State of

Tobacco
Control
2024 Report
 2024
“State of Tobacco Control” 2024: Menthol Cigarettes and
Flavored Cigars Continue to Addict Kids and Make it Harder for
Tobacco* Users to Quit; Biden Administration Delays FDA Rules
that would Halt their Sale
The American Lung Association’s annual “State of Tobacco Control” report
evaluates states and the federal government’s actions to eliminate the
nation’s leading cause of preventable death—tobacco use. These proven-
effective and urgently needed tobacco control laws and policies save lives.
In the report, the Lung Association assigns letter grades, A through F, to the
state and federal policies best proven to prevent and reduce tobacco use.
“State of Tobacco Control” 2024 finds that the tobacco industry and its allies’
influence in Washington, DC remains strong as they have convinced the Biden
administration to delay finalizing lifesaving rules to end the sale of menthol
cigarettes and flavored cigars further into 2024. The White House delaying
final action on the rules will result in increased addiction, disease and death
from tobacco products especially among Black persons in the U.S. and make
achieving the Biden administration’s Cancer Moonshot goals much more difficult.

Federal Government Fails to Move Forward on

Historic Efforts to Reduce Tobacco Use
To fulfill its goals to reduce cancer deaths and improve health equity, the
Biden administration needed to finalize the menthol cigarette and flavored
cigar rules. Failing to end the sale of menthol cigarettes and flavored cigars
will result in more death and disease caused by smoking, especially among
historically marginalized communities. The tobacco companies have
engaged in a relentless effort since the 1950s of targeted marketing of
menthol cigarettes in Black communities using advertising, free samples and
donations to Black community organizations. Unfortunately, they have been
highly successful in this effort, with over 80% of Black individuals in the U.S
who smoke using menthol cigarettes today, up from only 10% prior to the
beginning of the targeted marketing in the 1950s. Menthol cigarettes make
it both easier to start and harder to quit by reducing the harshness of the
smoke and cooling the throat. This has led to more disease and death among
Black communities. In fact, a study released in 2021 found that menthol
cigarettes were responsible for 1.5 million new smokers, 157,000 smoking-
related premature deaths and 1.5 million life-years lost among African
Americans from 1980–2018.1
In addition, flavored cigars now form a substantial part of the overall cigar
market, and a higher proportion of youth and young adults start using cigars
with flavored versions compared to older adults. Data from the 2023 National
Youth Tobacco Survey (NYTS) show that 64.8% of middle and high school
students who smoke cigars use flavored cigars, amounting to 270,000 kids.2
Menthol flavored little cigars can also easily act as substitutes for menthol
cigarettes if their sale is not prohibited at the same time.
Based on Canada’s menthol cigarette prohibition and projecting those

* All refences to tobacco use, tobacco control or tobacco products in this document refers specifically to the use of
manufactured, commercial tobacco products and not to the sacred or traditional use of tobacco by American Indians and
other communities.

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 2024
results to the U.S., one study found removing menthol cigarettes from the
marketplace in the U.S would result in over 1.3 million people quitting smoking,
including over 381,000 Black individuals.3 The delay of the menthol cigarette
and flavored cigar rules puts these significant public health gains at risk. It will
also make President Biden’s Cancer Moonshot goal of preventing more than
4 million cancer deaths by 2047 that much more difficult to achieve.
“State of Tobacco Control” 2024 Federal Grades
Grading Category Grade
Federal Regulation of Tobacco Products C
Federal Quit Smoking Coverage D
Federal Tobacco Taxes F
Federal Mass Media Campaigns A
Federal Minimum Age I*

FDA must also finalize its review of all pending premarket tobacco product
marketing applications. More than two years after the September 9, 2021,
deadline established by court ruling, FDA has not yet completed its review of
the millions of e-cigarette products that had submitted pre-market tobacco
product applications. The FDA has not granted a marketing authorization to
any menthol e-cigarette or other e-cigarette with a flavor other than tobacco
to date, a major victory for lung health. However, e-cigarette companies –
including Juul, RJ Reynolds and many others – have filed multiple lawsuits
challenging FDA marketing denial orders. Many pre-market tobacco
applications for e-cigarettes and other tobacco products submitted after
September 9, 2020, remain unaddressed by FDA as well.
The federal government’s enforcement against illegal e-cigarette products
has been decidedly more mixed, but 2023 showed an increase in meaningful
action taken against companies engaged in distribution of illegal products,
notably including wholesalers, manufacturers and importers. In addition, FDA
worked with U.S. Customs and Border Protection in 2023 to block the import
of a number of brands of e-cigarettes and to seize e-cigarettes at the border.
The U.S. Department of Justice (DOJ) also filed for a permanent injunction
against an additional e-cigarette manufacturer in December 2023 and the
seventh manufacturer overall. However, millions of flavored illegal e-cigarette
products remain available for sale across the country contributing to the 2.13
million middle and high school students that continued using e-cigarettes in
2023 according to the Centers for Disease Control and Prevention (CDC)’s
2023 National Youth Tobacco Survey.4 Indeed, the most popular brand among
kids – Elf Bar – simply changed its name to avoid importation enforcement
efforts.5 Continued enforcement actions by the DOJ against manufacturers,
importers and distributors selling illegal products will be necessary to get the
situation under control.
The decline in adult cigarette smoking rates stalled out according to the most
recent data, staying at 11.6% in 2022 compared to 11.5% in 2021, according
to results from the CDC’s 2022 National Health Interview Survey. Overall
adult tobacco use actually increased in 2022 though, driven by a rise in adult
e-cigarette use from 4.5% to 6%.6 The increases in e-cigarette use over
the past two years have been driven by the 18- to 24-year-old age group
and 65.5% of e-cigarette users in this age group did not smoke cigarettes
previously in 2022.7

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Overall tobacco use rates also mask significant disparities in tobacco use
among races/ethnicities and among socio-economic levels. Tobacco use
remains alarmingly high among: Lesbian, Gay and Bisexual adults at 26.1%
Tobacco remains the leading compared to 19.5% among heterosexual adults; adults enrolled in Medicaid
cause of preventable death (27.9%) and with no health insurance (26.6%) compared to 17.4% of adults
and disease in America, killing with private health coverage; and among adults ever diagnosed with anxiety
480,000 people each year. In or depression at 27.0% compared to 16.8% among persons never diagnosed
addition, 16 million Americans live with either.9 Certain populations are also disproportionately exposed to
with a tobacco-related disease.8 secondhand smoke, including: children ages 3-11, Black people in the U.S.,
persons living in poverty and people with a high school education or less.10
Parts of the country, especially many Southern and Appalachian states remain
unprotected from secondhand smoke in public places and workplaces at the
state level.

States Continue Inadequate Efforts to Reduce Tobacco Use

It was a disappointing year for passage of state policies to prevent and
reduce tobacco use in 2023. Some progress was made on increasing funding
for tobacco prevention programs but only one state – New York – passed a
significant cigarette tax increase. No state enacted comprehensive smokefree
air or flavored tobacco product laws.
■ Nine states—Florida, Indiana, Kansas, Kentucky, Nebraska, New York, North
Dakota, Texas and Wisconsin—registered funding increases for programs
to prevent and reduce tobacco use of close to $1 million and in some
cases significantly more. Monies from the recent state settlements with
Juul contributed to the funding increases in some of these states. However,
there were decreases in tobacco prevention funding of $1 million or more
in Nevada, Ohio and Washington state. Four states received “A” grades in
this category in “State of Tobacco Control” 2024 while 41 states and the
District of Columbia received “F” grades.
■ New York increased its cigarette tax by $1.00 per pack, making it once
again the highest state cigarette tax in the country at $5.35 per pack. The
District of Columbia was the only jurisdiction to receive an “A” grade in
Tobacco Taxes in “State of Tobacco Control” 2024 while 31 states received
“F” grades.
■ No states passed laws eliminating smoking in public places and
workplaces in 2023. This marks the 11th straight year where no state has
passed a comprehensive smokefree law. Illinois did add e-cigarettes
to its comprehensive smokefree law. There were disturbing rollbacks in
smokefree laws in North Dakota (cigar bars) and Shreveport, Louisiana
(casinos). 12 states and the District of Columbia received “A” grades in this
category in “State of Tobacco Control” 2024 while 12 states received “F”
grades.
■ Despite robust campaigns in a number of states, including Hawaii, Maine,
Minnesota, New York, Oregon and Vermont, no state approved laws
eliminating the sale of flavored tobacco products. Massachusetts and
the District of Columbia received “A” grades in this category in “State of
Tobacco Control” 2024 while 45 states received “F” grades.
■ Access to tobacco use treatment has increased because of Medicaid
expansion in North Carolina and South Dakota in 2023. However, any gains
have been overshadowed by the more than 13 million Medicaid enrollees

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losing healthcare coverage as a result of state Medicaid programs
reviewing and disenrolling enrollees after the COVID-19 public health
emergency was lifted. Often the terminations were for procedural rather
than substantive or eligibility reasons. Twelve states received “A” grades in
this category in “State of Tobacco Control” 2024 while five states received
“F” grades.
■ Tobacco industry efforts to lobby state legislatures to pass laws that
prevent local communities from passing their own stronger tobacco
control laws continued in 2023. Unfortunately, these efforts were
successful in South Carolina, but failed everywhere else attempted,
including in Arizona, Maine, Missouri and Ohio.

From the failure of the Biden White House to finalize the menthol cigarette
and flavored cigar rules to the lack of progress at the state level, 2023 was a
lost opportunity for moving forward on the proven public policies called for in
“State of Tobacco Control.” The Biden administration must continue efforts to
enforce against the importation, distribution and sale of illegal e-cigarettes.
The increase in adult tobacco use in 2022 is a worrying sign, and an indication
that state and federal lawmakers must redouble their efforts to prevent and
reduce tobacco use in 2024.

White House bows to tobacco industry pressure and

fails to finalize menthol cigarette and flavored cigar rules
by the end of 2023
In an extremely disappointing end to 2023, the White House bowed to
tobacco industry pressure and failed to move forward in 2023 with finalizing
rules to eliminate menthol as a characterizing flavor in cigarettes and prohibit
all characterizing flavors in cigars. This lack of action prioritizes politics and
tobacco industry profits over public health and if the White House fails to
finalize the rules, will mean they cannot achieve President Biden’s Cancer
Moonshot goal of reducing cancer deaths by half in 25 years.
Menthol flavoring has been marketed and falsely perceived as a healthier
alternative to non-menthol tobacco products.11 For generations, the tobacco
industry has intentionally targeted Black, Brown, youth, LGBTQIA+ and other
communities with the marketing of menthol cigarettes. This false perception
of less risk and relentless marketing has resulted in increased initiation
with menthol cigarettes and high usage of menthol cigarettes, contributing
to more tobacco-related death and disease as well as tobacco-related
health disparities. Over 80% of Black individuals who smoke use menthol
cigarettes.12 Menthol cigarette use is also elevated among lesbian, gay and
bisexual (LGB)** individuals with 51% of LGB individuals who smoke using
menthol cigarettes compared to 40% of heterosexual individuals who
smoke.13
Research shows menthol cigarettes increase both the likelihood of becoming
addicted to cigarettes and the degree of addiction.14 Research also indicates
that people who smoke menthol cigarettes are less likely than those who
smoke non-menthol cigarettes to successfully quit smoking despite having

** National data is not available for transgender individuals.

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a higher urge to end their tobacco dependence. As would be expected,
15

the proportion of people who smoke who say they would quit in response
to a menthol cigarette prohibition is higher among Black people than other
demographic groups. One study projecting results from Canada’s menthol
cigarette prohibition to the U.S. estimates 1.3 million people who smoke would
quit, including 381,000 Black individuals.16

The FDA has not authorized any flavored e-cigarette

for sale, now the federal government needs to continue
stepped up enforcement efforts to remove illegal e-cigarettes
from the market
FDA has yet to complete its court-ordered and long overdue review of
millions of pre-market tobacco applications (PMTAs) for e-cigarette
products with nicotine derived from tobacco that were supposed to be
completed by September 9, 2021, as well as other products over which FDA
asserted its authority in 2016. FDA has issued marketing denial orders for all
flavored e-cigarette products it has reviewed to date, including all menthol
e-cigarettes. This included one e-cigarette market share leader, Vuse Alto,
but a final decision on Juul’s original application had yet to be completed at
the time this report was finalized. The Lung Association has repeatedly called
for all flavored tobacco products, including e-cigarettes, to be removed from
the marketplace, and applauds FDA’s decisions to not authorize flavored
e-cigarettes as part of its review process to date. Flavors are a key driver of
youth tobacco use, and no evidence has been presented that shows flavored
products can meet the public health standard that the Tobacco Control Act
requires.
Following the same litigation strategy as the big tobacco companies, many
e-cigarette companies have filed lawsuits against FDA marketing denial orders
for flavored e-cigarettes. The Lung Association has signed on to more than
20 amicus briefs with coalition partners in 2022 and 2023 asking courts to
uphold these orders. FDA marketing denial orders have been upheld by all but
two of the eight U.S. circuit courts to issue decisions on these cases to date.
Now, FDA and federal law enforcement agencies within the Department of
Justice and at U.S. Customs and Border Protection (CBP) need to step up
enforcement efforts against e-cigarettes and other tobacco products that are
on the market illegally. Such efforts should be focused at the manufacturer,
importer and distributor level, and involve removing illegal products from the
market.
The Lung Association was pleased by the FDA announcement in May 2023
that e-cigarette products from several companies – Elf Bar, Esco Bar and Eon
Smoke – were added to an FDA import alert red list with CBP in order to be
detained at the border without conducting a full inspection at the time of entry.
Additional e-cigarette products have been added to the list, and in December
2023, FDA worked with CBP to seize 1.4 million illiegal e-cigarette products
at the border. However, Elf Bar, the most popular e-cigarette with kids in
2023, was able to avoid enforcement initially by simply changing the name
of its product, a disturbing loophole that needs to be closed. A recent U.S.
Department of Health and Human Services Inspector General report looked at
FDA enforcement against retailers from 2010 to 2020, and found that FDA did
not always follow through with more serious penalties such as civil monetary

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penalties and no tobacco sales orders after sending warning letters. The
17

Lung Association hopes recent actions may reflect increased enforcement.

Enforcement efforts are crucial because the country continues to experience
high rates of youth vaping. E-cigarettes remain the most used tobacco
product by kids, according to CDC’s 2023 National Youth Tobacco Survey.
Specifically, 10% of high school students and 4.6% of middle school students
reported current e-cigarette use in 2023. Overall youth tobacco use, including
e-cigarette use, stands at 12.6% among high school students and 6.6%
“To help address the continuing
among middle school students, a disturbingly high level.18 Flavored tobacco
youth e-cigarette epidemic, the
products, including flavored e-cigarettes all of which are illegal, continue to
American Lung Association and
be a big driver of youth tobacco use, with 89.4% of kids who use e-cigarettes
the Ad Council launched the
and 86.9% of youth tobacco users overall in 2023 using flavored products.19
“#DoTheVapeTalk youth vaping
Flavored e-cigarettes and tobacco products continue to be available in a wide
awareness campaign to provide
variety of flavors, attracting and addicting our youth.
parents with the facts to address
the dangers of vaping with their
kids, while they’re still willing to
Fifth circuit ruling threatens access to tobacco cessation
listen.”
treatment; Biden administration highlights tobacco cessation
as part of Cancer Moonshot Initiative
The Affordable Care Act’s (ACA) preventive services provision requires most
health plans to cover a comprehensive tobacco cessation benefit without
cost-sharing. A lawsuit, Braidwood v. Becerra, threatens this coverage and
coverage to all preventive services under ACA. In March 2023, a federal
district judge limited the number of preventive services required to be covered
without cost-sharing, although the Fifth Circuit Court of Appeals then stayed
the decision. The Lung Association has been a part of numerous amicus
briefs on this case and will continue to be involved as it moves through the
courts to protect preventive services, including tobacco cessation.
Recognizing the cancer toll that tobacco causes, the Biden administration
is focusing on helping people who use tobacco quit as part of the Cancer
Moonshot Initiative. In July, the Department of Health and Human Services
(HHS) released a draft “Framework to Support and Accelerate Smoking
Cessation.” The Lung Association commented on how HHS can work to
increase and improve cessation and improve health equity.

Final court outcome of graphic cigarette warning labels

and reduction in nicotine levels in cigarettes product standard
still pending
In December 2022, a U.S. District Court judge vacated FDA’s rule establishing
graphic warning labels on cigarettes as required by the Tobacco Control Act.
The decision is currently on appeal with the Fifth Circuit Court of Appeals
and is another blatant example of the tobacco industry filing court cases in
jurisdictions where they are likely to get the friendliest reception. The three-
judge panel of the Fifth Circuit Court of Appeals had yet to rule on this case
when this report went to press.
The Biden administration Fall 2023 Unified Federal Regulatory Agenda
listed its intent to propose a product standard on reducing nicotine levels
in cigarettes. The Lung Association supports reducing nicotine levels in all
tobacco products, and sent a joint letter with the American Thoracic Society
in 2022 urging that if a proposed product standard is issued, it should apply

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to all tobacco products, including e-cigarettes and smokeless tobacco.
Reducing the Availability
and Accessibility of Tobacco
Products. Tobacco retailers are FDA releases five-year strategic plan
extensive in the United States,
In December 2023, FDA’s Center for Tobacco Products released a five-year
especially in urban areas. A study
strategic plan, the first time since the center’s creation in 2009 that such a
of tobacco product retailers in
plan has been put forth. The Lung Association submitted comments on a
30 cities in 2021 found that there
draft version of the strategic plan in August 2023 that focused on many of
are 31 times more retailers than
the policies and actions detailed above. The final strategic plan is a high-level
McDonalds and 16 times more
document, lacking any specific policy actions. The Lung Association will be
retailers than Starbucks. In addition,
following the implementation of this strategic plan closely, and encouraging
in most cities, tobacco product
FDA to continue to implement the Tobacco Control Act in a way that
retailers were concentrated in the
promotes public health.
lowest-income neighborhoods.20
States and communities should
enact legislation to reduce the
2023 was a mostly disappointing year for passage of tobacco
number of tobacco product
retailers and prohibit them from
prevention policies on the state and local levels
being clustered together or near No states passed comprehensive smokefree workplace laws or
youth-focused locations like comprehensive flavored tobacco product laws in 2023. While North Carolina
schools and childcare facilities. and South Dakota officially expanded their state Medicaid programs, at least
Both Chicago, IL and Milwaukee, 13.3 million of enrollees that lost Medicaid coverage with the unwinding of the
WI took action to restrict where Medicaid continuous coverage requirements during the Covid-19 pandemic,
new tobacco retailers can locate far surpassed those coverage gains. Several states did register significant
in 2023, which is a trend the Lung increases in tobacco prevention funding this fiscal year, but, unlike last year,
Association hopes will spread to it was offset by several significant decreases. New York did increase its
additional communities. cigarette tax by a $1.00 per pack but was the only state in 2023 to enact an
increase.
■ Funding for State Tobacco Prevention and Cessation Programs:
Momentum continued in 2023 for state funding for programs to prevent
and reduce tobacco use with nine states – Florida, Indiana, Kansas,
Kentucky, Nebraska, New York, North Dakota, Texas and Wisconsin –
registering increases of close to $1 million or more. The monies from
the settlement of the lawsuits against the e-cigarette company Juul
with most states during 2022 and 2023 were largely responsible for the
increases in many of these states. However, unlike in 2022, three states
– Nevada, Ohio and Washington saw decreases in funding of $1 million
or more. Adequately funding state tobacco control programs is critical
for addressing the youth vaping epidemic the country still faces. It can
also bring crucial focus and resources to alleviate disparities in who uses
tobacco products and help achieve health equity in tobacco control.
Funding should be provided to organizations that directly serve the
communities most impacted in specific states. In the current fiscal year,
2024, one state – Maine – funded its state tobacco control program at or
above the level recommended by CDC.
■ Eliminating Sales of Flavored Tobacco Products: With the removal of
menthol cigarettes and flavored cigars from the market by FDA in doubt,
it is especially important that states and localities act to end the sale
of all flavored tobacco products. Unfortunately, no states approved
laws stopping the sale of flavored tobacco products in 2023, despite
campaigns in a number of states, including Hawaii, Maine, Minnesota,
New York, Oregon and Vermont. Local ordinances did continue to pass in

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communities in Colorado, Hawaii, Illinois, Maine and Ohio. However, only
two states and the District of Columbia earned grades better than a “D”
grade in this category this year, showing how much work remains to be
done by state and local lawmakers.
■ Increasing State Tobacco Taxes: Increasing tobacco taxes by $1.00 per
pack or more is one of the most effective ways to reduce tobacco use,
“State of Tobacco Control” 2024 especially among kids. One state – New York – did pass a $1.00 cigarette
is focused on proven policies that tax increase this year, increasing its state tax to $5.35 per pack, now the
federal and state governments highest in the country. Many states still had significant budget surpluses
can enact to prevent and reduce this fiscal year, a likely contributor to the lack of tobacco tax proposals.
tobacco use. These include: Currently, there is a wide variation in cigarette tax rates, with the lowest
state cigarette tax in Missouri at a meager 17 cents per pack and New York
■ Tobacco prevention and quit
now the highest at $5.35 per pack. The current state cigarette tax average
smoking funding, programs
is $1.93 per pack.
and robust health insurance
■ Smokefree Public Places and Workplaces: Disappointingly, for the
coverage;
11th year running, no state approved a comprehensive law eliminating
■ Comprehensive smokefree laws
smoking in public places and workplaces, including restaurants, bars and
that eliminate smoking in all
casinos. Illinois did add e-cigarettes to its comprehensive smokefree law
public places and workplaces;
in 2023, and California’s governor vetoed a bill that would have allowed
■ Increased tobacco taxes;
marijuana smoking and vaping in restaurants maintaining the state’s strong
■ Eliminating the sale of all smokefree protections. There was minor progress on passing additional
flavored tobacco products; local smokefree ordinances in several states, but also disturbing rollbacks
■ Full implementation of the U.S. in smokefree laws in North Dakota (cigar bars) and Shreveport, Louisiana
Food and Drug Administration’s (casinos). This troubling lack of progress and even backsliding in some
(FDA) Family Smoking Prevention places on smokefree laws needs to be reversed.
and Tobacco Control Act; and ■ Expanding Medicaid and Tobacco Cessation Coverage: In 2023, North
■ Hard hitting federal media Carolina became the 40th state to expand Medicaid. Medicaid expansion
campaigns to encourage has been proven to expand access to quit smoking treatments and
smokers to quit and prevent services. The Affordable Care Act expanded Medicaid coverage to
young people from starting to individuals at 138% of the federal poverty level ($34,307 per year for a
use tobacco. family of three) or lower. Individuals with low incomes smoke at rate of
The report assigns grades based 29.9%, significantly higher than the general population (11.3%).21 Research
on laws and regulations designed shows Medicaid quit attempts in expansion states increased by over
to prevent and reduce tobacco 20%.22 Virginia also saw improvements in access to tobacco cessation
use, including e-cigarettes in coverage. The state passed legislation to prohibit the tobacco surcharge,
effect as of January 2024. The which can discourage people who smoke from buying health insurance
federal government, all 50 state and has not been shown to help people quit.23
governments and the District of
Columbia are graded to determine
Tobacco industry continues its efforts to stop stronger local
if their laws and policies are
tobacco control policies
adequately protecting citizens
from the enormous toll tobacco In 2023, the tobacco industry and its allies continued their efforts to remove
use takes on lives, health and the local control and prevent local governments from passing stronger tobacco
economy. control laws—called preemption. These types of laws deny local governments
the ability to pass meaningful public policies to prevent and reduce tobacco
use, including addressing the youth vaping epidemic or tobacco-related
disparities. Unfortunately, legislation was approved in South Carolina that
prevents communities from passing laws stronger than current state law on
flavored tobacco products, licensing of tobacco product retailers or regulating
ingredients in tobacco products. Such efforts were successfully defeated by the
Lung Association and other public health organizations in several other states,
including Arizona, Maine, Missouri and Ohio. The Lung Association expects the

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tobacco industry to continue its full court press on this issue in 2024.
“State of Tobacco Control” 2024 continues to provide a blueprint that states
and the federal government can follow to put in place proven policies that
will have the greatest impact on reducing tobacco use and exposure to
secondhand smoke in the U.S. The real question is: Will federal and state
lawmakers take the actions needed in 2024 to stop tobacco companies
from putting their profits ahead of public health in our country?

1. Mendez D, Le TTT. Consequences of a match made in hell: the harm caused by menthol smoking to the
African American population over 1980–2018. Tob Control 2021;0:1–3.
2. Birdsey J, Cornelius M, Jamal A, et al. Tobacco Product Use Among U.S. Middle and High School Students
— National Youth Tobacco Survey, 2023. MMWR Morb Mortal Wkly Rep 2023;72:1173–1182.
3. Fong GT, Chung-Hall J, Meng G, Craig LV, Thompson ME, Quah ACK, Cummings KM, Hyland A, O’Connor
RJ, Levy DT, Delnevo CD, Ganz O, Eissenberg T, Soule EK, Schwartz R, Cohen JE, Chaiton MO. Impact of
Canada’s menthol cigarette ban on quitting among menthol smokers: pooled analysis of pre-post evaluation
from the ITC Project and the Ontario Menthol Ban Study and projections of impact in the USA. Tob Control.
2023 Nov;32(6):734-738. Tobacco Control 2022;31:556-563.
4. Birdsey J, Cornelius M, Jamal A, et al. Tobacco Product Use Among U.S. Middle and High School Students
— National Youth Tobacco Survey, 2023. MMWR Morb Mortal Wkly Rep 2023;72:1173–1182.
5. Perrone, Matthew. FDA warns stores to stop selling Elf Bar, the top disposable e-cigarette in the US, AP,
June 22, 2023 https://apnews.com/article/ecigarettes-elf-bar-vapes-4353becf747846b528ec2aea609ed2f9.
6. National Center for Health Statistics. National Health Interview Survey 2019-2022. Generated interactively:
Nov 30 2023 from https://wwwn.cdc.gov/NHISDataQueryTool/SHS_adult/index.html.
7. Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview
Survey, 2022. Analysis performed by the American Lung Association Epidemiology and Statistics Unit using
SPSS software..
8. U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of
Progress. A Report of the Surgeon General. Atlanta, GA, 2014.
9. Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview
Survey, 2022. Analysis performed by the American Lung Association Epidemiology and Statistics Unit using
SPSS software.
10. Tsai J, Homa DM, Neff LJ, Sosnoff CS, Wang L, Blount BC, Melstrom PC, King BA. Trends in Secondhand
Smoke Exposure, 2011-2018: Impact and Implications of Expanding Serum Cotinine Range. Am J Prev Med.
2021 Sep;61(3): e109-e117. doi: 10.1016/j.amepre.2021.04.004.
11. Anderson, Stacey J. “Marketing of menthol cigarettes and consumer perceptions: a review of tobacco
industry documents.” Tobacco control vol. 20 Suppl 2,Suppl_2 (2011): ii20-8. doi:10.1136/tc.2010.041939
12. Substance Abuse and Mental Health Services Administration’s public online data analysis system (PDAS).
National Survey on Drug Use and Health, 2021.
13.Ibid.
14. Tobacco Products Scientific Advisory Committee, U.S. Food & Drug Administration, Menthol cigarettes and
Public Health: Review of the Scientific Evidence and Recommendations (2011)
15. “Menthol and Other Flavors in Tobacco Products.” U.S. Food & Drug Administration, April 29, 2021. https://
www.fda.gov/tobacco-products/products-ingredients-components/menthol-and-other-flavors-tobacco-
products
16. Fong GT, Chung-Hall J, Meng G, Craig LV, Thompson ME, Quah ACK, Cummings KM, Hyland A, O’Connor
RJ, Levy DT, Delnevo CD, Ganz O, Eissenberg T, Soule EK, Schwartz R, Cohen JE, Chaiton MO. Impact of
Canada’s menthol cigarette ban on quitting among menthol smokers: pooled analysis of pre-post evaluation
from the ITC Project and the Ontario Menthol Ban Study and projections of impact in the USA. Tob Control.
2023 Nov;32(6):734-738. Tobacco Control 2022;31:556-563.
17. U.S. Department of Health and Human Services, Office of the Inspector General. “FDA’s Approach to
Overseeing Online Tobacco Retailers Needs Improvement.” December 2022. Available at: https://oig.hhs.
gov/oei/reports/OEI-01-20-00241.pdf.
18. Birdsey J, Cornelius M, Jamal A, et al. Tobacco Product Use Among U.S. Middle and High School Students
— National Youth Tobacco Survey, 2023. MMWR Morb Mortal Wkly Rep 2023;72:1173–1182.
19. Ibid.
20. ASPire Center. “Tobacco Retailers.” Available at: Tobacco Retailers - ASPiRE Center. Accessed 11/11/2021.
21. Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview
Survey, 2022. Analysis performed by the American Lung Association Epidemiology and Statistics Unit using
SPSS software.
22. Mclean, JC, M. Pesko, S. Hill. “Public Insurance Expansions and Smoking Cessation Medications”.
Economic Inquiry, May 7, 2019. Accessed at: https://onlinelibrary.wiley.com/doi/abs/10.1111/ecin.12794
23. Dorilas, Ernest, Steven C. Hill, and Michael F. Pesko. Tobacco Surcharges Associated With Reduced ACA
Marketplace Enrollment. Health Affairs 2022 41:3, 398-405. https://doi.org/10.1377/hlthaff.2021.01313

10 Lung.org American Lung Association “State of Tobacco Control” 2024

 2024
Tobacco Prevention and Cessation Funding Overview
CDC- Percentage State
Tobacco Tobacco Other Total CDC Recommended of CDC- Tobacco
Settlement Tax State State Funding Total Spending Recommended Related
State Name Funding Funding Funding Funding to States Funding Level Level Revenue Grade
Alabama $943,452 $0 $767,762 $1,711,214 $1,513,283 $3,224,497 $55,900,000 5.8% $278,200,000 F
Alaska $0 $0 $6,500,200 $6,500,200 $1,284,919 $7,785,119 $10,200,000 76.3% $76,500,000 B
Arizona $0 $18,000,000 $0 $18,000,000 $1,708,792 $19,708,792 $64,400,000 30.6% $389,000,000 F
Arkansas $11,021,036 $0 $0 $11,021,036 $1,103,153 $12,124,189 $36,700,000 33.0% $273,200,000 F
California $0 $204,352,000 $3,700,000 $208,052,000 $3,571,588 $211,623,588 $347,900,000 60.8% $2,577,900,000 C
Colorado $0 $21,782,726 $969,502 $22,752,228 $1,692,350 $24,444,578 $52,900,000 46.2% $437,200,000 F
Connecticut $12,000,000 $0 $642,664 $12,642,664 $1,177,808 $13,820,472 $32,000,000 43.2% $433,600,000 F
Delaware $9,654,500 $0 $0 $9,654,500 $991,511 $10,646,011 $13,000,000 81.9% $130,600,000 A
District of $0 $1,000,000 $900,000 $1,900,000 $1,031,660 $2,931,660 $10,700,000 27.4% $61,500,000 F
Columbia
Florida $83,388,848 $0 $375,985 $83,764,833 $2,587,647 $86,352,480 $194,200,000 44.5% $1,432,400,000 F
Georgia $2,133,444 $0 $39,902 $2,173,346 $2,127,823 $4,301,169 $106,000,000 4.1% $423,700,000 F
Hawaii $6,714,586 $0 $812,231 $7,526,817 $1,156,607 $8,683,424 $13,700,000 63.4% $131,800,000 C
Idaho $3,738,900 $138,700 $0 $3,877,600 $1,171,888 $5,049,488 $15,600,000 32.4% $71,300,000 F
Illinois $11,100,000 $0 $660,216 $11,760,216 $2,241,976 $14,002,192 $136,700,000 10.2% $1,124,900,000 F
Indiana $9,109,918 $0 $0 $9,109,918 $1,832,809 $10,942,727 $73,500,000 14.9% $517,400,000 F
Iowa $0 $0 $4,270,171 $4,270,171 $1,137,971 $5,408,142 $30,100,000 18.0% $248,500,000 F
Kansas $1,001,960 $0 $938,756 $1,940,716 $1,516,090 $3,456,806 $27,900,000 12.4% $175,400,000 F
Kentucky $2,000,000 $0 $900,000 $2,900,000 $1,656,354 $4,556,354 $56,400,000 8.1% $475,100,000 F
Louisiana $500,000 $2,618,808 $1,436,532 $4,555,340 $1,635,696 $6,191,036 $59,600,000 10.4% $436,100,000 F
Maine $11,805,577 $4,100,000 $0 $15,905,577 $1,169,002 $17,074,579 $15,900,000 107.4% $192,100,000 A
Maryland $11,305,138 $0 $9,938,227 $21,243,365 $1,694,510 $22,937,875 $48,000,000 47.8% $609,700,000 F
Massachusetts $0 $0 $6,294,468 $6,294,468 $1,902,654 $8,197,122 $66,900,000 12.3% $692,600,000 F
Michigan $0 $1,750,000 $444,000 $2,194,000 $2,347,639 $4,541,639 $110,600,000 4.1% $1,067,400,000 F
Minnesota $0 $0 $11,998,663 $11,998,663 $1,596,128 $13,594,791 $52,900,000 25.7% $694,100,000 F
Mississippi $8,695,000 $0 $0 $8,695,000 $1,341,100 $10,036,100 $36,500,000 27.5% $252,400,000 F
Missouri $300,000 $0 $2,563,731 $2,863,731 $1,349,783 $4,213,514 $72,900,000 5.8% $273,000,000 F
Montana $5,680,705 $0 $0 $5,680,705 $1,356,206 $7,036,911 $14,600,000 48.2% $100,000,000 F
Nebraska $3,652,146 $0 $0 $3,652,146 $1,187,754 $4,839,900 $20,800,000 23.3% $97,600,000 F
Nevada $950,000 $0 $0 $950,000 $1,384,475 $2,334,475 $30,000,000 7.8% $220,000,000 F
New Hampshire $0 $0 $606,841 $606,841 $1,144,210 $1,751,051 $16,500,000 10.6% $257,300,000 F
New Jersey $6,854,795 $950,855 $500,000 $8,305,650 $1,855,458 $10,161,108 $103,300,000 9.8% $792,800,000 F
New Mexico $4,449,300 $0 $0 $4,449,300 $918,549 $5,367,849 $22,800,000 23.5% $135,000,000 F
New York $5,000,000 $0 $41,733,600 $46,733,600 $2,905,769 $49,639,369 $203,000,000 24.5% $1,874,800,000 F
North Carolina $11,250,000 $0 $2,099,600 $13,349,600 $2,353,231 $15,702,831 $99,300,000 15.8% $465,300,000 F
North Dakota $6,019,384 $0 $37,500 $6,056,884 $1,055,244 $7,112,128 $9,800,000 72.6% $51,600,000 B
Ohio $7,500,000 $0 $280,000 $7,780,000 $2,464,914 $10,244,914 $132,000,000 7.8% $1,202,700,000 F
Oklahoma $29,837,719 $2,736,907 $0 $32,574,626 $1,618,668 $34,193,294 $42,300,000 80.8% $491,000,000 A
Oregon $0 $28,800,000 $0 $28,800,000 $1,556,750 $30,356,750 $39,300,000 77.2% $497,900,000 B
Pennsylvania $16,429,000 $0 $0 $16,429,000 $2,399,303 $18,828,303 $140,000,000 13.4% $1,540,000,000 F
Rhode Island $0 $0 $429,205 $429,205 $1,383,858 $1,813,063 $12,800,000 14.2% $188,900,000 F
South Carolina $0 $5,000,000 $0 $5,000,000 $1,720,878 $6,720,878 $51,000,000 13.2% $222,300,000 F
South Dakota $0 $4,500,000 $0 $4,500,000 $1,046,792 $5,546,792 $11,700,000 47.4% $80,300,000 F
Tennessee $0 $0 $2,600,000 $2,600,000 $1,664,198 $4,264,198 $75,600,000 5.6% $403,500,000 F
Texas $0 $0 $6,032,166 $6,032,166 $3,349,957 $9,382,123 $264,100,000 3.6% $1,741,200,000 F
Utah $3,275,756 $3,159,700 $9,000,000 $15,435,456 $1,256,406 $16,691,862 $19,300,000 86.5% $139,000,000 A
Vermont $1,088,918 $0 $1,603,103 $2,692,021 $1,101,504 $3,793,525 $8,400,000 45.2% $104,500,000 F
Virginia $10,671,993 $0 $0 $10,671,993 $1,847,658 $12,519,651 $91,600,000 13.7% $408,000,000 F
Washington $0 $0 $4,636,500 $4,636,500 $1,828,532 $6,465,032 $63,600,000 10.2% $480,600,000 F
West Virginia $0 $0 $451,404 $451,404 $1,229,006 $1,680,410 $27,400,000 6.1% $227,600,000 F
Wisconsin $1,387,756 $0 $5,315,000 $6,702,756 $1,588,681 $8,291,437 $57,500,000 14.4% $691,000,000 F
Wyoming $2,221,596 $0 $239,844 $2,461,440 $1,020,771 $3,482,211 $8,500,000 41.0% $40,000,000 F
* Information in this chart covers state fiscal year 2024 which is July 1, 2023 to June 30, 2024 for all states except Alabama, Michigan, New York and Texas as well as the District of Columbia.

