Did your state make the grade?

The American Lung Association has identified four key actions for the Biden Administration and Congress to take in 2021 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. Congress and the U.S. Food and Drug Administration (FDA) must act to remove all flavored tobacco products from the marketplace, including menthol cigarettes, flavored cigars and e-cigarettes;
  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, and Congress must pass the “Quit for COVID-19” Act; and
  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.

2020 saw introduction and action on several tobacco-related bills in Congress. For the first time ever, a house of Congress voted to end the sale of all flavored tobacco products. In February 2020, the House of Representatives passed the Reversing the Youth Tobacco Epidemic Act, H.R. 2339, which also would have prohibited most online sales of tobacco products and taken several other important actions. Disappointingly, the Senate did not take further action on the measure.

Representative Lisa Blunt Rochester (DE) and Senator Tom Carper (DE) also introduced the “Quit for COVID-19” Act in the House and Senate, which would extend comprehensive tobacco cessation benefits to all adult Medicaid recipients.

As the result of two different lawsuits brought by the American Lung Association and our partners, two major provisions of the Tobacco Control Act moved forward in 2020, which resulted in FDA’s grade improving from an “F” to a “D”.

  • A federal judge ruled in 2019 that FDA must require tobacco product manufacturers to submit all premarket review applications by May 12, 2020; that was subsequently extended to September 9, 2020 due to the pandemic. The ruling was an important step in holding FDA accountable and requiring manufacturers to prove that there are indeed appropriate for the protection of the public health. However, a subsequent ruling by a different federal judge in 2020 exempted premium cigars from this requirement. FDA should act in 2021 to fulfill the court’s parameters and update the deeming rule so all cigars are included. The Lung Association and our partners issued premarket principles to guide the FDA during its review of these applications, and have also called on the FDA to remove all illegal products currently on the market.
  • Also, in 2019, a federal judge required FDA to issue new graphic warning labels for 50% of the front and back of all cigarette packs. FDA met the court-ordered deadline of March 15, 2020, with the warning labels appearing on all cigarette packs by June of 2021; however, R.J. Reynolds and Altria have both sued the FDA to halt the implementation of these warning labels. The Lung Association and our partners are supporting FDA’s legal efforts to push back against the industry’s cases.

The Lung Association is disappointed and opposes FDA’s July 2020 order that allowed Altria to make a modified risk tobacco product claim about its IQOS product. This comes despite Altria presenting no evidence of the effect this designation would have on youth use and perception.

A full list of the American Lung Association’s 2021 federal tobacco agenda is on our website.

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