American Lung Association's State of Tobacco Control Report Released


According to the American Lung Association’s recently released 2019 State of Tobacco Control report, states and the federal government have not taken meaningful action in establishing policies to prevent and reduce tobacco use, the nation's leading cause of preventable death and disease. In addition, youth use of e-cigarettes has reached epidemic levels—rising 78% from 2017 to 2018.

The American Lung Association's annual State of Tobacco Control report grades states and the federal government on steps taken to enact proven effective tobacco control policies. An estimated 480,000 deaths are caused by tobacco use every year, and 27.1% of high school students used at least one tobacco product in 2018—up from 19.6% in 2017. Within this context, 2019’s State of Tobacco Control sounds the alarm and calls for the federal government and states to take urgent action to reduce and prevent tobacco use.

“We know how to save lives—with the proven tobacco control policies called for in State of Tobacco Control,” said American Lung Association National President and CEO Harold P. Wimmer in a statement. “This year's report finds a disturbing failure of the federal government and states to take action to prevent and reduce tobacco use in 2018, placing the health and lives of Americans at risk, including our youth.”

State Grades Overview
State of Tobacco Control 2019 grades states and the District of Columbia in five areas that have been proven to prevent and reduce tobacco use and save lives:

  • Funding for state tobacco prevention programs: 43 states and D.C. received ‘F’ grades in this grading category
  • Strength of smoke-free workplace laws: 29 states and D.C. received a grade of ‘B’ or better, making this the grading category where states received the best grades overall. (Note: This year the grading category was updated to reflect the inclusion of e-cigarettes in smoke-free laws.)
  • Level of state tobacco taxes: 34 states received an ‘F’ grade in this grading category
  • Coverage and access to services to quit tobacco: 37 states and D.C. received a ‘C’ grade or worse in this grading category
  • Minimum age of sale for tobacco products to 21: 40 states received an ‘F’ grade in this grading category

In this year's report, no state earned an ‘A’ grade in every category, but the best states were Alaska, California, the District of Columbia, Hawaii, Maine, and Massachusetts. The states earning the worst grades (all Fs) are Mississippi, Missouri, Texas, and Virginia.

The report also found modest progress was made on laws to increase the tobacco sales age to 21 and increasing tobacco taxes in 2018, with Massachusetts passing a Tobacco 21 law and the District of Columbia and Oklahoma passing significant tobacco tax increases. In total, six states and the District of Columbia have now enacted Tobacco 21 laws, which will significantly reduce youth tobacco use and save lives.

November 23, 2018, marked the 20th anniversary of the Tobacco Master Settlement Agreement, where 46 states and the District of Columbia settled with the tobacco industry and continue to receive ongoing annual payments that can and should be used to help states fund tobacco prevention programs. States received $27.3 billion in total from such funds in fiscal year 2019, but State of Tobacco Control 2019 found no states are using these funds to invest in tobacco prevention programs at levels recommended by the Centers for Disease Control and Prevention. Three states—Connecticut, Tennessee, and West Virginia—provide no state funding at all for such programs. “States must summon the political will to use these tobacco settlement payments and revenue from tobacco taxes to adequately fund tobacco control efforts, and pass smoke-free workplace laws, Tobacco 21 laws, and large tobacco tax increases to reduce tobacco use among youth and adults,” Mr. Wimmer said.

Federal Grades Overview

State of Tobacco Control 2019 grades the federal government in four areas:

  • U.S. Food and Drug Administration (FDA) regulation of tobacco products (2019 grade: ‘F’)
  • Federal coverage of quit smoking treatments (2019 grade: ‘D’)
  • Level of federal tobacco taxes (2019 grade: ‘F’)
  • Federal mass media campaigns to prevent and reduce tobacco use (2019 grade: ‘A’)

In November 2018, the FDA announced its intention to pursue several measures to address the skyrocketing e-cigarette use among youth; however, the proposed actions amounted to half measures that are unlikely to have a meaningful impact in reducing youth e-cigarette use, according to the Lung Association. The FDA also announced it intends to propose a rule to remove menthol cigarettes and all flavored cigars from the marketplace. While such an action would be historic if taken, the lack of concrete actions by FDA in 2018 results in another ‘F’ grade for FDA Regulation of Tobacco Products in 2019’s State of Tobacco Control.

State report cards as well as federal grades can be found at

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.