11 Lung.org American Lung Association “State of Tobacco Control” 2024

 2024
Smokefree Air Grading Chart
Casinos/
Government Private Childcare Gaming Retail E-Cigarettes
State Workplaces Workplaces Schools Facilities Restaurants Bars Establishments* stores Included Grade
Alabama Restricted No provision Restricted Restricted No provision No provision No provision Restricted No F
Alaska Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited N/A (tribal Prohibited Yes B
establishments
only)
Arizona Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited No B
(tribal establishments
not subject to state law)
Arkansas Prohibited Prohibited Prohibited Prohibited Restricted* Restricted* Restricted Prohibited Only in K-12 C
(non-public schools &
workplaces some colleges
with three or
fewer employees
exempt)
California Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited (tribal Prohibited Yes A
(public establishments
schools only) not subject to
state law)
Colorado Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited (tribal Prohibited Yes (certain B
(certain (certain (allowed in establishments marijuana
marijuana marijuana cigar-tobacco not subject to establishments
establishments establishments bars) state law) exempt)
exempt)
Connecticut Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Yes B
(allowed in (tribal establishments
tobacco bars) not subject to
state law)
Delaware Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Yes A
District of Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited (allowed N/A Prohibited Yes A
Columbia in cigar bars and
allows for an economic
hardship waiver)
Florida Prohibited Prohibited Prohibited Prohibited Prohibited Restricted* Prohibited (tribal Prohibited Yes C
establishments not
subject to state law)
Georgia Prohibited Restricted Prohibited Prohibited Restricted Restricted N/A Restricted Yes F
Hawaii Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited N/A Prohibited Yes A
Idaho Prohibited Restricted Prohibited Prohibited Prohibited No provision Prohibited Prohibited No C
(tribal establishments
not subject to
state law)
Illinois Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Yes A
Indiana Prohibited Prohibited Prohibited Prohibited Prohibited Restricted* No provision Prohibited (retail No C
tobacco and cigar
specialty stores
exempt)
Iowa Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Restricted Prohibited No B
(tribal establishments
not subject to
state law)
Kansas Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Restricted (casino Prohibited No B
floors and tribal
establishments
not subject to
state law)
Kentucky Restricted No provision Prohibited No provision No provision No provision No provision No provision Yes F
(prohibited in
state government
buildings)
Louisiana Prohibited Prohibited Prohibited Prohibited Prohibited No provision Restricted Prohibited Only in and C
(tribal establishments on grounds of
not subject K-12 Schools
to state law)
Maine Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Restricted (tribal Prohibited Prohibited in B
establishments not public places,
subject to state law) but not in all
workplaces
Maryland Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited No B
Massachusetts Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Yes A
(allowed in
smoking bars)
Michigan Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Restricted Prohibited No C
(allowed in (tribal establishments
cigar bars) not subject to
state law)
Minnesota Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Yes A
(workplaces (workplaces (tribal establishments
with two or with two or not subject
fewer fewer to state law)
employees employees
exempt) exempt)
Mississippi Restricted No provision Prohibited Prohibited No provision No provision No provision No provision No F
(public schools
only)
Missouri Restricted Restricted Prohibited Prohibited Restricted No provision No provision Restricted No F
(publicschools only)

12 Lung.org American Lung Association “State of Tobacco Control” 2024

 2024
Smokefree Air Grading Chart (cont.)
Casinos/
Government Private Childcare Gaming Retail E-Cigarettes
State Workplaces Workplaces Schools Facilities Restaurants Bars Establishments* stores Included Grade
Montana Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited (tribal Prohibited Only in K-12 B
establishments Schools and
not subject to on School
state law) Property
Nebraska Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited (tribal Prohibited Yes A
(allowed in establishments
cigar shops) not subject to state law)
Nevada Prohibited Prohibited Prohibited Prohibited Prohibited Restricted Restricted Prohibited Yes C
(smoking allowed (tribal establishments
in bars or parts of not subject
bars if age-restricted) to state law)*
New Hampshire Restricted Restricted Prohibited Prohibited Prohibited Prohibited Restricted Restricted Yes F
(public schools (allowed in cigar
only) bars and allows for
an economic
hardship waiver)
New Jersey Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Restricted* Prohibited Yes B
(allowed in
cigar bars/lounges)
New Mexico Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited No provision Prohibited Yes B
(allowed in
cigar bars)
New York Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Yes A
(allowed in (tribal establishments
cigar bars not subject to
and allows for state law)
an economic
hardship waiver)
North Carolina Restricted No provision Prohibited Restricted Prohibited Prohibited N/A (tribal No provision No F
(prohibited in` (public (allowed in casinos only)
state government schools only) cigar bars)
buildings)
North Dakota Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Yes A
(tribal establishments
not subject to
state law)
Ohio Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Yes A
Oklahoma Restricted Restricted Prohibited Prohibited Restricted No provision Restricted Prohibited Only in K-12- F
(prohibited on (tribal establishments schools and
state government not subject to on school
property) state law) grounds
Oregon Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Yes A
(allowed in (tribal establishments (allowed in
cigar bars) not subject to smoke shops)
state law)
Pennsylvania Prohibited Prohibited Prohibited Prohibited Restricted No provision Restricted Prohibited No D
Rhode Island Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Allowed in Prohibited Yes C
(allowed in designated areas
smoking bars)
South Carolina Restricted No provision Restricted Prohibited No provision No provision N/A No provision Only in K-12 F
Schools and
on School Property
South Dakota Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Yes B
(smoking of certain (tribal establishments
tobacco products not subject
allowed in certain bars) to state law)
Tennessee Prohibited Prohibited Prohibited Prohibited Restricted* Restricted* N/A Prohibited Yes D
(non-public
workplaces with
three or fewer
employees
exempt)
Texas No provision No provision Restricted Prohibited No provision No provision No provision No provision Yes F
Utah Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited N/A Prohibited Yes B
Vermont Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited N/A Prohibited Yes A
Virginia Restricted No provision Prohibited Prohibited Restricted Restricted No provision Restricted Only in K-12 F
(public schools (excludes Schools and
only) home-based on School
childcare Property
providers)
Washington Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Only in a few C
(tribal specific public
establishments places and
not subject to workplaces
state law)
West Virginia Restricted No provision Prohibited Restricted No provision No provision No provision No provision Only in Most Parts D
(public schools of K-12 Schools
only) and School Property
Wisconsin Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited Prohibited No B
(allowed in (tribal establishments
existing not subject to
tobacco bars) state law)
Wyoming Restricted No provision No provision No provision No provision No provision No provision No provision N/A F
* An N/A in this category means either the state only has casinos/gaming establishments located on sovereign tribal lands, which are not subject to state smokefree laws or does not allow commercial gaming.

13 Lung.org American Lung Association “State of Tobacco Control” 2024

 2024
Tobacco Taxes Grading Chart
Tax on Tax on
Tax on Tax on Smokeless Pipe/RYO Tax on
State Cigarette Tax Little Cigars Large Cigars Tobacco Tobacco E-Cigarettes Total Score Grade

Alabama 6 1 1 0 0 0 8 F
Alaska 18 2 2 2 2 0 26 D
Arizona 18 1 1 0 0 0 20 F
Arkansas 12 2 1 2 2 0 19 F
California 18 2 2 2 2 2 28 C
Colorado 18 2 2 2 2 2 28 C
Connecticut 30 2 1 0 1 0 34 B
Delaware 18 1 1 0 1 0 21 F
District of Columbia 30 2 0 2 2 2 38 A
Florida 12 0 0 2 2 0 16 F
Georgia 6 1 2 2 2 0 13 F
Hawaii 24 2 1 2 2 2 33 B
Idaho 6 1 1 2 2 0 12 F
Illinois 24 2 1 0 1 1 29 C
Indiana 12 2 2 0 2 1 19 F
Iowa 12 2 1 1 2 0 18 F
Kansas 12 1 1 1 1 0 16 F
Kentucky 12 1 1 0 1 1 16 F
Louisiana 12 1 1 2 2 0 18 F
Maine 18 2 2 2 2 2 28 C
Maryland 24 2 1 1 1 1 30 C
Massachusetts 24 2 1 2 1 2 32 B
Michigan 18 1 1 2 2 0 24 D
Minnesota 24 2 1 2 2 2 33 B
Mississippi 6 2 2 2 2 0 14 F
Missouri 6 2 2 2 2 0 14 F
Montana 12 2 1 0 2 0 17 F
Nebraska 6 2 2 0 2 0 12 F
Nevada 12 1 1 2 2 2 20 F
New Hampshire 12 2 0 2 2 0 18 F
New Jersey 18 1 1 0 1 0 21 F
New Mexico 18 2 1 1 1 1 24 D
New York 30 2 1 0 1 1 35 B
North Carolina 6 2 2 2 2 0 14 F
North Dakota 6 2 2 0 2 0 12 F
Ohio 12 2 1 1 1 0 17 F
Oklahoma 18 2 1 2 2 0 25 D
Oregon 24 2 1 0 2 2 31 C
Pennsylvania 18 2 0 0 0 2 22 F
Rhode Island 30 2 1 0 2 0 35 B
South Carolina 6 1 1 1 1 0 10 F
South Dakota 12 2 2 2 2 0 20 F
Tennessee 6 2 1 1 1 0 11 F
Texas 12 0 0 2 2 0 16 F
Utah 12 2 2 2 2 2 22 F
Vermont 24 2 2 2 2 2 34 B
Virginia 6 2 2 0 2 0 12 F
Washington 24 2 1 0 2 0 29 C
West Virginia 12 1 1 1 1 0 16 F
Wisconsin 18 2 1 2 2 0 25 D
Wyoming 6 2 2 2 2 2 16 F

14 Lung.org American Lung Association “State of Tobacco Control” 2024

 2024
Access to Cessation Services Grading Chart
Medicaid SEHP Investment Private
Medicaid Medicaid Barriers to Medicaid SEHP SEHP Barriers to Per Insurance Tobacco Total
State Medications Counseling Coverage Expansion Medications Counseling Coverage Smoker Mandate Surcharge Score Grade

Alabama 14 6 7 -8 4 2 0 5 0 0 30 F
Alaska 14 8 7 0 4 2 0 20 0 0 55 C
Arizona 14 8 11 0 4 2 1 15 0 0 55 C
Arkansas 14 8 11 0 2 3 1 10 0 1 50 C
California* 14 12 12 0 N/A N/A N/A 20 3 2 63 A
Colorado 14 12 14 0 3 3 1 20 3 1 71 A
Connecticut 14 12 13 0 4 4 2 0 2 1 52 C
Delaware 11 8 10 0 2 4 2 20 3 0 60 B
District of Columbia* 12 4 12 0 N/A N/A N/A 20 3 2 53 B
Florida* 12 8 11 -8 N/A N/A N/A 20 0 0 43 C
Georgia 14 6 8 -8 4 3 1 5 0 -2 31 F
Hawaii 14 8 13 0 3 3 2 20 0 0 63 A
Idaho 14 4 12 0 4 2 2 20 0 0 58 B
Illinois 14 12 13 0 3 1 1 20 3 0 67 A
Indiana 14 12 13 0 4 3 2 5 0 -2 51 C
Iowa 14 6 12 0 4 4 1 5 0 0 46 D
Kansas 14 12 14 -8 4 4 2 0 0 0 42 D
Kentucky 14 12 14 0 4 2 1 5 3 1 56 B
Louisiana 14 12 12 0 4 1 2 5 1 0 51 C
Maine 14 12 14 0 4 2 2 20 3 0 71 A
Maryland 14 8 11 0 4 3 2 20 3 0 65 A
Massachusetts 14 12 14 0 4 3 1 5 3 2 58 B
Michigan* 14 10 13 0 N/A N/A N/A 0 0 0 37 D
Minnesota 14 10 13 0 4 4 2 20 3 0 70 A
Mississippi 14 4 14 -8 4 4 2 10 0 0 44 D
Missouri 14 12 14 0 4 3 2 0 0 0 49 C
Montana 14 8 13 0 3 3 2 20 0 0 63 A
Nebraska 14 8 13 0 4 3 1 5 0 0 48 D
Nevada* 12 6 13 0 N/A N/A N/A 0 2 0 33 F
New Hampshire 14 10 13 0 4 3 1 5 0 0 50 C
New Jersey 14 10 14 0 4 1 1 0 3 2 49 C
New Mexico 14 8 13 0 2 2 1 20 3 0 63 A
New York 14 8 13 0 4 2 2 10 3 2 58 B
North Carolina 14 10 10 0 4 2 1 5 0 1 47 D
North Dakota 14 12 11 0 2 3 2 20 1 0 65 A
Ohio 14 12 13 0 4 4 2 0 0 0 49 C
Oklahoma 14 8 14 0 3 3 1 20 0 0 63 A
Oregon 14 12 12 0 4 3 1 5 3 0 54 C
Pennsylvania 14 8 13 0 4 2 2 5 0 0 48 D
Rhode Island 14 12 12 0 4 4 2 5 1 2 56 B
South Carolina 14 12 14 -8 3 4 2 20 0 0 61 B
South Dakota 4 4 10 0 4 2 2 20 0 0 46 D
Tennessee 14 10 8 -8 4 4 2 0 0 0 34 F
Texas 14 12 11 -8 4 2 2 5 0 0 42 D
Utah 9 8 9 0 4 2 1 20 1 0 54 C
Vermont 14 8 13 0 1 2 1 20 3 2 64 A
Virginia 14 12 13 0 4 2 1 10 3 2 61 B
Washington 14 6 13 0 3 3 2 0 3 0 44 D
West Virginia 14 4 10 0 4 2 2 5 0 0 41 F
Wisconsin 14 12 14 -8 4 3 1 5 0 -2 43 D
Wyoming 14 8 9 -8 1 4 2 20 0 0 50 C

15 Lung.org American Lung Association “State of Tobacco Control” 2024

 2024
Flavored Tobacco Product Laws Grades
State Restrictions Grade

Alabama No state law or regulation F

Alaska No state law or regulation F
Arizona No state law or regulation F
Arkansas No state law or regulation F
California Most flavored tobacco products prohibited B
Colorado No state law or regulation F
Connecticut No state law or regulation F
Delaware No state law or regulation F
District of Columbia All flavored tobacco products prohibited in virtually all locations. A
Florida No state law or regulation F
Georgia No state law or regulation F
Hawaii No state law or regulation F
Idaho No state law or regulation F
Illinois No state law or regulation F
Indiana No state law or regulation F
Iowa No state law or regulation F
Kansas No state law or regulation F
Kentucky No state law or regulation F
Louisiana No state law or regulation F
Maine Some flavored cigars prohibited F
Maryland No state law or regulation F
Massachusetts All flavored tobacco products prohibited in virtually all locations A
Michigan No state law or regulation F
Minnesota No state law or regulation F
Mississippi No state law or regulation F
Missouri No state law or regulation F
Montana No state law or regulation F
Nebraska No state law or regulation F
Nevada No state law or regulation F
New Hampshire No state law or regulation F
New Jersey All flavored e-cigarettes prohibited in all locations D
New Mexico No state law or regulation F
New York Most flavored e-cigarettes prohibited in all locations D
North Carolina No state law or regulation F
North Dakota No state law or regulation F
Ohio No state law or regulation F
Oklahoma No state law or regulation F
Oregon No state law or regulation F
Pennsylvania No state law or regulation F
Rhode Island All flavored e-cigarettes prohibited in all locations D
South Carolina No state law or regulation F
South Dakota No state law or regulation F
Tennessee No state law or regulation F
Texas No state law or regulation F
Utah Flavored e-cigarettes prohibited except in retail tobacco specialty businesses F
Vermont No state law or regulation F
Virginia No state law or regulation F
Washington No state law or regulation F
West Virginia No state law or regulation F
Wisconsin No state law or regulation F
Wyoming No state law or regulation F

16 Lung.org American Lung Association “State of Tobacco Control” 2024

 2024
“State of Tobacco Control” 2024 Methodology
The American Lung Association’s “State of Tobacco Control” 2024 is a
report card that evaluates state and federal tobacco control policies by
comparing them to targets based on the most current recognized criteria
for effective tobacco control measures, and translating each state and the
federal government’s relative progress into a letter grade of “A” through “F.”
A grade of “A” is assigned for excellent tobacco control policies while an “F”
indicates inadequate policies. The primary reference for state tobacco control
laws is the American Lung Association’s State Legislated Actions on Tobacco
Issues online database. The American Lung Association has published this
comprehensive summary of state tobacco control laws since 1988. Data for
the state Access to Cessation Services section is taken from the American
Lung Association’s State Tobacco Cessation Coverage database.

Calculation of Tobacco control and prevention measures at the federal level are graded
in five areas: federal regulation of tobacco products; federal coverage of
Federal Grades treatments to quit tobacco; federal excise taxes on tobacco products; federal
mass media campaigns; and federal minimum age of sale for tobacco
products. The sources for the targets and the basis of the evaluation criteria
are described below.

Federal Regulation of Tobacco Products

Since the passage of the Family Smoking Prevention and Tobacco Control
Act gave the U.S. Food and Drug Administration (FDA) the authority to regulate
tobacco products in June 2009, the grading system for this category has
been based on how the federal government is implementing its authority, and
whether Congress is providing full funding to FDA with no policy riders to limit
the agency’s authority.
The American Lung Association has identified three important items that FDA
was required by the Tobacco Control Act to implement, that FDA indicated
they would take action on or would significantly improve the public health: 1)
implementation of a rule asserting authority over all other tobacco products
besides cigarettes, smokeless tobacco and roll-your-own tobacco – also
known as the “deeming” rule; 2) requiring large, graphic cigarette warning
labels that cover the top 50% of the front and back of cigarette packs; and
3) issuing at least one product standard to reduce the toxicity, addictiveness
and/or appeal of tobacco products, including removal of flavored tobacco
products from the marketplace. Points were awarded based on how the
federal government has implemented these three items as well as whether
Congress funded FDA’s Center for Tobacco Products at the levels called for in
the Family Smoking Prevention and Tobacco Control Act without policy riders.

The Federal Regulation of Tobacco Products grade breaks down as follows:

Grade Points Earned
A 15 or 16 Total Points
B 13 or 14 Total Points
C 12 Total Points
D 10 or 11 Total Points
F Under 10 Total Points

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Implementation of Final “Deeming” Rule Giving FDA Authority over All
Tobacco Products (4 points)
Target is implementation of final rule that gives FDA authority over all tobacco
products in addition to cigarettes and smokeless tobacco.
+4 points: Deeming rule fully implemented; pre-market review of all
deemed tobacco products complete; products without
marketing orders from FDA are removed from marketplace.
+3 points: FDA has begun the pre-market tobacco application (PMTA)
process for all deemed tobacco products.
+2 points: FDA only implementing portions of deeming rule
+0 points: FDA postpones implementation of the entire rule

Graphic Cigarette Warning Labels (4 points)

Target is FDA requires large, graphic cigarette warning labels that cover the
top 50% of the front and back of cigarette packs.
+4 points: FDA requires large, graphic cigarette warning labels that cover
the top 50% of the front and back of cigarette packs.
+1 points: FDA proposes large, graphic cigarette warning labels that
cover the top 50% of the front and back of cigarette packs.
+0 points: No graphic warning label proposal or requirement is issued.

Product Standards to Address Toxicity, Addictiveness and Appeal of

Tobacco Products, including Removal of Flavored Tobacco Products such
as Menthol Cigarettes (4 points)
Target is FDA takes action to reduce the toxicity, addictiveness and/or appeal
of tobacco products, including removing flavored tobacco products from the
marketplace.
+4 points: Strong product standard is finalized that will be appropriate
for the protection of public health, including eliminating all
flavored tobacco products.
+3 points: Strong product standard is finalized, including removing some
but not all flavored tobacco products.
+2 points: Strong product standard is proposed that will be appropriate
for the protection of public health, including eliminating all
flavored tobacco products.
+1 points: Product standard is proposed, including removing some but
not all flavored tobacco products from the marketplace
+0 points: No product standard is issued and all flavored products
remain on the marketplace.

Funding for FDA Center for Tobacco Products (4 points)

Target is Congress provides funding for FDA Center for Tobacco Products
at levels called for in Family Smoking Prevention and Tobacco Control Act
without attaching limiting policy riders.
+4 points: Congress provides full funding without attaching limiting
policy riders.
+2 points: Congress provides full funding but with policy riders.
+1 points: Congress provides funding at a level inconsistent with the
Tobacco Control Act
+0 points: No funding at all provided.

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Federal Cessation Treatment Coverage
The cessation treatment coverage criteria used in the American Lung
Association’s “State of Tobacco Control” 2024 report is based on the coverage
of tobacco cessation treatments provided by the federal government through
its four main public insurance programs: 1) Medicare (for individuals over age
65), 2) Medicaid (for low-income individuals and families), 3) TRICARE (for
members of the military and their families), and 4) Federal Employee Health
Benefits Program (for federal employees and their families). A fifth category
covers federal requirements for tobacco cessation treatment coverage in
state health insurance marketplaces under the Affordable Care Act. Providing
help to quit through these programs and state health insurance marketplaces
will reach large numbers of individuals who use tobacco, improve health,
prevent unnecessary death, save taxpayer money and set an example for
other health plans. The federal government must lead by example and cover a
comprehensive benefit for everyone to whom it provides health care.
The definition of a comprehensive tobacco cessation benefit used in these
criteria follows the recommendations in the Clinical Practice Guideline entitled
Treating Tobacco Use and Dependence. In this Guideline, published in 2008,
the U.S. Public Health Service recommends the use of seven medications
and three types of counseling as effective for helping individuals who use
tobacco to quit. This definition has been reaffirmed in the 2021 United States
Preventive Services Task Force (USPSTF) recommendation.
The Federal Cessation Coverage grade breaks 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

Medicare (4 points)
Target is all Medicare recipients have easy access to a comprehensive
cessation benefit.
+4 points: All Guideline-recommended medications and counseling are
covered.
+3 points: At least 4 medications and 1 type of counseling are covered.
+2 points: At least 2 medications and 1 type of counseling are covered.
+1 point: At least 1 treatment is covered.
+0 points: No coverage.

Medicaid (4 points)
Target is all Medicaid enrollees have easy access to a comprehensive
cessation benefit.
+4 points: All Guideline-recommended medications and counseling
are required to be covered.
+3 points: At least 4 medications and 1 type of counseling are
required to be covered.
+2 points: At least 2 medications and 1 type of counseling are
required to be covered.
+1 point: At least 1 treatment is required to be covered.

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+0 points: No required coverage.

TRICARE (4 points)
Target is all TRICARE enrollees have easy access to a comprehensive
cessation benefit.
+4 points: All Guideline-recommended medications and counseling are
covered.
+3 points: At least 4 medications and 1 type of counseling are covered.
+2 points: At least 2 medications and 1 type of counseling are covered.
+1 point: At least 1 treatment is covered.
+0 points: No coverage.

Federal Employee Health Benefits (FEHB) (4 points)

Target is all federal employees & dependents have easy access to a
comprehensive cessation benefit.
+4 points: All Guideline-recommended medications and counseling are
covered.
+3 points: At least 4 medications and 1 type of counseling are covered.
+2 points: At least 2 medications and 1 type of counseling are covered.
+1 point: At least 1 treatment is covered.
+0 points: No coverage.

Federal Requirements for State Health Insurance Marketplaces

Target is all plans in marketplaces cover a comprehensive tobacco cessation
benefit.
+4 points: All Guideline-recommended medications and counseling are
required to be covered.
+3 points: Administration releases guidance outlining coverage of a
comprehensive tobacco cessation benefit as a preventive
service.
+2 points: Administration requires that all plans sold in the State Health
Insurance Marketplaces cover tobacco cessation treatment
as part of the preventive services requirement.
+1 points: Administration proposes new regulations that no longer
require all plans in the State Health Insurance Marketplaces to
provide tobacco cessation treatment.
+0 points: Administration finalizes new regulations or issues guidance
that no longer require all plans in the State Health Insurance
Marketplaces to provide tobacco cessation treatment.
Bonus Points: 1 bonus point in each category is awarded if coverage is
provided with minimal barriers to access. Common barriers to access include
required counseling, prior authorization, stepped care therapy, cost sharing,
duration limits, annual limits and lifetime limits to tobacco cessation treatment.

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Federal Tobacco Excise Taxes
Criteria for the federal tobacco excise taxes grade are identical to the state
tobacco excise tax grade. For more information, see the State Tobacco Excise
Taxes section on p. 25.
The Federal Tobacco Excise Tax grade breaks down as follows:
Grade Points Earned
A 36 to 40 points
B 32 to 35 points
C 28 to 31 points
D 24 to 27 points
F 23 and below points

Federal Mass Media Campaigns

Health communications interventions, including mass media campaigns
designed to encourage individuals to quit tobacco or discourage youth from
starting to smoke have been found to be an effective intervention to prevent
and reduce tobacco use, according to the U.S. Surgeon General and U.S.
Centers for Disease Control and Prevention (CDC). More information on health
communications interventions and their effectiveness can be found in CDC’s
Best Practices for Comprehensive Tobacco Control Programs – 2014.
Two agencies of the federal government ran different mass media campaigns
for part or all of 2023 that seek to reduce or prevent tobacco use among
different populations: 1) CDC’s Tips from Former Smokers media campaign,
which targets adults who use tobacco and 2) FDA’s Real Costs campaign,
which targets youth ages 12 to 17 with tobacco prevention messages. Both
mass media campaigns will continue to run in 2024.
The federal mass media campaign grade criteria are based off the reach,
duration and frequency of these mass media campaigns as well as if the
campaign refers people to available services that can help them quit.

The Federal Mass Media campaign grade breaks down as follows:

Grade Points Earned
A 22 to 24 points
B 20 to 21 points
C 17 to 19 points
D 15 to 16 points
F Under 15 points

Reach (3 points for each campaign, 6 points total)

Target: Advertising from each mass media campaign reaches 75% or more of
its target audience each quarter the campaign is running.
+3 points: Ads reach 75% or more of target audience each quarter
+2 points: Ads reach 55-74% of target audience each quarter
+1 point: Ads reach 1-54% of target audience each quarter
+0 points: No ad campaign.

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Duration (3 points for each campaign, 6 points total)
Target: Each mass media campaign runs for 12 months of the year.
+3 points: Ads run 9-12 months per year
+2 points: Ads run 6-8 months per year
+1 point: Ads run 1-5 months per year
+0 points: No ad campaign.

Frequency (3 points for each campaign, 6 points total)

Target: Each campaign has an average gross rating point of 1,200 for the
1st quarter the campaign is running and 800 or higher rating points for
subsequent quarters.
+3 points: Average targeted rating point of 1,200 or higher for 1st
quarter of campaign; average targeted rating point of 800 or
higher for subsequent quarters
+2 points: Average targeted rating point of 1,000 or higher for 1st
quarter of campaign; average targeted rating point of 600 or
higher for subsequent quarters
+1 points: Average targeted rating point of 800 or higher for 1st quarter
of campaign; average targeted rating point of 400 or higher
for subsequent quarters
+0 points: No ad campaign.

Promotion of Available Services (3 points for each campaign, 6 points

total)
Target: Media campaign refers people to available resources that can help
them quit tobacco use.
+3 points: Media campaign refers people to available resources directly
+1 points: Media campaign refers people to location where available
resources can be accessed.

Federal Minimum Age of Sale for Tobacco Products

In March 2015, the National Academy of Medicine (formerly the Institute
of Medicine) issued a report looking at the impact increasing the age of
sale for tobacco products could have on youth tobacco use rates. The
report concluded that increasing the age of sale for tobacco products to 21
nationwide could prevent 223,000 deaths among people born between 2000
and 2019, including 50,000 fewer dying from lung cancer, the nation’s leading
cancer killer.1 In 2019, Congress passed a law increasing the minimum age of
sale to 21 and required FDA to issue confirming regulations.
A grade was awarded in this category based on whether the federal
government increased the age of sale for tobacco products to 21 and issued
the regulations as required by statute. The letter grade received deductions
based on if groups, like active-duty military, were exempted from the age
of sale of 21. The federal government would receive an automatic F grade if
some tobacco products, such as e-cigarettes, were exempted from the age
of sale increase, there was preemption on state or local governments from
raising the age of sale or the age of sale was 19 or 20 years old.
Grade breaks down as follows:
A = age of sale for all tobacco products is 21 years of age with no
exceptions;

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B = age of sale for all tobacco products is 21 years of age, but certain
groups such as active-duty military are exempted;
F = age of sale for tobacco products is below 21 years of age, some
tobacco products are exempted from the age of sale to 21 increase
or preemption on state or local governments concerning tobacco
sales age increases is imposed;
I = age of sale for all tobacco products is 21 years of age, but
implementing regulations not issued as required by statute.

Calculation of State level tobacco control policies are graded in five key areas: tobacco
prevention and cessation funding, smokefree air laws, state tobacco excise
State Grades taxes, access to quit tobacco treatments and services and state laws to end
the sale of flavored tobacco products. The sources for the targets and the
basis of the evaluation criteria are described below.

State Tobacco Prevention and Cessation Program Funding

In January 2014, the Centers for Disease Control and Prevention (CDC)
published an updated version of its Best Practices for Comprehensive
Tobacco Control Programs, which was first published in 1999, and
previously updated in 2007. Based on “Best Practices” as determined by
evidence-based analysis of state tobacco control programs, this CDC
guidance document recommends that states establish programs that are
comprehensive, sustainable and accountable. The CDC lists five components
as crucial in a comprehensive tobacco control program: State and Community
Interventions, Mass-Reach Health Communication Interventions, Cessation
Interventions, Surveillance and Evaluation and Infrastructure, Administration
and Management.2
The CDC also recommends an overall level of funding for each state’s
tobacco control program based on a variety of state-specific factors such
as prevalence of tobacco use, the cost and complexity of conducting mass
media to reach targeted audiences in the state and the proportion of the
population that is below 200% of the federal poverty level.3 For the tobacco
prevention and control spending area, the CDC recommendation for state
funding of comprehensive programs served as the denominator in the
percentage calculation to obtain each state’s grade. Each state’s total funding
for these programs (including federal funding from the CDC given to states
for tobacco prevention and cessation activities) served as the numerator.
After calculating the percentage of the CDC recommendation each state had
funded, grades were assigned according to the following formula:

Percent of CDC
Grade Recommended Level
A 80% or more
B 70% to 79%
C 60% to 69%
D 50% to 59%
F Less than 50%

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Limitation of Grading System on State Tobacco Control
Expenditures
The American Lung Association bases its tobacco prevention and cessation
program funding grades on the total amount allocated to tobacco control
programs in each state, including applicable federal funding, but does not
evaluate the expenditure in each of the CDC-recommended categories. The
Lung Association does not evaluate the efficacy of any element of any state’s
program. Therefore, a state may receive a high grade but be significantly
underfunding a particular component or components of a comprehensive
program. It also may be true that a state with a low grade is adequately
funding a specific component or program in one community.
However, the CDC recommends a comprehensive program and explains that
simply funding an element of the program will not achieve the needed results.
The CDC explicitly calls for programs that are comprehensive, sustained
and accountable. The American Lung Association agrees with the CDC and
believes that the total funding is a fair basis for grading that is also generally
under the full control of state lawmakers.

State Smokefree Air Laws

The U.S Surgeon General, in a seminal 2006 report on the health effects of
secondhand smoke and re-affirmed in subsequent reports in 2010 and 2014,
has concluded that secondhand smoke is a serious health hazard causing or
making worse a wide range of diseases and conditions. It also concluded that
there is no risk-free level of exposure to secondhand smoke and that the only
way to fully eliminate exposure to secondhand smoke in indoor environments
is to completely prohibit smoking.4 Secondhand marijuana smoke contains
many of the same toxins and carcinogens found in directly-inhaled cigarette
smoke, in similar amounts if not more.5 A 2016 Surgeon General report on
youth e-cigarette use found that secondhand e-cigarette aerosol is not
harmless and contains harmful and potentially harmful chemicals.6
For “State of Tobacco Control” 2024, the Lung Association has revamped the
scoring system for the Smokefree Air category to a grading system based
on the strength of a state’s law restricting smoking in public places and
workplaces from a points-based system that had awarded a set number of
points across multiple categories. An “A” grade indicates that a state has a
comprehensive law prohibiting smoking and vaping of tobacco and cannabis/
marijuana in virtually all public places and workplaces with only small
exceptions. Grades are lowered based on the type of exemptions present in a
state’s law(s).
Grades break down as follows:
A = All public places and workplaces, including restaurants, bars and
casinos are smokefree & e-cigarettes/marijuana are completely
included in state smokefree law;
B = Broad small workplace exemptions i.e. for businesses with three
or fewer employees; stand-alone bar/establishments under age 21
or casino or other gaming establishment exemptions; e-cigarettes
excluded from smokefree law or use only prohibited in select public
places such as schools; and/or marijuana hospitality establishment
smokefree exemptions where the service of food, drink or live
entertainment are present in state law;

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C = Two or more exemptions for small workplaces, casino/other gaming
establishments or bar/establishments under 21 are present in state
law;
D = Restaurants/bars are smokefree, but other public places/workplaces
are either completely exempted or have designated smoking areas
in state law;
F = any restrictions on smoking in public places and workplaces that are
weaker than grades A through D above.

There are two situations that create exceptions to the gr ading system:
Preemption or Local opt-out: State preemption of stricter local ordinances or
states that have a provision in state law allowing communities to opt-out of
the law is penalized by a reduction of one letter grade.
Local Ordinances: States with statewide laws that do not earn “A” grades
may be graded based on local smokefree ordinances or regulations instead.
Strong local smokefree air ordinances/regulations that include workplaces,
restaurants and bars are considered according to the percentage of
population covered in the state. States with over 95% of their population
covered by comprehensive local smokefree ordinances will receive an “A,”
over 80% a “B,” over 65% a “C” and over 50% a “D.” Local ordinances that
cover less than 50% of the population will not be considered for evaluation
under this exception.7

Limitations of the grading system:

Many states that receive A grades in “State of Tobacco Control” do have
small, specialized exemptions where smoking is still allowed such as for cigar/
tobacco/hookah bars, certain percentages or all hotel/motel rooms and/or
tobacco/e-cigarette retail stores. The Lung Association opposes virtually all
exemptions to smokefree workplace laws and urges state lawmakers to close
these loopholes regardless of the grade they receive.

