The American Lung Association has identified four key actions that federal policymakers must take in 2020 that will ultimately eliminate the death and disease caused by tobacco use:

  1. Congress and the U.S. Food and Drug Administration (FDA) must act to eliminate all flavored tobacco products from the marketplace, including menthol cigarettes, flavored cigars and e-cigarettes;
  2. FDA must adhere to the Tobacco Control Act and deny product marketing applications to any product that fails to meet the public health standard;
  3. The U.S. Department of Health and Human Services (HHS) must clarify and ensure that all tobacco users have access to a comprehensive tobacco cessation benefit without barriers and cost-sharing;
  4. Congress must increase federal funding for the Centers for Disease Control and Prevention (CDC)’s Office on Smoking and Health to help states combat the youth e-cigarette epidemic and to further strengthen its “Tips from Former Smokers” Campaign.

While the federal government took an important step forward this year with the year-end passage of Tobacco 21 and increasing funding for CDC’s Office on Smoking and Health by $20 million, as a whole, 2019 was a disappointing year for advancing proven policies to reduce tobacco use. Despite a promise from the Trump Administration in September to “clear the markets” of all flavored e-cigarettes after new surveys show high school use of e-cigarettes climbed to 27.5 percent in 2019, the January 2, 2020 announcement to leave thousands of flavored e-cigarettes on the market will not end the youth e-cigarette epidemic.

Raising the federal minimum age of sale to 21, which took effect immediately on December 30, was an important first step forward. The American Lung Association successfully advocated for the legislation to be comprehensive and to close state exemptions, such as for military personnel, while also not limiting states from pursuing stronger protections. Additional rules from FDA to provide guidance on the law’s implementation are forthcoming.

Led by House Appropriations Committee leaders Nita Lowey (NY) and Rosa DeLauro (CT), the House of Representatives included an additional $40 million in its Fiscal Year 2020 funding bill for the CDC’s Office on Smoking and Health. Ultimately the final bill signed into law included an increase of $20 million, which will allow CDC to strengthen its “Tips from Former Smokers” campaign as well as provide new resources for states and communities on the front-lines of the youth e-cigarette epidemic. This is a significant increase and an important response from Congress to the youth e-cigarette epidemic.

As the result of two different lawsuits brought by the American Lung Association and our partners, two major provisions of the Tobacco Control Act will move forward in 2020:

  • Enforcement of the Deeming Rule: On May 15, 2019 a federal judge issued a motion for summary judgement, siding with the American Lung Association and our partners in the lawsuit we filed against FDA in 2018. The judge concluded that FDA acted unlawfully by delaying requiring e-cigarettes and other newly deemed tobacco products to go through a pre-market review process. The judge subsequently ruled that the filing deadline for all premarket review applications is May 12, 2020. The ruling was an important step in holding FDA accountable and requiring manufacturers to submit their products to prove they are indeed appropriate for the protection of the public health.
  • Graphic Warning Labels on Cigarette Packs: While FDA was required by the 2009 Tobacco Control Act to ensure all cigarette packs had graphic warning labels on the 50% of the front and back of all cigarette packs by 2011, FDA failed to move forward after a setback in federal courts. The judgment in the American Lung Association and public health partner’s lawsuit compels FDA to release final graphic warnings by March 15, 2020, with the warning labels appearing on all cigarette packs by June of 2021.

Both CDC and FDA continued their proven effective, evidence-based mass media campaigns – “Tips from Former Smokers” and “The Real Cost” – respectively aimed at prompting smokers to seek help for quitting and encouraging youth not to begin to use any tobacco product. Both campaigns remain a strong and fiscally responsible investment in reducing tobacco use nationwide.

Looking ahead to 2020:

  • Sponsored by House Energy and Commerce Chairman Frank Pallone (NJ), the Reversing the Youth Tobacco Epidemic Act, H.R. 2339, is expected to come to the House floor in the first quarter of 2020. Among other key requirements, this comprehensive legislation would remove all flavored products, including menthol cigarettes, from the marketplace. A Senate companion was introduced in early January by Senator Sherrod Brown (OH).
  • Manufacturers of all “deemed” tobacco products – including many cigars, all e-cigarettes, hookah and other tobacco products that came under FDA’s authority in August 2016 – will be required to submit premarket review applications (PMTAs) to the FDA no later than May 12, 2020 in order to stay on the marketplace for up to one year. During that year, FDA will review the application and determine whether the product should be allowed to remain on the market. The American Lung Association has urged FDA to be fully transparent with the applications it receives and where they are in the process. Just how FDA will remove the products that fail to submit complete applications by the deadline has not been shared but given the number of illegal products currently on the marketplace, rigorous enforcement action will be needed.
  • FDA must release the final graphic cigarette warning labels regulation no later than March 15, 2020. A lawsuit against FDA for the graphic warning labels is expected.
  • Important new studies showing youth use of tobacco products will be released in 2020, including the Youth Risk Behavioral Survey, which shows state data. This will be the first time this study has been released since the e-cigarette epidemic was declared. Updated National Youth Tobacco Survey data are expected in the fall of 2020.

United States Facts

Economic Costs Due to Smoking:

$289,500,000,000

Adult Smoking Rate:

13.7%

Adult Tobacco Use Rate:

19.7%

High School Smoking Rate:

5.8%

High School Tobacco Use Rate:

31.2%

Middle School Smoking Rate:

2.3%

Middle School Tobacco Use Rate:

12.5%

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 2018 National Health Interview Survey. High school and middle school smoking and tobacco use rates are taken from the 2019 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.

Page last updated: March 17, 2020

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