide smokefree air law. The American Lung Association was one of the organizations leading the campaign for this law.

  • 1996

    American Lung Association assumes responsibility for publishing State Legislated Actions on Tobacco Issues. This record is still maintained and updated, and is available at

  • 1995

    In response to a letter from the American Lung Association and its public health partners, the U.S. Food and Drug Administration asserts jurisdiction over tobacco products by declaring nicotine a drug. President Clinton approves this proposal in 1996, giving the agency authority to regulate cigarettes as a "drug delivery device."

  • 1994

    Seven tobacco company executives testify before Rep. Henry Waxman's (D-CA) congressional committee that they do not believe nicotine is addictive.

  • 1993

    The U.S. Environmental Protection Agency published Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. The report concludes that secondhand smoke is responsible for approximately 3,000 lung cancer deaths each year in nonsmoking adults and impairs the respiratory health of hundreds of thousands of children.

  • 1990

    San Luis Obispo, California becomes the first city in the world to eliminate smoking in all public buildings, including bars and restaurants.

  • 1989

    A bill spearheaded by Sen. Frank Lautenberg (D-NJ) and Rep. Dick Durbin (D-IL) passed Congress banning smoking on all domestic airlines. The American Lung Association was one of the public health groups leading efforts to pass this law.

  • 1988

    Tobacco Free America (American Lung Association, American Heart Association and American Cancer Society) publish State Legislated Actions on Tobacco Issues. This document tracked tobacco control policies – like tobacco taxes, smokefree air laws, and tobacco control program funding – for every state.

  • 1988

    California voters approve Proposition 99, which increased the cigarette tax by 25 cents and dedicated some of the revenue to create the first comprehensive statewide tobacco control program in California. It was also the first time a state dedicated proceeds from tobacco taxes to help prevent and stop smoking. The American Lung Association was instrumental in the passage of this proposition, and subsequent support for the California Tobacco Control Program.

  • 1987

    The RJ Reynolds tobacco company debuts the Joe Camel character in its U.S. advertisements. This cartoon character hooked millions of kids on Camel tobacco products.

  • 1987

    Aspen, Colorado becomes the first city in the United States to require smokefree restaurants.

  • 1987

    Congress prohibits smoking on domestic flights of less than two hours. Takes effect in 1988.

  • 1986

    The 19th Surgeon General's report on The Health Consequences of Involuntary Smoking is published. This report first officially acknowledged and emphasized the harmful effects of secondhand smoke.

  • 1984

    The U.S. Food and Drug Administration approves nicotine gum as the first drug designed to help people quit smoking.

  • 1975

    The Minnesota Clean Indoor Air Act goes into effect. This is the first statewide law in the nation that requires separate smoking areas in public places.

  • 1968

    Philip Morris introduces the Virginia Slims brand. With its iconic "You've come a long way baby" ad campaign targeting women.

  • 1966

    Health warnings first appear on cigarette packs in response to congressional legislation. The warnings read, "Caution—cigarette smoking may be hazardous to your health."

  • 1964

    The first Surgeon General's report on smoking is published. Called Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service, this report recognized the proven link between smoking and lung cancer.

  • 1961

    The American Lung Association, along with its public health partners, write to President Kennedy, highlighting the increasing evidence of the health hazards of smoking and urging him to establish a commission to address the problem. This letter led to the publishing of the landmark Surgeon General's report in 1964.

  • 1954

    Richard Doll and A. Bradford Hill, publish an article in the British Medical Journal that confirms the link between smoking and lung cancer.

    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.
    Get more facts »

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