State Tobacco Excise Taxes

The U.S. Surgeon General, in The Health Consequences of Smoking – 50
Years of Progress released in January 2014 to commemorate the 50th
anniversary of the first Surgeon General’s report on smoking in 1964,
concluded that “increases in the prices of tobacco products, including those
resulting from excise tax increases, prevent initiation of tobacco use, promote
cessation and reduce the prevalence and intensity of tobacco use among
youth and adults.”8
Research has clearly demonstrated that as the price of cigarettes increases,
consumption decreases. For each 10% price increase, it is estimated that
consumption drops by about 7% for youth and 3 to 5% for adults.9 Increasing
taxes on tobacco products other than cigarettes is also important. Nationally,
rates of cigar smoking among youth now equal rates of cigarette smoking
and e-cigarettes are the most popular tobacco product used by youth.
The grading system for State Tobacco Excise Taxes is a points-based system,
with the level of a state’s cigarette tax worth up to 30 possible points and
taxes on other tobacco products worth up to 10 possible points, for a total of
40 points available in the grading category.
The 30 points for the level of a state’s cigarette tax will continue to be based

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on the average (mean) of all state taxes as the midpoint, or the lowest “C”
grade. The average cigarette tax was chosen because it is often seen as an
indication of where states are in their cigarette taxing policies. The average
state excise tax on January 1, 2024, was $1.93 per pack. The range of state
excise taxes ($0.17 to $5.35 per pack) is divided into quintiles, and a state is
assigned 6 points for attaining each quintile.
The score earned for the level of a state’s cigarette tax is broken down as
follows:
Score Tax
30 points $3.86 and over
24 points $2.895 to $3.859
18 points $1.93 to $2.894
12 points $0.965 to $1.929
6 points Under $0.965

For taxes on tobacco products other than cigarettes, a state is evaluated on

whether the tax on five specific types of tobacco products is a) equivalent
to the state’s tax on cigarettes and b) the tax on the specific type of tobacco
product is not based on the weight of the product. Taxing tobacco products
other than cigarettes by weight is inadequate because it means the tax level
does not keep pace with inflation and tobacco industry or other price increases.
The five specific types of tobacco products other than cigarettes which
states are evaluated on are: 1) little cigars, 2) large cigars, 3) smokeless
tobacco, 4) pipe/roll-your-own tobacco and 5) e-cigarettes. In “State of
Tobacco Control” 2020, e-cigarettes replaced dissolvable tobacco products
as one of the five categories.
States can earn up to 2 points total for each type of other tobacco product;
1 point if the tax is equivalent to the cigarette tax and 1 point if the tax is not
weight-based. States will not be penalized for having a weight-based tax if
they also have a minimum tax that is equal to the current cigarette tax or the
weight-based tax is equivalent to the cigarette tax.
The overall grade breaks down as follows:
Grade Points Earned
A 36 to 40 points
B 32 to 35 points
C 28 to 31 points
D 24 to 27 points
F 23 and below points

State Access to Cessation Services

The Access to Cessation Services grading system sets targets for states
and awards points in three areas: 1) State Medicaid coverage of tobacco
cessation treatments, 2) State Employee Health Plan coverage of tobacco
cessation treatments and 3) the Investment per Smoker each state makes
in its quitline, a service available in all states that provides tobacco cessation
counseling over the phone. Bonus points are available in two other target
areas, Standards for Private Insurance and limiting or prohibiting Tobacco
Surcharges in private insurance.

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In 2008, the U.S. Department of Health and Human Services’ Public Health
Service published an update to its Clinical Practice Guideline on Treating
Tobacco Use and Dependence. This Guideline, based on a thorough review
of scientific evidence on tobacco cessation, recommends several treatment
options that have proven effective in helping people quit smoking. These
options include the use of five nicotine-replacement therapies (gum, patch,
lozenge, nasal spray, inhaler), bupropion and varenicline (non-nicotine
medications), and three types of counseling (individual, group and phone).
It also recommends that all public and private health insurance plans cover
the cessation treatments recommended in the Guideline.10 In 2020, the U.S.
Surgeon General reiterated the need for this comprehensive cessation benefit
without barriers in “Smoking Cessation: A Report of the Surgeon General.”11
Targets established in the Medicaid, State Employee Health Plan and
Standards for Private Insurance categories were based on these Public Health
Service Guideline and U.S. Surgeon General recommendations for cessation
treatments.
In the 2014 Best Practices for Comprehensive Tobacco Control Programs
document, supporting state quitlines is one of the major goals under
Cessation Interventions for state tobacco control programs.12 Funding to the
state quitline is included in the Access to Cessation Services section to show
a full picture of what the state is offering for cessation services. Grading in this
section is based on the amount of funding provided to the state quitline for
services divided by the number of individuals who smoke in the state.
In 2015, the Lung Association incorporated information on what tobacco
cessation treatments are provided to the Medicaid expansion population
into this grade. Points awarded in the Medicaid Coverage section below
incorporate this information. Points available in the Medicaid coverage section
were 40 to represent new Medicaid expansion enrollees. If a state has not
opted to expand Medicaid up to the levels established in the Affordable Care
Act (ACA), the state receives an automatic deduction of 8 points to represent
the substantial number of individuals who use tobacco that do not have
access to cessation treatments because of this decision.
The Lung Association will deduct up to 2 points for any state that implements
a policy to charge Medicaid enrollees a tobacco surcharge or that has policies
that charge Medicaid enrollees that smoke more for coverage than Medicaid
enrollees that do not use tobacco. The Lung Association also added 2 bonus
points available to states that prohibit or limit tobacco surcharges, or health
insurance policies that charge individuals who use tobacco more in premiums
than individuals who do not use tobacco. States can limit or remove these
surcharges.
All data in the Access to Cessation Services section of “State of Tobacco
Control” 2024 was collected and analyzed by the American Lung Association.
The cessation grades are based on the maximum number of total points, a
score of 70, assigned according to the categories described in detail below.
Over half of the points (40 points total) under the Access to Cessation
Services section are awarded for coverage under a state’s Medicaid program.
This weighting is due to the higher smoking rates among the Medicaid
population than among the general population, as well as the need to cover
treatments to help people of lower income who smoke quit. Twenty points
total are awarded for the investment per smoker in the state’s quitline and 10
points total are awarded for State Employee Health Plan coverage.

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The score of 70 serves as the denominator, and the state’s total points
serves as the numerator to calculate a percentage score. Grades were given
following a standard grade-school system using that percentage score.
The grades break down as follows:
Grade Points Earned
A 63 to 70
B 56 to 62
C 49 to 55
D 42 to 48
F 41 and under

Key to Cessation Coverage Ratings by Category:

Medicaid Coverage (40 points):13 Target is barrier-free coverage of all
Guideline-recommended medications and counseling for the state’s entire
Medicaid population (including the Medicaid expansion population).
1. States receive up to 14 points for coverage of medications: 2 points for
coverage for all enrollees of each of the 7 medications. If coverage of a
medication varies by plan or pregnancy status, 1 point is awarded for each
medication covered in this way;
2. States receive up to 12 points for coverage of counseling: 4 points for
each type of counseling covered (individual, group and phone). If a
counseling coverage varies by plan or pregnancy status, 2 points is
awarded for each type of counseling coverage;
3. States receive up to 14 points for providing coverage without barriers: 1 to
3 points are deducted for each barrier to coverage that exists in a state.
Deductions vary based on type of barrier and severity.
4. There is an automatic letter grade deduction for the Access to Cessation
Services grade, if a state has not expanded Medicaid coverage up to the
levels established in the Affordable Care Act (138% of the federal poverty
level for all eligibility categories).
5. States that impose a tobacco surcharge or charge individuals who use
tobacco higher premiums than individuals who do not use tobacco
for Medicaid coverage will have 2 points deducted from the Medicaid
coverage score.
State Employee Health Plan Coverage (10 points): Target is barrier-free
coverage of all Guideline-recommended medications and counseling for all of
a state’s employees and dependents.
6. 0 to 4 points are given for coverage of medications; deductions were
made if only some health plans/managed care organizations provide
coverage;
7. 0 to 4 points are given for coverage of counseling; deductions were made
if only some health plans/managed care organizations provide coverage;
8. 0 to 2 points are given if coverage is free of barriers.
Quitlines (20 points): States are graded based on a curve set by the median
investment per smoker, which in fiscal year 2023 was $1.93 per smoker.
Points are awarded based on the scale below:

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$$/smoker > $3.86 20 points
$$/smoker $2.90 - $3.85 15 points
$$/smoker $1.94 - $2.89 10 points
$$/smoker $0.97 - $1.93 5 points
$$/smoker < $0.97 0 points

Standards for Private Insurance Coverage (up to 3 bonus points):

Target is a legislative or regulatory standard requiring coverage of all PHS-
recommended medications and counseling in private insurance plans within
the state.
1. 1 point given for legislation requiring the coverage of some tobacco
cessation treatments or if a state insurance commissioner issues a
bulletin on the enforcement of the tobacco cessation FAQ issued by the
federal government;14
2. 2 points given for legislation requiring coverage of all tobacco cessation
treatments for some state regulated private insurance plans;
3. 3 points given for legislation requiring coverage of all tobacco cessation
treatments for all state regulated private insurance plans.
Tobacco Surcharges (up to 2 bonus points): Target is a state policy
prohibiting small group and individual health insurance plans from charging
individuals who use tobacco higher premiums than individuals who do not
use tobacco. States can prohibit this practice or limit these surcharges to
amounts smaller than federal law allows, which is 50%.
1. 2 points given if state prohibits tobacco surcharges; or
2. 1 point given if state limits tobacco surcharges to less than 50% of the
premium charged to individuals who do not use tobacco.

State Flavored Tobacco Product Laws

Flavored tobacco products have long played an important role in youth
starting to use tobacco products and in the case of menthol, keeping people,
particularly Black persons in the U.S., addicted. According to CDC’s 2023
National Youth Tobacco Survey, close to 90% of high school and middle
school students who use e-cigarettes use a flavored product.15 In addition,
86.9% of youth who use tobacco used a flavored product.16
Menthol cigarettes play a key role in addicting youth who smoke and keeping
people hooked. Over three quarters of youth who smoke ages 12-17 smoke
menthol cigarettes.17 Black Americans are disproportionately impacted
with over 80% of Black persons who smoke using menthol cigarettes.18
Menthol cigarette use is also elevated among LGBTQ+ Americans, women
and persons with lower incomes. A recent study showed that while overall
cigarette use declined by 26% over the past decade, 91% of that decline was
due to non-menthol cigarettes.19
Given the key role that flavors play in getting and keeping people addicted
to tobacco products, and the slow pace of action by the federal government
on the topic, a new grade was added to “State of Tobacco Control” 2021
evaluating states on whether they have prohibited the sale of all flavored
tobacco products. This grade replaced the Minimum Age grade from “State
of Tobacco Control” 2020 and earlier years. Grades are based on the strength
of a state’s restrictions on flavored tobacco products with exemptions for

29 Lung.org American Lung Association “State of Tobacco Control” 2024

 2024
certain products or in certain locations decreasing the grade.
Grades break down as follows:
A = the sale of all flavored tobacco products is prohibited;
B = the sale of most flavored tobacco products, including menthol
cigarettes, is prohibited with some narrow exemptions;
C = the sale of all flavored tobacco products, including menthol
cigarettes, is limited to over age 21 stores/locations;
D = the sale of one type of flavored tobacco product is completely
prohibited (i.e. flavored e-cigarettes or flavored tobacco product
restrictions that completely exempt menthol cigarettes);
F = No state law on flavored tobacco products or the sale of one type of
flavored tobacco product restriction that exempts menthol.

There is one situation that creates an exception to the grading system:

■ Local Ordinances: States without a statewide law or weaker statewide
restrictions on flavored tobacco products may be graded based on local
ordinances. Local ordinances that prohibit the sale of all flavored tobacco
are considered according to the percentage of population covered in the
state. States with over 95% of their population covered by local flavored
tobacco product ordinances will receive an “A,” over 80% a “B,” over 65%
a “C” and over 50% a “D.” Local ordinances that cover less than 50% of the
population will not be considered for evaluation under this exception.

State Statistics Used in the Report

Adult smoking rates are taken from the CDC’s 2022 Behavioral Risk Factor
Surveillance System for all states. Adult smoking means having used
cigarettes on one or more of the past 30 days.
High school smoking and tobacco use, and middle school smoking rates,
are taken from CDC’s 2021 Youth Risk Behavior Survey, state youth tobacco
surveys or other state-based surveys that measure youth smoking or tobacco
use rates. High school tobacco use includes having used cigarettes, cigars,
smokeless tobacco or electronic vapor products on one or more of the past
30 days for most states. In states where the tobacco products covered by the
survey used are different, a sentence has been added to the state-specific
footnotes on each state page describing the tobacco products included.
Economic cost information is for 2018 and from multiple sources, see this
CDC website page for details. 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.
State-by-state tobacco-related revenue data (revenue from state tobacco
settlement payments and tobacco taxes) is provided by the Campaign for
Tobacco-Free Kids.

30 Lung.org American Lung Association “State of Tobacco Control” 2024

 2024
1. Institute of Medicine, Public Health Implications of Raising the Minimum Age of Legal Access
to Tobacco Products, Washington, DC: The National Academies Press, 2015, http://www.
nationalacademies.org/hmd/Reports/2015/TobaccoMinimumAgeReport.aspx.
2. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco
Control Programs—2014. Atlanta: U.S. Department of Health and Human Services, Centers
for Disease Control and Prevention, National Center for Chronic Disease Prevention and
Health Promotion, Office on Smoking and Health, 2014.
3. Ibid.
4. Office on Smoking and Health (US). The Health Consequences of Involuntary Exposure to
Tobacco Smoke: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control
and Prevention (US); 2006. Available from: https://www.ncbi.nlm.nih.gov/books/NBK44324/
5. American Lung Association. Marijuana and Lung Health. Available at: https://www.lung.org/
quit-smoking/smoking-facts/health-effects/marijuana-and-lung-health.
6. U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young
Adults. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Center for Chronic Disease
Prevention and Health Promotion, Office on Smoking and Health, 2016.
7. Data to calculate percent of state populations covered by local ordinances is obtained from
the Americans for Nonsmokers’ Rights Foundation.
8. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50
Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health
and Human Services, Centers for Disease Control and Prevention, National Center for
Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
9. There is general consensus among tobacco researchers that every 10 percent increase in
the price of cigarettes decreases cigarette consumption by about 4 percent in adults and
about 7 percent in children. Tauras J, et al. Effects of Price and Access Laws on Teenage
Smoking Initiation: A National Longitudinal Analysis, Bridging the Gap Research, ImpacTeen.
April 24, 2001.
10. Treating Tobacco Use and Dependence: 2008 Update. Content last reviewed February
2020. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/
prevention/guidelines/tobacco/index.html
11. U.S. Department of Health and Human Services. Smoking Cessation. A Report of the
Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention, National Center for Chronic Disease Prevention and Health
Promotion, Office on Smoking and Health, 2020.
12. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco
Control Programs—2014. Atlanta: U.S. Department of Health and Human Services, Centers
for Disease Control and Prevention, National Center for Chronic Disease Prevention and
Health Promotion, Office on Smoking and Health, 2014.
13. As of January 1, 2014, the Affordable Care Act (ACA) required that state Medicaid programs
no longer exclude coverage of tobacco cessation medications. In State of Tobacco
Control a state was only given credit for covering tobacco cessation medications if there is
documentable evidence that the Medicaid program is covering that medication, regardless
of the federal requirement.
14. On May 2, 2014, the U.S. Departments of Labor, Health and Human Services and Treasury
issued an FAQ that clarified what health insurance plans under the Affordable Care Act
should cover in terms of tobacco cessation medications and counseling, https://www.cms.
gov/cciio/resources/fact-sheets-and-faqs/aca_implementation_faqs19.html (see question 5).
15. Birdsey J, Cornelius M, Jamal A, et al. Tobacco Product Use Among U.S. Middle and High
School Students — National Youth Tobacco Survey, 2023. MMWR Morb Mortal Wkly Rep
2023;72:1173–1182.
16. Ibid.
17. Substance Abuse and Mental Health Services Administration's public online data analysis
system (PDAS). National Survey on Drug Use and Health, 2021.
18. Ibid.
19. Delnevo CD, Ganz O, Goodwin RD, Banning Menthol Cigarettes: A Social Justice Issue Long
Overdue. Nicotine Tob Res, 2020 Oct 8;22(10):1673-1675. https://doi.org/10.1093/ntr/ntaa152.

31 Lung.org American Lung Association “State of Tobacco Control” 2024

 United States Report Card
2024
S

Federal Regulation
of Tobacco Products C Federal Tobacco Taxes F
E

Implementation of Rule Asserting Authority over All Tobacco CIGARETTE TAX:

Products: Rule partially implemented
T

Tax rate per pack of 20: $1.01

Graphic Cigarette Warning Labels: Warning labels finalized,
A

but not in effect* OTHER TOBACCO PRODUCT TAXES:

Product Standards, including Flavored Tobacco Products: Little Cigars: Equalized: Yes; Weight-Based: Yes
T

Product standards to end the sale of menthol cigarettes and Large Cigars: Equalized: No; Weight-Based: No
flavored cigars proposed
S

Smokeless Tobacco: Equalized: No; Weight-Based: Yes

Funding for FDA Center for Tobacco Products: Full funding
without policy riders Pipe/RYO Tobacco: Equalized: No; Weight-Based: Yes

* FDA has finalized graphic warning labels for cigarettes, but a federal E-cigarettes: Equalized: N/A; Weight-Based: N/A
D

court decision, which has been appealed, has vacated the rule.

D Thumbs down for the Biden administration for failing to

E

finalize rules to end the sale of menthol cigarettes and

flavored cigars.
Federal Mass Media Campaigns A
T

TIPS FROM FORMER SMOKERS MEDIA CAMPAIGN:

D
I

Federal Cessation Coverage Reach: Meets Target

N

Duration: Under Target

Medicaid Coverage: Partially Required
Frequency: Meets Target
U

Medicare Coverage: Partially Covered

Promotion of Services: Meets Target
TRICARE Coverage: Covered
FDA “REAL COSTS” MEDIA CAMPAIGN
Federal Employee Health Benefits Coverage: Covered
Reach: Meets Target
State Health Insurance Exchanges: Partially Required
Duration: Meets Target
Frequency: Meets Target
Promotion of Services: Under Target

Federal Minimum Age I*

Minimum Age of Sale for Tobacco Products: 21
* The federal government gets an “I” for Incomplete because FDA has
not issued implementing regulations that were required by statute to be
issued by June 17, 2020

Federal Highlights:
The American Lung Association has Homeland Security must act to remove all illegal
identified five key actions for the Biden tobacco products from the marketplace;
administration and Congress to take in 4. Congress must at least maintain current funding
2024 that will help ultimately eliminate for the Centers for Disease Control and Prevention
the death and disease caused by (CDC)’s Office on Smoking and Health;
tobacco use:
5. Congress must pass H.R. 4775, the Helping Tobacco
1. The White House must swiftly finalize the two rules Quit Act, bipartisan legislation giving more people
that will remove all menthol cigarettes and flavored access to the resources they need to quit tobacco.
cigars from the marketplace;
In addition, FDA is overdue in finalizing the Tobacco
2. The Food and Drug Administration (FDA) must 21 regulations as required by statute, which is why
finalize its review of all premarket tobacco product they earn an “incomplete” for the fifth and final
applications for both tobacco-derived and grade on Federal Minimum Age of Sale for Tobacco
synthetic-nicotine products; Products. Congress ordered FDA to finalize these rules
3. The FDA and the Departments of Justice and in 2020.

32 Lung.org American Lung Association “State of Tobacco Control” 2024

United States Highlights:
2024
Key highlights from 2023 include: and unless the two rules are implemented.

U
• In February, President Biden announced his unity The Lung Association is carefully watching two

N
agenda, of which the Cancer Moonshot was different threats to important tobacco control efforts:
prominently featured, announcing a goal to cut the first, Braidwood v. Becerra, a lawsuit that could

I
U.S. cancer death rates in half in 25 years. In it, the result in the elimination of the Affordable Care Act

T
President specifically called out smoking as the requirement that tobacco cessation coverage be
greatest cause of deaths from cancer in the U.S. In provided to most people without cost-sharing. The

E
June, the White House hosted the first ever forum on Lung Association has weighed in via amicus brief
tobacco cessation. opposing the removal of this critical provision. The

D
• In January and October, FDA rejected premarket second is a lawsuit brought by R.J. Reynolds in the Fifth
applications from Reynolds Tobacco for flavored Circuit Court of Appeals that continues to hold up the
graphic warning labels for cigarette packs.

S
e-cigarettes, including for its popular Vuse Alto
menthol e-cigarettes; Reynolds has subsequently
Federal Facts

T
filed a lawsuit against FDA in the US Court of Appeals
for the Fifth Circuit, challenging that decision. The Economic Costs Due to Smoking: 600,000,000,000

A
Lung Association and our partners filed an amicus
Adult Smoking Rate: 11.6%

T
brief in that case, one of 6 amicus briefs in similar
cases challenging FDA e-cigarette marketing denial Adult Tobacco Use Rate: 19.3%

E
orders that were filed in 2023.
High School Smoking Rate: 1.9%

S
• Some in the House of Representatives actively
High School Tobacco Use Rate: 12.6%
worked to undermine federal efforts to reduce
tobacco use. In May, the House Committee on Middle School Smoking Rate: 1.1%
Appropriations added a legislative provision called a
Middle School Tobacco Use Rate: 6.6%
rider to the FDA’s funding bill that would prohibit FDA
from finalizing the menthol cigarette rules. In July, Smoking Attributable Deaths per Year: 480,320
the House Appropriations Committee’s funding bill Smoking Attributable Lung Cancer
proposed to entirely eliminate the CDC’s Office on Deaths per Year: 163,700
Smoking and Health.
Smoking Attributable Respiratory Disease
• In May, FDA took enforcement action against retailers Deaths per Year: 113,100
that were selling illegal e-cigarettes. In December,
Adult smoking and tobacco use rates are taken from the 2022 National
U.S. Customs and Border Protection working with Health Interview Survey. High school and middle school smoking and
FDA seized illegal e-cigarettes that were being tobacco use rates are taken from the 2023 National Youth Tobacco
Survey.
smuggled into the U.S., including Elf Bar, the most Economic cost information is for 2018 and from multiple sources, see
popular brand among youth. this CDC website page for details. Smoking attributable deaths reflect
average annual estimates for the period 2005-2009 and are calculated
for persons aged 35 years and older. Smoking-attributable healthcare
• In July, court-ordered signs warning of health risks expenditures based on 2004 smoking-attributable fractions and 2009
caused by smoking were posted by the major U.S. personal healthcare expenditure data. Deaths and expenditures should
not be compared by state.
tobacco companies in about 200,000 retail outlets
across the nation that sell cigarettes, telling the
public the truth about the deadly consequences
of cigarette smoking. This was a remedy in the
Department of Justice’s civil racketeering lawsuit
against major tobacco companies.
• In October, the draft rules that would end the sale
of menthol cigarettes and flavored cigars were
transmitted to the White House for a final review.
While a late December release was expected, in
December, the White House announced a delay
until at least March 2024 after it met with officials
representing the tobacco companies. The Cancer
Moonshot 25-year target cannot be achieved until

33 Lung.org American Lung Association “State of Tobacco Control” 2024

 Alabama Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
M

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $1,711,214
A

Tax Rate per pack of 20: $0.675

FY2024 Federal Funding for
State Tobacco Control Programs: $1,513,283* OTHER TOBACCO PRODUCT TAXES:
B

FY2024 Total Funding for Tax on Little Cigars: Equalized: No; Weight-Based: No
A

State Tobacco Control Programs: $3,224,497 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes
L

State Spending Recommendation: $55,900,000

Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: Yes
Percentage of CDC Recommended Level: 5.8%
A

Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A

State Tobacco-Related Revenue: $278,200,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

Smokefree Air: F Access to Cessation Services: F

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Restricted STATE MEDICAID PROGRAM:

Private work sites: No provision Medicaid Medications: All 7 medications are covered
Schools: Restricted Medicaid Counseling: Some counseling is covered
Child care facilities: Restricted Medicaid Barriers to Coverage: Some barriers exist to access
care
Restaurants: No provision
Medicaid Expansion: No
Bars: No provision
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: No provision
Medications: All 7 medications are covered
Retail stores: Restricted
Counseling: Some counseling is covered
E-Cigarettes Included: No
Barriers to Coverage: Some barriers exist to access care
Preemption/Local Opt-Out: No
Citation: ALA. CODE §§ 22-15A-1 et seq. (2003). STATE QUITLINE:
Investment per Smoker: $1.82; the median investment per
smoker is $1.93.

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: No
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Alabama Tobacco Cessation Coverage page for
coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

34 Lung.org American Lung Association “State of Tobacco Control” 2024

Alabama State Highlights:
2024
Tobacco use remains a leading cause practices for tobacco control, including the benefits

A
of preventable death and disease in of a statewide smokefree law. In order to reduce the

L
the United States and in Alabama. death and disease caused by tobacco use in Alabama,
To address this enormous toll, the state legislators will need to recognize the health and

A
American Lung Association calls for the economic burden of tobacco use and secondhand
following actions to be taken by Alabama’s elected smoke exposure by enacting public health protections

B
officials: and investing in evidence-based tobacco prevention
programs. The Lung Association will continue to

A
1. Implement a comprehensive tobacco retail licensing
program to ensure enforcement and compliance work with partners to ensure successful passage

M
with tobacco control statutes; and preservation of comprehensive local smokefree
ordinances.
2. Pass comprehensive local smokefree ordinances

A
that protect all workers and patrons from Alabama State Facts
secondhand smoke; and
Health Care Cost Due to Smoking: $1,885,747,576
3. Ensure access to comprehensive quit tobacco
Adult Smoking Rate: 15.6%
coverage for Medicaid recipients.
High School Smoking Rate: 5.7%
It was an active year for tobacco prevention and
control issues in the Alabama legislature in 2023. The High School Tobacco Use Rate: 18.6%
Lung Association and other public health partners
Middle School Smoking Rate: N/A
were engaged in educating on the best practices for
updating provisions for state licensing, enforcement, Smoking Attributable Deaths: 8,650
and compliance of tobacco products, including
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
e-cigarettes. This includes removing youth penalties Surveillance System. High school smoking and tobacco use rates are
taken from the 2021 Youth Risk Behavior Surveillance System. A current
and promoting policies that effectively reduced youth middle school smoking rate is not available for this state.
tobacco and nicotine use. House Bill 319 and Senate Health impact information is taken from the Smoking Attributable Mortality,
Bill 271, introduced by Representative Drummond and Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
Senator Gudger respectively, was legislation that, are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
unfortunately, did not appropriately hold tobacco and 2009 personal healthcare expenditure data. Deaths and expenditures
retailers accountable and would have enacted harsher should not be compared by state.

penalties on youth. This legislation failed to pass.

Local public health coalitions and communities
continue to be limited in their ability to focus on
tobacco control issues, such as implementing strong
smokefree ordinances. Tobacco control partners
continue to be engaged with community education
on the dangers of tobacco use and secondhand
smoke across Alabama. The Lung Association plays
a prominent role by offering technical assistance on
the best practices of tobacco prevention and control.
The Alabama Department of Public Health continues
to affect social norm change around tobacco use,
address the marketing of tobacco products to youth,
and promote policies that eliminate exposure to
secondhand smoke through the Tobacco Prevention
and Control Program.
In 2024, the American Lung Association will advocate
for the implementation of a comprehensive tobacco
retail licensing program to ensure enforcement and
compliance with tobacco control statutes. We will
also continue to educate state legislators on best

35 Lung.org American Lung Association “State of Tobacco Control” 2024

 Alaska Report Card
2024
A

Tobacco Prevention and

Control Program Funding: B Tobacco Taxes: D
K

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $6,385,700
S

Tax Rate per pack of 20: $2.00

FY2024 Federal Funding for
OTHER TOBACCO PRODUCT TAXES:
A

State Tobacco Control Programs: $1,284,919*

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
L

State Tobacco Control Programs: $7,670,619 Tax on Large Cigars: Equalized: Yes; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No
A

State Spending Recommendation: $10,200,000

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 75.2%
Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A
State Tobacco-Related Revenue: $76,500,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

Smokefree Air: B Access to Cessation Services: C

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: All 7 medications are covered
Schools: Prohibited Medicaid Counseling: Some counseling is covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Some barriers exist to access
care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: N/A (tribal establishments
only) Medications: All 7 medications are covered
Retail stores: Prohibited Counseling: Some counseling is covered
E-Cigarettes Included: Yes Barriers to Coverage: Substantial barriers exist to access
care
Preemption/Local Opt-Out: Yes
Citation: ALASKA STAT. §§ 18.35.301 to 18.35.399 (2018). STATE QUITLINE:
Investment per Smoker: $7.32; the median investment per
Note: If the local opt-out provision in Alaska’s law were removed, Alaska’s
grade would be an “A.” smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Alaska Tobacco Cessation Coverage page for
coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

36 Lung.org American Lung Association “State of Tobacco Control” 2024

Alaska State Highlights:
2024
Tobacco use remains the leading cause

A
Alaska State Facts
of preventable death and disease in the
Health Care Cost Due to Smoking: $438,143,263

L
United States and in Alaska. To address
this enormous toll, the American Lung Adult Smoking Rate: 15.9%

A
Association calls for the following
High School Smoking Rate: 8.4%
actions to be taken by Alaska’s elected officials:

S
1. Appropriate and maintain funding for the state’s High School Tobacco Use Rate: N/A

K
tobacco prevention and control program; and Middle School Smoking Rate: N/A
2. Achieve tax parity for all tobacco products.

A
Smoking Attributable Deaths: 610
In the 2023 Alaska legislative session, Senator Gary
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Stevens introduced Senate Bill 89 to tax electronic Surveillance System. High school smoking data comes from CDCs 2019
cigarettes. The bill was also sponsored by Senators Youth Risk Behavior Surveillance System. A current high school tobacco
use rate and middle school smoking rate is not available for this state.
Giessel, Gray-Jackson, Kiehl and Tobin. SB 89 also Health impact information is taken from the Smoking Attributable Mortality,
proposed aligning state law with the federal law raising Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
the minimum age to buy, sell or possess tobacco and are calculated for persons aged 35 years and older. Smoking-attributable
electronic smoking products from age 19 to 21. healthcare expenditures based on 2004 smoking-attributable fractions
and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state. Alaska State Highlights:
SB 89 received a dual referral to the Senate Finance
and Labor and Commerce committees; the bill passed
both committees and moved to the Senate Floor
where it passed on third reading on May 16, 2023, with
14 yeas and 6 nays.
Prior to the end of the 2023 legislative session, the bill
was transmitted to the House for consideration. The
bill carries over and will be considered by the House
chamber during the 2024 legislative session.
Allocation of funding for tobacco prevention and
control programs in Alaska for fiscal year 2024 was set
at $6.5 million, which was a similar level to last year,
but maintains a significant cut from two years ago.
The Lung Association will continue to advocate for
returning to the previous higher level of funding.
In 2024, the American Lung Association will continue
to work with our volunteers and stakeholders to
continue efforts to raise tobacco taxes to reduce
consumption and delay youth initiation and ensure
adequate funding for prevention and quit programs.

37 Lung.org American Lung Association “State of Tobacco Control” 2024

 Arizona Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
N

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $18,000,000
O

Tax Rate per pack of 20: $2.00

FY2024 Federal Funding for
State Tobacco Control Programs: $1,708,792* OTHER TOBACCO PRODUCT TAXES:
Z

FY2024 Total Funding for Tax on Little Cigars: Equalized: No; Weight-Based: No
I

State Tobacco Control Programs: $19,708,792 Tax on Large Cigars: Equalized: No; Weight-Based: No
R

CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes
State Spending Recommendation: $64,400,000
Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: Yes
A

Percentage of CDC Recommended Level: 30.6%

Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A
State Tobacco-Related Revenue: $389,000,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

Smokefree Air: B Access to Cessation Services: C

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: All 7 medications are covered
Schools: Prohibited Medicaid Counseling: Some counseling is covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Some barriers exist to access
care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: Prohibited (tribal
establishments not subject to state law) Medications: All 7 medications are covered
Retail stores: Prohibited Counseling: Some counseling is covered
E-Cigarettes Included: No Barriers to Coverage: Some barriers exist to access care
Preemption/Local Opt-Out: No STATE QUITLINE:
Citation: ARIZ. REV. STAT. § 36-601.01 & AZ ADMIN RULES §§ Investment per Smoker: $3.01; the median investment per
R9-2-101 to R9-2-112 (2007). smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Arizona Tobacco Cessation Coverage page for
coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

38 Lung.org American Lung Association “State of Tobacco Control” 2024

Arizona State Highlights:
2024
Tobacco use remains the leading cause During the 2024 legislative session, the American

A
of preventable death and disease in the Lung Association will again work diligently to educate

R
United States and in Arizona. To address our lawmakers on the enormous negative economic
this enormous toll, the American Lung impacts that tobacco use has on Arizona. Creating

I
Association calls for the following a tobacco retailer licensing system and opposing all
actions to be taken by Arizona’s elected officials: forms of statewide preemption on tobacco product

Z
1. Enact a statewide tobacco retailer licensing system; sales laws will continue to be a priority.

O
2. Oppose all forms of statewide preemption for sales Arizona State Facts

N
or use of tobacco products; and Health Care Cost Due to Smoking: $2,383,033,467
3. Increase state funding for tobacco prevention and

A
Adult Smoking Rate: 12.7%
cessation programs.
High School Smoking Rate: 3.4%
The American Lung Association continues to
champion tobacco control issues in Arizona by High School Tobacco Use Rate: 17.4%
leading legislative efforts and partnering with key
Middle School Smoking Rate: 2.4%
organizations, state departments, and legislators to
ensure tobacco education and prevention remains Smoking Attributable Deaths: 8,250
among the state’s top priorities.
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
In 2023, funding for Arizona’s tobacco control Surveillance System. High school smoking and tobacco use data come
from the 2021 Youth Risk Behavior Surveillance System. Middle school
program, Tobacco Free Arizona, went from $17.7 million smoking rate is taken from the 2017 Youth Tobacco Survey.
in fiscal year 2023 to $18 million in fiscal year 2024. The Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
program is funded by a percentage of revenue from deaths reflect average annual estimates for the period 2005-2009 and
tobacco taxes, and funding has remained relatively are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
consistent over the years. However, the American Lung and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
Association in Arizona keeps a close eye on funding
levels to ensure these vital tobacco prevention and
quit smoking programs receive the funding dedicated
to them. Even at current funding levels, the state
remains well short of Centers for Disease Control and
Prevention recommended levels.
During the 2023 legislative session, the Lung
Association in Arizona worked on legislation to
create a statewide tobacco retail license, raise the
sales age of tobacco products to 21, and to include
electronic smoking devices in the Clean Indoor Air Act.
Unfortunately, there was a competing bill introduced by
the tobacco industry that had a weak statewide retail
license system and also added preemption that would
have prevented local communities from passing any
stronger local laws on tobacco product sales, including
tobacco retail licensing and flavors. The tobacco
industry bill also raised the penalty on youth under the
age of sale for possessing tobacco products. Neither
bill ultimately advanced to the Governor.
On the local front, the Lung Association along with
a coalition of partners continue to work with city
councilmembers in Tempe enacting a tobacco retailer
license and worked with the City of Flagstaff to
implement their licensing requirement passed in 2019.

