For some of the key victories and milestones in the American Lung Association's efforts to reduce tobacco use, see our Tobacco Control Timeline

  1. The states with the best grades in the “State of Tobacco Control” 2023 report were California, Maine, Massachusetts and the District of Columbia.
  2. The states with the worst grades in the “State of Tobacco Control” 2023 report were Alabama, Mississippi, North Carolina and Texas.
  3. A 2021 study found that menthol cigarettes were responsible for 1.5 million new smokers, 157,000 smoking-related premature deaths and 1.5 million life years lost among African Americans from 1980 to 2018.
  4. CDC has definitively linked smoking to more severe illness from COVID-19.
  5. While overall cigarette use declined by 26% from 2009 to 2019, 91% of that decline was due to non-menthol cigarettes.
  6. Among current youth e-cigarette users in 2022, flavored e-cigarette use was 84.9% among middle and high school students.
  7. From 2019 to 2021, disposable e-cigarette use skyrocketed by more than 23 times among high school e-cigarette users (from 2.4% to 55.8%) and more than 14 times among middle school e-cigarette users (from 3% to 43.8%).
  8. Approximately 16.5% of high school students in the U.S. use at least one tobacco product, including e-cigarettes, according to the 2022 National Youth Tobacco Survey.
  9. Four and half percent of middle school students use at least one tobacco product, including e-cigarettes, according to the 2022 National Youth Tobacco Survey.
  10. Smoking is the number one preventable cause of death in the U.S., killing over 480,000 people per year.
  11. Secondhand smoke causes more than 41,000 deaths in the U.S. each year.
  12. Twenty-eight states and Washington D.C. have passed laws making virtually all public places and workplaces, including restaurants and bars smokefree.
  13. The District of Columbia has the highest cigarette tax in the country at $4.50 per pack.
  14. Missouri has the lowest cigarette tax in the country at 17 cents per pack.
  15. The average cigarette taxes of all states plus the District of Columbia are $1.91 per pack.
  16. Five states – Delaware, Maine, Oklahoma, Oregon and Utah– are funding their tobacco control programs above or close to CDC-recommended levels (in Fiscal Year 2023).
  17. No state increased its cigarette tax in 2022.
  18. No state approved a comprehensive smokefree workplace law in 2022.
  19. 17 states – California, Colorado, Connecticut, Illinois, Indiana, Kansas, Kentucky, Maine, Massachusetts, Missouri, North Dakota, Ohio, Oregon, Rhode Island, South Carolina, Virginia and Wisconsin– offer a comprehensive cessation benefit to tobacco users on Medicaid.
  20. 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 $2.37 per smoker in each state.
  21. 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.
  22. 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.
  23. The American Lung Association played a key role in airplanes becoming smokefree in the 1990s.
  24. 40 states and the District of Columbia spend less than half of what the CDC recommends on their state tobacco prevention programs.
  25. States spend less than three cents of every dollar of the over $27 billion they get from tobacco settlement payments and tobacco taxes to reduce tobacco use in fiscal year 2022.
  26. Each day, more than 1,100 kids under 18 try their first cigarette and close to 100 kids become new, regular smokers.
  27. Each day, more than 700 kids try their first cigar. On average, more than 30 kids try their first cigar every hour in the United States – equaling about 267,000 every year.
  28. Smoking costs the U.S. economy over $600 billion in direct health care costs and lost productivity every year.
  29. The five largest cigarette companies spent close to $21.5 million dollars per day marketing their products in 2020.
  30. Secondhand smoke costs the U.S. economy $7 billion per year due to premature death.
  31. Smoking rates are over twice as high for Medicaid recipients (22.7%) compared to those with private insurance (9.2%).
  32. 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.
  33. 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.
  34. A 2019 study found patients in Medicaid expansion states who ordered a cessation medication had a 65% higher chance of quitting than those in non-expansion states.  
  35. In 2022 South Dakota voters passed a ballot initiative to expand Medicaid, providing more smokers in their state with access to tobacco cessation treatments.
  36. Uninsured Americans smoke at a rate more than two times higher (21.2%) than people with private insurance (9.2%).
  37. An estimated one-third of Americans living in public housing smoke.
  38. The smoking rate among adults ever diagnosed with anxiety or depression is 82% higher than among those never diagnosed with either.
  39. Indigenous Peoples (American Indians/Alaska Natives) have the highest commercial tobacco smoking rates among any racial/ethnic group.
  40. Massachusetts and the District of Columbia are the only states that prohibit the sale of all flavored tobacco products, including menthol cigarettes.

Page last updated: January 19, 2023