How does your state compare?

The American Lung Association has identified five key actions for the Biden administration and Congress to take in 2023 that will help ultimately eliminate the death and disease caused by tobacco use:

  1. The Biden administration must swiftly finalize the two rules that will remove all menthol cigarettes and flavored cigars from the marketplace;
  2. The Food and Drug Administration (FDA) must finalize its review of all premarket tobacco product
  3. The FDA and Department of Justice must act to remove all illegal tobacco products from the marketplace;
  4. Congress must increase federal funding for the Centers for Disease Control and Prevention (CDC)’s Office on Smoking and Health to ensure adequate and culturally appropriate cessation resources for individuals who smoke menthol cigarettes, to further strengthen its “Tips from Former Smokers” Campaign and to help states combat the youth e-cigarette epidemic.
  5. Congress must pass the “Resources to Prevent Youth Vaping Act” to increase user fee funding for the FDA’s Center for Tobacco Products and make e-cigarette manufacturers pay their fair share.

Key highlights from 2022 include:

  •  In March, Congress closed the so-called “Puff Bar” loophole, giving the FDA authority over synthetic nicotine products. Many e-cigarette manufacturers claimed to switch to synthetic nicotine to avoid FDA’s authority.
  • In April 2022, the Food and Drug Administration released two proposed rules, one to end the sale of menthol cigarettes and the other, flavored cigars. The Lung Association strongly supports the proposed rules and urges FDA and the Biden Administration to finalize them quickly.
  • In October, FDA and the Department of Justice announced their intent to seek injunctions against six manufacturers whose e-cigarette products were on the market illegally. The Lung Association heralded this announcement and encouraged additional enforcement actions.
  • At the end of December, Congress passed an omnibus appropriations bill that increased funding for CDC’s Office on Smoking and Health (OSH) to $246.5 million for fiscal year (FY) 2023; OSH funding provides support for critical efforts to reduce tobacco use such as CDC’s “Tips from Former Smokers” campaign. A November 2022 study found the “Tips” campaign not only helps people quit smoking, but seeing the ads helped people stay quit.
  • In December, a federal judge ordered the major U.S. tobacco companies to post signs in 200,000 retail locations about the deadly consequences of cigarette smoking.  This is one of the final remaining remedies ordered by a federal judge in 2006 after she found the major companies guilty of civil racketeering lawsuit.
  • The Lung Association is carefully watching the impact of Braidwood v. Becerra and whether it will eliminate the requirement that tobacco cessation coverage be provided to most people without cost-sharing. The Lung Association has weighed in via amicus brief opposing the removal of this critical Affordable Care Act requirement as well.
  • The lawsuits brought by Altria and RJ Reynolds in two separate federal courts continue to hold up the graphic warning labels for cigarette packs. In December, in the Reynolds case, a federal judge in Texas vacated the warning label rule. The Lung Association and our partners are supporting FDA rules to push back against the Altria challenge.
  • FDA is also more than two and a half years overdue in publishing the final Tobacco 21 regulations as required by statute, which is why they earn an “incomplete” for the fifth and final grade on Federal Minimum Age of Sale for Tobacco Products.
Federal Facts
Healthcare Costs Due to Smoking: $289,500,000,000
Adult Smoking Rate: 12.5%
Adult Tobacco Use Rate: 19.0%
High School Smoking Rate: 2.0%
High School Tobacco Use Rate: 16.5%
Middle School Smoking Rate: 1%
Middle School Tobacco Use Rate: 4.5%
Smoking Attributable Deaths per Year: 480,320
Smoking Attributable Lung Cancer Deaths Per Year: 163,700
Smoking Attributable Respiratory Disease Deaths per Year: 113,100

Adult smoking and tobacco use rates are taken from the 2020 National Health Interview Survey. High school and middle school smoking and tobacco use rates are taken from the 2022 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. 

Federal Information

Learn more about specific legislation regarding efforts towards effective Tobacco Control.

Federal Grades Report Methodology