39 Lung.org American Lung Association “State of Tobacco Control” 2024

 Arkansas Report Card
2024
S

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
A

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $11,021,036
S

Tax Rate per pack of 20: $1.15

FY2024 Federal Funding for
N

State Tobacco Control Programs: $1,103,153* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
A

State Tobacco Control Programs: $12,124,189 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No
K

State Spending Recommendation: $36,700,000

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 33%
R

Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A

State Tobacco-Related Revenue: $273,200,000
For more information on tobacco taxes, go to:
A

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati

from the Centers for Disease Control and Prevention.
Note: The Arkansas Legislature appropriated $14,575,685 to the
Arkansas Tobacco Prevention and Cessation Program, however, only
$11,021,036 has been allocated for tobacco prevention and control
activities. The Arkansas Tobacco Prevention and Cessation Program
Access to Cessation Services: C
is mandated by law to distribute funding to other agencies. The
total funding amount above includes the activities of the Arkansas OVERVIEW OF STATE CESSATION COVERAGE
Department of Health’s Tobacco Prevention and Cessation Program,
tobacco prevention activities of the Minority Health and Health Disparities STATE MEDICAID PROGRAM:
Program and the Arkansas Tobacco Control Board.
Medicaid Medications: All 7 medications are covered
Medicaid Counseling: Some types of counseling are covered
Smokefree Air: C Medicaid Barriers to Coverage: Some barriers exist to access
care
OVERVIEW OF STATE SMOKING RESTRICTIONS
Medicaid Expansion: Yes
Government work sites: Prohibited
Private work sites: Prohibited (non-public workplaces with STATE EMPLOYEE HEALTH PLAN(S):
three or fewer employees exempt) Medications: Some medications are covered
Schools: Prohibited Counseling: Some counseling is covered
Child care facilities: Prohibited Barriers to Coverage: Some barriers exist to access care
Restaurants: Restricted* STATE QUITLINE:
Bars: Restricted* Investment per Smoker: $1.93; the median investment per
Casinos/Gaming Establishments: Restricted smoker is $1.93

Retail stores: Prohibited OTHER CESSATION PROVISIONS:

E-Cigarettes Included: Only in K-12 schools & some colleges Private Insurance Mandate: No provision

Preemption/Local Opt-Out: No Tobacco Surcharge: Limits tobacco surcharges

Citation: ARK. CODE ANN. §§ 20-27-1801 et seq. (2019). Citation: See Arkansas Tobacco Cessation Coverage page for
coverage details.
* Smoking is allowed in restaurants and bars that do not allow persons
under 21 to enter at any time.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

40 Lung.org American Lung Association “State of Tobacco Control” 2024

Arkansas State Highlights:
2024
Tobacco use remains the leading cause state’s constitutionally required balanced budget.

A
of preventable death and disease in The Lung Association and its partner health

R
the United States and in Arkansas. organizations will continue to lay the groundwork
To address this enormous toll, the for a campaign to repeal the state law that prohibits

K
American Lung Association calls for the local governments from passing tobacco control
following actions to be taken by Arkansas’s elected ordinances in their communities. Alongside this

A
officials: effort, the Lung Association will engage community

N
1. Ensure continued access to tobacco use treatment partners to support local tobacco policies that are
services for all those who want to quit smoking, not preempted by state law. This is priority work and

S
including comprehensive coverage for such an ongoing campaign to give Arkansas cities and
services under Medicaid; counties the option to adopt meaningful tobacco

A
2. Allocate state funding of $14.6 million for the control measures to protect the health of their
residents. As the legislature begins its work in 2024,

S
Arkansas Tobacco Prevention and Cessation
Program and ensure that funding is spent according the Lung Association will continue its efforts to
to CDC’s Best Practices for Comprehensive educate policymakers, business leaders and media
Tobacco Control Programs; and on the importance of the American Lung Association’s
goals to reduce all tobacco use, including e-cigarettes,
3. Repeal state preemption of local tobacco control and to protect public health.
authority.
During the 2023 session of the legislature, the Arkansas State Facts
American Lung Association worked to ensure funding Health Care Cost Due to Smoking: $1,215,082,968
for Medicaid expansion was included in the state’s
Adult Smoking Rate: 18.7%
constitutionally required balanced budget. Maintaining
Medicaid expansion in the state is important for High School Smoking Rate: 4.9%
reducing tobacco use because it provides low-cost
High School Tobacco Use Rate: 20%
access to quit smoking medications and services
for a population, Medicaid enrollees, that smoke at Middle School Smoking Rate: N/A
significantly higher rates.
Smoking Attributable Deaths: 5,790
The Lung Association also supported providing $14.6
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
million in funding for Arkansas’s Tobacco Prevention Surveillance System. High school smoking and tobacco use data come
and Cessation Program, which was passed in House from the 2021 Youth Risk Behavior Surveillance System. A current middle
school smoking rate is not available for this state.
Bill 1080. However, a portion was required to be Health impact information is taken from the Smoking Attributable Mortality,
used for purposes other than the tobacco control Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
program this year leaving only $11 million total for are calculated for persons aged 35 years and older. Smoking-attributable
tobacco prevention and reduction activities. This healthcare expenditures based on 2004 smoking-attributable fractions
and 2009 personal healthcare expenditure data. Deaths and expenditures
program is charged with developing and implementing should not be compared by state.
a statewide comprehensive tobacco education,
prevention, and cessation program.
The Arkansas Tobacco Prevention and Cessation
Program (ARTPCP) supports initiatives like Project
Prevent Youth Coalition, consisting of students all over
the state who choose to live their lives tobacco and
nicotine free, and encourage others to do the same. Be
Well Arkansas (the state’s tobacco Quitline); the Coral’s
Reef tobacco youth education program; and Be Well
Baby are also provided by the ARTPCP.
During the 2024 fiscal session of the legislature,
the Lung Association will work to ensure funding
for Medicaid expansion and Arkansas’ Tobacco
Prevention and Cessation Program are included in the

41 Lung.org American Lung Association “State of Tobacco Control” 2024

 California Report Card
2024
A

Tobacco Prevention and

Control Program Funding: C Tobacco Taxes: C
I

FY2024 State Funding for CIGARETTE TAX:

N

Tobacco Control Programs: $208,052,000

Tax Rate per pack of 20: $2.87
FY2024 Federal Funding for
R

State Tobacco Control Programs: $3,571,588* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
O

State Tobacco Control Programs: $211,623,588 Tax on Large Cigars: Equalized: Yes; Weight-Based: No
F

CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No

State Spending Recommendation: $347,900,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
I

Percentage of CDC Recommended Level: 60.8%

Tax on E-cigarettes: Equalized: Yes; Weight-Based: No
L

State Tobacco-Related Revenue: $2,577,900,000

For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
A

from the Centers for Disease Control and Prevention.

C

Smokefree Air: A Access to Cessation Services: A*

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: All 7 medications are covered
Schools: Prohibited (public schools only) Medicaid Counseling: All 3 forms of counseling are covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Minimal barriers exist to
access care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: Prohibited (tribal
establishments not subject to state law) Medications: Data not provided
Retail stores: Prohibited Counseling: Data not provided
E-Cigarettes Included: Yes Barriers to Coverage: Data not provided
Preemption/Local Opt-Out: No STATE QUITLINE:
Citation: CA LABOR CODE § 6404.5; CA GOVT. CODE §§ Investment per Smoker: $4.61; the median investment per
7596 to 7598; CA EDUC. CODE §§ 48900(h) & 48901; & CA smoker is $1.93
HEALTH & SAFETY CODE § 1596.795 (2016).
OTHER CESSATION PROVISIONS:
Thumbs up for Governor Newsom for vetoing
U legislation that would have weakened California’s
Private Insurance Mandate: Yes
comprehensive smokefree air law. Tobacco Surcharge: Prohibits tobacco surcharges
Citation: See California Tobacco Cessation Coverage page for
coverage details.
* California was not able to provide State Employee Health Plan tobacco
cessation coverage data this year. This part of the grade was excluded
from the grade calculation.

Flavored Tobacco Products: B

Restrictions on Flavored Tobacco Products: Most flavored
tobacco products prohibited

42 Lung.org American Lung Association “State of Tobacco Control” 2024

California State Highlights:
2024
Tobacco use remains the leading cause California’s Proposition 56, approved by voters in

C
of preventable death and disease in 2016, increased the state cigarette tax by $2.00 per

A
the United States and in California. pack, and continues to direct much-needed funds to
To address this enormous toll, the California’s Tobacco Control Program, helping tobacco

L
American Lung Association calls for the users quit and preventing children from starting.
following actions to be taken by California’s elected

I
In 2024, the American Lung Association will
officials: monitor the implementation of California’s state

F
1. Continue to pass restrictions on the sale of flavored flavored tobacco product law and encourage local

O
tobacco on the local level; and communities to pass more robust policies that close
2. Enact stronger tobacco control laws throughout the state law loopholes. The Lung Association will also

R
state, particularly limitations on secondhand smoke continue our work to pass other local tobacco control
and tobacco product sales. policies, focusing on restricting tobacco product sales

N
and limiting exposure to secondhand smoke.
In 2023, California continued its progress and

I
nationwide leadership on tobacco control. The California State Facts

A
California legislature passed Senate Bill 626 (Senator
Health Care Cost Due to Smoking: $13,292,359,950
Rubio), smoking in the workplace: transient lodging
establishments, which makes all hotel and motel Adult Smoking Rate: 9.7%
guestrooms and transient lodging establishments High School Smoking Rate: 1.2%
100% smokefree. By eliminating the existing exemption
in state law that permits hotels and motels to allow High School Tobacco Use Rate: 6.6%
smoking in up to 20% of guestroom accommodations, Middle School Smoking Rate: 0.4%
it is now illegal to smoke completely in hotels and
motels. Smoking Attributable Deaths: 39,950

California Governor Gavin Newsom continued to Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school (10th and 12th grade only) smoking
protect workers from secondhand smoke by vetoing and tobacco use and middle school (8th grade only) smoking data come
Assembly Bill 374 (Assemblymember Haney), from the 2022 California Youth Tobacco Survey. High school tobacco
use includes cigarettes, cigars, smokeless tobacco, and electronic vapor
which would have allowed cannabis consumption products, as well as hookah and heated tobacco products, making it
incomparable to other states.
lounges to sell non-cannabis infused food and host
Health impact information is taken from the Smoking Attributable Mortality,
live entertainment, thereby exposing workers to Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
secondhand smoke. deaths reflect average annual estimates for the period 2005-2009 and
are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
In addition to these significant achievements, and 2009 personal healthcare expenditure data. Deaths and expenditures
the California legislature passed Assembly Bill should not be compared by state.

935 (Assemblymember Connolly), which added

enforcement language to California’s statewide
flavored tobacco law. The bill makes provisions
of the flavored tobacco law punishable by civil
penalties similar to the Stop Tobacco Access to Kids
Enforcement (STAKE) Act.
Throughout 2023, localities across the state continued
their efforts to pass comprehensive flavored tobacco
laws, in some cases stronger than state law. This
included Marin County, Kern County, Monterey, as well
as the city of Stockton. In addition to the local flavored
tobacco ordinances, progress continued on other
comprehensive tobacco control measures across
the state in large and small localities. Localities also
passed laws prohibiting smoking in multiunit housing,
making certain outdoor locations smoke-free, and to
reduce the number and density of tobacco retailers.

43 Lung.org American Lung Association “State of Tobacco Control” 2024

 Colorado Report Card
2024
O

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: C
D

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $22,752,228
A

Tax Rate per pack of 20: $1.94

FY2024 Federal Funding for
State Tobacco Control Programs: $1,692,350* OTHER TOBACCO PRODUCT TAXES:
R

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
O

State Tobacco Control Programs: $24,444,578 Tax on Large Cigars: Equalized: Yes; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No
L

State Spending Recommendation: $52,900,000

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 46.2%
O

Tax on E-cigarettes: Equalized: Yes; Weight-Based: No

State Tobacco-Related Revenue: $437,200,000
For more information on tobacco taxes, go to:
C

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati

from the Centers for Disease Control and Prevention.

Smokefree Air: B Access to Cessation Services: A

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited (certain marijuana Medicaid Medications: All 7 medications are covered
establishments exempt) Medicaid Counseling: All 3 types of counseling are covered
Schools: Prohibited Medicaid Barriers to Coverage: No barriers exist to access
Child care facilities: Prohibited care
Restaurants: Prohibited (certain marijuana establishments Medicaid Expansion: Yes
exempt)
STATE EMPLOYEE HEALTH PLAN(S):
Bars: Prohibited (allowed in cigar-tobacco bars)
Medications: Most medications are covered
Casinos/Gaming Establishments: Prohibited (tribal
Counseling: Some counseling is covered
establishments not subject to state law)
Barriers to Coverage: Minimal barriers exist to access care
Retail stores: Prohibited
E-Cigarettes Included: Yes (certain marijuana establishments STATE QUITLINE:
exempt) Investment per Smoker: $6.55; the median investment per
Preemption/Local Opt-Out: No smoker is $1.93

Citation: COLO. REV. STAT. ANN. §§ 25-14-201 et seq. (2020). OTHER CESSATION PROVISIONS:
Private Insurance Mandate: Yes
Tobacco Surcharge: Limits tobacco surcharges
Citation: See Colorado Tobacco Cessation Coverage page for
coverage details.

U Thumbs up for Colorado for providing comprehensive

coverage for all tobacco cessation medications and
types of counseling to Medicaid enrollees with minimal
barriers.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

44 Lung.org American Lung Association “State of Tobacco Control” 2024

Colorado State Highlights:
2024
Tobacco use remains the leading cause purchase, use and possession of tobacco products;

C
of preventable death and disease in • Silverton: Updated tobacco retail licensing fees and

O
the United States and in Colorado. required two annual compliance checks from local
To address this enormous toll, the health department; and

L
American Lung Association calls for the
following actions to be taken by Colorado’s elected • Denver: Updated penalties for tobacco retailers to

O
officials: include suspension and revocation of licenses.
The Lung Association will continue to advocate for

R
1. Eliminate the sale of all flavored tobacco products;
Colorado policymakers to exercise their authority at
2. Expand local tobacco retail licensure programs; and both the state and local levels to enact policies that

A
3. Protect and close remaining loopholes in state or reduce the burden of tobacco in our state.

D
local smokefree laws.
Colorado State Facts
The American Lung Association in Colorado supports

O
evidence-based policy interventions to reduce Health Care Cost Due to Smoking: $1,891,467,308
tobacco use rates and prevent youth initiation. Adult Smoking Rate: 10.7%
Together with our partners, the Lung Association
High School Smoking Rate: 4.5%
works to ensure tobacco control and prevention
remains a priority for state legislators and local High School Tobacco Use Rate: 18.9%
decisionmakers.
Middle School Smoking Rate: 1.4%
The Lung Association continued to educate elected
officials and the general public about the negative Smoking Attributable Deaths: 5,070
public health impacts of tobacco use in Colorado Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
in 2023, and the ongoing importance of providing Surveillance System. High school smoking and tobacco use rates are
taken from the 2021 Youth Risk Behavior Surveillance System. Middle
adequately funded tobacco prevention and cessation school smoking rate is taken from the 2019 Colorado Healthy Kids Survey.
programs. We also remain engaged with the Colorado Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
Attorney General’s office as it decides how to disperse deaths reflect average annual estimates for the period 2005-2009 and
$31.7 million in settlement funds resulting from the are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
state’s lawsuit against Juul Labs. The Lung Association and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
advocates that settlement funds be directed to
evidence-based prevention programs.
The legislature placed a measure on the November
2023 ballot (Proposition II) to maintain tobacco
taxes at levels that voters approved in 2020 under
Proposition EE. The Lung Association endorsed
Proposition II, as we did with Proposition EE. Colorado’s
Taxpayer Bill of Rights (TABOR) required voter approval
on Proposition II to avoid a $23.65 million refund to
tobacco wholesalers and reduced tobacco taxes,
which would have led to fewer resources directed to
tobacco prevention programs. Voters overwhelmingly
approved Proposition II 67.5% to 32.5%.
Several localities had success in enacting stronger
tobacco control policies in 2023:
• Pitkin County: Tobacco retail licensure and a
prohibition of future tobacco retailers;
• Golden: Ending the sale of all flavored tobacco
products as well as repealing penalties for underage
purchase, use and possession of tobacco products;
• Larimer County: Repealing penalties for underage

45 Lung.org American Lung Association “State of Tobacco Control” 2024

 Connecticut Report Card
2024
T

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: B
U

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $12,642,664
C

Tax Rate per pack of 20: $4.35

FY2024 Federal Funding for
OTHER TOBACCO PRODUCT TAXES:
I

State Tobacco Control Programs: $1,177,808*

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
T

State Tobacco Control Programs: $13,820,472 Tax on Large Cigars: Equalized: No; Weight-Based: No
C

CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes
State Spending Recommendation: $32,000,000
Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: No
E

Percentage of CDC Recommended Level: 43.2%

Tax on E-cigarettes: Equalized: No; Weight-Based: Yes
State Tobacco-Related Revenue: $433,600,000
N

For more information on tobacco taxes, go to:

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.
N

C
O

Smokefree Air: B Access to Cessation Services:

C

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: All 7 medications are covered
Schools: Prohibited Medicaid Counseling: All 3 types of counseling are covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Minimal barriers exist to
access care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited (allowed in tobacco bars)
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: Prohibited (tribal
establishments not subject to state law) Medications: All 7 medications are covered
Retail stores: Prohibited Counseling: All 3 types of counseling are covered
E-Cigarettes Included: Yes Barriers to Coverage: Minimal barriers exist to access care
Preemption/Local Opt-Out: Yes STATE QUITLINE:
Citation: CONN. GEN. STAT. §§ 19a-342, 19a-342a and 31- Investment per Smoker: $0.39; the median investment per
40q (2021). smoker is $1.93
* If Connecticut repealed preemption of stronger local smokefree OTHER CESSATION PROVISIONS:
ordinances, the state’s grade would be an “A.”
Private Insurance Mandate: Yes
Tobacco Surcharge: Prohibits tobacco surcharges in some
plans
Citation: See Connecticut Tobacco Cessation Coverage page
for coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

46 Lung.org American Lung Association “State of Tobacco Control” 2024

Connecticut State Highlights:
2024
Tobacco use remains the leading cause In June 2023, the reconstituted Tobacco and Health

C
of preventable death and disease in Trust Fund Board met for the first time. Advocates are

O
the United States and in Connecticut. looking forward to the expenditure of funds towards
To address this enormous toll, the best practice programs and a robust and sustainable

N
American Lung Association calls for the investment in combatting the leading cause of
following actions to be taken by Connecticut’s elected preventable death and disease in the state. The Lung

N
officials: Association and our community partners will continue
1. Protect and increase funding for tobacco prevention to advance proven policy issues with heightened

E
and cessation programs; efforts to enhance our partnerships and amplify the
voices of people disproportionately burdened by

C
2. Defend the state’s indoor air laws protecting tobacco use. The Lung Association looks forward to
residents from secondhand smoke; and

T
advancing Connecticut’s tobacco control policy and
3. Reduce youth access to tobacco through local working towards a healthier Connecticut in 2024.

I
flavor ordinances and zoning regulations in cities
Connecticut State Facts

C
and towns.
After a very promising year in the 2022 Connecticut Health Care Cost Due to Smoking: $2,038,803,314

U
General Assembly, the 2023 session had mixed results Adult Smoking Rate: 10%
when it comes to tobacco control policy. Advocates

T
were discouraged that the initial Governor’s budget High School Smoking Rate: 1.3%
proposed a 50% cut to the year’s allocation to the High School Tobacco Use Rate: 10.6%
Tobacco and Health Trust Fund, before the first deposit
Middle School Smoking Rate: N/A
established the previous year was even available
to spend. However, champions in the legislature Smoking Attributable Deaths: 4,900
demonstrated a dedication to ensuring the Tobacco
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
and Health Trust Fund (THTF) could get off the ground Surveillance System. High school smoking and tobacco use rates are
and level funded the THTF for Fiscal Year 2024 at $12 taken from the 2021 Youth Risk Behavior Surveillance System. A current
middle school smoking rate is not available for this state.
million. Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
The legislature also passed bills requiring the Juul deaths reflect average annual estimates for the period 2005-2009 and
settlement funds be used towards youth tobacco are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
prevention work and that the Tobacco and Health Trust and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
Fund dollars be dispersed according to the CDC Best
Practices. Unfortunately, the legislature also passed a
law that will allow cigar bars back into the state. While
somewhat limited in the number and location, public
health advocates are very concerned about what
this will mean moving forward, especially considering
proponents of the bill specifically stated they see this
as a pilot program with the hope for growth in coming
years.
In addition, during the 2023 legislative session, many
groups worked to remove flavored tobacco products
from the marketplace. Because the proposed policy
failed to include all products and protections for all
people, the Lung Association could not support this
legislation. The Lung Association will continue to build
community partnerships and educate community
leaders about the detrimental role flavors play in
attracting youth to nicotine addiction with the goal to
eventually remove all flavored commercial tobacco
products from the market.

47 Lung.org American Lung Association “State of Tobacco Control” 2024

 Delaware Report Card
2024
E

Tobacco Prevention and

Control Program Funding: A Tobacco Taxes: F
R

FY2024 State Funding for CIGARETTE TAX:

A

Tobacco Control Programs: $9,654,500

Tax Rate per pack of 20: $2.10
FY2024 Federal Funding for
W

State Tobacco Control Programs: $991,511* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: No; Weight-Based: No
A

State Tobacco Control Programs: $10,646,011 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes
L

State Spending Recommendation: $13,000,000

Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: No
Percentage of CDC Recommended Level: 81.9%
E

Tax on E-cigarettes: Equalized: No; Weight-Based: Yes

State Tobacco-Related Revenue: $130,600,000
For more information on tobacco taxes, go to:
D

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati

from the Centers for Disease Control and Prevention.

Smokefree Air: A Access to Cessation Services: B

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: Most medications are covered
Schools: Prohibited Medicaid Counseling: Some counseling is covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Some barriers exist to access
care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: Prohibited
Medications: Some cessation medications are covered
Retail stores: Prohibited
Counseling: All 3 forms of counseling are covered
E-Cigarettes Included: Yes
Barriers to Coverage: Minimal barriers exist to access care
Preemption/Local Opt-Out: No
Citation: DEL. CODE ANN. tit. 16, §§ 2901 et seq. (2015). STATE QUITLINE:
Investment per Smoker: $13.39; the median investment per
smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: Yes
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Delaware Tobacco Cessation Coverage page for
coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

48 Lung.org American Lung Association “State of Tobacco Control” 2024

Delaware State Highlights:
2024
Tobacco use remains the leading cause the Centers for Disease Control and Prevention’s

D
of preventable death and disease in recommended level. The Lung Association believes

E
the United States and in Delaware. funding for this vital program needs to continue to be
To address this enormous toll, the increased especially considering the continued high

L
American Lung Association calls for the youth use of electronic cigarettes.
following actions to be taken by Delaware’s elected

A
The American Lung Association in Delaware
officials: will continue to educate lawmakers and identify

W
1. Protect Delaware’s tobacco tax structure and champions in the ongoing fight against tobacco. Our
defend any attempted rollbacks on specific goal is to build champions within the legislature and

A
products; at the grassroots level to advance our goals which
2. Fund tobacco prevention and cessation programs include protecting the current tobacco tax structure

R
at the Centers for Disease Control and Prevention in place by opposing any attempts to roll back taxes
on specific products and protect the much-needed

E
(CDC) recommended level and protect recent
increases in funding; and increased funding for tobacco prevention and control
programs.
3. Increase the cigarette tax by at least $1.00 per
pack and create greater parity between the tax on Delaware State Facts
cigarettes and other tobacco products.
Health Care Cost Due to Smoking: $532,321,239
The 2023 legislative session was the first year of
Adult Smoking Rate: 12.9%
the 152nd General Assembly of Delaware’s two-year
session. In 2023, the American Lung Association High School Smoking Rate: 2.7%
in Delaware along with other public health partners
High School Tobacco Use Rate: 18.3%
were successful in maintaining the increase in critical
funding for tobacco prevention and cessation. Middle School Smoking Rate: N/A
During the 2023 session a bill which would decrease Smoking Attributable Deaths: 1,440
the tax rate on “premium” cigars from 30% to 20% of
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
the wholesale price was re-introduced. This reduction Surveillance System. High school smoking and tobacco use rates are
would undermine Delaware’s comprehensive tax taken from the 2019 Youth Risk Behavior Surveillance System. A current
middle school smoking rate is not available for this state.
strategy that was passed in 2017 which attempted Health impact information is taken from the Smoking Attributable Mortality,
to create some parity among tobacco products. Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
The Lung Association and its partners focused on are calculated for persons aged 35 years and older. Smoking-attributable
protecting Delaware’s tobacco tax structure and healthcare expenditures based on 2004 smoking-attributable fractions
and 2009 personal healthcare expenditure data. Deaths and expenditures
opposed this bill as an attempt to undermine it. The should not be compared by state.
bill was not addressed during the 2023 session but
will be carried over into the 2024 session and will be a
priority for the Lung Association.
Another important tool in fighting tobacco use in
Delaware is much needed funding for tobacco
prevention and cessation. The Delaware Health Fund
is where tobacco Master Settlement Agreement (MSA)
dollars received by the state have been directed since
within the first few years after the MSA was negotiated.
Delaware has been one of the few states to largely
keep promises made at the time and use the money
for health-related purposes. Total tobacco prevention
and cessation funding, which comes from this fund,
reflected a $2.5 million sustained increase due to
advocacy from the Lung Association at approximately
$9.6 million in fiscal year 2024. However, this amount
of funding is still lower than historical levels and below

49 Lung.org American Lung Association “State of Tobacco Control” 2024

 District of Columbia Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: A
I

FY2024 City Funding for CIGARETTE TAX:

B

Tobacco Control Programs: $1,900,000

Tax Rate per pack of 20: $4.50
FY2024 Federal Funding for
M

City Tobacco Control Programs: $1,031,660* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
U

City Tobacco Control Programs: $2,931,660 Tax on Large Cigars: Equalized: No; Weight-Based: N/A
CDC Best Practices
L

Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No

City Spending Recommendation: $10,700,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
O

Percentage of CDC Recommended Level: 27.4%

Tax on E-cigarettes: Equalized: Yes; Weight-Based: No
City Tobacco-Related Revenue: $61,500,000
C

For more information on tobacco taxes, go to:

* Includes tobacco prevention and cessation funding provided to the www.lung.org/slati
District from the Centers for Disease Control and Prevention.
F

Smokefree Air: A Access to Cessation Services: B*

O

OVERVIEW OF CITY SMOKING RESTRICTIONS OVERVIEW OF CITY CESSATION COVERAGE

Government work sites: Prohibited CITY MEDICAID PROGRAM:

Medicaid Medications: Most medications are covered
T

Private work sites: Prohibited

Schools: Prohibited Medicaid Counseling: Limited counseling is covered
C

Child care facilities: Prohibited Medicaid Barriers to Coverage: Minimal barriers exist to
access care
I

Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited (allowed in cigar bars and allows for an
R

economic hardship waiver) CITY EMPLOYEE HEALTH PLAN(S):

T

Casinos/Gaming Establishments: N/A Medications: Data not provided

Retail stores: Prohibited Counseling: Data not provided
S

E-Cigarettes Included: Yes Barriers to Coverage: Data not provided

I

Preemption/Local Opt-Out: No CITY QUITLINE:

D

Citation: D.C. CODE ANN. tit. 7 §§ 7-741.01 to 7-741.07 (2017). Investment per Smoker: $6.64; the median investment per
smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: Yes
Tobacco Surcharge: Prohibits tobacco surcharges
Citation: See District of Columbia Tobacco Cessation
Coverage page for coverage details.
*The District of Columbia was not able to provide City Employee Health
Plan tobacco cessation coverage data. This part of the grade was
excluded from the grade calculation.

Flavored Tobacco Products: A

Restrictions on Flavored Tobacco Products: All flavored
tobacco products prohibited in virtually all locations.

50 Lung.org American Lung Association “State of Tobacco Control” 2024

District of Columbia City Highlights:
2024
Tobacco use remains the leading cause recurring due to earlier year’s cigarette tax increase

D
of preventable death and disease in is a good thing, the amount remains far short of the

I
the United States and in the District of CDC-recommended level.
Columbia. To address this enormous

S
The American Lung Association in the District of
toll, the American Lung Association calls Columbia will continue to build champions within the

T
for the following actions to be taken by the District’s Council and develop a grassroots advocacy network to
elected officials: advance our 2024 goals which include the continued

R
1. Provide support to implement the law removing all implementation and enforcement of the legislation that
flavored tobacco products from the market and passed removing all flavored tobacco products from

I
ensure one agency within the District has oversight the market in the District and ensuring that tobacco-

C
for tobacco enforcement; related laws are enforced in a consistent and equitable
way.

T
2. Fund tobacco prevention and cessation programs at
the level recommended by the Centers for Disease
District of Columbia Facts
Control and Prevention (CDC); and
Health Care Cost Due to Smoking: $391,048,877

O
3. Improve the city’s Medicaid coverage for tobacco
cessation treatments to be comprehensive and Adult Smoking Rate: 10.6%

F
consistent across plans. High School Smoking Rate: 3.2%
During 2023, the American Lung Association in the
High School Tobacco Use Rate: 11.6%
District of Columbia along with a very active tobacco

C
coalition which includes both community-based Middle School Smoking Rate: N/A

O
organizations and national health organizations worked Smoking Attributable Deaths: 790
closely with the city’s Department of Licensing and

L
Consumer Protection (DLCP) and the Department of Adult smoking data comes from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking and tobacco use rates are
Health to ensure that the District’s law to remove all taken from the 2021 Youth Risk Behavior Surveillance System. A current

U
middle school smoking rate is not available for the city.
flavored tobacco products from the market was fully
Health impact information is taken from the Smoking Attributable Mortality,
implemented and enforced.

M
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
As part of the original legislation passed in June are calculated for persons aged 35 years and older. Smoking-attributable

B
healthcare expenditures based on 2004 smoking-attributable fractions
of 2021, an amendment was added to allow for and 2009 personal healthcare expenditure data. Deaths and expenditures
the consumption of hookah on site in specific age should not be compared by state.

I
restricted businesses as long as they met certain

A
requirements. The Lung Association is committed
to continuing to support DC Department of Health in
ensuring that the businesses operating currently do in
fact meet these requirements and have the necessary
approvals in place to continue to remain in operation.
The flavors law enforcement discussion continues to
highlight a broader issue that currently enforcement of
tobacco related laws resides in various departments
within DC Government and may not be enforced
at the same level. Moving forward, advocates will
encourage enforcement for all tobacco related issues
be consolidated to ensure they are enforced in the
most effective and consistent way. Advocates are also
recommending all revenue associated with the fines
be directed to enforcement efforts and to tobacco
control and prevention programming.
Funding for the District’s tobacco control program
remained at $1.9 million for fiscal year 2024. While the
fact that funding for the tobacco control program is

51 Lung.org American Lung Association “State of Tobacco Control” 2024

 Florida Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
D

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $83,764,833
I

Tax Rate per pack of 20: $1.339

FY2024 Federal Funding for
R

State Tobacco Control Programs: $2,587,647* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: N/A; Weight-Based: N/A
O

State Tobacco Control Programs: $86,352,480 Tax on Large Cigars: Equalized: N/A; Weight-Based: N/A
L

CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No

State Spending Recommendation: $194,200,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
F

Percentage of CDC Recommended Level: 44.5%

Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A
State Tobacco-Related Revenue: $1,432,400,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

U Thumbs up for Florida for constitutionally protecting

the allocation of tobacco settlement dollars to
its tobacco control program, so a consistent and
Access to Cessation Services: C*
increasing investment can be made.
OVERVIEW OF STATE CESSATION COVERAGE

C
STATE MEDICAID PROGRAM:
Smokefree Air:
Medicaid Medications: Most medications are covered
OVERVIEW OF STATE SMOKING RESTRICTIONS Medicaid Counseling: Some counseling is covered
Government work sites: Prohibited Medicaid Barriers to Coverage: Some barriers exist to access
care
Private work sites: Prohibited
Medicaid Expansion: No
Schools: Prohibited
Child care facilities: Prohibited STATE EMPLOYEE HEALTH PLAN(S):
Medications: Data not provided
Restaurants: Prohibited
Counseling: Data not provided
Bars: Restricted*
Barriers to Coverage: Data not provided
Casinos/Gaming Establishments: Prohibited (tribal
establishments not subject to state law) STATE QUITLINE:
Retail stores: Prohibited Investment per Smoker: $5.74; the median investment per
E-Cigarettes Included: Yes smoker is $1.93

Preemption/Local Opt-Out: Yes OTHER CESSATION PROVISIONS:

Citation: FLA. STAT. ch. 386.201 et seq. (2019). Private Insurance Mandate: No provision

* Smoking is allowed in bars that make 10% or less of their sales from Tobacco Surcharge: No prohibition or limitation on tobacco
food. surcharges
Citation: See Florida Tobacco Cessation Coverage page for
coverage details.
*Florida was not able to provide State Employee Health Plan tobacco
cessation coverage data. This part of the grade was excluded from the
grade calculation.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

52 Lung.org American Lung Association “State of Tobacco Control” 2024

Florida State Highlights:
2024
Tobacco use remains the leading cause to advocate for local control of tobacco prevention

F
of preventable death and disease in the and control policies to ensure that communities can

L
United States and in Florida. To address respond to the needs of their community through
this enormous toll, the American Lung policy change. The Lung Association will continue

O
Association calls for the following to educate on the need to enact a comprehensive
actions to be taken by Florida’s elected officials: tobacco retail licensing program that includes

R
1. Reinstate local control of the marketing, sale and e-cigarette retailers focused on strong regulation

I
delivery of tobacco and nicotine products to local with an annual licensing fee for all retailers, annual
compliance checks and enforcement.

D
government;
2. Institute strong regulation and licensing of all Florida State Facts

A
tobacco retailers, including electronic cigarette Health Care Cost Due to Smoking: $8,643,645,763
retailers, with annual compliance and enforcement;
and Adult Smoking Rate: 11.3%

3. Guarantee access to comprehensive quit tobacco High School Smoking Rate: 3.3%
coverage with no barriers to care for Medicaid
High School Tobacco Use Rate: N/A
recipients.
Middle School Smoking Rate: 1.1%
Florida experienced no movement on tobacco
prevention and control policies during the 2023 Smoking Attributable Deaths: 32,300
legislative session. Representative Jervonte “Tae”
Adult smoking data comes from CDC’s 2022 Behavioral Risk Factor
Edmonds and Senator Tina Scott Polsky introduced Surveillance System. High school smoking data are taken from the 2021
Youth Risk Behavior Survey and middle school smoking data are taken
House Bill 519 and Senate Bill 530 to reinstate the local from the 2020 Florida Youth Tobacco Survey. A current high school
control of marketing, sale and delivery of tobacco and tobacco use rate is not available for this state.

nicotine products to local government. Unfortunately, Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
neither piece of legislation was heard in committee. deaths reflect average annual estimates for the period 2005-2009 and
are calculated for persons aged 35 years and older. Smoking-attributable
The American Lung Association was able to protect healthcare expenditures based on 2004 smoking-attributable fractions
and 2009 personal healthcare expenditure data. Deaths and expenditures
funding for Tobacco Free Florida and ensure the total should not be compared by state.
Fiscal Year 2024 program budget of $83,388,848.
Funding will continue to be dedicated to tackling the
youth e-cigarette epidemic. The Tobacco Free Florida
program is committed to providing a variety of free
services to assist individuals with smoking cessation.
In addition to the $15.5 million allocated for Quitline
services and implementation of a referral program,
the program dedicates an additional $9.1 million for in-
person cessation counseling.
Despite most tobacco control policies being prevented
locally, there is continued education and activity
across Florida through the tobacco free partnerships.
In fact, many municipalities and counties capitalized
on the reinstated authority to regulate the smoking
of tobacco products and/or e-cigarettes on public
beaches and parks. This has included, but not limited
to the areas of Clearwater Beach, St. Pete Beach,
Sarasota, Hernando County, Miami-Dade County,
Miami Beach, Fort Lauderdale, Palm Beach, Monroe
County, St. Augustine, Neptune Beach, Atlantic Beach,
Fernandina Beach, Panama City Beach, and Treasure
Island.
In 2024, the American Lung Association will continue

53 Lung.org American Lung Association “State of Tobacco Control” 2024

 Georgia Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
I

FY2024 State Funding for CIGARETTE TAX:

G

Tobacco Control Programs: $2,173,346

Tax Rate per pack of 20: $0.37
FY2024 Federal Funding for
R

State Tobacco Control Programs: $2,127,823* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: No; Weight-Based: No
O

State Tobacco Control Programs: $4,301,169 Tax on Large Cigars: Equalized: Yes; Weight-Based: No
E

CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No

State Spending Recommendation: $106,000,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
G

Percentage of CDC Recommended Level: 4.1%

Tax on E-cigarettes: Equalized: No; Weight-Based: Yes
State Tobacco-Related Revenue: $423,700,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention

D Thumbs down for Georgia for having the second lowest

cigarette tax in the country at 37 cents per pack.
Smokefree Air: F
OVERVIEW OF STATE SMOKING RESTRICTIONS Access to Cessation Services: F
Government work sites: Prohibited
OVERVIEW OF STATE CESSATION COVERAGE
Private work sites: Restricted
STATE MEDICAID PROGRAM:
Schools: Prohibited
Medicaid Medications: All 7 medications are covered
Child care facilities: Prohibited
Medicaid Counseling: Some counseling is covered
Restaurants: Restricted
Medicaid Barriers to Coverage: Some barriers exist to access
Bars: Restricted care
Casinos/Gaming Establishments: N/A Medicaid Expansion: No
Retail stores: Restricted STATE EMPLOYEE HEALTH PLAN(S):
E-Cigarettes Included: Yes Medications: All 7 medications are covered
Preemption/Local Opt-Out: No Counseling: Most counseling is covered
Citation: GA. CODE ANN. §§ 31-12A-1 et seq. (2005). Barriers to Coverage: Some barriers exist to access care

STATE QUITLINE:
Investment per Smoker: $1.27; the median investment per
smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: No provision
Tobacco Surcharge: State has a tobacco surcharge for
Medicaid enrollees
Citation: See Georgia Tobacco Cessation Coverage page for
coverage details.

