Methodology Introduction Federal Grades State Grades

CALCULATION OF FEDERAL GRADES

Tobacco control and prevention measures at the federal level are graded in four distinct areas: Food and Drug Administration regulation of tobacco products; coverage of tobacco cessation treatment and promotion; the amount of the federal excise tax on cigarettes; and the ratification of the Framework Convention on Tobacco Control. The sources for the targets and the basis of the evaluation criteria are described below.

Food and Drug Administration Regulation of Tobacco Products
The criteria for strong and effective Food and Drug Administration regulation of tobacco products are based on Critical Elements of Any Legislation to Grant FDA Authority to Regulate Tobacco Products developed by the American Lung Association, American Cancer Society, American Heart Association and Campaign for Tobacco-Free Kids.

FDA Regulation of Tobacco Products: Target is FDA having strong and unfettered authority over tobacco products that includes the critical elements of strong legislation.

Grade
 Target
A
 FDA has strong and unfettered authority
F
 FDA does not have strong and unfettered authority

Cessation Treatment Coverage
In 2002, the Secretary of U.S. Department of Health and Human Services convened a Subcommittee on Cessation of the Interagency Committee on Smoking and Health. The Secretary charged the 16-member subcommittee with the responsibility of developing a set of bold, science-based steps that the federal government could undertake to dramatically reduce tobacco use rates in the United States. In 2003, the subcommittee issued a National Action Plan for Tobacco Cessation. The cessation criteria used in the American Lung Association State of Tobacco Control 2008 are based on the performance of the federal government in each of the four quantifiable recommendations for the federal government laid out by the subcommittee.

The cessation grades break down as follows:

Grade
 Points Earned
A
 18 to 20 Total Points
B
 16 to 17 Total Points
C
 14 to 15 Total Points
D
 12 to 13 Total Points
F
 Under 12 Total Points

National Tobacco Quitline Network (5 points): Target is the establishment of a federally-funded National Tobacco Quitline Network that will provide universal access to evidence-based counseling and medication for tobacco cessation via a nationwide toll-free telephone number portal to state quitlines and grants to states to establish and/or enhance quitline services.
+5 = Congress appropriates the recommended $3.2 billion for the National Tobacco Quitline Network. Congress funds grants to states and a toll-free number that serves as a portal to the appropriate state quitline.
+2 = Implements a National Tobacco Quitline Network, consisting of grants to states and a toll-free number that serves as a portal to state quitlines, and provides some funding.
+1 = Designs a National Tobacco Quitline Network, consisting of grants to states and a toll-free number that serves as a portal to state quitlines, but provides no funding.
0 = No provision
National Media Campaign (5 points): Target is the establishment of an ongoing, extensive, paid media campaign to help Americans quit using tobacco.
+5 = Congress appropriates the recommended $1 billion in funding for a campaign and the national media campaign is implemented.
+2 = Implements a national media campaign to help Americans quit and provides some funding.
+1 = Designs a national media campaign to help Americans quit but provides no funding.
0 = No campaign
Federal Coverage of Cessation Benefits (5 points): Target is coverage of evidence-based counseling and medication for tobacco cessation that follows the U.S. Public Health Service Guideline for tobacco cessation (updated in May 2008) included in benefits provided to all federal beneficiaries and in all federally funded healthcare programs.
+5 = Meets requirement for providing coverage through all federally funded healthcare programs.
+3 = Provides coverage to all federal employees, most Medicare and Medicaid beneficiaries; exempts other programs.
+2 = Provides coverage to all federal employees, and some Medicare or Medicaid beneficiaries.
+1 = Provides coverage to all federal employees, some Medicare beneficiaries
or some Medicaid beneficiaries.
0 = No coverage
Smokers’ Health Fund (5 points): Target is the establishment and funding of a Smokers’ Health Fund to carry out all of the recommendations of the National Action Plan for Tobacco Cessation of at least $14 billion per year. This fund would be supported by a proposed $2.00 increase in the federal cigarette excise tax and similar increases in the excise taxes on other tobacco products. Score is based on two components: whether the required excise tax increase was enacted and whether the fund was established to support cessation activities.
+5 = Meets recommendation of a $2.00 cigarette tax increase including a proportional increase in the excise tax on other tobacco products. At least 50 percent of the funds from the tax increase are designated to implement the activities delineated in the National Action Plan.
+2 = Establishes a fund to support cessation activities but does not include a cigarette tax increase.
0 = No coverage
Bonus points (2 points): The National Action Plan for Tobacco Cessation suggested two more federal initiatives: to fund research into tobacco dependence at $500 million per year; and to invest in training and education of clinicians at $500 million per year. A bonus point is awarded for implementation of each initiative.

Federal Cigarette Excise Tax
Criteria for the federal cigarette excise tax are identical to the state cigarette excise tax. For more information, see the State Cigarette Excise Tax section.
The Excise Tax grades break down as follows:

Grade
 Tax
A
 $2.68 and up
B
 $2.01 to $2.679
C
 $1.34 to $2.009
D
 $0.67 to $1.339
F
 Under $0.67

Framework Convention on Tobacco Control
The Framework Convention on Tobacco Control (FCTC) is an international public health treaty created to ensure evidence-based measures are implemented worldwide to control tobacco use and addiction. The full text of the FCTC and its treaty obligations can be found here.

Framework Convention on Tobacco Control: Target is FCTC ratification by the U.S. Senate.

Grade
 Criteria
A
 Ratification by the U.S. Senate
B
 FCTC approved by the Senate Foreign Relations Committee
C
 President sends FCTC to Senate for ratification
D
 President/Administration sign FCTC
F
 No action on FCTC