The American Lung Association State of Tobacco Control 2007 is a report card that evaluates federal and state tobacco control laws by comparing them against recognized criteria and translating each state’s relative progress into a letter grade of A, B, C, D or F. A grade of “A” is assigned for excellent tobacco control policies while an “F” indicates inadequate policies. The principal reference for all state tobacco laws is the American Lung Association’s State Legislated Actions on Tobacco Issues on-line database, available at http://slati.lungusa.org. The American Association has published this compendium of state tobacco laws since 1988.
FEDERAL CALCULATION
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 Essential Elements of FDA Regulation 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 to establish FDA authority over tobacco products that includes the critical elements of strong legislation outlined in the document “Critical Elements of Any legislation to Grant FDA Authority to Regulate Tobacco Products.” This document can be found by visiting LungUSA.org.
A = Meets target
F = does not meet target
Cessation
In 2002, the U.S. Secretary of Health and Human Services convened a Subcommittee on Cessation of the Interagency Committee on Smoking and Health (ICSH). 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 2007 are based on some of the quantifiable recommendations for the federal government laid out by the subcommittee.
Federal Cessation Criteria:
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 = Meets the recommendation of $3.2 billion for the national Tobacco Quitline network. The network 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 = Meets recommendation of $1 billion in funding for a campaign and includes a national media campaign.
+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 evidence-based counseling and medication for tobacco cessation based on the U.S. Public Health Service guidelines for tobacco cessation 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 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 whether the required excise tax increase was enacted and if the fund has been 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 Action Plan for Tobacco Cessation suggested that two more federal initiatives fund research into tobacco dependence at $500 million per year, and invest in training and education of clinicians at $500 million per year. A bonus point is awarded for implementation of each initiative.
The cessation grades break down as follows:
A = 18 to 20
B = 16 to 17
C = 14 to 15
d = 12 to 13
F = under 12
Federal Cigarette Excise Tax
The criteria for the federal cigarette excise tax are based on the average state cigarette excise tax. For more information, see the State Cigarette Excise Tax section on pages 48 and 49.
The Excise Tax grades break down as follows:
A = $2.21 and over
B = $1.66 to $2.209
C = $1.11 to $1.659
D = $0.555 to $1.109
F = Under $0.555
Framework Convention on Tobacco Control
The Framework Convention on Tobacco Control (FCTC) is a legal instrument to set standards that countries can adopt to control tobacco use and addiction. A full review of the FCTC and its treaty obligations can be found at the WHO FCTC.
Framework Convention on Tobacco Control: Target is FCTC ratification by the U.S. Senate.
A = Ratification by the S. Senate.
B = FCTC approved by the Senate Foreign Relations Committee.
C = President sends FCTC to Senate for ratification.
D = President signs FCTC.
F = No action on FCTC.
Methodology continued...