D Thumbs down for Georgia charging Medicaid enrollees

a tobacco surcharge to access healthcare.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

54 Lung.org American Lung Association “State of Tobacco Control” 2024

Georgia State Highlights:
2024
Tobacco use remains the leading cause

G
Georgia State Facts
of preventable death and disease
in the United States and in Georgia. Health Care Cost Due to Smoking: $3,182,695,641

E
]=
To address this enormous toll, the Adult Smoking Rate: 12.5%

O
American Lung Association calls for
High School Smoking Rate: 3.3%
the following actions to be taken by Georgia’s elected

R
officials: High School Tobacco Use Rate: 18.8%

G
1. Increase the cigarette tax to the current average Middle School Smoking Rate: N/A
cigarette tax and equalize taxes for all tobacco
Smoking Attributable Deaths: 11,690

I
products, including e-cigarettes;

A
2. Increase funding for the Georgia tobacco prevention Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking and tobacco use rates are
and control program; and taken from the 2021 Youth Risk Behavior Surveillance System. A current
middle school smoking rate is not available for this state.
3. Oppose all forms of preemption of local tobacco Health impact information is taken from the Smoking Attributable Mortality,
control authority. Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
During the 2023 legislative session in Georgia, several are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
pieces of legislation were introduced around tobacco and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
control policy. However, once again members of
the General Assembly did not make strong tobacco
prevention and control policies a priority.
Senate Bill 47 was championed by the state health
department and carried by Senator Chuck Hufstetler.
It added e-cigarette devices to the current Smokefree
Air Act while not closing the many loopholes in the
smokefree air law. The legislation did pass despite
efforts by the Lung Association and other partners to
make it more comprehensive.
Representative Ron Stephens sponsored House Bill 191
which would raise the tax rate on a pack of cigarettes
from 37 cents to 57 cents. The current tax rate is the
second lowest in the country. This bill did get a hearing
in subcommittee of Ways and Means but did not pass.
House Resolution 43, Costs and Effects of Smoking
Joint Study Committee was once again sponsored by
Representative Michelle Au. This bill unfortunately did
not get a hearing. A poll commissioned by the Georgia
Budget and Policy Institute (GBPI) and the University
of Georgia (UGA) released in February 2023, showed
that 63% of respondents would support moving the
tobacco tax rate to the national average.
In 2024, the American Lung Association in Georgia will
join our tobacco control partners to educate state and
local officials on the health and economic benefits of
strong tobacco control policies. This includes the state
policy goals highlighted above.

55 Lung.org American Lung Association “State of Tobacco Control” 2024

 Hawai‘i Report Card
2024
I

Tobacco Prevention and

Control Program Funding: C Tobacco Taxes: B
‘

FY2024 State Funding for CIGARETTE TAX:

I

Tobacco Control Programs: $7,526,817

Tax Rate per pack of 20: $3.20
A

FY2024 Federal Funding for

State Tobacco Control Programs: $1,156,607* OTHER TOBACCO PRODUCT TAXES:
W

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
State Tobacco Control Programs: $8,683,424 Tax on Large Cigars: Equalized: No; Weight-Based: No
A

CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No

State Spending Recommendation: $13,700,000
H

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No

Percentage of CDC Recommended Level: 63.4%
Tax on E-cigarettes: Equalized: Yes; Weight-Based: No
State Tobacco-Related Revenue: $131,800,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

U Thumbs up for Hawai‘i for equalizing the state

e-cigarette tax with the state cigarette and most other
Smokefree Air: A tobacco product taxes.

OVERVIEW OF STATE SMOKING RESTRICTIONS

Government work sites: Prohibited
Access to Cessation Services: A
Private work sites: Prohibited OVERVIEW OF STATE CESSATION COVERAGE
Schools: Prohibited STATE MEDICAID PROGRAM:
Child care facilities: Prohibited Medicaid Medications: All 7 medications are covered
Restaurants: Prohibited Medicaid Counseling: Some counseling is covered
Bars: Prohibited Medicaid Barriers to Coverage: Minimal barriers exist to
Casinos/Gaming Establishments: N/A access care

Retail stores: Prohibited Medicaid Expansion: Yes

E-Cigarettes Included: Yes STATE EMPLOYEE HEALTH PLAN(S):

Preemption/Local Opt-Out: No Medications: Some medications are covered
Citation: HAW. REV. STAT. §§ 328J-1 to 328J-15 (2016). Counseling: Some counseling is covered
Barriers to Coverage: Minimal barriers exist to access care

STATE QUITLINE:
Investment per Smoker: $8.44; the median investment per
smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Hawai‘i Tobacco Cessation Coverage page for
coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

D Thumbs down for Hawai‘i for failing to pass legislation

to end the sale of flavored tobacco products or to allow
local communities to do so.

56 Lung.org American Lung Association “State of Tobacco Control” 2024

Hawai‘i State Highlights:
2024
Tobacco use remains the leading cause in tobacco control, particularly in community-based

H
of preventable death and disease in the youth cessation programs, which currently is not

A
United States and in Hawai‘i. To address funded by the Hawai‘i Tobacco Prevention and Control
this enormous toll, the American Lung Trust Fund.

W
Association calls for the following Because the state legislature has failed to enact
actions to be taken by Hawai‘i’s elected officials: flavored tobacco products restrictions, it’s imperative

A
1. Prohibit the sale of all flavored tobacco products; that preemptions instituted in 2018 that prohibit
counties from creating tobacco control policies be

I
2. Repeal state preemption of county tobacco control
authority; and repealed. Allowing counties to have the ability to create

‘
stronger tobacco control laws will allow the adoption
3. Increase funding for tobacco prevention and

I
of innovative and place-appropriate laws.
cessation programs by protecting the Master
Settlement Agreement funds. The American Lung Association in Hawai‘i will continue
to work with its partners and volunteers in 2024 to
2023 was a year marked by major successes and place an emphasis on the value, both financial and
painful losses in tobacco control advocacy in Hawai‘i. health-related, of effective tobacco control policies.
Act 62 was signed into law by Governor Josh Green on We will continue to advocate for an increase in
June 6 with a large crowd of lawmakers and tobacco
control advocates looking on. The Act finally includes dedicated funding for tobacco control activities,
electronic smoking devices and e-liquids under eliminating the sale of all flavored tobacco products,
the definition of “tobacco products” for purposes and allowing counties to be able to determine tobacco
of the cigarette tax and tobacco tax law, bringing control laws for their residents.
parity amongst combustible tobacco products and Hawai‘i State Facts
e-cigarettes.
Health Care Cost Due to Smoking: $526,253,732
The act effectively established the tax rate for
electronic smoking devices and e-liquids at 70% of the Adult Smoking Rate: 10%
wholesale price, making the tax on e-cigarettes one High School Smoking Rate: 3%
of the highest in the nation. The act also increased the
license and permit fees for wholesalers, dealers, and High School Tobacco Use Rate: N/A
retailers and made it illegal to ship electronic smoking Middle School Smoking Rate: N/A
devices and liquids except to retailers.
Smoking Attributable Deaths: 1,420
While Act 62 was a major milestone in tobacco control,
various bills aiming to restrict the sale of flavored Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking rate is taken from the 2021
tobacco products died during the legislative session Youth Risk Behavior Surveillance System. A current high tobacco use rate
and middle school smoking rate are not available for this state.
(HB 1076, SB 1374, HB2347, SB2903, HB551, SB 496).
Health impact information is taken from the Smoking Attributable Mortality,
House Bill 551, the most successful in the bunch, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
passed the House but failed to get a single hearing deaths reflect average annual estimates for the period 2005-2009 and
are calculated for persons aged 35 years and older. Smoking-attributable
in the Senate. This marks the 9th year that similar healthcare expenditures based on 2004 smoking-attributable fractions
and 2009 personal healthcare expenditure data. Deaths and expenditures
legislation has died in the Hawai‘i Legislature. should not be compared by state.

The Coalition for a Tobacco-Free Hawai‘i and their

Youth Council were key partners in the success of
Act 62. The Youth Council organized highly effective
campaigns and visits to pressure lawmakers to
support the legislation. The Coalition staff and
members quickly mobilized partners and worked with
the media to create coverage of the issue.
While a lot has been achieved, a lot more is still
undone. To truly turn the tide of the youth vaping
epidemic, comprehensive tobacco control must be
enacted. This includes instituting full restrictions of all
flavored tobacco products and a continued investment

57 Lung.org American Lung Association “State of Tobacco Control” 2024

 Idaho Report Card
2024
O

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
H

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $3,877,600
A

Tax Rate per pack of 20: $0.57

FY2024 Federal Funding for
State Tobacco Control Programs: $1,171,888* OTHER TOBACCO PRODUCT TAXES:
D

FY2024 Total Funding for Tax on Little Cigars: Equalized: No; Weight-Based: No
I

State Tobacco Control Programs: $5,049,488 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No
State Spending Recommendation: $15,600,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 32.4%
Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A
State Tobacco-Related Revenue: $71,300,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

Smokefree Air: C Access to Cessation Services: B

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Restricted Medicaid Medications: All 7 medications are covered
Schools: Prohibited Medicaid Counseling: Minimal counseling is covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Minimal barriers exist to
access care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: No provision
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: Prohibited (tribal
establishments not subject to state law) Medications: All 7 medications are covered
Retail stores: Prohibited Counseling: Some counseling is covered
E-Cigarettes Included: No Barriers to Coverage: Some barriers exist to access care
Preemption/Local Opt-Out: No STATE QUITLINE:
Citation: IDAHO CODE §§ 39-5501 et seq. (2007). Investment per Smoker: $4.54; the median investment per
smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Idaho Tobacco Cessation Coverage page for
coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

58 Lung.org American Lung Association “State of Tobacco Control” 2024

Idaho State Highlights:
2024
Tobacco use remains the leading cause Committee’s commitment to reducing youth

I
of preventable death and disease in the tobacco use. During the 2024 legislative session, in

D
United States and in Idaho. To address collaboration with our tobacco prevention partners,
this enormous toll, the American Lung we will work with Committee members to expand

A
Association calls for the following investment in a comprehensive suite of evidence-
actions to be taken by Idaho’s elected officials: based programs and policy changes. These changes

H
1. Increase funding for tobacco prevention and control will keep youth from picking up their first nicotine

O
work in Idaho; product, support youth and adults in their quitting
efforts, and reduce exposure to secondhand smoke
2. Treat electronic smoking devices consistent with and e-cigarette aerosol statewide.
other commercial tobacco products in all areas
under state law; and Action is needed to reduce youth access to tobacco
and e-cigarette products and create parity between
3. Implement tobacco retail licensure fees at a level electronic cigarettes and commercial tobacco
that supports enforcement of the legal sale age. products, including taxing electronic devices
Approximately 50% of Idaho legislators were new in equivalent to commercial tobacco products. Similarly,
the 2023 Session. During 2023, tobacco prevention work is needed to set the tobacco retail licensure fee
partners focused on educating new legislators about at a level that supports required enforcement checks.
the impact of commercial tobacco use and addiction The American Lung Association in Idaho will continue
in Idaho and the policies, programs, and funding to work with partners in 2024 towards these goals and
mechanisms that reduce the health impacts of to support local communities in passing policies that
commercial tobacco use. protect residents from the negative effects of tobacco
During the 2023 legislative session, the Joint Legislative and e-cigarette use and from breathing secondhand
Millennium Fund Committee, which is responsible for smoke and e-cigarette aerosol.
recommending how tobacco settlement money is
Idaho State Facts
allocated in the State of Idaho budget, articulated its
intent to direct its future funding recommendations to Health Care Cost Due to Smoking: $508,053,436
support programs and projects that focus on tobacco Adult Smoking Rate: 11.9%
and other substance use prevention and cessation
programs, especially for youth. High School Smoking Rate: 3.8%

Also in 2023, the Idaho Legislature considered High School Tobacco Use Rate: 18.5%
proposed legislation that would have included Middle School Smoking Rate: N/A
e-cigarettes and other emerging products in Idaho’s
tobacco taxes. While House Bill 331 did not include Smoking Attributable Deaths: 1,800
all components we would recommend in a strong Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
tobacco tax policy, it demonstrated support for Surveillance System. High school smoking and tobacco use data come
from the 2021 Youth Risk Behavior Surveillance System. A current middle
increasing tobacco taxes for the first time since the school smoking rate is not available for this state.
introduction of e-cigarettes into the local marketplace. Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
The State of Idaho’s Tobacco Prevention and Control deaths reflect average annual estimates for the period 2005-2009 and
are calculated for persons aged 35 years and older. Smoking-attributable
Program, Project Filter, housed within the Department healthcare expenditures based on 2004 smoking-attributable fractions
of Health and Welfare, conducts tobacco prevention and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
and control activities that prevent youth and young
adult commercial tobacco use, eliminates exposure
to secondhand smoke, promotes quitting among
youth and adults, and identifies and eliminates health
disparities. Project Filter’s activities prioritize three
populations: people with behavioral health conditions,
rural Idahoans disproportionately impacted by tobacco
use, and youth and young adults to prevent initiation of
tobacco and nicotine products.
We applaud the Joint Legislative Millennium Fund

59 Lung.org American Lung Association “State of Tobacco Control” 2024

 Illinois Report Card
2024
S

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: C
I

FY2024 State Funding for CIGARETTE TAX:

O

Tobacco Control Programs: $11,760,216

Tax Rate per pack of 20: $2.98
FY2024 Federal Funding for
N

State Tobacco Control Programs: $2,241,976* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
I

State Tobacco Control Programs: $14,002,192 Tax on Large Cigars: Equalized: No; Weight-Based: No
L

CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes
State Spending Recommendation: $136,700,000
L

Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: No

Percentage of CDC Recommended Level: 10.2%
Tax on E-cigarettes: Equalized: No; Weight-Based: No
I

State Tobacco-Related Revenue: $1,124,900,000

For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

Smokefree Air: A Access to Cessation Services: A

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: All 7 medications are covered
Schools: Prohibited Medicaid Counseling: All 3 types of counseling are covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Minimal barriers exist to
access care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited
Casinos/Gaming Establishments: Prohibited STATE EMPLOYEE HEALTH PLAN(S):
Medications: Some medications are covered
Retail stores: Prohibited
Counseling: Some counseling is covered
E-Cigarettes Included: Yes
Barriers to Coverage: Some barriers exist to access care
Preemption/Local Opt-Out: No
Citation: 410 ILL. COMP. STAT. 82/1 et seq. (2024). STATE QUITLINE:
Investment per Smoker: $4.49; the median investment per
U Thumbs up for Illinois for adding e-cigarettes to its
comprehensive smokefree air law.
smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: Yes
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Illinois Tobacco Cessation Coverage page for
coverage details.

U Thumbs up for Illinois for providing comprehensive

coverage for all tobacco cessation medications and
types of counseling to Medicaid enrollees with minimal
barriers.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

60 Lung.org American Lung Association “State of Tobacco Control” 2024

Illinois State Highlights:
2024
Tobacco use remains the leading cause users in 2024. The proportion of people who smoke

I
of preventable death and disease in the and use menthol cigarettes has increased as overall

L
United States and in Illinois. To address cigarette smoking has decreased, particularly among
this enormous toll, the American Lung population groups that experience tobacco-related

L
Association calls for the following disparities. The tobacco industry aggressively targets

I
actions to be taken by Illinois’ elected officials: its marketing to certain populations, especially Black
people, Latinos, young adults, and LGBTQ+ adults.

N
1. Increase funding for state tobacco control
programs; These groups are more likely to smoke menthol

O
cigarettes compared to other population groups.
2. Allocate all Juul settlement funds to tobacco
prevention; and The IDPH TCP funded and oversaw 34 local health

I
departments (LHDs) engaging with local schools and
3. Ensure tax parity between other tobacco products,

S
school districts, students, parent groups, and local
including e-cigarettes and cigarettes. coalitions to strengthen and implement existing school
In the 15th year of the landmark Smoke-Free Illinois Act tobacco and e-cigarette use policies. Youth and young
(SFIA), on May 10, 2023, the Illinois General Assembly adult-focused media campaigns are run in jurisdictions
passed and Governor J.B. Pritzker later signed into law, where LHDs are educating about strengthening school
House Bill 1540 which adds electronic cigarettes to the policies and youth tobacco/e-cigarette prevention
SFIA, prohibiting their use in virtually all indoor public curricula are provided in schools. All youth-focused
places. This new law, which took effect January 1, 2024, media includes promotion of My Life, My Quit, Illinois
comes on the heels of nearly 30 municipalities passing youth tobacco/e-cigarette cessation resource.
their own measures to prohibit the use of electronic Illinois has made great progress in reducing
cigarettes in indoor public places. Additionally, thanks the tobacco burden and needs to continue its
to a settlement reached by Attorney General Kwame commitment by increasing state funding for tobacco
Raoul in April 2022 that brought hundreds of millions prevention and control. Additional funding is available
of dollars to the state, the General Assembly increased through Master Settlement Agreement and Juul
funding for the Illinois Tobacco Quitline by $1 million in settlement dollars that have and will be given to the
the fiscal year 2024 budget. state mainly to reduce and prevent tobacco use,
Locally, Evanston became the first city in Illinois especially among youth. It is crucial that Illinois use
to end the sale of all flavored tobacco products, these funds for their intended purpose so we can
including menthol cigarettes and flavored cigars; the prevent tobacco addiction in future generations.
new law will take effect on April 1. The Cook County
Board of Commissioners also passed an ordinance Illinois State Facts
in 2023 ending the sale of flavored e-cigarettes in Health Care Cost Due to Smoking: $5,495,627,110
unincorporated Cook County. The Lung Association
Adult Smoking Rate: 12.4%
and partners advocated for a comprehensive
ordinance to be passed that included all flavored High School Smoking Rate: 2.5%
tobacco products. On January 18, 2023, the city
High School Tobacco Use Rate: 17.1%
of Chicago passed an ordinance that puts strong
restrictions on tobacco retailers, including creating Middle School Smoking Rate: N/A
a new city license for e-cigarette retailers, placing Smoking Attributable Deaths: 18,280
strict limitations on where they can be located and
increasing fines for selling tobacco products to Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking and tobacco use rates are
underage individuals. taken from the 2021 Youth Risk Behavior Surveillance System. A current
middle school smoking rate is not available for this state.
The Illinois Tobacco Quitline (ITQL) and the Illinois Health impact information is taken from the Smoking Attributable Mortality,
Department of Public Health (IDPH) Tobacco Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
Prevention and Control Program (TCP) collaborated, are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
along with the public health communication company and 2009 personal healthcare expenditure data. Deaths and expenditures
and IDPH contractor Rescue Agency, in researching should not be compared by state.

and developing a target awareness and ITQL

promotion campaign to reach menthol tobacco

61 Lung.org American Lung Association “State of Tobacco Control” 2024

 Indiana Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
N

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $9,109,918
A

Tax Rate per pack of 20: $0.995

FY2024 Federal Funding for
OTHER TOBACCO PRODUCT TAXES:
I

State Tobacco Control Programs: $1,832,809*

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
D

State Tobacco Control Programs: $10,942,727 Tax on Large Cigars: Equalized: Yes; Weight-Based: No
N

CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes
State Spending Recommendation: $73,500,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
I

Percentage of CDC Recommended Level: 14.9%

Tax on E-cigarettes: Equalized: No; Weight-Based: No
State Tobacco-Related Revenue: $517,400,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention

U Thumbs up for Indiana for increasing funding for its

state tobacco control program by over $1.5 million this
fiscal year.
Access to Cessation Services: C
OVERVIEW OF STATE CESSATION COVERAGE
Smokefree Air: C STATE MEDICAID PROGRAM:
Medicaid Medications: All 7 medications are covered
OVERVIEW OF STATE SMOKING RESTRICTIONS
Medicaid Counseling: All 3 forms of counseling are covered
Government work sites: Prohibited
Medicaid Barriers to Coverage: Minimal barriers exist to
Private work sites: Prohibited access care
Schools: Prohibited Medicaid Expansion: Yes
Child care facilities: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Restaurants: Prohibited
Medications: All 7 medications are covered
Bars: Restricted*
Counseling: Some counseling is covered
Casinos/Gaming Establishments: No provision
Barriers to Coverage: Minimal barriers exist to access care
Retail stores: Prohibited (retail tobacco and cigar specialty
stores exempt) STATE QUITLINE:

E-Cigarettes Included: No Investment per Smoker: $1.33; the median investment per
smoker is $1.93
Preemption/Local Opt-Out: No
OTHER CESSATION PROVISIONS:
Citation: IND. CODE. §§ 7.1-5-12 et seq. (2020).
Private Insurance Mandate: No provision
* Smoking is allowed in bars/taverns that do not employ persons under
age 18 and do not allow persons under age 21 to enter. Tobacco Surcharge: Tobacco surcharge for Medicaid
Note: The Smokefree Air grade only examines state tobacco control enrollees
law and does not reflect local smokefree ordinances. Indiana has made
great strides in protecting people from secondhand smoke by passing Citation: See Indiana Tobacco Cessation Coverage page for
comprehensive local smokefree ordinances that cover 32.1% of the coverage details.
state’s population.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

62 Lung.org American Lung Association “State of Tobacco Control” 2024

Indiana State Highlights:
2024
Tobacco use remains the leading cause VOICE youth leaders and adult allies from across the

I
of preventable death and disease in the state participated in the 2023 Youth Day at the Indiana

N
United States and in Indiana. To address Statehouse. Held in January 2023, it was a day of
this enormous toll, the American Lung leadership training and the opportunity to meet with

D
Association calls for the following state decision makers.
actions to be taken by Indiana’s elected officials:

I
The Indiana Tobacco Prevention and Cessation
1. Remove youth possession, use and purchase (PUP) Commission has a partnership with the Indiana High

A
laws; School Athletic Association (IHSAA) where they

N
2. Raise the state cigarette tax by $1.00 per pack or continued to share the Don’t Puff This Stuff campaign
more; and to help end vaping among Hoosier teens. The IHSAA’s

A
social media channels generated a total of 20 million
3. Increase funding for tobacco prevention and impressions.
cessation.
Although 2024 is not a budget year, the Lung
During the 2023 legislative session, the American Association will continue working on increasing
Lung Association collaborated with Tobacco Free Indiana’s cigarette tax and funding for tobacco
Indiana to host our annual Advocacy Day. Over 50 prevention and cessation by implementing a
coalition members held 90 legislative visits where they robust public education campaign. We will educate
advocated for increasing Indiana’s Tobacco Prevention decisionmakers on the public health value these
and Cessation funding and raising our cigarette tax by two public health strategies will provide. Additionally,
$2.00 per pack. Unfortunately, a cigarette tax increase giving control back to local municipalities to determine
did not ultimately end up passing. whether restricting flavored tobacco products is an
There was more positive news on funding for tobacco approach that they would like to take is another way
prevention and cessation. In a decision strongly we can reach our goals of reducing tobacco use in
supported by the Lung Association, the Indiana Indiana.
Attorney General’s office decided to award the full Juul
settlement award of $15.7 million to the state’s tobacco Indiana State Facts
prevention and cessation program. The funds are to Health Care Cost Due to Smoking: $2,930,404,456
be used in support of prevention, education, harm
Adult Smoking Rate: 16.2%
reduction and mitigation efforts related to youth using
electronic nicotine delivery systems. High School Smoking Rate: 4.2%
On the local level, tobacco control partners across High School Tobacco Use Rate: N/A
the state of Indiana have had some small policy
Middle School Smoking Rate: 1.9%
wins. In Marshall County, the Plymouth Public Parks
department unanimously voted to make the park in Smoking Attributable Deaths: 11,070
Plymouth smokefree, including the well-attended
Adult smoking data comes from CDC’s 2022 Behavioral Risk Factor
Blueberry Festival event. Following this success, the Surveillance System. High school smoking rate is taken from CDCs 2021
park in the City of Culver in Marshall County also Youth Risk Behavior Surveillance System. Middle school smoking data are
taken from the 2018 Indiana Youth Tobacco Survey. A current high school
passed a policy declaring their parks to be smoke tobacco use rate is not available for this state.
and vape free. In Vigo County, where Indiana’s first Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
smokefree casino will open in 2024, the Terre Haute deaths reflect average annual estimates for the period 2005-2009 and
city council unanimously passed an ordinance that are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
added e-cigarettes to the city’s strong smoke-free air and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
ordinance. Vigo County then passed its own ordinance
adding e-cigarettes to its law soon after.
The 2022 Indiana Youth Tobacco Survey (IYTS),
administered to 5,400 middle and high school
students in the fall 2022, showed that 20% of high
schoolers and 7% of middle school students have
ever used e-cigarettes. With flavors being the 3rd
most common reason for using e-cigarettes, 240

63 Lung.org American Lung Association “State of Tobacco Control” 2024

 Iowa Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
W

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $4,270,171
Tax Rate per pack of 20: $1.36
O

FY2024 Federal Funding for

State Tobacco Control Programs: $1,137,971* OTHER TOBACCO PRODUCT TAXES:
I

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
State Tobacco Control Programs: $5,408,142 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: Yes
State Spending Recommendation: $30,100,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 18%
Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A
State Tobacco-Related Revenue: $ 248,500,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention

Smokefree Air: B Access to Cessation Services: D

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: All 7 medications are covered
Schools: Prohibited Medicaid Counseling: Some counseling is covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Some barriers exist to access
care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: Restricted (tribal
establishments not subject to state law) Medications: All 7 medications are covered
Retail stores: Prohibited Counseling: All 3 types of counseling are covered
E-Cigarettes Included: No Barriers to Coverage: Some barriers exist to access care
Preemption/Local Opt-Out: No STATE QUITLINE:
Citation: IOWA CODE §§ 142D.1 to 142D.9 (2008). Investment per Smoker: $1.67; the median investment per
smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Iowa Tobacco Cessation Coverage page for
coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

64 Lung.org American Lung Association “State of Tobacco Control” 2024

Iowa State Highlights:
2024
Tobacco use remains the leading cause in the spring of 2023. This survey has helped IHHS

I
of preventable death and disease in the identify gaps in tobacco cessation services and led to

O
United States and in Iowa. To address the development of comprehensive tobacco cessation
this enormous toll, the American Lung programs offered by Quitline Iowa, the state of Iowa’s

W
Association calls for the following free tobacco cessation program.
actions to be taken by Iowa’s elected officials: Adequately funding evidence-based tobacco control

A
1. Allocate all Juul settlement funds to tobacco programs is effective at preventing and reducing
prevention; tobacco use. Iowa has made progress in reducing
2. Close the loophole for casinos in the Smokefree Air the tobacco burden and needs to continue its
Act; and commitment to this endeavor by increasing state
funding for tobacco prevention and control. Additional
3. Include alternative nicotine products in the definition funding is available through Juul settlement dollars that
of tobacco products. have and will be given to the state to reduce tobacco
The Iowa Tobacco Prevention Alliance, of which the use, especially among youth. It is crucial that Iowa
American Lung Association is a member, worked use these funds for their intended purpose so we can
successfully with partners to defeat House File 566, a prevent tobacco addiction in future generations.
bill that would have eliminated the Iowa Tobacco Use
Prevention and Control Commission. Created after Iowa State Facts
the landmark Master Settlement Agreement of 1998 Health Care Cost Due to Smoking: $1,285,256,462
between 52 states and territories and the four largest
Adult Smoking Rate: 14.7%
tobacco companies, the Commission has served as
an influential voice for the public to advise our state on High School Smoking Rate: 4.1%
effective tobacco prevention and control programs in
High School Tobacco Use Rate: 16.2%
Iowa. Under HF 566, the Commission would have been
absolved, leaving Iowa communities without a crucial Middle School Smoking Rate: 1%
body to be their voice in the fight against tobacco.
Smoking Attributable Deaths: 5,070
In fiscal year 2023, partnerships from 50 out of 99 of
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Iowa’s counties submitted tobacco free/nicotine free Surveillance System. High school smoking and tobacco use rates are
policies for a local business, childcare, school, outdoor taken from the 2021 Youth Risk Behavior Surveillance System. Middle
school (8th grade only) smoking rate is taken from the 2021 Iowa Youth
event, or parks. The Tobacco Use Prevention and Survey; results are rounded to the nearest whole number.
Control Program received 222 policies and more than Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
215, or 97%, were comprehensive, meaning they cover deaths reflect average annual estimates for the period 2005-2009 and
all types of tobacco and nicotine, apply to everyone are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
(employees, students, visitors, etc.) always, include any and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
company vehicles, and at least apply to all enclosed
areas. These comprehensive tobacco free/nicotine
free policies go above and beyond the Iowa Smokefree
Air Act requirements, which only covers cigarettes, not
e-cigarettes or other forms of tobacco or nicotine.
Improving the health of pregnant people and people
living with mental and/or behavioral health disorders
through reduction in tobacco and nicotine use is a
priority for the Iowa Department of Health and Human
Services (IHHS) in 2024. Capitalizing on an opportunity
to gain greater understanding of the unique health
needs of these populations in Iowa, IHHS’s Tobacco
Control Program partnered with the Center for Social
and Behavioral Research at the University of Northern
Iowa to conduct a survey of providers of community,
behavioral, and mental health services across the state

65 Lung.org American Lung Association “State of Tobacco Control” 2024

 Kansas Report Card
2024
S

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
A

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $1,940,716
S

Tax Rate per pack of 20: $1.29

FY2024 Federal Funding for
N

State Tobacco Control Programs: $1,516,090* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: No; Weight-Based: No
A

State Tobacco Control Programs: $3,456,806 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: No
K

State Spending Recommendation: $27,900,000

Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: No
Percentage of CDC Recommended Level: 12.4%
Tax on E-cigarettes: Equalized: No; Weight-Based: Yes
State Tobacco-Related Revenue: $175,400,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

U Thumbs up for Kansas for increasing funding for its

state tobacco control program by close to $1 million
dollars from Juul settlement funds this fiscal year. Access to Cessation Services: D
OVERVIEW OF STATE CESSATION COVERAGE
Smokefree Air: B STATE MEDICAID PROGRAM:
Medicaid Medications: All 7 medications are covered
OVERVIEW OF STATE SMOKING RESTRICTIONS
Medicaid Counseling: All 3 forms of counseling are covered
Government work sites: Prohibited
Medicaid Barriers to Coverage: Minimal barriers exist to
Private work sites: Prohibited
access care
Schools: Prohibited
Medicaid Expansion: No
Child care facilities: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Restaurants: Prohibited
Medications: All 7 medications are covered
Bars: Prohibited
Counseling: All 3 types of counseling are covered
Casinos/Gaming Establishments: Restricted (casino floors
and tribal establishments not subject to state law) Barriers to Coverage: Minimal barriers exist to access care

Retail stores: Prohibited STATE QUITLINE:

E-Cigarettes Included: No Investment per Smoker: $0.54; the median investment per
smoker is $1.93
Preemption/Local Opt-Out: No
OTHER CESSATION PROVISIONS:
Citation: KAN. STAT. ANN. §§ 21-6109 to 21-6116 (2015).
Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Kansas Tobacco Cessation Coverage page for
coverage details.

U Thumbs up for Kansas for providing comprehensive

coverage for all tobacco cessation medications and
types of counseling to Medicaid enrollees with limited
barriers.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

66 Lung.org American Lung Association “State of Tobacco Control” 2024

Kansas State Highlights:
2024
Tobacco use remains the leading cause on eliminating youth purchase, use and possession

K
of preventable death and disease in the penalties in Kansas tobacco policy. We also will

A
United States and in Kansas. To address work to increase funding for tobacco prevention and
this enormous toll, the American Lung cessation programs in the 2024 legislative session to

N
Association calls for the following curb tobacco initiation by children and youth and to
actions to be taken by Kansas elected officials: motivate adult smokers to quit.

S
1. Increase state funding for tobacco control programs
Kansas State Facts

A
and ensure that funding is spent according to
Centers for Disease Control and Prevention (CDC) Health Care Cost Due to Smoking: $1,128,040,688

S
Best Practices for Comprehensive Tobacco Control Adult Smoking Rate: 14.5%
programs;
High School Smoking Rate: 4.6%
2. Pass legislation to remove ineffective and regressive
criminal and monetary penalties for youth in the High School Tobacco Use Rate: 14.9%
State’s tobacco statutes; and Middle School Smoking Rate: N/A
3. Oppose all forms of preemption of local tobacco Smoking Attributable Deaths: 4,390
control authority.
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
One success of the 2023 Legislative Session in Kansas Surveillance System. High school smoking and tobacco use rates are
taken from the 2021 Youth Risk Behavior Surveillance System. A current
was the passage of House Bill 2269, a bill to increase middle school smoking rate is not available for this state.
age of sale from 18 to 21. HB 2269 received active Health impact information is taken from the Smoking Attributable Mortality,
support from GOP leadership and the bill passed Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
House and Senate with no amendments. Governor are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
Laura Kelly signed it into law in April 2023. The Lung and 2009 personal healthcare expenditure data. Deaths and expenditures
Association supported this legislation but would should not be compared by state.

have preferred language like in House bill 2294 that

fixed other problems with Kansas’ laws concerning
underage sales of tobacco products.
Preemption of local tobacco control authority
remained a threat in 2023. One such bill was House
Bill 2447 prohibiting cities and counties from
ending the sale of products or services otherwise
allowed by state law. As originally introduced it was
extremely broad. Amendments were made to remove
preemption by cities and counties regarding alcohol,
consumer materials to the extent necessary to comply
with local building or fire codes, requiring licensing or
permitting of individuals, partnerships, corporation or
other business entity and zoning authority. Despite the
amendment, the bill failed.
Kansas was part of the 33-state settlement with Juul in
September 2022 over its efforts to market e-cigarettes
to youth. Funds received from Juul go to the state’s
General Fund. Tobacco control advocates successfully
worked to transfer the specific payment dollars from
the General Fund to the Tobacco Use Prevention
program as part of the annual budget process. This
increased tobacco prevention funding for Kansas by
close to $1 million in fiscal year 2024.
In 2024, the American Lung Association in Kansas and
Greater Kansas City and coalition partners will focus

67 Lung.org American Lung Association “State of Tobacco Control” 2024

 Kentucky Report Card
2024
Y

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
K

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $2,900,000
C

Tax Rate per pack of 20: $1.10

FY2024 Federal Funding for
OTHER TOBACCO PRODUCT TAXES:
U

State Tobacco Control Programs: $1,656,354*

FY2024 Total Funding for Tax on Little Cigars: Equalized: No; Weight-Based: No
T

State Tobacco Control Programs: $4,556,354 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes
N

State Spending Recommendation: $56,400,000

Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: No
Percentage of CDC Recommended Level: 8.1%
E

Tax on E-cigarettes: Equalized: No; Weight-Based: No

State Tobacco-Related Revenue: $475,100,000
For more information on tobacco taxes, go to:
K

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati

from the Centers for Disease Control and Prevention.

