Progress on policies proven to prevent and reduce use at the state level continued to languish in 2013, with only two states passing tobacco tax increases and no states approving comprehensive smokefree workplace laws. Eleven states did register increases in tobacco prevention and cessation funding in 2013, but once again only two states funded their tobacco prevention programs at or above levels recommended by the Centers for Disease Control and Prevention (CDC).
States also failed to make significant progress in helping their smokers quit. While implementing new elements of the Affordable Care Act, most states failed to ensure a comprehensive tobacco cessation benefit for Medicaid enrollees, state employees and new enrollees in state marketplaces.
Only Two States Increase Cigarette Taxes by Significant Amounts in 2013.
As of January 2, 2014 the national cigarette tax average is $1.53 per pack. Only two states increased their taxes by significant amounts in 2013. The two lowest cigarette excise taxes remain in Missouri ($0.17) and Virginia ($0.30). New York ($4.35) and Massachusetts ($3.51) have the nation's highest cigarette taxes.
- Massachusetts – increased its cigarette tax by $1.00 to $3.51 per pack, giving the state the 2nd highest cigarette tax in the country. Taxes on other tobacco products, products other than cigarettes, also increased.
- Minnesota – increased its cigarette tax by $1.60 per pack bringing its tax to $2.83 per pack. Most other tobacco products are now taxed at rates equivalent to the cigarette tax as well.
No States Pass Statewide Comprehensive Smokefree Laws
No states passed new comprehensive smokefree laws in 2013, leaving the number of states that have passed such laws at 28. Efforts in several states, including Kentucky, Pennsylvania and Texas were not successful.
- Progress did continue at the local level. Campaigns in local communities in a number of states, including Alabama, Mississippi, and Missouri, resulted in new comprehensive ordinances protecting people in work and public places from the dangers of secondhand smoke.
Some Progress but States Continue to Underfund Tobacco Prevention and Control Programs
Eleven states – Colorado, Iowa, Maryland, Minnesota, Nevada, North Carolina, Ohio, Oregon, Tennessee and Texas – increased funding for their tobacco prevention and cessation programs in fiscal year 2014. However, 40 states and the District of Columbia received F grades for failing to fund their tobacco prevention and cessation programs at even 50 percent of the CDC-recommended level.
- In all 50 states and the District of Columbia, funding for tobacco prevention and cessation programs was $485.5 million in fiscal year 2014, an increase from $462.5 million in fiscal year 2013. However, this pales in comparison to the $24.9 billion states are expected to receive in tobacco settlement payments and tobacco taxes in fiscal year 2014. 
- New Jersey is the only state that failed to allocate any state funds to preventing and reducing tobacco use in fiscal year 2014.
States Continue to Not Give Smokers the Help They Need to Quit
Public and private health insurance coverage was a big topic in 2013 as states and the federal government worked towards implementing many changes required in the Affordable Care Act. Despite an increased emphasis on preventive services, including tobacco cessation, no state received an ‘A’ grade this year for providing smokers with the help they need to quit.
- Medicaid enrollees still do not have access to all the help they need to quit. Only two states provide a comprehensive tobacco cessation benefit to Medicaid enrollees.
- Only four states provide a comprehensive tobacco cessation benefit to state employees.
- State quitlines remain chronically underfunded. On average, states invested only $3.76 per smoker in quitlines in fiscal year 2014. 
- Campaign for Tobacco-Free Kids. “Broken Promises to Our Children: The 1998 State Tobacco Settlement 15 Years Later.” Appendix B – Tobacco Prevention Spending vs. State Tobacco Revenues. Available at: http://www.tobaccofreekids.org/content/what_we_do/state_local_issues/settlement/FY2014/Appendix%20B.%20%20Prevention%20Spending%20vs.%20Revenues.pdf.
- This amount does not include data from 3 states – South Carolina, Texas and West Virginia – which the American Lung Association was unable to obtain quitline investment per smoker information for.
- Centers for Disease Control and Prevention. 2011 Youth Risk Behavior Surveillance Survey.
The American Lung Association commends New York City Mayor Mike Bloomberg for his lasting legacy of reducing tobacco use in New York. During his 12 years as mayor, New York City’s youth smoking rate declined to 8.5 percent.  Mayor Bloomberg championed a comprehensive approach, including the city’s smokefree workplace law, higher local cigarette taxes and hard-hitting media campaigns to encourage people to quit or never start.
In 2014, the Centers for Disease Control and Prevention expects to release an update to its Best Practices for Comprehensive Tobacco Control Programs, which was last updated in 2007. The revised funding recommendations will be incorporated into “State of Tobacco Control 2015.”
Did You Know
2014 is the 50th anniversary of the historic 1964 Surgeon General’s report on smoking and health, which linked smoking to lung cancer and other deadly diseases for the first time.
A recent article in the Journal of the American Medical Association found that about 8 million lives have been saved through tobacco control efforts since 1964, including 800,000 lung cancer deaths between 1975 and 2000.
Smoking is the number one preventable cause of death in the U.S., killing over 1,200 people per day.
Secondhand smoke kills almost 50,000 people each year.
28 states and Washington DC have passed laws prohibiting smoking in almost all public places and workplaces, including restaurants and bars.
New York has the highest cigarette tax in the country at $4.35 per pack.
Missouri has the lowest cigarette tax in the country at 17 cents per pack.
The average of all state plus the District of Columbia cigarette taxes is $1.53 per pack.
Alaska and North Dakota are the only two states that fund their tobacco control programs at or above the CDC-recommended level (in Fiscal Year 2014).
Massachusetts and Minnesota approved cigarette tax increases large enough to impact public health in 2013.
2 states – Indiana and Massachusetts – offer a comprehensive cessation benefit to tobacco users on Medicaid.
2 states – Alabama and Georgia – offer virtually no help with quitting to most tobacco users on Medicaid.
In 2009, the American Lung Association played a key role in the passage of the Family Smoking Prevention and Tobacco Control Act, which gives the U.S. Food and Drug Administration authority over tobacco products.
The American Lung Association played a key role in airplanes becoming smokefree in the 1990s.
40 states and Washington DC spend less than half of what the CDC recommends on their state tobacco prevention programs.
States spend less than two cents of every dollar they get in tobacco-related revenue to fight tobacco use.
Each day, almost 3,900 kids under 18 try their first cigarette and more than 1,000 kids become new, regular smokers.
Each day, 3,000 kids try their first cigar.
Smoking costs the U.S. economy $263 million in direct health care costs and $266 million in lost productivity each day.
The five largest cigarette companies spent over $22.9 million dollars a day marketing their products in 2011.
The American Lung Association has been fighting smoking and tobacco use since the 1950s.
Smoking rates for Medicaid recipients are over 50 percent higher than the general population.
Only 4 states – Maine, North Dakota, South Dakota and Wyoming – fund their quitlines at or above CDC-recommended levels.
A 2013 study of California’s tobacco prevention program shows that the state saved $55 in healthcare costs for every $1 invested from 1989 to 2008.
A 2012 study of Massachusetts’ comprehensive Medicaid quit smoking benefit found that Massachusetts saved $3 for every $1 spent helping smokers quit in just over a year.
Spread the Word
The American Lung Association’s annual "State of Tobacco Control" report was released nationwide on Wednesday, January 22, 2014.Learn More
Surgeon General’s Report
Despite the great progress of the past, in the last few years, tobacco control efforts have slowed and in some areas, even stalled.Learn More