‘State of Tobacco Control’ 2021 Report Says Ending Tobacco Use Is Critical, Especially During the COVID-19 Pandemic

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Even amid the COVID-19 pandemic, tobacco use remains a serious public health threat. In addition to tobacco-related death and disease, smoking also increases the risk of the most severe impacts of COVID-19. The American Lung Association has released its 19th annual “State of Tobacco Control” report, which calls on federal and state governments to enact meaningful policies that will prevent and reduce tobacco use and, in turn, save lives.

Tobacco use remains the nation’s leading cause of preventable death and disease, causing approximately 480,000 deaths every year. Similar to COVID-19, tobacco use and secondhand smoke exposure disproportionately impact certain communities, including communities of color, LGBTQ+ Americans, and persons of lower income. To address this critical public health threat and related health disparities, the “State of Tobacco Control” report provides a roadmap for state and federal governments on their efforts to pass proven tobacco control policies and grades them on actions already taken.

“The Biden Administration has a golden opportunity to restore our nation’s public health infrastructure and increase investments in public health,” said Harold Wimmer, President and Chief Executive Officer of the American Lung Association. “The new administration should take important actions that remain unfinished from the past two administrations, including ensuring the FDA uses its full authority to fulfill the requirements of the Tobacco Control Act passed 12 years ago.”

Federal Grades Overview

“State of Tobacco Control” grades the federal government in five areas:

  • Federal government regulation of tobacco products (2021 grade: D)
  • Federal coverage of quit smoking treatments (2021 grade: D)
  • Level of federal tobacco taxes (2021 grade: F)
  • Federal mass media campaigns to prevent and reduce tobacco use (2021 grade: A)
  • Federal minimum age of sale for tobacco products to 21 (2021 grade: A).

According to Mr. Wimmer, at the top of the list is ensuring FDA correctly implements and enforces premarket tobacco product authorization requirements for all tobacco products, including e-cigarettes, in part by removing all flavored products.

In addition, as a result of a lawsuit filed by the American Lung Association and its partners, the FDA issued the final graphic warning labels for cigarette packs on March 15, 2020. However, these are now on hold due to multiple lawsuits filed by the tobacco industry. The Lung Association urges the Biden Administration to defend these warnings, which will increase awareness and knowledge of the dangers of tobacco products.

“The year’s report calls on the Biden Administration to continue proven efforts, such as the removal of all flavored tobacco products, including all menthol products, from the market,” said Mr. Wimmer. “In the meantime, state and local governments should be resolved to seize the moment and protect public health by ending the sale of flavored tobacco products.”

State Grades Overview
“State of Tobacco Control” grades states and the District of Columbia in five areas that have been proven to prevent and reduce tobacco use and save lives, including a new category for the 2021 report:

  • New: Ending the sale of all flavored tobacco products: 45 states and Washington, DC, received F grades in this new grading category in 2021.
  • Funding for state tobacco prevention programs: 42 states and Washington, DC, received F grades in 2021.
  • Strength of smoke-free workplace laws: 24 states received A grades in 2021.
  • Level of state tobacco taxes: 33 states received F grades in 2021.
  • Coverage and access to services to quit tobacco: 29 states received a D grade or worse in 2021.

Removing flavored tobacco is a top priority of the American Lung Association. As a result, this year the Lung Association added a new state grade category for flavored tobacco products in its “State of Tobacco Control” report.

Menthol cigarettes remain a key vector for tobacco-related death and disease in Black communities, with close to 85% of Black Americans who smoke using them. Ending the sale of flavored tobacco products—including menthol—will not only help end the youth vaping epidemic, but will also help address the disproportionate impact of tobacco use and exposure to secondhand smoke in Black and Brown communities.

“It’s no surprise that menthol is predominantly used by Black Americans, as the tobacco industry has historically targeted this group,” said Mr. Wimmer. “It is critical that we hold the tobacco industry accountable for the death and disease caused by this intentional targeting of Black communities, and ensure it never happens again by passing proven tobacco control laws to protect those most vulnerable and save lives.”

During the pandemic, one step taken to protect lung health is the expansion of smoke-free protections in casinos. Across the country, more than 200 tribal and nontribal casinos reopened smoke-free after being closed due to COVID-19. The American Lung Association urges states and tribal casinos to make these changes permanent to protect their workers from secondhand smoke. Nebraska also passed legislation adding e-cigarettes to its state smoke-free law.

The report also commended Colorado and Oregon voters for increasing their state cigarette taxes by $1.10 and $2.00 per pack. In addition, Florida, Hawaii, Illinois, Maine, and Utah were recognized for increasing funding for their state tobacco control programs by $1 million—or in some cases, significantly more.

To learn more about this year’s “State of Tobacco Control” grades, visit

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®.