U Thumbs up for Kentucky for increasing funding for its

state tobacco control program by close to $1 million
dollars this fiscal year.
Access to Cessation Services: B
OVERVIEW OF STATE CESSATION COVERAGE
Smokefree Air: F STATE MEDICAID PROGRAM:
Medicaid Medications: All 7 medications are covered
OVERVIEW OF STATE SMOKING RESTRICTIONS
Medicaid Counseling: All 3 types of counseling are covered
Government work sites: Restricted (Prohibited in state
government buildings) Medicaid Barriers to Coverage: No barriers exist to access
care
Private work sites: No provision
Medicaid Expansion: Yes
Schools: Prohibited
Child care facilities: No provision STATE EMPLOYEE HEALTH PLAN(S):
Medications: All 7 medications are covered
Restaurants: No provision
Counseling: Some counseling is covered
Bars: No provision
Barriers to Coverage: Some barriers exist to access care
Casinos/Gaming Establishments: No provision
Retail stores: No provision STATE QUITLINE:

E-Cigarettes Included: Yes Investment per Smoker: $1.21; the median investment per
smoker is $1.93
Preemption/Local Opt-Out: No
OTHER CESSATION PROVISIONS:
Citation: KY REV. STAT. ANN. §§ 61.165 (2006), 61.167 (2004),
438.050 (2019), 438.345 (2019) & EXEC. ORDER 2014-0747 Private Insurance Mandate: Yes
(2014). Tobacco Surcharge: Limits tobacco surcharges
Note: The Smokefree Air grade only examines state tobacco control law Citation: See Kentucky Tobacco Cessation Coverage page for
and does not reflect local smokefree ordinances. Kentucky has made
great strides in protecting people from secondhand smoke by passing coverage details.
comprehensive local smokefree ordinances that cover 35.1% of the
state’s population.
U Thumbs up for Kentucky for providing comprehensive
coverage for all tobacco cessation medications and
types of counseling to Medicaid enrollees with no
barriers.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

68 Lung.org American Lung Association “State of Tobacco Control” 2024

Kentucky State Highlights:
2024
Tobacco use remains the leading cause Kentucky are actively educating the public and elected

K
of preventable death and disease in officials about the dangers of secondhand smoke and

E
the United States and in Kentucky. aerosol and the benefits of smokefree policies as well
To address this enormous toll, the as building support for local laws.

N
American Lung Association calls for the Separately, a January 2023 Mason Dixon Poll showed
following actions to be taken by Kentucky’s elected that nearly 70 percent of Kentuckians support

T
officials: requiring establishments that sell nicotine products

U
1. Require all establishments selling nicotine products to hold licenses as a tool to help enforce the state law
to obtain licenses, provide for and fund specific prohibiting sales to persons under the age of 21.

C
enforcement measures and establish a meaningful According to the 2021 Kentucky Incentives for
penalty structure for underage sales violations;

K
Prevention Survey, over 1 in 5 Kentucky 10th graders
2. Increase funding for the state tobacco prevention had used an e-cigarette in the last 30 days.

Y
and cessation program to $10 million, allocate the As the legislature begins its work in 2024, the
incremental $14 million the state stands to receive American Lung Association will continue its efforts to
in Juul settlement funds over 6 years to the program educate policymakers, business leaders and media
and ensure that funding is spent according to the on the importance of the American Lung Associations
Centers for Disease Control and Preventions Best goals to prevent and reduce all tobacco use, including
Practices for Comprehensive Tobacco Control e-cigarettes, and to protect public health.
Programs; and
3. Support and defend local comprehensive Kentucky State Facts
smokefree laws, including e-cigarettes. Health Care Cost Due to Smoking: $1,926,976,238
Upon conclusion of Kentucky’s 2023 regular legislative Adult Smoking Rate: 17.4%
session, both House Bill 370 and House Bill 310 - bills
High School Smoking Rate: 4.9%
to penalize youth for purchase, use and possession of
tobacco products and to penalize clerks for selling to High School Tobacco Use Rate: 22.5%
underage purchasers, respectively - died without ever
Middle School Smoking Rate: N/A
being assigned to committee for consideration. The
Lung Association and partner organizations maintained Smoking Attributable Deaths: 8,860
strong opposition to both measures throughout the
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
session. Surveillance System. High school smoking and tobacco use data come
from the 2021 Youth Risk Behavior Surveillance System. A current middle
Recurring funding for the state’s tobacco prevention school smoking rate is not available for this state.
and control program remained at $2 million this Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
fiscal year. However, additional funding from another deaths reflect average annual estimates for the period 2005-2009 and
account was transferred to the program resulting are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
in $900,000 increase in funding for the year. This is and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
a much-needed increase but remains short of the
funding the program received a few years ago.
At the local level, advances continued in 2023 on
smokefree policy momentum in Northern Kentucky
that started in Dayton in 2022. Comprehensive
smokefree ordinances were adopted in Bellevue,
Corinth and Highland Heights. Supporting strong
local smokefree advocates, the Lung Association and
partner organizations were also successful in defeating
a proposed exemption to Owensboro’s smokefree
ordinance in place since 2014. Churchill Downs, owner
of Ellis Entertainment, asked the city for the exemption
to allow smoking in 15 percent of its planned gaming
venue. Approximately 20 other communities in

69 Lung.org American Lung Association “State of Tobacco Control” 2024

 Louisiana Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
N

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $4,555,340
A

Tax Rate per pack of 20: $1.08

FY2024 Federal Funding for
OTHER TOBACCO PRODUCT TAXES:
I

State Tobacco Control Programs: $1,635,696*

FY2024 Total Funding for Tax on Little Cigars: Equalized: No; Weight-Based: No
S

State Tobacco Control Programs: $6,191,036 Tax on Large Cigars: Equalized: No; Weight-Based: No
I

CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: No

State Spending Recommendation: $59,600,000
U

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No

Percentage of CDC Recommended Level: 10.4%
Tax on E-cigarettes: Equalized: No; Weight-Based: Yes
O

State Tobacco-Related Revenue: $436,100,000

For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
L

from the Centers for Disease Control and Prevention.

Smokefree Air: C Access to Cessation Services: C

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: All 7 medications are covered
Schools: Prohibited Medicaid Counseling: All 3 types of counseling are covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Some barriers exist to access
care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: No provision
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: Restricted (tribal
establishments not subject to state law) Medications: All 7 medications are covered
Retail stores: Prohibited Counseling: Some counseling is covered
E-Cigarettes Included: Only in and on grounds of K-12 Barriers to Coverage: Minimal barriers exist to access care
Schools
STATE QUITLINE:
Preemption/Local Opt-Out: No
Investment per Smoker: $1.43; the median investment per
Citation: LA REV. STAT. ANN. §§ 40:1291.1 to 1291.24 (2015). smoker is $1.93
Note: The Smokefree Air grade only examines state tobacco control law OTHER CESSATION PROVISIONS:
and does not reflect local smokefree ordinances. Louisiana has made
great strides in protecting people from secondhand smoke by passing Private Insurance Mandate: Insurance Commissioner bulletin
comprehensive local smokefree ordinances that cover 33% of the state’s
population. Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Louisiana Tobacco Cessation Coverage page for
coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

70 Lung.org American Lung Association “State of Tobacco Control” 2024

Louisiana State Highlights:
2024
Tobacco use remains the leading cause There continues to be support within local

L
of preventable death and disease in municipalities for public health protections from

O
the United States and in Louisiana. secondhand smoke. The Town of Ringgold passed
To address this enormous toll, the a comprehensive smokefree air ordinance in 2023.

U
American Lung Association calls for the Casino and bar workers in this community are now
following actions to be taken by Louisiana’s elected protected from the dangers of secondhand smoke

I
officials: exposure. Unfortunately, despite the outcry in the city

S
1. Ensure smokefree protections for all bars and of Shreveport from residents and workers, the City
casino workers in all municipalities; Council amended the two-year-old smokefree air

I
ordinance in favor of allowing smoking in casinos.
2. Strengthen the existing statewide smokefree law to

A
include bar and casino worker protections; and In 2024, the American Lung Association in Louisiana
will join our tobacco control partners to educate

N
3. Sustain tobacco prevention and quit tobacco state legislators about the health and economic
funding.

A
benefits of strong tobacco control policies, including
It was quite a busy year for tobacco control issues a comprehensive statewide smokefree air law. The
during the Louisiana legislative session in 2023 Lung Association will also continue to work with
despite it being a fiscal only session. House Bill 179, partners in the Coalition for a Tobacco Free Louisiana
introduced by Representative Wheat, would have to ensure successful passage and preservation of
prohibited the sale of flavored e-cigarettes except for comprehensive local smokefree ordinances.
tobacco, mint and menthol flavored e-cigarettes. The
Lung Association advocated for this legislation to be Louisiana State Facts
extended to flavors and all tobacco products. HB 179 Health Care Cost Due to Smoking: $1,891,666,196
did not become law.
Adult Smoking Rate: 16.7%
House Bill 635, introduced by Representative Hollis,
passed, and became law to increase the e-cigarette High School Smoking Rate: 7%
tax from 5 cents/ml to 15 cents/ml with revenue High School Tobacco Use Rate: 25.5%
dedicated to various non-tobacco control purposes,
Middle School Smoking Rate: 3.8%
including a state Policy Salary Fund, Department of
Wildlife and Fisheries, Office of the State Fire Marshall Smoking Attributable Deaths: 7,210
and the Louisiana Public Defender Board. HB 635
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
also included the establishment of a vapor product Surveillance System. High school smoking and tobacco use rates are
and alternative nicotine product directory. The Lung taken from the 2021 Youth Risk Behavior Surveillance System. Middle
school smoking rate is taken from the 2017 Youth Tobacco Survey.
Association and its partners advocated for a higher tax Health impact information is taken from the Smoking Attributable Mortality,
on e-cigarettes as well as the funds to be dedicated to Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
tobacco prevention and control. are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
Louisiana residents will benefit from the passage and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
and implementation of House Bill 578 championed
by Representative Glover to expand quitting tobacco
insurance benefits. All insurance providers, including
Medicaid, must offer quitting tobacco benefits for a
minimum of six months with no barriers to coverage.
The influence of the tobacco industry was very
apparent in many of the bills during the 2023 legislative
session especially Senate Bill 224, House Bill 111, and
House Bill 127. Senate Bill 224 attempted to reduce the
tax on cigars but did not pass. House Bill 111 secured an
exemption from the cigar and pipe tobacco tax for any
products sampled at a cigar and pipe tobacco industry
convention. House Bill 127 exempted certain tobacco
products from being taxed when given as samples at
various events.

71 Lung.org American Lung Association “State of Tobacco Control” 2024

 Maine Report Card
2024
E

Tobacco Prevention and

Control Program Funding: A Tobacco Taxes: C
N

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $15,905,577
I

Tax Rate per pack of 20: $2.00

FY2024 Federal Funding for
A

State Tobacco Control Programs: $1,169,002* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
M

State Tobacco Control Programs: $17,074,579 Tax on Large Cigars: Equalized: Yes; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: Yes
State Spending Recommendation: $15,900,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 107.4%
Tax on E-cigarettes: Equalized: Yes; Weight-Based: No
State Tobacco-Related Revenue: $192,100,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention

U Thumbs up for Maine for funding its tobacco control

program at or above the CDC-recommended level this
fiscal year.
Access to Cessation Services: A
OVERVIEW OF STATE CESSATION COVERAGE
Smokefree Air: B STATE MEDICAID PROGRAM:
Medicaid Medications: All 7 medications are covered
OVERVIEW OF STATE SMOKING RESTRICTIONS
Medicaid Counseling: All 3 types of counseling are covered
Government work sites: Prohibited
Medicaid Barriers to Coverage: No barriers exist to access
Private work sites: Prohibited care
Schools: Prohibited Medicaid Expansion: Yes
Child care facilities: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Restaurants: Prohibited
Medications: All 7 medications are covered
Bars: Prohibited
Counseling: Some counseling is covered
Casinos/Gaming Establishments: Restricted (tribal
Barriers to Coverage: Minimal barriers exist to access care
establishments not subject to state law)
Retail stores: Prohibited STATE QUITLINE:

E-Cigarettes Included: Prohibited in public places, but not in Investment per Smoker: $34.48; the median investment per
all workplaces smoker is $1.93

Preemption/Local Opt-Out: No OTHER CESSATION PROVISIONS:

Citation: ME REV. STAT. ANN. tit. 22, §§ 1541 to 1545 (2021), Private Insurance Mandate: Yes
1547 (2007), 1580-A (2009) & CODE of ME RULES 10-144, Tobacco Surcharge: No prohibition or limitation on tobacco
Ch. 249 (2006). surcharges
Citation: See Maine Tobacco Cessation Coverage page for
coverage details.

U Thumbs up for Maine for providing comprehensive

coverage for all tobacco cessation medications and
types of counseling with minimal barriers to Medicaid
enrollees.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: Some flavored
cigars prohibited

72 Lung.org American Lung Association “State of Tobacco Control” 2024

Maine State Highlights:
2024
Tobacco use remains the leading cause products in South Portland failed, ensuring youth in

M
of preventable death and disease in the that community will continue to be protected. Work
United States and in Maine. To address on the local level will continue to build momentum for

A
this enormous toll, the American Lung statewide action to ensure all Maine kids from Kittery

I
Association calls for the following to Madawaska are protected. Additionally, the bill to
actions to be taken by Maine’s elected officials: end the sale of tobacco products in pharmacies which

N
1. Enact legislation prohibiting the sale of menthol passed both chambers of the legislature was carried
over to 2024 awaiting final funding and enactment.

E
cigarettes and all flavored tobacco products
statewide; The American Lung Association in Maine will continue
2. Preserve full funding of Maine’s tobacco prevention to work with our coalition partners - the Maine Public
and control program and align program spending Health Association, the American Heart Association,
with the recommendations of the U.S. Centers the American Cancer Society Cancer Action Network,
for Disease Control and Prevention (CDC) Best Campaign for Tobacco Free Kids and others to
Practices; and advance tobacco control and prevention policies
and defend our successful programs and smokefree
3. End the sale of tobacco products in pharmacies. policies against rollbacks. As the legislature begins
The 2023 Maine legislative session resulted in mixed its work in 2024, the Lung Association will continue to
success for tobacco prevention policies. For more grow our coalition to educate policymakers, business
than a decade, a top priority of the American Lung leaders and the media of the importance of the Lung
Association has been to increase funding for the Maine Association’s goals to reduce tobacco use and protect
tobacco control program to the level recommended public health.
by the U.S. CDC. After many years of advocacy,
Maine finally fully funded its tobacco prevention and Maine State Facts
treatment program in 2022 and that funding was Health Care Cost Due to Smoking: $811,120,557
sustained in 2023. Defensive victories were also
Adult Smoking Rate: 15%
realized during the 2023 legislative session as multiple
preemption measures that would have restricted High School Smoking Rate: 4.3%
local municipalities from enacting tobacco prevention
High School Tobacco Use Rate: 18.1%
policies were defeated.
Middle School Smoking Rate: 1.4%
Two tobacco prevention priorities of the Lung
Association are in limbo after the 2023 legislative Smoking Attributable Deaths: 2,390
session. Efforts continued to advance legislation
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
ending the sale of menthol cigarettes and all flavored Surveillance System. High school smoking and tobacco use data come
from CDC’s 2021 Youth Risk Behavior Surveillance System. Middle school
tobacco products. Gains were made in 2023 with smoking rate is taken from the 2021 Maine Integrated Youth Health Survey.
the Health & Human Services Committee voting the Health impact information is taken from the Smoking Attributable Mortality,
measure out with a recommendation to pass; and Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
the Senate passing the measure. The Maine House are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
of Representatives tabled the measure at the end of and 2009 personal healthcare expenditure data. Deaths and expenditures
the first half of the session, meaning it will carry over should not be compared by state.

for consideration into 2024. This is still a priority for

the Lung Association, and the organization is actively
working with members of the House to see this bill
through to becoming a law.
Although the legislature has not yet enacted a
statewide measure, progress continued on the
local level with Bar Harbor and Falmouth passing
comprehensive ordinances ending the sale of
menthol and flavored tobacco products. In the early
part of 2023, an effort to repeal a local ordinance
ending the sale of menthol and flavored tobacco

73 Lung.org American Lung Association “State of Tobacco Control” 2024

 Maryland Report Card
2024
D

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: C
N

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $21,243,365*
A

Tax Rate per pack of 20: $3.75

FY2024 Federal Funding for
State Tobacco Control Programs: $1,694,510** OTHER TOBACCO PRODUCT TAXES:
L

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
Y

State Tobacco Control Programs: $22,937,875 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: No
R

State Spending Recommendation: $48,000,000

Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: No
A

Percentage of CDC Recommended Level: 47.8%

Tax on E-cigarettes: Equalized: No; Weight-Based: No
State Tobacco-Related Revenue: $632,100,000
For more information on tobacco taxes, go to:
M

* This funding amount does not include funds from Maryland’s www.lung.org/slati
settlement with Juul that are expected to be allocated to the state
tobacco control program later this fiscal year.
** Includes tobacco prevention and cessation funding provided to states
from the Centers for Disease Control and Prevention. Access to Cessation Services: A
B
OVERVIEW OF STATE CESSATION COVERAGE
Smokefree Air:
STATE MEDICAID PROGRAM:
OVERVIEW OF STATE SMOKING RESTRICTIONS Medicaid Medications: All 7 medications are covered
Government work sites: Prohibited Medicaid Counseling: Some counseling is covered
Private work sites: Prohibited Medicaid Barriers to Coverage: Some barriers exist to access
Schools: Prohibited care

Child care facilities: Prohibited Medicaid Expansion: Yes

Restaurants: Prohibited STATE EMPLOYEE HEALTH PLAN(S):

Bars: Prohibited Medications: All 7 medications are covered

Casinos/Gaming Establishments: Prohibited Counseling: Some counseling is covered

Retail stores: Prohibited Barriers to Coverage: Minimal barriers exist to access care

E-Cigarettes Included: No STATE QUITLINE:

Preemption/Local Opt-Out: No Investment per Smoker: $7.89; the median investment per
smoker is $1.93
Citation: MD. CODE ANN., HEALTH-GEN. §§ 24-501 to 24-511
(2008) & MD. CODE ANN., LAB. & EMPLOY. §§ 5-101 & 5-608 OTHER CESSATION PROVISIONS:
(2008).
Private Insurance Mandate: Yes
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Maryland Tobacco Cessation Coverage page for
coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

74 Lung.org American Lung Association “State of Tobacco Control” 2024

Maryland State Highlights:
2024
Tobacco use remains the leading cause legislation which would allow local governments to

M
of preventable death and disease in pass and enforce their own tobacco control laws.
the United States and in Maryland.

A
The Clean Indoor Air Act in Maryland currently
To address this enormous toll, the does not include e-cigarettes, there are also some

R
American Lung Association calls for the definitional loopholes that need to be corrected
following actions to be taken by Maryland’s elected to ensure that all Marylanders are protected from

Y
officials: exposure to secondhand smoke. Closing these

L
1. Defend and preserve the much-needed funding loopholes will continue to be a priority for the Lung
increase for tobacco prevention and cessation of Association moving forward.

A
$8.25 million; The American Lung Association in Maryland will
2. Restore local control by overturning preemption in continue to educate lawmakers on the ongoing fight

N
the state via legislation; and against tobacco. Our goal is to build champions within

D
3. Close loopholes in the Clean Indoor Air Act, the legislature and grassroots advocates to advance
including for electronic cigarettes. our goals which include most notably to protect
the increased funding for tobacco prevention and
During the 2023 legislative session, the American Lung cessation, restore local control and close loopholes in
Association in Maryland along with other public health the Clean Indoor Air Act.
partners were successful in protecting Maryland’s
Clean Indoor Air Act. As part of the package to Maryland State Facts
develop an infrastructure around marijuana sales in
Health Care Cost Due to Smoking: $2,709,568,436
the state there was language included which would
have allowed for the onsite smoking of marijuana in Adult Smoking Rate: 9.6%
certain establishments that also served food. The High School Smoking Rate: 3.6%
Lung Association and its partners were opposed to
this provision and were able to successfully have it High School Tobacco Use Rate: 15.6%
removed to mirror the protections of the Clean Indoor Middle School Smoking Rate: N/A
Air Act as it relates to tobacco.
Smoking Attributable Deaths: 7,490
In fiscal year 2023, the tobacco prevention and
cessation program received a much-needed increase Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking and tobacco use data come
of $8.25 million as a result of the Lung Association from the 2021 Youth Risk Behavior Surveillance System. A current middle
and partners advocacy for an increase in the tobacco school smoking rate is not available for this state.
Health impact information is taken from the Smoking Attributable Mortality,
tax. This increase was maintained for fiscal year 2024. Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
Additionally, House Bill 321 passed, the bill requires deaths reflect average annual estimates for the period 2005-2009 and
are calculated for persons aged 35 years and older. Smoking-attributable
any revenue associated with the enforcement actions healthcare expenditures based on 2004 smoking-attributable fractions
of the sale of e-cigarettes, including the recent Juul and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
settlement to be directed to the tobacco prevention
and cessation program. This will result in $2.4 million in
additional funding for the program.
Finally, the Lung Association and partners were
successful in beating back an effort in Wicomico
County which would have allowed for the
establishment of cigar bars. This bill would have
undermined Maryland’s Clean Indoor Air Act.
Since 2013 and the court ruling in Altadis v. Prince
George’s County, Maryland has had strong preemption
rules in place restricting local governments from acting
locally on tobacco sales and distribution. This has
created a number of challenges, especially in the area
of tobacco control. The Lung Association will continue
to partner with stakeholders to address statewide

75 Lung.org American Lung Association “State of Tobacco Control” 2024

 Massachusetts Report Card
2024
S

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: B
T

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $6,294,468
T

Tax Rate per pack of 20: $3.51

FY2024 Federal Funding for
E

State Tobacco Control Programs: $1,902,654* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
S

State Tobacco Control Programs: $8,197,122 Tax on Large Cigars: Equalized: No; Weight-Based: No
U

CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No

State Spending Recommendation: $66,900,000
Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: No
H

Percentage of CDC Recommended Level: 12.3%

Tax on E-cigarettes: Equalized: Yes; Weight-Based: No
State Tobacco-Related Revenue: $692,600,000
C

For more information on tobacco taxes, go to:

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.
A

A Access to Cessation Services: B

S

Smokefree Air:
S

OVERVIEW OF STATE CESSATION COVERAGE

STATE MEDICAID PROGRAM:

A

OVERVIEW OF STATE SMOKING RESTRICTIONS

Government work sites: Prohibited Medicaid Medications: All 7 medications are covered
M

Private work sites: Prohibited Medicaid Counseling: All 3 types of counseling are covered
Schools: Prohibited Medicaid Barriers to Coverage: Minimal barriers exist to
access care
Child care facilities: Prohibited
Medicaid Expansion: Yes
Restaurants: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Bars: Prohibited (allowed in smoking bars)
Medications: All 7 medications are covered
Casinos/Gaming Establishments: Prohibited
Counseling: Most counseling is covered
Retail stores: Prohibited
Barriers to Coverage: Some barriers exist to access care
E-Cigarettes Included: Yes
Preemption/Local Opt-Out: No STATE QUITLINE:
Investment per Smoker: $1.55; the median investment per
Citation: MASS. GEN. LAWS ch. 270, § 22 (2018).
smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: Yes
Tobacco Surcharge: Prohibits tobacco surcharges
Citation: See Massachusetts Tobacco Cessation Coverage
page for coverage details.

U Thumbs up for Massachusetts for providing

comprehensive coverage for all tobacco cessation
medications and types of counseling with minimal
barriers to Medicaid enrollees.

Flavored Tobacco Products: A

Restrictions on Flavored Tobacco Products: All flavored
tobacco products prohibited in virtually all locations.

76 Lung.org American Lung Association “State of Tobacco Control” 2024

Massachusetts State Highlights:
2024
Tobacco use remains the leading cause initiating tobacco use. While legislation has been

M
of preventable death and disease in the introduced to increase the tobacco tax in the state, the
United States and in Massachusetts. legislature has been dormant in taking further action,

A
To address this enormous toll, the including in 2023.

S
American Lung Association calls for The American Lung Association will continue to
the following actions to be taken by Massachusetts’s work with our state coalition partners to advance

S
elected officials: tobacco control and prevention efforts and defend our

A
1. Increase comprehensive tobacco control program successful programs and smokefree policies against
funding for prevention and cessation to the level rollbacks. As the Massachusetts Legislature begins

C
recommended by the U.S. Centers for Disease its work in 2024, the Lung Association and tobacco
Control and Prevention (CDC). control partners will continue to grow our coalition to

H
2. Increase the tobacco tax by a minimum of $1.00 per educate policymakers, business leaders and the media
of the importance of the American Lung Association’s

U
pack and tax non-cigarette tobacco products at a
comparable rate; and goals to reduce tobacco use and protect public health.

S
3. Prevent rollbacks to tobacco control funding, Massachusetts State Facts
smokefree and tobacco prevention laws.

E
Health Care Cost Due to Smoking: $4,080,690,302
Massachusetts continues to be a leader nationwide in

T
Adult Smoking Rate: 10.4%
tobacco control efforts. Four years have passed since
laws making the Bay State the first in the nation to end High School Smoking Rate: 3.5%

T
the sale of all flavored tobacco products went into full
High School Tobacco Use Rate: N/A

S
effect. Fortunately, there were no successful legislative
efforts in 2023 to rollback this comprehensive Middle School Smoking Rate: 0.8%
measure. Although, communities across the
Smoking Attributable Deaths: 9,300
Commonwealth have experienced an increase in sales
of “non-menthol” products that have the properties Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking data comes from CDC’s 2021
and characteristics of menthol products. Local Boards Youth Risk Behavior Surveillance System. Middle school smoking rate is
of Health and community advocates are working to taken from the 2017 Massachusetts Youth Health Survey.
Health impact information is taken from the Smoking Attributable Mortality,
address these illegal product sales through increased Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
compliance checks and retailer education. The deaths reflect average annual estimates for the period 2005-2009 and
are calculated for persons aged 35 years and older. Smoking-attributable
industry continues to push back with claims that these healthcare expenditures based on 2004 smoking-attributable fractions
products are not included in the Massachusetts flavor and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
restriction.
Upon first introduction, the Governor’s Budget did not
specifically earmark funding to the Massachusetts
Tobacco Control Program (MTCP). Thanks to advocacy
from the Lung Association and our state partners,
Senator Keenan introduced an amendment that
restored and increased the MTCP budget to $6.2
million, roughly $90,000 up from the prior fiscal year
and a 67% increased from fiscal year 2018. Even
with this budget increase, the Commonwealth of
Massachusetts severely underfunds the MTCP based
on the recommendations of the CDC.
Massachusetts last raised the cigarette excise tax
in 2013, at that time becoming the highest in the
Northeast. However, the state has now fallen behind
other Northeast states and this policy is one of the
most effective in prompting current tobacco users
to make a quit attempt and preventing youth from

77 Lung.org American Lung Association “State of Tobacco Control” 2024

 Michigan Report Card
2024
N

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: D
A

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $2,194,000
G

Tax Rate per pack of 20: $2.00

FY2024 Federal Funding for
State Tobacco Control Programs: $2,347,639* OTHER TOBACCO PRODUCT TAXES:
I

FY2024 Total Funding for Tax on Little Cigars: Equalized: No; Weight-Based: No
H

State Tobacco Control Programs: $4,541,639 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices
C

Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No

State Spending Recommendation: $110,600,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
I

Percentage of CDC Recommended Level: 4.1%

Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A
State Tobacco-Related Revenue: $1,067,400,000
M

For more information on tobacco taxes, go to:

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

Smokefree Air: C Access to Cessation Services: D*

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: All 7 medications are covered
Schools: Prohibited Medicaid Counseling: Some counseling is covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Minimal barriers exist to
access care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited (allowed in cigar bars)
Casinos/Gaming Establishments: Restricted (tribal STATE EMPLOYEE HEALTH PLAN(S):
establishments not subject to state law) Medications: Data not available
Retail stores: Prohibited Counseling: Data not available
E-Cigarettes Included: No Barriers to Coverage: Data not available
Preemption/Local Opt-Out: Yes STATE QUITLINE:
Citation: MICH. COMP. LAWS §§ 333.12601 to 333.12615 & Investment per Smoker: $0.80; the median investment per
333.12905 (2010). smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Michigan Tobacco Cessation Coverage page for
coverage details.
* Michigan was not able to provide State Employee Health Plan tobacco
cessation coverage data. This part of the grade was excluded from the
grade calculation.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

78 Lung.org American Lung Association “State of Tobacco Control” 2024

Michigan State Highlights:
2024
Tobacco use remains the leading cause these ordinances. Data shows that flavored tobacco

M
of preventable death and disease in products attract young people to try these products.
the United States and in Michigan. Over 80% of youth e-cigarette users use a flavored

I
To address this enormous toll, the product, according to recently released national data.

C
American Lung Association calls for the As we look ahead to 2024, the American Lung
following actions to be taken by Michigan’s elected

H
Association in Michigan will continue to work with
officials: a broad coalition of stakeholders to advocate for

I
1. Pass a law to license all tobacco retailers, including evidence-based solutions to reduce the number of
e-cigarette retailers; individuals using tobacco products, especially our

G
2. Prohibit flavorings, including mint and menthol, for youth.

A
all tobacco products; Michigan State Facts
3. Eliminate purchase, use and possession laws and

N
Health Care Cost Due to Smoking: $4,589,784,016
preemption of stronger local laws;
Adult Smoking Rate: 15.2%
4. Increase cigarette taxes and match the tax on non-
cigarette forms of tobacco like spit tobacco, cigars, High School Smoking Rate: 1.7%
hookah and e-cigarettes to the cigarette tax.
High School Tobacco Use Rate: 14.1%
In the fall of 2023, a comprehensive, statewide, five
Middle School Smoking Rate: N/A
bill tobacco reduction package was introduced in
the state Senate that would implement this agenda. Smoking Attributable Deaths: 16,170
These bills address a broad range of topics, including
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
setting up a comprehensive tobacco retail licensing Surveillance System. High school smoking and tobacco use data come
from the 2021 Youth Risk Behavior Surveillance System. A current middle
system, repealing potentially preemptive language on school smoking rate is not available for this state.
tobacco sales in state law, increasing tobacco taxes Health impact information is taken from the Smoking Attributable Mortality,
and tobacco control program funding and eliminating Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
the sale of all flavored tobacco products. It would be are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
a ground-breaking package that has the potential and 2009 personal healthcare expenditure data. Deaths and expenditures
to significantly reduce tobacco use rates. The Lung should not be compared by state.

Association will continue to work with other health

organizations to advocate for hearings to be held
on the bills and for action taken in both houses of
the legislature before the end of the 2024 legislative
session.
In addition to those bills, there is more that Michigan
policymakers could be doing. The state continues
to only spend 4.1% of what is recommended by the
Centers for Disease Control and Prevention for a state
of our size. While there was a small but encouraging
increase in funding for the first time in many years in
the state budget for fiscal year 2024, Michigan needs
to continue to increase spending on tobacco control
and prevention. Increasing tobacco taxes and ensuring
parity for all forms of tobacco will raise the revenue to
increase spending.
Local efforts continue in Detroit and Grand Rapids
to prohibit the sale of flavored tobacco products,
should the statewide prohibition fail to be enacted.
The Lung Association will work with partners in those
communities to get flavored products off the market
and to have the mechanisms in place to enforce

79 Lung.org American Lung Association “State of Tobacco Control” 2024

 Minnesota Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: B
T

FY2024 State Funding for CIGARETTE TAX:

O

Tobacco Control Programs: $11,998,663*

Tax Rate per pack of 20: $3.04
FY2024 Federal Funding for
S

State Tobacco Control Programs: $1,596,128** OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
E

State Tobacco Control Programs: $13,594,791 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices
N

Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No

State Spending Recommendation: $52,900,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
N

Percentage of CDC Recommended Level: 25.7%

Tax on E-cigarettes: Equalized: Yes; Weight-Based: No
State Tobacco-Related Revenue: $694,100,000
I

For more information on tobacco taxes, go to:

* This funding amount does not include funds from Minnesota’s www.lung.org/slati
M

settlement with Juul that are expected to be allocated to the state

tobacco control program later this fiscal year.
** Includes tobacco prevention and cessation funding provided to states
from the Centers for Disease Control and Prevention. Access to Cessation Services: A
OVERVIEW OF STATE CESSATION COVERAGE
Smokefree Air: A STATE MEDICAID PROGRAM:
OVERVIEW OF STATE SMOKING RESTRICTIONS Medicaid Medications: All 7 medications are covered
Government work sites: Prohibited (workplaces with two or Medicaid Counseling: Most types of counseling are covered
fewer employees exempt)
Medicaid Barriers to Coverage: Minimal barriers exist to
Private work sites: Prohibited (workplaces with two or fewer access care
employees exempt)
Medicaid Expansion: Yes
Schools: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Child care facilities: Prohibited
Medications: All 7 medications are covered
Restaurants: Prohibited
Counseling: All 3 types of counseling are covered
Bars: Prohibited
Barriers to Coverage: Minimal barriers exist to access care
Casinos/Gaming Establishments: Prohibited (tribal
establishments not subject to state law) STATE QUITLINE:
Retail stores: Prohibited Investment per Smoker: $5.24; the median investment per
smoker is $1.93
E-Cigarettes Included: Yes
OTHER CESSATION PROVISIONS:
Preemption/Local Opt-Out: No
Private Insurance Mandate: Yes
Citation: MINN. STAT. §§ 144.411 to 144.417 (2020).
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Minnesota Tobacco Cessation Coverage page
for coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

80 Lung.org American Lung Association “State of Tobacco Control” 2024

Minnesota State Highlights:
2024
Tobacco use remains the leading cause 32% margin, with strong support across political and

M
of preventable death and disease in demographic lines.
the United States and in Minnesota.

I
The American Lung Association in Minnesota will
To address this enormous toll, the continue to work together with coalition partners in

N
American Lung Association calls for the 2024 as part of the Smoke Free Generation coalition
following actions to be taken by Minnesota’s elected

N
to eliminate access to all flavored commercial tobacco
officials: products and finish this major piece of legislation.

