State of Tobacco Control 2015

In January 2014, the United States recognized the 50th anniversary of the 1964 Surgeon General's first report on smoking and health, which found smoking causes lung cancer and is associated with other diseases, including what is now known as chronic obstructive pulmonary disease (COPD). Recognizing the continued toll tobacco takes in the U.S. 50 years after the first report, the Surgeon General released its 32nd report on smoking and health, The Health Consequences of Smoking—50 Years of Progress. The report found that 50 years later, smoking is deadlier than ever and is now causally linked to a bevy of additional diseases, including diabetes, congenital defects such as orofacial clefts, macular degeneration, liver and colorectal cancers as well as others. Tobacco now kills 480,000 Americans a year, and another 16 million Americans are living with a tobacco-caused disease. Economic costs due to smoking in the U.S. are estimated to be more than $289 billion, including both direct medical costs and lost productivity.1

Three Bold Goals to End Tobacco Caused Death and Disease

Recognizing that tobacco-caused death and disease will only be eliminated with decisive action, the American Lung Association and its partners have called for immediate action by all levels of government to achieve three bold goals:

  1. Reduce smoking rates, currently at about 18 percent, to less than 10 percent by 2024;
  2. Protect all Americans from secondhand smoke by 2019; and
  3. Ultimately eliminate the death and disease caused by tobacco use.

The 13th annual American Lung Association "State of Tobacco Control 2015" report evaluates states and the federal government on the tobacco control laws and policies necessary to achieve these three bold goals, including prevention and cessation funding and programs; smokefree laws; tobacco taxes; and aggressive implementation of the Food and Drug Administration's (FDA) Family Smoking Prevention and Tobacco Control Act.  The report assigns grades based on tobacco control laws and regulations in effect as of January 2, 2015. The federal government, all 50 state governments and the District of Columbia are graded to determine if their laws and policies are adequately protecting citizens from the enormous toll tobacco use takes on lives and the economy.

Little Progress Made at State or Federal Level in 2014

"State of Tobacco Control 2015" finds 2014 was generally a disappointing year with little to no progress made at the state and federal levels.

States Continue Lackluster Performance

  • No state passed a comprehensive smokefree law or significantly increased tobacco taxes.
  • More activity did occur at the local level with major cities such as New Orleans, Louisiana, Montgomery, Alabama and Lubbock, Texas seriously considering passage of local smokefree ordinances when this report went to press.
  • Only two states cover a comprehensive tobacco cessation benefit for Medicaid enrollees—though several states made progress toward a comprehensive benefit this year, including Connecticut, Maine and Ohio.
  • Only two states, Alaska and North Dakota, fund their state tobacco prevention programs at the new levels recommended by the Centers for Disease Control and Prevention (CDC).
  • Find out if your state made the grade this year. 

Some Progress at the Federal Level in 2014

  • The federal government issued guidance to insurance companies in May 2014 making clear that all seven FDA-approved medications and all three forms of counseling should be covered in health insurance plans under the Affordable Care Act to help smokers quit.
  • FDA released its long-overdue proposal to assert its authority over all tobacco products including e-cigarettes, little cigars and other tobacco products.  It did, however, fail to finalize this proposal by the end of 2014.
  • FDA also launched its new youth prevention public education media campaign, "The Real Cost" and CDC continued its highly successful "Tips from Former Smokers" campaign.  A new study in the American Journal of Preventive Medicine found that "Tips" is highly cost effective in helping smokers quit and reducing smoking-caused deaths.2
  • No action was taken to increase federal tobacco taxes.
  • Find out how the federal government did in this year's report.

The three bold goals called for by the American Lung Association and its partners will only be met if current trends are reversed and federal, state and local policymakers muster the political will to implement these lifesaving measures to prevent and reduce tobacco use. 

  1. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. 2014.

  2. Xu, Xin et al. A Cost-Effectiveness Analysis of the First Federally Funded Antismoking Campaign.  American Journal of Preventive Medicine. December 9, 2014.

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