Did your state make the grade?

The American Lung Association has identified four key actions for the Biden Administration and Congress to take in 2022 that will help ultimately eliminate the death and disease caused by tobacco use:

  1. FDA must adhere to the Tobacco Control Act and reject product marketing applications (PMTAs) for any product that fails to prove it is appropriate for the protection of the public health, including all flavored products; 
  2. The Biden Administration must propose and finalize rules that will remove all menthol cigarettes and flavored cigars from the marketplace; 
  3. 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; and 
  4. The U.S. Department of Health and Human Services (HHS) must clarify and ensure that most health plans, including state Medicaid expansion plans, cover a comprehensive tobacco cessation benefit without barriers and cost-sharing: and Congress must pass the “Quit Because of COVID-19” Act. 

Key highlights from 2021 and Items for 2022 include: 

  • In response to a court-ordered deadline, in April 2021, the Biden Administration announced that by April 2022, it would propose two new rules to remove menthol cigarettes and flavored cigars from the marketplace. The Lung Association eagerly anticipates the proposed rules and strongly encourages comprehensive regulations.  
  • To meet the September 9, 2021, court-ordered deadline, FDA began to review and issue denial orders to some of the millions of e-cigarettes that submitted premarket tobacco marketing applications. While FDA denied millions of applications, it has not acted on the applications from e-cigarette manufacturers with the largest market shares, nor has the agency appeared to issue any marketing orders denial orders to manufacturers for their menthol flavored e-cigarettes. We are also unaware of FDA action on any marketing orders for tobacco products other than e-cigarettes such as cigars and hookah. While the Lung Association is frustrated with FDA’s lack of progress with the remaining deeming applications, we are supporting the agency’s authority over these products in amicus briefs filed with the courts in lawsuits brought by e-cigarette companies whose products were denied marketing orders. 
  • The House-passed appropriations bill increased funding for CDC’s Office on Smoking and Health (OSH) to $250 million for fiscal year (FY) 2022; the Senate Appropriations committee bill includes an increase to $247.5. OSH was funded at $237.5 million in FY2021. However, it is unclear whether OSH will receive any increase, as the federal government is operating under a continuing resolution through February 18, 2022. OSH funding provides support for critical efforts to reduce tobacco use such as CDC’s “Tips from Former Smokers” campaign. This campaign, which is celebrating its 10th anniversary this year has led to more than 1 million smokers quitting.  
  • The Administration has not yet acted on limiting non-compliant health plans which are not required to cover treatment to help people quit tobacco use, to remain on the market. These “skimpy” plans compete with plans that are required to cover treatments to help people quit tobacco use. The Lung Association continues to urge Congress to pass the “Quit Because of COVID-19 Act” which would ensure all Medicaid enrollees have access to a comprehensive tobacco cessation benefit. The legislation has bipartisan support in the House and the Senate.  
  • In 2021, the House passed the Build Back Better act that which for the first time ever, taxed e-cigarettes. However, the tax on e-cigarettes was dropped in the Senate in December.  
  • The lawsuits brought by Altria and RJ Reynolds in two separate federal courts continue to hold up the graphic warning labels for cigarette packs. As a result of the delays, FDA will not finalize the proposed rules until at least 2023. The Lung Association and our partners are supporting FDA’s legal efforts to push back against the industry’s cases. 
Federal Facts
Economic Cost Due to Smoking: $289,500,000,000
Adult Smoking Rate: 14.0%
Adult Tobacco Use Rate: 20.8%
High School Smoking Rate: 4.6%
High School Tobacco Use Rate: 23.6%
Middle School Smoking Rate: 1.6%
Middle School Tobacco Use Rate: 6.7%
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 2019 National Health Interview Survey. High school and middle school smoking and tobacco use rates are taken from the 2020 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