E
1. Eliminate the sale of all flavored commercial tobacco
products; Minnesota State Facts

S
2. Raise the tax on all commercial tobacco products; Health Care Cost Due to Smoking: $2,519,011,064

O
and Adult Smoking Rate: 13%
3. Protect and close remaining loopholes in the

T
High School Smoking Rate: 3.6%
Minnesota Clean Indoor Air Act.
High School Tobacco Use Rate: 14.9%

A
The 2023 Minnesota Legislative Session delivered
major wins for tobacco prevention and treatment. Middle School Smoking Rate: 1.7%
The American Lung Association – as part of the Smoking Attributable Deaths: 5,910
Minnesotans for a Smoke-Free Generation statewide
coalition of more than 50 organizations helped to pass Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school (11th grade only) smoking and tobacco
two significant provisions within the Health and Human use, and middle school (8th grade only) smoking rates are taken from the
2022 Minnesota Student Survey.
Services Budget bill.
Health impact information is taken from the Smoking Attributable Mortality,
A strong victory was realized in the bill’s language to Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
dedicate Minnesota’s landmark $60.5 settlement with are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
Juul and Altria and any potential future settlement and 2009 personal healthcare expenditure data. Deaths and expenditures
to tobacco prevention to prevent youth commercial should not be compared by state.

tobacco addiction. Minnesota’s first-in-the-nation

trial held Juul Labs as well as Altria (formerly known as
Philip Morris) accountable for deceiving consumers
and illegally targeting youth.
The bill also provided support for Medical Assistance
(Medicaid) and MinnesotaCare enrollees that are
trying to quit smoking, vaping or smokeless tobacco
by expanding the type of health care professionals
that can be reimbursed to provide treatment and
eliminating barriers to FDA-approved medications to
treat tobacco addiction.
Also, during the 2023 legislative session efforts
continued to advance legislation to end the sale of all
flavored tobacco products, with bipartisan legislation
(Senate File 2123/House File 2177) introduced and
passing the Senate Health and Human Services
committee. Although the legislature failed to enact
a statewide measure, progress continued at the
local level with policies currently covering 25.2% of
Minnesotans.
Polling done by Minnesotans for a Smoke-Free
Generation in early 2023 showed that 70% of residents
are concerned about vaping, smoking and other
tobacco use among Minnesota youth. The survey
also found that Minnesota residents support ending
the sale of flavored tobacco products by a 62% to

81 Lung.org American Lung Association “State of Tobacco Control” 2024

 Mississippi Report Card
2024
I

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
P

FY2024 State Funding for CIGARETTE TAX:

P

Tobacco Control Programs: $8,695,000

Tax Rate per pack of 20: $0.68
FY2024 Federal Funding for
I

State Tobacco Control Programs: $1,341,100* OTHER TOBACCO PRODUCT TAXES:

S

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
State Tobacco Control Programs: $10,036,100 Tax on Large Cigars: Equalized: Yes; Weight-Based: No
S

CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No

State Spending Recommendation: $36,500,000
I

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No

Percentage of CDC Recommended Level: 27.5%
S

Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A

State Tobacco-Related Revenue: $252,400,000
For more information on tobacco taxes, go to:
S

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati

from the Centers for Disease Control and Prevention.
I

Note: The Mississippi Legislature appropriated $20 million to the

Mississippi State Department of Health, Office of Tobacco Control;
Access to Cessation Services: D
M

however, only $8,695,000 is allocated for tobacco prevention and control

activities. The Office of Tobacco Control is mandated by law to distribute
funding to other agencies. The total funding amount above includes the
activities of the Mississippi State Department of Health Office of Tobacco OVERVIEW OF STATE CESSATION COVERAGE
Control, Attorney General’s Office of Alcohol and Tobacco Enforcement
Unit, and the University of Mississippi Medical Center, A Comprehensive STATE MEDICAID PROGRAM:
Tobacco Center.
Medicaid Medications: All 7 medications are covered
Medicaid Counseling: Some counseling is covered
Smokefree Air: F Medicaid Barriers to Coverage: Minimal barriers exist to
access care
OVERVIEW OF STATE SMOKING RESTRICTIONS
Medicaid Expansion: No
Government work sites: Restricted
Private work sites: No provision STATE EMPLOYEE HEALTH PLAN(S):
Medications: All 7 medications are covered
Schools: Prohibited (public schools only)
Counseling: All 3 types of counseling are covered
Child care facilities: Prohibited
Barriers to Coverage: Minimal barriers exist to access care
Restaurants: No provision
Bars: No provision STATE QUITLINE:

Casinos/Gaming Establishments: No provision Investment per Smoker: $2.02; the median investment per
smoker is $1.93
Retail stores: No provision
OTHER CESSATION PROVISIONS:
E-Cigarettes Included: No
Private Insurance Mandate: No provision
Preemption/Local Opt-Out: No
Tobacco Surcharge: No prohibition or limitation on tobacco
Citation: MISS. CODE ANN. §§ 29-5-161 (2007), 41-114-1 surcharges
(2010), 97-32-29 (2000) & MS ADMIN CODE Tit. 15, Part III,
Subpart 55 § 103.02 (2009). Citation: See Mississippi Tobacco Cessation Coverage page
for coverage details.
Note: The Smokefree Air grade only examines state tobacco control law
and does not reflect local smokefree ordinances. Mississippi has made
great strides in protecting people from secondhand smoke by passing
comprehensive local smokefree ordinances that cover 30.6% of the
state’s population. Flavored Tobacco Products: F
Restrictions on Flavored Tobacco Products: No state law or
regulation

82 Lung.org American Lung Association “State of Tobacco Control” 2024

Mississippi State Highlights:
2024
Tobacco use remains the leading cause economic burden of tobacco use and exposure to

M
of preventable death and disease in secondhand smoke. The Lung Association will also
the United States and in Mississippi. continue to work with partners to ensure successful

I
To address this enormous toll, the passage and preservation of comprehensive local

S
American Lung Association calls for the smokefree ordinances.
following actions to be taken by Mississippi’s elected

S
officials: Mississippi State Facts

I
1. Increase funding for the Mississippi tobacco Health Care Cost Due to Smoking: $1,236,940,761

S
prevention and cessation program; Adult Smoking Rate: 17.4%
2. Ensure smokefree protections for all workers and

S
High School Smoking Rate: 5.9%
residents with the passage of a comprehensive
statewide smokefree law; and High School Tobacco Use Rate: 21.6%

I
3. Guarantee access to comprehensive quit tobacco Middle School Smoking Rate: 1.5%

P
coverage with no barriers to care for Medicaid Smoking Attributable Deaths: 5,410

P
recipients.
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Tobacco prevention and control issues were not

I
Surveillance System. High school smoking and tobacco use rates are
taken from the 2021 Youth Risk Behavior Surveillance System. Middle
a priority for the Mississippi Legislature in 2023. school smoking rate is taken from the 2017 Youth Tobacco Survey.
While comprehensive statewide smokefree bills Health impact information is taken from the Smoking Attributable Mortality,
were introduced, House Bill 107 also known as the Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
Mississippi Smoke-free Air Act did not garner the are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
support needed to be heard. Tobacco control partners and 2009 personal healthcare expenditure data. Deaths and expenditures
continued to educate lawmakers on the harmful should not be compared by state.

effects of secondhand smoke and the impact on

health in Mississippi.
The Mississippi House of Representatives and the
Mississippi Senate did pass legislation to sustain the
amount of funding to the Mississippi State Department
of Health’s Office of Tobacco Control for youth
prevention, tobacco free community coalitions, and
adult cessation programs statewide. While there was
continued interest by certain legislators to increase
the price of tobacco products, the filed bills did not
achieve final passage.
There continues to be significant support in local
municipalities for public health protections from
secondhand smoke. According to a Lung Association
analysis using local ordinance data from the American
for Nonsmokers’ Rights Foundation and 2022 U.S.
Census data, a total of 160 cities and 7 counties have
adopted comprehensive smokefree ordinances that
cover private workplaces, restaurants and bars. This
accounts for approximately 30.6% of Mississippians
being protected by smokefree policies.
In 2024, the American Lung Association will continue
to advocate for the benefits of tobacco control
policies, including the need to protect all workers by
passing comprehensive protections from secondhand
smoke. In order to meet the bold goals in Mississippi,
state legislators will need to recognize the health and

83 Lung.org American Lung Association “State of Tobacco Control” 2024

 Missouri Report Card
2024
I

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
R

FY2024 State Funding for CIGARETTE TAX:

U

Tobacco Control Programs: $2,863,731

Tax Rate per pack of 20: $0.17
FY2024 Federal Funding for
O

State Tobacco Control Programs: $1,349,783* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
S

State Tobacco Control Programs: $4,213,514 Tax on Large Cigars: Equalized: Yes; Weight-Based: No
S

CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No

State Spending Recommendation: $72,900,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
I

Percentage of CDC Recommended Level: 5.8%

Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A
M

State Tobacco-Related Revenue: $273,000,000

For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

D Thumbs down for Missouri for having the lowest

cigarette tax in the country at 17 cents per pack.
Smokefree Air: F
OVERVIEW OF STATE SMOKING RESTRICTIONS Access to Cessation Services: C
Government work sites: Restricted
OVERVIEW OF STATE CESSATION COVERAGE
Private work sites: Restricted
STATE MEDICAID PROGRAM:
Schools: Prohibited (public schools only)
Medicaid Medications: All 7 medications are covered
Child care facilities: Prohibited
Medicaid Counseling: All 3 types of counseling are covered
Restaurants: Restricted
Medicaid Barriers to Coverage: No barriers exist to access
Bars: No provision care
Casinos/Gaming Establishments: No provision Medicaid Expansion: Yes
Retail stores: Restricted
STATE EMPLOYEE HEALTH PLAN(S):
E-Cigarettes Included: No Medications: All 7 medications are covered
Preemption/Local Opt-Out: No Counseling: Most counseling is covered
Citation: MO. REV. STAT. §§ 191.765 to 191.777 (1992). Barriers to Coverage: No barriers exist to access care
Note: The Smokefree Air grade only examines state tobacco control law
and does not reflect local smokefree ordinances. Missouri has made STATE QUITLINE:
great strides in protecting people from secondhand smoke by passing
comprehensive local smokefree ordinances that cover 29.4% of the Investment per Smoker: $0.63; the median investment per
state’s population. smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Missouri Tobacco Cessation Coverage page for
coverage details.

U Thumbs up for Missouri for providing comprehensive

coverage without barriers for all tobacco cessation
medications and types of counseling to Medicaid
enrollees.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

84 Lung.org American Lung Association “State of Tobacco Control” 2024

Missouri State Highlights:
2024
Tobacco use remains the leading cause following poll and data results that informed the

M
of preventable death and disease strategic plan:
in the United States and in Missouri.

I
• Although more than 8 in 10 Missourians (83.4%)
To address this enormous toll, the support a statewide smokefree Missouri, 71% of

S
American Lung Association calls for the Missourians are not protected by law from exposure to
following actions to be taken by Missouri’s elected

S
secondhand smoke.
officials:
• LGBTQIA+ community in Missouri are 1.5 times more

O
1. Increase funding for tobacco control and cessation likely to use tobacco products than heterosexual
programs; individuals.

U
2. Oppose all forms of preemption of local tobacco During the 2024 legislative session, the American

R
control authority; Lung Association in Missouri will continue to work
3. Support comprehensive smokefree laws that cover with public health partners to increase tobacco

I
all bars, restaurants, casinos/gaming establishments control funding to bring Missouri closer to the CDC-
and workplaces without loopholes. recommended level. The Lung Association will
Missouri lawmakers passed an appropriations bill continue to educate state lawmakers and community
that includes funding for the newly implemented members on the issue of preemption so that they are
Medicaid expansion. For the second year in a row, a better equipped to avoid supporting bills that take
joint resolution was introduced that would have sent away the rights of local communities to pass policies
expansion back to the voters, with work reporting to protect their citizens from tobacco. The Lung
requirements added. The American Lung Association Association will also support local and state laws to
opposed this resolution, which did not pass. A broadly provide comprehensive protections from secondhand
supported piece of legislation extending postpartum smoke in public places and workplaces.
coverage to 12 months in Medicaid was truly agreed Missouri State Facts
and finally passed by lawmakers. Missouri’s Medicaid
coverage for tobacco use treatment is comprehensive Health Care Cost Due to Smoking: $3,032,471,478
and helps thousands of Missourians break the Adult Smoking Rate: 16.8%
powerful addiction of tobacco.
High School Smoking Rate: 5.1%
Two versions of state Tobacco 21 legislation were
introduced during the legislative session, both of High School Tobacco Use Rate: 21.3%
which were strong policies, but did not advance Middle School Smoking Rate: N/A
beyond their assigned committees. Two pieces
of legislation that would preempt local tobacco Smoking Attributable Deaths: 10,970
licensure regulations were also introduced. Since it Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
has been a favorite strategy of tobacco lobbyists to Surveillance System. High school smoking and tobacco use data come
from CDC’s 2021 Youth Risk Behavior Surveillance System. A current
add preemption amendments to Tobacco 21 policies, middle school smoking rate is not available for this state.
and with the introduction of the two standalone Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
tobacco preemption bills, this threat was perceived deaths reflect average annual estimates for the period 2005-2009 and
to be even stronger than in the past. Thanks to a are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
coordinated effort among our health partners and and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
key legislators, these preemptive policies did not
advance further.
The Missouri Department of Health and Senior
Services Tobacco Prevention and Control Program
(MO TPCP) launched the newest Missouri Tobacco
Prevention and Control strategic tobacco plan (2022-
2026) in October 2022. One key program included in
the plan is the “Tobacco is Changing” media campaign
to educate parents about the dangers of flavored
tobacco products. The MO TPCP also released the

85 Lung.org American Lung Association “State of Tobacco Control” 2024

 Montana Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
N

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $5,680,705
A

Tax Rate per pack of 20: $1.70

FY2024 Federal Funding for
OTHER TOBACCO PRODUCT TAXES:
T

State Tobacco Control Programs: $1,356,206*

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
N

State Tobacco Control Programs: $7,036,911 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes
O

State Spending Recommendation: $14,600,000

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 48.2%
M

Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A

State Tobacco-Related Revenue: $100,000,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

Smokefree Air: B Access to Cessation Services: A

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: All 7 medications are covered
Schools: Prohibited Medicaid Counseling: Some counseling is covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Minimal barriers exist to
access care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: Prohibited (tribal
establishments not subject to state law) Medications: Some medications are covered
Retail stores: Prohibited Counseling: Some counseling is covered
E-Cigarettes Included: Only in K-12 Schools and on School Barriers to Coverage: Some barriers exist to access care
Property
STATE QUITLINE:
Preemption/Local Opt-Out: No
Investment per Smoker: $4.58; the median investment per
Citation: MONT. CODE ANN. §§ 50-40-101 et seq. (2011). smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Montana Tobacco Cessation Coverage page for
coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

86 Lung.org American Lung Association “State of Tobacco Control” 2024

Montana State Highlights:
2024
Tobacco use remains the leading cause The Montana legislature meets every two years. The

M
of preventable death and disease in American Lung Association will continue to advocate
the United States and in Montana. for strengthening clean indoor protections and

O
To address this enormous toll, the growing momentum to increase funding for Montana’s

N
American Lung Association calls for the Tobacco Use Prevention Program during the 2024
following actions to be taken by Montana’s elected interim.

T
officials:
Montana State Facts
1. Increase funding for the state’s tobacco prevention

A
and quit programs; Health Care Cost Due to Smoking: $440,465,233

N
2. Remove preemption, allowing local governments Adult Smoking Rate: 15.2%
to protect public health from the health impacts of

A
High School Smoking Rate: 7%
tobacco use; and
High School Tobacco Use Rate: 27%
3. Defend and strengthen clean indoor air protections.
Middle School Smoking Rate: 3.4%
During the 2023 legislative session, several bills were
introduced to weaken tobacco prevention policies Smoking Attributable Deaths: 1,570
and protections in Montana. The American Lung
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Association joined with advocates and stakeholders to Surveillance System. High school smoking and tobacco use data are taken
from CDCs 2021 Youth Risk Behavior Surveillance System. Middle school
fend off each of these attacks. smoking rate (8th grade only) is taken from the 2020 Montana Prevention
Needs Assessment Survey.
House Bill 293, introduced by vape shop owner
Health impact information is taken from the Smoking Attributable Mortality,
Representative Marshall, proposed separating electronic Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
devices and other products from being designated as deaths reflect average annual estimates for the period 2005-2009 and
are calculated for persons aged 35 years and older. Smoking-attributable
tobacco products. This bill passed the House with a healthcare expenditures based on 2004 smoking-attributable fractions
and 2009 personal healthcare expenditure data. Deaths and expenditures
vote 49 to 48 (1 abstained, 3 absences). The legislation should not be compared by state.
moved to the Senate and died in committee.
House Bill 869, also introduced by Representative
Marshall, would have slashed funding for tobacco
use prevention and chronic disease programming. A
public hearing was held in the House Human Services
committee and was then tabled.
Senate Bill 205, introduced by Senator Trebas, would
have weakened Montana’s Clean Indoor Air Act (CIAA)
and proposed allowing ‘private establishments’ to
allow smoking by a permitting process. A public
hearing was held in the Senate Public Health, Welfare
and Safety committee and was tabled.
Senate Bill 371, introduced by Senator Trebas,
proposed removing enforcement mechanisms for the
clean indoor air act and penalties against businesses
who fail to comply with the law. SB 371 died in
committee.
One bill, Senate Bill 122, did make it through the
process and passed through both houses. The
legislation offered a 35-cent tax cap on the sale
of premium cigars – significantly impacting retail
prices. The American Lung Association joined other
advocates in asking Governor Greg Gianforte to veto
the legislation. The Governor signed SB 122 into law
which went into effect on July 1, 2023.

87 Lung.org American Lung Association “State of Tobacco Control” 2024

 Nebraska Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
K

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $3,652,146
S

Tax Rate per pack of 20: $0.64

FY2024 Federal Funding for
OTHER TOBACCO PRODUCT TAXES:
A

State Tobacco Control Programs: $1,187,754*

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
R

State Tobacco Control Programs: $4,839,900 Tax on Large Cigars: Equalized: Yes; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes
B

State Spending Recommendation: $20,800,000

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 23.3%
E

Tax on E-cigarettes: Equalized: No; Weight-Based: Yes

State Tobacco-Related Revenue: $97,600,000
N

For more information on tobacco taxes, go to:

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention

U Thumbs up for Nebraska for increasing funding for its

state tobacco control program by over $1 million from
Juul settlement funds this fiscal year. Access to Cessation Services: D
OVERVIEW OF STATE CESSATION COVERAGE
Smokefree Air: A STATE MEDICAID PROGRAM:
Medicaid Medications: All 7 medications are covered
OVERVIEW OF STATE SMOKING RESTRICTIONS
Medicaid Counseling: Some counseling is covered
Government work sites: Prohibited
Medicaid Barriers to Coverage: Minimal barriers exist to
Private work sites: Prohibited
access care
Schools: Prohibited
Medicaid Expansion: Yes
Child care facilities: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Restaurants: Prohibited
Medications: All 7 medications are covered
Bars: Prohibited (allowed in cigar shops)
Counseling: Most counseling is covered
Casinos/Gaming Establishments: Prohibited (tribal
establishments not subject to state law) Barriers to Coverage: Minimal barriers exist to access care

Retail stores: Prohibited STATE QUITLINE:

E-Cigarettes Included: Yes Investment per Smoker: $1.63; the median investment per
smoker is $1.93
Preemption/Local Opt-Out: Limited
OTHER CESSATION PROVISIONS:
Citation: NEB. REV. STAT. §§ 71-5716 to 71-5735 (2020).
Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Nebraska Tobacco Cessation Coverage page
for coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

88 Lung.org American Lung Association “State of Tobacco Control” 2024

Nebraska State Highlights:
2024
Tobacco use remains the leading cause

N
Nebraska State Facts
of preventable death and disease in
Health Care Cost Due to Smoking: $795,185,324

E
the United States and in Nebraska.
To address this enormous toll, the Adult Smoking Rate: 13%

B
American Lung Association calls for the
High School Smoking Rate: 2.7%
following actions to be taken by Nebraska’s elected

R
officials: High School Tobacco Use Rate: 14.9%

A
1. Maintain and/or increase funding for tobacco Middle School Smoking Rate: N/A
prevention and cessation programs; and

S
Smoking Attributable Deaths: 2,510
2. Oppose all forms of preemption of local tobacco

K
control authority. Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking and tobacco use data come
from the 2022 Nebraska Youth Tobacco Survey. A current middle school
The 2023 Legislative Session was an active one

A
smoking rate is not available for this state.
regarding tobacco control and prevention policies. Health impact information is taken from the Smoking Attributable Mortality,
The significant success of the session for tobacco Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
control advocates was the passage of Legislative Bill are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
539 which directed funds from the Juul Settlement and 2009 personal healthcare expenditure data. Deaths and expenditures
with the state of Nebraska to tobacco control and should not be compared by state.

prevention activities directed by the Nebraska

Department of Health and Human Services. The bill,
which directed $1.08 million to the Nebraska Tobacco
Control and Prevention program was amended into an
appropriations bill and passed the Legislature.
Legislative Bill 745 proposed an increase of $1.50 to
the state’s cigarette tax. Currently, the cigarette tax in
Nebraska is $.64 per pack and hasn’t increased in over
two decades. LB 745 received a hearing but did not
move out of Committee. A tax on e-cigarettes of $.05
per milliliter did pass in the 2023 session. The Lung
Association opposed this tax as it was not equalized
to the rate of tax on other tobacco products and will
result in most e-cigarettes having just a few pennies
added to their price, which will have no effect on kids
buying them.
The Legislature voted to extend postpartum coverage
for Medicaid recipients in 2023. Legislative Bill 419
extends postpartum coverage for Medicaid recipients
from 60 days to 12 months. This coverage extension
included coverage for tobacco cessation counseling
and medications for pregnant women providing
coverage for an estimated 3,000 additional women in
the state.
The 2024 session is a short session - 60 days versus
90 days in an odd number year – and the American
Lung Association in Nebraska and coalition partners
will continue to promote increased funding for
tobacco prevention and cessation programs and
lay groundwork and cultivate tobacco control and
prevention champions in the Legislature in the 2025
session.

89 Lung.org American Lung Association “State of Tobacco Control” 2024

 Nevada Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
D

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $950,000
A

Tax Rate per pack of 20: $1.80

FY2024 Federal Funding for
OTHER TOBACCO PRODUCT TAXES:
V

State Tobacco Control Programs: $1,384,475*

FY2024 Total Funding for Tax on Little Cigars: Equalized: No; Weight-Based: No
E

State Tobacco Control Programs: $2,334,475 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No
N

State Spending Recommendation: $30,000,000

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 7.8%
Tax on E-cigarettes: Equalized: Yes; Weight-Based: No
State Tobacco-Related Revenue: $220,000,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.
Thumbs down for Nevada for decreasing funding for its
D state tobacco control program by $2.5 million this fiscal
year. Access to Cessation Services: F*
OVERVIEW OF STATE CESSATION COVERAGE
Smokefree Air: C STATE MEDICAID PROGRAM:
Medicaid Medications: Most medications are covered
OVERVIEW OF STATE SMOKING RESTRICTIONS
Medicaid Counseling: Some counseling is covered
Government work sites: Prohibited
Medicaid Barriers to Coverage: Minimal barriers exist to
Private work sites: Prohibited
access care
Schools: Prohibited
Medicaid Expansion: Yes
Child care facilities: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Restaurants: Prohibited
Medications: Data not provided
Bars: Restricted (smoking allowed in bars or parts of bars if
age-Restricted) Counseling: Data not provided

Casinos/Gaming Establishments: Restricted (tribal Barriers to Coverage: Data not provided

establishments not subject to state law)* STATE QUITLINE:
Retail stores: Prohibited Investment per Smoker: $0.87; the median investment per
E-Cigarettes Included: Yes smoker is $1.93

Preemption/Local Opt-Out: No OTHER CESSATION PROVISIONS:

Citation: NEV. REV. STAT. § 202.2483 (2019). Private Insurance Mandate: Yes
* Smoking is allowed on casinos floors but is prohibited anywhere Tobacco Surcharge: No prohibition or limitation on tobacco
children are allowed to be. surcharges
Citation: See Nevada Tobacco Cessation Coverage page for
coverage details.
* Nevada was not able to provide State Employee Health Plan tobacco
cessation coverage data. This part of the grade was excluded from the
grade calculation.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

90 Lung.org American Lung Association “State of Tobacco Control” 2024

Nevada State Highlights:
2024
Tobacco use remains the leading cause taxed and lower-priced tobacco products. The Lung

N
of preventable death and disease in the Association opposed the measure.

E
United States and in Nevada. To address The state legislature does not meet in 2024, but
this enormous toll, the American Lung the American Lung Association will continue to

V
Association calls for the following build support and political will in order to advance
actions to be taken by Nevada’s elected officials:

A
comprehensive smokefree protections at the local and
1. Protect and expand the Nevada Clean Indoor Air state level.

D
Act;
Nevada State Facts
2. Increase funding for the state’s tobacco prevention

A
and control program; and Health Care Cost Due to Smoking: $1,080,272,434

3. Update the state tobacco retailer licensing program. Adult Smoking Rate: 14.8%

The American Lung Association along with partners High School Smoking Rate: 3.4%
from the Nevada Tobacco Control & Smoke-free
High School Tobacco Use Rate: N/A
Coalition continued to lead state efforts to prevent
and reduce tobacco use in 2023. Priorities of the Middle School Smoking Rate: 1.8%
Coalition continue to center around expansion of the Smoking Attributable Deaths: 4,050
Nevada Clean Indoor Air Act and proper funding for
the state’s tobacco prevention and control program. Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school and middle school smoking data come
The Lung Association priorities continue to be from the 2021 Nevada Youth Risk Behavior Survey. A current high school
tobacco use rate is not available for this state.
building support and political will in order to advance
Health impact information is taken from the Smoking Attributable Mortality,
comprehensive smokefree protections at the local Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
level and state level. deaths reflect average annual estimates for the period 2005-2009 and
are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
During the 2023 legislative session, a comprehensive and 2009 personal healthcare expenditure data. Deaths and expenditures
tobacco control bill, Assembly Bill 294, was introduced. should not be compared by state.

This bill would have prohibited the sale of flavored

tobacco products, strengthened the state’s tobacco
retailer license, phased out the sale of tobacco
products for people born after December 31,
2002, and increased tobacco cessation coverage.
Unfortunately, the bill did not see any movement.
The Lung Association along with our partners also
worked to maintain the budget for youth prevention
and tobacco control programs. In 2021, the legislature
included a two-year allocation of $5 million to the
Division of Public and Behavioral Health.
Unfortunately, the legislature did not appropriate these
funds in the budget for the biennium reducing funding
to only $950,000 for each of the next two years from
the tobacco Master Settlement Agreement. This will
have a direct impact on the Health Districts youth
prevention and tobacco control programs. Additionally,
the legislature passed a bill that will tax premium
cigars at a lower rate than other tobacco products by
imposing a cigar tax cap not to exceed 50 cents per
cigar. Tobacco taxes are one of the most effective
ways to reduce smoking and other tobacco use. Tax
parity among combustible and other tobacco products
is important to prevent initiation of tobacco products
and to keep tobacco users from switching to lower-

91 Lung.org American Lung Association “State of Tobacco Control” 2024

 New Hampshire Report Card
2024
E

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
R

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $606,841
I

Tax Rate per pack of 20: $1.78

FY2024 Federal Funding for
H

State Tobacco Control Programs: $1,144,210* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
S

State Tobacco Control Programs: $1,751,051 Tax on Large Cigars: Equalized: No; Weight-Based: N/A
P

CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No

State Spending Recommendation: $16,500,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
M

Percentage of CDC Recommended Level: 10.6%

Tax on E-cigarettes: Equalized: No; Weight-Based: Yes
State Tobacco-Related Revenue: $257,300,000
A

For more information on tobacco taxes, go to:

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.
H

Smokefree Air: F Access to Cessation Services: C

W

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

E

Government work sites: Restricted STATE MEDICAID PROGRAM:

Private work sites: Restricted Medicaid Medications: All 7 medications are covered
N

Schools: Prohibited (public schools only) Medicaid Counseling: Most counseling is covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Minimal barriers exist to
access care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited (allowed in cigar bars and allows for an
economic hardship waiver) STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: Restricted Medications: All 7 medications are covered
Retail stores: Restricted Counseling: Some counseling is covered
E-Cigarettes Included: Yes Barriers to Coverage: Some barriers exist to access care
Preemption/Local Opt-Out: Yes STATE QUITLINE:
Citation: N.H. REV. STAT. ANN. §§ 155:64 to 155:78 (2019) & Investment per Smoker: $1.11; the median investment per
178:20-a (2018). smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See New Hampshire Tobacco Cessation Coverage
page for coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

92 Lung.org American Lung Association “State of Tobacco Control” 2024

New Hampshire State Highlights:
2024
Tobacco use remains the leading cause

N
New Hampshire State Facts
of preventable death and disease in the
Health Care Cost Due to Smoking: $728,895,693

E
United States and in New Hampshire.
To address this enormous toll, the Adult Smoking Rate: 11.2%

W
American Lung Association calls for
High School Smoking Rate: 5.5%
the following actions to be taken by New Hampshire’s
elected officials: High School Tobacco Use Rate: N/A

H
1. Provide increased funding for the New Hampshire Middle School Smoking Rate: N/A
tobacco control and prevention program;

A
Smoking Attributable Deaths: 1,940
2. Defend against rollbacks to and close loopholes in

M
smokefree laws; and Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking rate is taken from CDCs 2019
Youth Risk Behavior Surveillance System. A current high school tobacco
3. End the sale of menthol and all other flavored use rate and middle school smoking rate are not available for this state.

P
tobacco products. Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable

S
The 2023 session of the General Court of New deaths reflect average annual estimates for the period 2005-2009 and
Hampshire was focused on educating lawmakers on are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions

H
the need to proactively address the tobacco use rates and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
in the state and on evidenced-based policy solutions.

I
Despite the New Hampshire Tobacco Prevention

R
program being woefully underfunded at only
approximately 10% of the level recommended by

E
the U.S. Centers for Disease Control and Prevention,
the level of state funding was only slightly increased
in 2023. Significantly increasing funding for New
Hampshire’s tobacco prevention and treatment efforts
remains the top priority for the 2024 session. New
Hampshire along with dozens of other states has
received funding as a result of a settlement with the
e-cigarette company Juul. It is imperative that the
funding the state has received be allocated to New
Hampshire’s tobacco prevention program to address
the youth vaping epidemic.
The most significant policy victory in 2023 was the
reauthorization of the New Hampshire Medicaid
expansion program – Granite Advantage ensuring
continued access to healthcare and tobacco treatment
and cessation for New Hampshire residents enrolled in
the program.
The American Lung Association in New Hampshire will
continue to work with our coalition partners including
the Tobacco Free New Hampshire Network, New
Hampshire Public Health Association, the American
Heart Association, Breathe New Hampshire, American
Cancer Society Cancer Action Network and others to
advance tobacco control and prevention efforts. As
the legislature begins its work in 2024, we will continue
to educate policy makers, Granite State residents and
business leaders and the media of the importance of
the Lung Association’s goals to reduce tobacco use
and protect public health.

93 Lung.org American Lung Association “State of Tobacco Control” 2024

 New Jersey Report Card
2024
Y

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
E

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $8,305,650
S

Tax Rate per pack of 20: $2.70

FY2024 Federal Funding for
R

State Tobacco Control Programs: $1,855,458* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: No; Weight-Based: No
E

State Tobacco Control Programs: $10,161,108 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices
J

Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes

State Spending Recommendation: $103,300,000
Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: No
Percentage of CDC Recommended Level: 9.8%
Tax on E-cigarettes: Equalized: No; Weight-Based: Yes
W

State Tobacco-Related Revenue: $792,800,000

For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
E

from the Centers for Disease Control and Prevention.

N

Smokefree Air: B Access to Cessation Services: C

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: All 7 medications are covered
Schools: Prohibited Medicaid Counseling: Most counseling is covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: No barriers to access care
Restaurants: Prohibited Medicaid Expansion: Yes
Bars: Prohibited (allowed in cigar bars/lounges) STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: Restricted* Medications: All 7 medications are covered
Retail stores: Prohibited Counseling: Limited counseling is covered
E-Cigarettes Included: Yes Barriers to Coverage: Some barriers exist to access care
Preemption/Local Opt-Out: No STATE QUITLINE:
Citation: N.J. STAT. ANN. §§ 26:3D-55 to 26:3D-64 (2020). Investment per Smoker: $0.64; the median investment per
smoker is $1.93
* Smoking in indoor areas of horse tracks is prohibited by state law.
Atlantic City, NJ where all the state’s casinos are located, has an
ordinance restricting smoking to 25 percent of the gaming floors of OTHER CESSATION PROVISIONS:
casinos. Private Insurance Mandate: Yes
Thumbs down for New Jersey for failing to pass
D legislation to close the loophole for casinos in its
Tobacco Surcharge: Prohibits tobacco surcharges
smokefree air law. Citation: See New Jersey Tobacco Cessation Coverage page
for coverage details.

Flavored Tobacco Products: D

Restrictions on Flavored Tobacco Products: All flavored
e-cigarettes prohibited in all locations

94 Lung.org American Lung Association “State of Tobacco Control” 2024

New Jersey State Highlights:
2024
Tobacco use remains the leading cause from secondhand smoke in public places and

N
of preventable death and disease in workplaces in 2024.

E
the United States and in New Jersey.
To address this enormous toll, the New Jersey State Facts

W
American Lung Association calls for the Health Care Cost Due to Smoking: $4,065,531,641
following actions to be taken by New Jersey’s elected
Adult Smoking Rate: 10.4%
officials:
High School Smoking Rate: 3.7%

J
1. Expand the smokefree law by making all casinos
smokefree; High School Tobacco Use Rate: N/A

E
2. Prohibit the sale of all flavored tobacco products; Middle School Smoking Rate: N/A

R
and
Smoking Attributable Deaths: 11,780

S
3. Increase the cigarette tax and tax on other tobacco
products by a significant amount. Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking rate is taken from the 2021

E
Youth Risk Behavior Surveillance System. A current middle school smoking
2023 continued to see significant progress towards rate and high school tobacco use rate is not available for this state.
legislation making New Jersey’s casinos smokefree.

Y
Health impact information is taken from the Smoking Attributable Mortality,
Both the Assembly and the Senate held hearings on Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
the issue and saw significant testimony in support. are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
Additionally, grassroots support for tobacco control and 2009 personal healthcare expenditure data. Deaths and expenditures
policies across the state of New Jersey has grown. should not be compared by state.

Casino workers have become extremely well

organized and have become a powerful force in the
legislature and in the media. The Lung Association
was disappointed that the legislation was not brought
up for a legislative vote. While the Lung Association
did not see any significant legislative or regulatory
progress on items passing regarding smokefree,
tobacco tax, tobacco control funding and prohibiting
the sale of flavored tobacco products, there continues
to be expanded support on these topics.
New Jersey’s casino workers have not only organized
in New Jersey but have taken their efforts nationwide.
They are working with casino workers in other states
to train them and work together to help those workers
organize themselves. We hope to see the movement
continue to grow.
New Jersey’s tobacco control program remains
underfunded but has seen increased investments
in the program in recent years. The U.S. Centers for
Disease Control and Prevention recommends that
New Jersey spend $103 million on its tobacco control
program. In the 2023-24 state budget, the program
was funded at $8.3 million – the Lung Association calls
for increasing funding to $15 million per year as a next
step towards the CDC-recommended level.
The Lung Association urges decisionmakers in New
Jersey to take the necessary steps to reduce the death
and disease caused by tobacco-use and exposure to
secondhand smoke, and to pass legislation to include
casinos in New Jersey’s otherwise strong protections

95 Lung.org American Lung Association “State of Tobacco Control” 2024

 New Mexico Report Card
2024
O

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: D
C

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $4,449,300*
I

Tax Rate per pack of 20: $2.00

FY2024 Federal Funding for
X

State Tobacco Control Programs: $918,549** OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
E

State Tobacco Control Programs: $5,367,849 Tax on Large Cigars: Equalized: No; Weight-Based: No
M

CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: No

State Spending Recommendation: $22,800,000
Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: No
Percentage of CDC Recommended Level: 23.5%
Tax on E-cigarettes: Equalized: No; Weight-Based: No
State Tobacco-Related Revenue: $135,000,000
W

For more information on tobacco taxes, go to:

* In the fiscal year 2024 state budget, $5,684,500 was appropriated for www.lung.org/slati
tobacco prevention and control activities by the New Mexico Department
E

of Health and New Mexico Indian Affairs Department; however, some of

the money going to the Department of Health is being held back due to

A
ongoing tobacco Master Settlement Agreement-related litigation.
N

** Includes tobacco prevention and cessation funding provided to states

Access to Cessation Services:
from the Centers for Disease Control and Prevention.
OVERVIEW OF STATE CESSATION COVERAGE

Smokefree Air: B STATE MEDICAID PROGRAM:

Medicaid Medications: All 7 medications are covered
OVERVIEW OF STATE SMOKING RESTRICTIONS Medicaid Counseling: Some counseling is covered
Government work sites: Prohibited Medicaid Barriers to Coverage: Minimal barriers exist to
access care
Private work sites: Prohibited
Medicaid Expansion: Yes
Schools: Prohibited
Child care facilities: Prohibited STATE EMPLOYEE HEALTH PLAN(S):

Restaurants: Prohibited Medications: Some medications are covered

Bars: Prohibited (allowed in cigar bars) Counseling: Some counseling is covered

Casinos/Gaming Establishments: No provision Barriers to Coverage: Some barriers exist to access care

Retail stores: Prohibited STATE QUITLINE:

E-Cigarettes Included: Yes Investment per Smoker: $6.01; the median investment per
smoker is $1.93
Preemption/Local Opt-Out: No
OTHER CESSATION PROVISIONS:
Citation: N.M. STAT. ANN. §§ 24-16-1 et seq. (2019).
Private Insurance Mandate: Yes
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See New Mexico Tobacco Cessation Coverage page
for coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

96 Lung.org American Lung Association “State of Tobacco Control” 2024

New Mexico State Highlights:
2024
Tobacco use remains the leading cause funded tobacco prevention and cessation program

N
of preventable death and disease in and will work to protect state tobacco prevention and

E
the United States and in New Mexico. control program funding.
To address this enormous toll, the
New Mexico State Facts

W
American Lung Association calls for the
following actions to be taken by New Mexico’s elected Health Care Cost Due to Smoking: $843,869,235
officials:
Adult Smoking Rate: 15%

M
1. Increase funding for the state’s tobacco prevention
High School Smoking Rate: 3.7%
and control program;

E
2. Increase excise taxes on tobacco products by $1.00 High School Tobacco Use Rate: 25.6%
per pack or more; and

X
Middle School Smoking Rate: 4.3%
3. Remove statewide preemption for tobacco product Smoking Attributable Deaths: 2,630

I
sales laws.

C
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
The American Lung Association provides leadership Surveillance System. High school smoking and tobacco use data come
from the 2021 Youth Risk Behavior Surveillance System. Middle school
in convening partners and guiding public policy efforts

O
smoking rate is taken from the 2017 New Mexico Youth Risk and Resiliency
to continue the state’s success in reducing the impact Survey.

of tobacco among New Mexicans. Together with Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
our partners, the Lung Association works to ensure deaths reflect average annual estimates for the period 2005-2009 and
are calculated for persons aged 35 years and older. Smoking-attributable
tobacco control and prevention remains a priority for healthcare expenditures based on 2004 smoking-attributable fractions
state legislators and local decision makers. and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
In 2023, the Lung Association’s focus was to continue
to educate legislators, legislative staff, and the general
public about smoking and the importance of providing
tobacco cessation programs for adults and youth,
and the dangers of secondhand smoke. During the
legislative session, the Lung Association along with our
partners worked to increase the excise tax on tobacco
products, close the loophole on indoor smoking
in racinos, prohibit the sale of flavored tobacco
products, restore the tobacco settlement fund, and
repeal preemption of local communities’ ability to
pass stronger tobacco sales policies. Disappointingly,
while these bills saw movement and passed their first
committee assignments, none of them made it to the
Governor’s desk for consideration.
Funding for the state tobacco control program from
tobacco Master Settlement Agreement dollars have
seen significant cuts in previous years and falls well
short of Centers for Disease Control and Prevention-
recommended levels. It is important for New Mexico
legislators and the Governor to consider protecting
the settlement dollars by removing the budget reserve
designation from the Tobacco Settlement Permanent
Fund, where 50% of annual of Master Settlement
Agreement payments are designated.
Moving forward in 2024, the American Lung
Association will once again make it a priority to
educate our legislature and communities about the
dangers of tobacco use, the importance of a well-

97 Lung.org American Lung Association “State of Tobacco Control” 2024

 New York Report Card
2024
K

Tobacco Prevention and

Control Program Funding: F F Tobacco Taxes: B
R

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $46,733,600
O

Tax Rate per pack of 20: $5.35

FY2024 Federal Funding for
OTHER TOBACCO PRODUCT TAXES:
Y

State Tobacco Control Programs: $2,905,769*

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
State Tobacco Control Programs: $49,639,369 Tax on Large Cigars: Equalized: No; Weight-Based: No
W

CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes
State Spending Recommendation: $203,000,000
Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: No
Percentage of CDC Recommended Level: 24.5%
E

Tax on E-cigarettes: Equalized: No; Weight-Based: No

State Tobacco-Related Revenue: $1,874,800,000
For more information on tobacco taxes, go to:
N

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati

from the Centers for Disease Control and Prevention

U Thumbs up for New York for increasing funding for its

state tobacco control program by over $7.5 million this
U Thumbs up for New York for increasing its cigarette tax
by $1.00 to $5.35 per pack, the new highest rate in the
fiscal year. country.

Smokefree Air: A Access to Cessation Services: B

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: All 7 medications are covered
Schools: Prohibited Medicaid Counseling: Some counseling is covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Minimal barriers exist to
access care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited (allowed in cigar bars and allows for an
economic hardship waiver) STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: Prohibited (tribal Medications: All 7 medications are covered
establishments not subject to state law) Counseling: Some counseling is covered
Retail stores: Prohibited Barriers to Coverage: Minimal barriers exist to access care
E-Cigarettes Included: Yes
STATE QUITLINE:
Preemption/Local Opt-Out: No
Investment per Smoker: $2.53; the median investment per
Citation: N.Y. [PUB. HEALTH] LAW §§ 1399-n to 1399-x (2019). smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: Yes
Tobacco Surcharge: Prohibits tobacco surcharges
Citation: See New York Tobacco Cessation Coverage page for
coverage details.

Flavored Tobacco Products: D

Restrictions on Flavored Tobacco Products: Most flavored
e-cigarettes prohibited in all locations

D Thumbs down for New York for failing to pass legislation

to end the sale of all flavored tobacco products
statewide.

98 Lung.org American Lung Association “State of Tobacco Control” 2024

New York State Highlights:
2024
Tobacco use remains the leading cause build upon its work in 2023 with a sustained push on

N
of preventable death and disease in preserving increased funding for the tobacco control

E
the United States and in New York. program and on enacting a statewide prohibition on
To address this enormous toll, the the sale of all flavored tobacco products in 2024. The

W
American Lung Association calls for the removal of menthol cigarettes, flavored cigars and
following actions to be taken by New York’s elected other flavored tobacco products is a social justice and
officials: health equity issue and must be addressed.

Y
1. Preserve funding for the New York state tobacco
New York State Facts
control program;

O
Health Care Cost Due to Smoking: $10,389,849,268
2. Prohibit the sale of all flavored tobacco products;
Adult Smoking Rate: 11.3%

R
and
3. Eliminate loopholes on the sale of e-cigarettes. High School Smoking Rate: 2.1%

K
New York has long been a national leader regarding its High School Tobacco Use Rate: 20.8%
tobacco control laws and continued to do so in 2023.
Middle School Smoking Rate: N/A
During the legislative session New York was very active
when it came to tobacco control policy. Governor Smoking Attributable Deaths: 28,170
Hochul, in January of 2023, called for an increase in
Adult smoking data comes from CDC’s 2022 Behavioral Risk Factor
the excise taxes on tobacco products in New York, in Surveillance System. High school smoking and tobacco use data come
addition to calling for an end to the sale of flavored from the 2022 New York Youth Tobacco Survey. High school tobacco
use includes cigarettes, cigars, smokeless tobacco, and electronic vapor
tobacco products, including menthol cigarettes. products, as well as hookah, making it incomparable to other states. A
current middle school smoking rate is not available for this state.
During the budget process, while the New York Health impact information is taken from the Smoking Attributable Mortality,
State Legislature disappointingly did not halt the Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
sale of flavored tobacco products, they did support are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
an increase of the tax to a nation leading $5.35 per and 2009 personal healthcare expenditure data. Deaths and expenditures
pack of cigarettes. There was also an over $7 million should not be compared by state.

increase in tobacco control program funding included

as part of the state budget, part of which came from
the settlement by Attorney General Letitia James with
Juul Labs that was finalized in 2023.
New data from New York’s Youth Tobacco Survey (NY
YTS) show that after staggering increases in youth
tobacco use between 2014 and 2018, primarily driven
by electronic cigarettes, tobacco use among high
school age youth has declined across all product
categories from 30.6% to 20.8% between 2018 and
2022.
• Cigarette smoking among high school youth is at
an all-time low: only 2.1% of high school youth are
current smokers, representing an over 90% decline
in the youth smoking rate since 2000.
• E-cigarette use among high school youth decreased
in 2020, a first since New York has monitored use of
these products, from 27.5% in 2018 to 22.5% in 2020.
• Other tobacco product use, including cigars,
smokeless tobacco, pipe tobacco, and hookah, also
decreased among high school youth, from 9.2% in
2018 to 6.1% in 2020.
The American Lung Association will continue to

99 Lung.org American Lung Association “State of Tobacco Control” 2024

 North Carolina Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
N

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $13,349,600
I

Tax Rate per pack of 20: $0.45

FY2024 Federal Funding for
L

State Tobacco Control Programs: $2,353,231* OTHER TOBACCO PRODUCT TAXES:

Tax on Little Cigars: Equalized: Yes; Weight-Based: No
O

FY2024 Total Funding for

State Tobacco Control Programs: $15,702,831 Tax on Large Cigars: Equalized: Yes; Weight-Based: No
R

CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No

State Spending Recommendation: $99,300,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
A

Percentage of CDC Recommended Level: 15.8%

Tax on E-cigarettes: Equalized: No; Weight-Based: Yes
State Tobacco-Related Revenue: $465,300,000
C

For more information on tobacco taxes, go to:

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.
H

Smokefree Air: F Access to Cessation Services: D

T

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

R

Government work sites: Restricted (Prohibited in state STATE MEDICAID PROGRAM:

government buildings) Medicaid Medications: All 7 medications are covered
O

Private work sites: No provision Medicaid Counseling: Some counseling is covered

N

Schools: Prohibited (public schools only) Medicaid Barriers to Coverage: Some barriers exist to access
Child care facilities: Restricted care
Restaurants: Prohibited Medicaid Expansion: Yes
Bars: Prohibited (allowed in cigar bars) STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: N/A (tribal casinos only) Medications: All 7 medications are covered
Retail stores: No provision Counseling: Some counseling is covered
E-Cigarettes Included: No Barriers to Coverage: Some barriers exist to access care
Preemption/Local Opt-Out: Yes STATE QUITLINE:
Citation: N.C. GEN. STAT. §§ 130A-491 to 130A-498 (2010), Investment per Smoker: $1.56; the median investment per
115C-407 (2007), 131D-4.4 (2007) & 131E-114.3 (2007). smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: No provision
Tobacco Surcharge: Limits tobacco surcharges
Citation: See North Carolina Tobacco Cessation Coverage
page for coverage details.

U Thumbs up for North Carolina for expanding Medicaid,

providing coverage, including tobacco cessation
treatment, for up to 600,000 people.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

100 Lung.org American Lung Association “State of Tobacco Control” 2024

North Carolina State Highlights:
2024
Tobacco use remains the leading cause

N
North Carolina State Facts
of preventable death and disease in
Health Care Cost Due to Smoking: $3,809,676,476

O
the United States and in North Carolina.
To address this enormous toll, the Adult Smoking Rate: 14.5%

R
American Lung Association calls for
High School Smoking Rate: 3.9%
the following actions to be taken by North Carolina’s

T
elected officials: High School Tobacco Use Rate: N/A

H
1. Implement a comprehensive tobacco retail licensing Middle School Smoking Rate: 2.4%
system, including e-cigarette retailers;
Smoking Attributable Deaths: 14,220
2. Increase the cigarette tax to the current average

C
cigarette tax and equalize taxes for all tobacco Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking rate comes from CDC’s 2021
products, including e-cigarettes; and Youth Risk Behavioral Surveillance System. Middle school smoking rate

A
comes from the 2019 North Carolina Youth Tobacco Survey. A current high
3. Rollback preemption of stronger local laws in North school tobacco use rate is not available for this state.

R
Carolina regarding tobacco use and prevention. Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
In 2023, the North Carolina General Assembly had a deaths reflect average annual estimates for the period 2005-2009 and

O
are calculated for persons aged 35 years and older. Smoking-attributable
heavy focus on Medicaid expansion, which ended up healthcare expenditures based on 2004 smoking-attributable fractions
and 2009 personal healthcare expenditure data. Deaths and expenditures
being tied to a controversial state budget. Ultimately,

L
should not be compared by state.
the budget passed with expansion along with a few

I
other provisions related to commercial tobacco use
prevention and cessation. This included $11,250,000 in

N
nonrecurring funds in each year of the biennium from

A
the state’s settlement with Juul Labs, Inc. for evidence-
based electronic cigarette and nicotine dependence
prevention and cessation activities targeting students
in grades 4 through 12. Additionally, the method of
taxing snuff changed from cost-based to weight-
based. Also added was a base tax for “alternative
nicotine products” of 10 cents per container containing
up to 20 units and ½ cent per unit for every unit over
20.
Partners continue discussions about the importance
of implementing a comprehensive evidence-based
tobacco retail licensing system, which would include
policy changes to raise the sale of age of tobacco
products to 21 years old in alignment with federal law.
In 2024, the American Lung Association in North
Carolina will join our tobacco control partners,
including the North Carolina Alliance for Health,
to educate state legislators about the health and
economic benefits of strong tobacco control policies.
This includes the state policy goals highlighted above.

101 Lung.org American Lung Association “State of Tobacco Control” 2024

 North Dakota Report Card
2024
A

Tobacco Prevention and

Control Program Funding: B Tobacco Taxes: F
T

FY2024 State Funding for CIGARETTE TAX:

O

Tobacco Control Programs: $6,056,884

Tax Rate per pack of 20: $0.44
FY2024 Federal Funding for
K

State Tobacco Control Programs: $1,055,244* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
A

State Tobacco Control Programs: $7,112,128 Tax on Large Cigars: Equalized: Yes; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes
D

State Spending Recommendation: $9,800,000

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: Yes
Percentage of CDC Recommended Level: 72.6%
Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A
State Tobacco-Related Revenue: $51,600,000
H

For more information on tobacco taxes, go to:

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.
T

D Thumbs down for North Dakota for having the third

lowest cigarette tax in the country.
R

Smokefree Air: A
O

OVERVIEW OF STATE SMOKING RESTRICTIONS Access to Cessation Services: A

N

Government work sites: Prohibited

OVERVIEW OF STATE CESSATION COVERAGE
Private work sites: Prohibited
STATE MEDICAID PROGRAM:
Schools: Prohibited
Medicaid Medications: All 7 medications are covered
Child care facilities: Prohibited
Medicaid Counseling: All 3 types of counseling are covered
Restaurants: Prohibited
Medicaid Barriers to Coverage: Some barriers exist to access
Bars: Prohibited care
Casinos/Gaming Establishments: Prohibited (tribal Medicaid Expansion: Yes
establishments not subject to state law)
STATE EMPLOYEE HEALTH PLAN(S):
Retail stores: Prohibited
Medications: Some medications are covered
E-Cigarettes Included: Yes
Counseling: Some counseling is covered
Preemption/Local Opt-Out: No
Barriers to Coverage: Minimal barriers to access care
Citation: N.D. CENT. CODE §§ 23-12-9 to 23-12-11 (2013).
STATE QUITLINE:
Investment per Smoker: $9.46; the median investment per
smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: Yes
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See North Dakota Tobacco Cessation Coverage
page for coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

102 Lung.org American Lung Association “State of Tobacco Control” 2024

North Dakota State Highlights:
2024
Tobacco use remains the leading cause

N
North Dakota State Facts
of preventable death and disease in
Health Care Cost Due to Smoking: $325,798,988

O
the United States and in North Dakota.
To address this enormous toll, the Adult Smoking Rate: 15.1%

R
American Lung Association calls for the
High School Smoking Rate: 5.9%
following actions to be taken by North Dakota’s elected

T
officials: High School Tobacco Use Rate: 23%

H
1. Raise the state tobacco tax currently at .44 per Middle School Smoking Rate: 2.4%
pack; and
Smoking Attributable Deaths: 980
2. Restrict access to flavored tobacco products.

D
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
North Dakota is ranked 49th in the U.S. for its tobacco Surveillance System. High school smoking and tobacco use rates are
taken from the 2021 Youth Risk Behavior Surveillance System. Middle
tax of 44 cents per pack, compared to a national

A
school smoking rate is taken from the 2017 Youth Tobacco Survey.
average of $1.93. Raising tobacco taxes by significant Health impact information is taken from the Smoking Attributable Mortality,

K
amounts is proven to be one of the most impactful Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
ways to prevent and reduce tobacco use, especially by are calculated for persons aged 35 years and older. Smoking-attributable

O
healthcare expenditures based on 2004 smoking-attributable fractions
youth. and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
This year’s legislative session in North Dakota was

T
a mix of a win and a loss. For over a decade, North

A
Dakota has had one of the strongest smokefree
air laws in the country. The law was the result of a
statewide ballot initiative in 2012 and passed in every
county in the state. Since 2012 the adult smoking rate
in North Dakota dropped from 21.1% to 15.1% (2022).
During the 2023 legislative session, the tobacco
industry once again introduced legislation to weaken
the law by allowing indoor smoking in ‘cigar bars.’ The
American Lung Association, local advocates, youth
voices, along with Tobacco Free North Dakota worked
hard to defeat the amendment but ultimately lost by a
slim margin.
On a positive note, the tobacco licensing loophole
for vape shops in North Dakota was finally closed
during the 2023 session. Now all commercial tobacco
products will be treated equally in their classification
and regulation, as well as requiring a tobacco license
for sales.
North Dakota was one of 34 states that together sued
Juul for marketing practices directed at youth and was
awarded $6 million over a period of six to ten years.
North Dakota’s settlement states that funds can be
used for any lawful purpose but does not specify
where the funds will be directed.
The American Lung Association will continue to work
with partners at the local level to protect local clean
indoor air policies along with educating both state and
local decision makers about the benefits of a higher
tobacco tax and restricting access to flavored tobacco
products.

103 Lung.org American Lung Association “State of Tobacco Control” 2024

 Ohio Report Card
2024
O

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
I

FY2024 State Funding for CIGARETTE TAX:

H

Tobacco Control Programs: $7,780,000

Tax Rate per pack of 20: $1.60
FY2024 Federal Funding for
O

State Tobacco Control Programs: $2,464,914* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
State Tobacco Control Programs: $10,244,914 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: No
State Spending Recommendation: $132,000,000
Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: No
Percentage of CDC Recommended Level: 7.8%
Tax on E-cigarettes: Equalized: No; Weight-Based: Yes
State Tobacco-Related Revenue: $1,202,700,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

D Thumbs down for Ohio for decreasing state funding for

its tobacco control program by over $7 million this fiscal
year.
Access to Cessation Services: C
OVERVIEW OF STATE CESSATION COVERAGE
Smokefree Air: A STATE MEDICAID PROGRAM:
Medicaid Medications: All 7 medications are covered
OVERVIEW OF STATE SMOKING RESTRICTIONS
Medicaid Counseling: All 3 types of counseling are covered
Government work sites: Prohibited
Medicaid Barriers to Coverage: Minimal barriers exist to
Private work sites: Prohibited access care
Schools: Prohibited Medicaid Expansion: Yes
Child care facilities: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Restaurants: Prohibited
Medications: All 7 medications are covered
Bars: Prohibited
Counseling: All 3 types of counseling are covered
Casinos/Gaming Establishments: Prohibited
Barriers to Coverage: Minimal barriers exist to access care
Retail stores: Prohibited
STATE QUITLINE:
E-Cigarettes Included: Yes
Investment per Smoker: $0.93; the median investment per
Preemption/Local Opt-Out: No smoker is $1.93
Citation: OHIO REV. CODE ANN §§ 3794.01 to 3794.09 (2021). OTHER CESSATION PROVISIONS:
Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Ohio Tobacco Cessation Coverage page for
coverage details.

U Thumbs up for Ohio for providing comprehensive

coverage of all tobacco cessation medications and
types of counseling with minimal barriers to Medicaid
enrollees.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

104 Lung.org American Lung Association “State of Tobacco Control” 2024

Ohio State Highlights:
2024
Tobacco use remains the leading cause Local efforts are underway in Ohio to prohibit the

O
of preventable death and disease in the sale of flavored tobacco products and to enact
United States and in Ohio. To address tobacco retailer licensing to enable enforcement.

H
this enormous toll, the American Lung The Lung Association will work with partners in those

I
Association calls for the following communities to enact these ordinances to get flavored
actions to be taken by Ohio’s elected officials: products off the market and to have the mechanisms

O
1. Continue to allow local communities to prohibit in place to enforce these ordinances. Data shows that
flavorings for all tobacco products, including flavored tobacco products attract young people to
e-cigarettes; try these products. Close to 90% of youth e-cigarette
users use a flavored product, according to recently
2. Restore the funding for tobacco prevention and released national data.
cessation programs cut this year to bring it closer
to the Centers for Disease Control and Prevention As we look to 2024, the American Lung Association
(CDC)s recommendation for Ohio; and in Ohio will continue to work with a broad coalition of
stakeholders to increase funding for evidence-based
3. Match the tax on non-cigarette forms of tobacco tobacco prevention and cessation programs and put
like spit tobacco, cigars and hookah to the cigarette restrictions on the sale of flavored tobacco products.
tax.
The Lung Association was pleased that Ohio Governor Ohio State Facts
Mike DeWine, a long-time champion on preventing Health Care Cost Due to Smoking: $5,647,310,236
and reducing tobacco use, has vetoed two attempts
Adult Smoking Rate: 17.1%
by the legislature to preempt local communities
from regulating tobacco products. This proposed High School Smoking Rate: 3.3%
preemption was a reaction to the city of Columbus
High School Tobacco Use Rate: 20.4%
enacting a comprehensive prohibition on the sale of
all flavored tobacco products in the fall of 2022 that Middle School Smoking Rate: 3%
took effect January 1, 2024. We were disappointed Smoking Attributable Deaths: 20,180
when the House of Representatives voted to override
the governor’s veto of local preemption language in Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking and tobacco use rates are
December 2023. An override will have a devastating taken from the 2021 Youth Risk Behavior Surveillance System. Middle
school smoking rate is taken from the 2019 Ohio Youth Tobacco Survey.
effect on public health in Ohio eliminating all tobacco
Health impact information is taken from the Smoking Attributable Mortality,
retail license programs in the state, which are used Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
by over 25 communities to enforce the state’s deaths reflect average annual estimates for the period 2005-2009 and
are calculated for persons aged 35 years and older. Smoking-attributable
tobacco 21 law by providing compliance checks and healthcare expenditures based on 2004 smoking-attributable fractions
and 2009 personal healthcare expenditure data. Deaths and expenditures
accountability of tobacco and e-cigarette retailers should not be compared by state.
through their local health department. The Lung
Association calls on the Senate to vote no on any
attempt to override the veto.
The legislature also cut in half the state funding for
tobacco prevention and cessation programs in the
two-year state budget approved this year. These
programs are vitally needed to help reduce rates of
tobacco use in Ohio, which still remain well above
the national average. As the next two-year budget is
drafted, the Lung Association calls on the legislature
to continue to increase its investment in tobacco
prevention and cessation. Ohio spends only 7.8%
of what is recommended by the CDC for a state of
our size. The revenue raised by increasing taxes on
tobacco products could help fund further increases in
tobacco control and prevention funding.

105 Lung.org American Lung Association “State of Tobacco Control” 2024

 Oklahoma Report Card
2024
A

Tobacco Prevention and

Control Program Funding: A Tobacco Taxes: D
M

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $32,574,626
O

Tax Rate per pack of 20: $2.03

FY2024 Federal Funding for
State Tobacco Control Programs: $1,618,668* OTHER TOBACCO PRODUCT TAXES:
H

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
State Tobacco Control Programs: $34,193,294
A

Tax on Large Cigars: Equalized: No; Weight-Based: No

CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No
L

State Spending Recommendation: $42,300,000

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 80.8%
K

Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A

State Tobacco-Related Revenue: $491,000,000
For more information on tobacco taxes, go to:
O

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati

from the Centers for Disease Control and Prevention.

U Thumbs up for Oklahoma for continuing to

constitutionally protect the state’s allocation of
tobacco settlement dollars, so a consistent investment Access to Cessation Services: A
in tobacco prevention and cessation can be made.
OVERVIEW OF STATE CESSATION COVERAGE

Smokefree Air: F STATE MEDICAID PROGRAM:

Medicaid Medications: All 7 medications are covered
OVERVIEW OF STATE SMOKING RESTRICTIONS Medicaid Counseling: Some counseling is covered
Government work sites: Restricted (Prohibited on state Medicaid Barriers to Coverage: Minimal barriers exist to
government property) access care
Private work sites: Restricted Medicaid Expansion: Yes
Schools: Prohibited STATE EMPLOYEE HEALTH PLAN(S):
Child care facilities: Prohibited Medications: Most medications are covered
Restaurants: Restricted Counseling: Some counseling is covered
Bars: No provision Barriers to Coverage: Some barriers exist to access care
Casinos/Gaming Establishments: Restricted (tribal STATE QUITLINE:
establishments not subject to state law)
Investment per Smoker: $11.50; the median investment per
Retail stores: Prohibited smoker is $1.93
Recreational/cultural facilities: Prohibited
OTHER CESSATION PROVISIONS:
E-Cigarettes Included: Only in K-12-schools and on school Private Insurance Mandate: No provision
grounds
Tobacco Surcharge: No prohibition or limitation on tobacco
Preemption/Local Opt-Out: Yes surcharges
Citation: OKLA. STAT. ANN. tit. 21, § 1247 (2021) & tit. 63, §§ Citation: See Oklahoma Tobacco Cessation Coverage page
1-1521 et seq. (2019). for coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

106 Lung.org American Lung Association “State of Tobacco Control” 2024

Oklahoma State Highlights:
2024
Tobacco use remains the leading cause The American Lung Association continues to build

O
of preventable death and disease in partnerships across the state, uniting those in tobacco
the United States and in Oklahoma. control through the Oklahoma Tobacco Control

K
To address this enormous toll, the Alliance, which local Lung Association staff chair.

L
American Lung Association calls for the Thanks to investments from both the state department
following actions to be taken by Oklahoma’s elected of health and TSET, multiple public awareness

A
officials: campaigns were launched across the state, including
a focus on the tobacco industry’s deception marketing

H
1. Repeal preemption on local government’s authority
to pass stronger tobacco control laws; practices, menthol tobacco products, rural tobacco

O
use and mental health and tobacco.
2. Impose a license on e-cigarette retailers and tax
e-cigarette products; and The American Lung Association calls on lawmakers

M
to continue their work by focusing penalties on those
3. Pass legislation eliminating smoking in all public who sell tobacco and e-cigarette products. There

A
places and workplaces. remains no required permit to sell addictive e-cigarette
In a disappointing development, after passing a bold products. Additionally, secondhand smoke remains a
law in 2022 removing penalties on youth caught with concern for the health of all Oklahomans, and the Lung
tobacco products and replacing them with education Association encourages the state to remove its local
and cessation courses, Oklahoma lawmakers in 2023 preemption laws and support a statewide smokefree
reversed course through House Bill 2165 to enable indoor air law. Finally, the state must stay vigilant in
monetary penalties of up to $100. The tobacco protecting the Tobacco Settlement Endowment Trust,
industry spends an estimated $149.5 million marketing a key factor in the state’s above average tobacco
their addictive products to Oklahomans, and financial control funding.
penalties for youth use of these products are both
ineffective and impose an unequal burden on families. Oklahoma State Facts
With the failure of House Bill 2238 in 2023, the state of Health Care Cost Due to Smoking: $1,622,429,589
Oklahoma now requires manufacturers of e-cigarette Adult Smoking Rate: 15.6%
products to attest to the Oklahoma Alcoholic Beverages
Law Enforcement (ABLE) Commission that they High School Smoking Rate: 4%
either have applied for a Premarket Tobacco Product High School Tobacco Use Rate: 22.1%
Application to the U.S. Food and Drug Administration
Middle School Smoking Rate: N/A
(FDA) or have received a marketing order authorizing
the sale of said products. The ABLE commission has Smoking Attributable Deaths: 7,490
since published a directory and it will be unlawful
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
for any person to manufacture, distribute, or sell any Surveillance System. High school smoking and tobacco use rates are
product not listed in the directory. It could provide a taken from the 2021 Youth Risk Behavior Surveillance System. A current
middle school smoking rate is not available for this state.
useful tool for the state to crack down on illegal sales Health impact information is taken from the Smoking Attributable Mortality,
of e-cigarette products if the state conducts regular Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
compliance checks on e-cigarette retailers. are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
Several promising bills were filed but did not receive and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
approval by the legislature. These include bills to repeal
preemption of local authority to pass tobacco control
policies, to prohibit smoking in cars with children
present and to allow pharmacists to prescribe nicotine
replacement therapy (NRT) directly to customers.
Additionally, a bill that would impact the Tobacco
Settlement Endowment Trust’s (TSET) investment of
tobacco settlement funds did not become law. House
Bill 2254 would have required TSET to invest 4% of
funds in Oklahoma-based venture capital companies
and funds.

107 Lung.org American Lung Association “State of Tobacco Control” 2024

 Oregon Report Card
2024
N

Tobacco Prevention and

Control Program Funding: B Tobacco Taxes: C
O

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $28,800,000
G

Tax Rate per pack of 20: $3.33

FY2024 Federal Funding for
State Tobacco Control Programs: $1,556,750* OTHER TOBACCO PRODUCT TAXES:
E

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
R

State Tobacco Control Programs: $30,356,750 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes
O

State Spending Recommendation: $39,300,000

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 77.2%
Tax on E-cigarettes: Equalized: Yes; Weight-Based: No
State Tobacco-Related Revenue: $497,900,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

Smokefree Air: A Access to Cessation Services: C

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: All 7 medications are covered
Schools: Prohibited Medicaid Counseling: All 3 types of counseling are covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Some barriers exist to access
care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited (allowed in cigar bars)
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: Prohibited (tribal
establishments not subject to state law) Medications: All 7 medications are covered
Retail stores: Prohibited (allowed in smoke shops) Counseling: Most types of counseling are covered
E-Cigarettes Included: Yes Barriers to Coverage: Minimal barriers exist to access care
Preemption/Local Opt-Out: No STATE QUITLINE:
Citation: OR. REV. STAT. §§ 433.835 to 433.990 (2020). Investment per Smoker: $1.71; the median investment per
smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: Yes
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Oregon Tobacco Cessation Coverage page for
coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

108 Lung.org American Lung Association “State of Tobacco Control” 2024

Oregon State Highlights:
2024
Tobacco use remains the leading cause

O
Oregon State Facts
of preventable death and disease in the
United States and in Oregon. To address Health Care Cost Due to Smoking: $1,547,762,592

R
this enormous toll, the American Lung Adult Smoking Rate: 12.4%

E
Association calls for the following
High School Smoking Rate: 4.9%
actions to be taken by Oregon’s elected officials:

G
1. End the sale of all flavored tobacco products; and High School Tobacco Use Rate: 23.1%

O
2. Ensure Oregon’s Clean Indoor Air Act remains intact. Middle School Smoking Rate: 2.6%

During the 2023 legislative session, Representative

N
Smoking Attributable Deaths: 5,470
Lisa Reynolds introduced and sponsored House Bill
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
3090 which proposed a prohibition on the distribution Surveillance System. High school (11th grade only) smoking and tobacco
and sales of all flavored tobacco products. A work use, and middle school (8th grade only) smoking rates are taken from the
2019 Oregon Healthy Teens Survey. High school tobacco use includes
session and public hearing was held in the House cigarettes, cigars, smokeless tobacco, and electronic vapor products, as
well as hookah, making it incomparable to other states.
committee on Behavioral Health and Health Care.
Health impact information is taken from the Smoking Attributable Mortality,
An amendment to exempt existing hookah lounges Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
was introduced and accepted. The amended bill was deaths reflect average annual estimates for the period 2005-2009 and
are calculated for persons aged 35 years and older. Smoking-attributable
passed out of committee and referred to the Joint healthcare expenditures based on 2004 smoking-attributable fractions
and 2009 personal healthcare expenditure data. Deaths and expenditures
Committee on Ways and Means. should not be compared by state.

Senate Minority Leader Tim Knopp led a six-week

Republican walkout of the chamber which prevented
the Senate from reaching a two-thirds quorum to pass
bills. Unfortunately, House Bill 3090 fell victim to this
delay tactic and died in committee.
County ordinances passed in 2022 to end the sale
of flavored tobacco products in Washington and
Multnomah counties have yet to be implemented due
to legal challenges.
During the 2024 legislative session, the American
Lung Association will work with partners supporting
legislation to end the sale of flavored tobacco
products statewide. The Lung Association will also
work to protect other tobacco control policy measures,
including Oregon’s Clean Indoor Air Act.

109 Lung.org American Lung Association “State of Tobacco Control” 2024

 Pennsylvania Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
I

FY2024 State Funding for CIGARETTE TAX:

N

Tobacco Control Programs: $16,429,000

Tax Rate per pack of 20: $2.60
FY2024 Federal Funding for
A

State Tobacco Control Programs: $2,399,303* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
V

State Tobacco Control Programs: $18,828,303 Tax on Large Cigars: Equalized: No; Weight-Based: N/A
L

CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based:

State Spending Recommendation: $140,000,000 Yes
Y

Percentage of CDC Recommended Level: 13.4% Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: Yes
S

State Tobacco-Related Revenue: $1,540,000,000 Tax on E-cigarettes: Equalized: Yes; Weight-Based: No

* Includes tobacco prevention and cessation funding provided to states For more information on tobacco taxes, go to:
N

from the Centers for Disease Control and Prevention.

www.lung.org/slati
N

Smokefree Air: D Access to Cessation Services: D

E

OVERVIEW OF STATE SMOKING RESTRICTIONS

OVERVIEW OF STATE CESSATION COVERAGE
P

Government work sites: Prohibited

STATE MEDICAID PROGRAM:
Private work sites: Prohibited
Medicaid Medications: All 7 medications are covered.
Schools: Prohibited
Medicaid Counseling: Some counseling is covered
Child care facilities: Prohibited
Medicaid Barriers to Coverage: Minimal barriers exist to
Restaurants: Restricted access care
Bars: No provision Medicaid Expansion: Yes
Casinos/Gaming Establishments: Restricted
STATE EMPLOYEE HEALTH PLAN(S):
Retail stores: Prohibited Medications: All 7 medications are covered
E-Cigarettes Included: No Counseling: Minimal counseling is covered
Preemption/Local Opt-Out: Yes Barriers to Coverage: Minimal barriers exist to access care
Citation: 35 PA. STAT §§ 637.1 to 637.11 (2008).
STATE QUITLINE:
Investment per Smoker: $1.51; the median investment per
smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Pennsylvania Tobacco Cessation Coverage
page for coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

110 Lung.org American Lung Association “State of Tobacco Control” 2024

Pennsylvania State Highlights:
2024
Tobacco use remains the leading cause increase, but thousands of lives would be saved.

P
of preventable death and disease in Furthermore, more funds could be generated, and

E
the United States and in Pennsylvania. additional lives could be protected if tobacco tax rates
To address this enormous toll, the were equalized across all tobacco products, including

N
American Lung Association calls for the non-cigarette tobacco products such as cigars and
following actions to be taken by Pennsylvania’s elected e-cigarettes. This would also help prevent youth from

N
officials: initiating or switching use due to an uneven tobacco
tax regime.

S
1. Preserve state funding for comprehensive tobacco
prevention and control programs; The American Lung Association will continue to work

Y
2. Close loopholes in Pennsylvania’s Clean Indoor Air with our partners in 2024 to educate lawmakers and
the public on the importance of enacting proven

L
Act; and
policies to prevent and reduce tobacco use such as
3. End the sale of all flavored tobacco products,

V
properly funding tobacco prevention and cessation
including menthol. programs, removing exemptions from the state Clean

A
During the 2023 legislative session, the Lung Indoor Air Act, and increasing tobacco taxes and
Association and partners continued a comprehensive equalizing rates across all tobacco products.

N
statewide effort to educate legislators and the public
Pennsylvania State Facts

I
on the importance of tobacco control programs
and their necessity to further reduce tobacco use. A Health Care Cost Due to Smoking: $6,383,194,368

A
successful day at the Capitol was held, our first in-
Adult Smoking Rate: 14.9%
person event since 2020, with participants across the
commonwealth discussing the necessity of sustaining High School Smoking Rate: 4.2%
robust funding for Pennsylvania’s tobacco prevention
High School Tobacco Use Rate: 19.7%
program. Thanks to the efficacy of our advocates,
lawmakers continued funding the program at previous Middle School Smoking Rate: N/A
levels with no reductions in fiscal year 2024. Smoking Attributable Deaths: 22,010
Efforts to close loopholes in the Clean Indoor Air
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Act, which would prohibit smoking in virtually all Surveillance System. High school smoking and tobacco use data come
from the 2021 Youth Risk Behavior Surveillance System. A current middle
Pennsylvania workplaces, including bars and casinos, school smoking rate is not available for this state.
incrementally advanced. Legislators met to hear public Health impact information is taken from the Smoking Attributable Mortality,
comment on the bill and the impact that it would Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
have on Pennsylvania workers and families. During are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
that public hearing, casino workers, leaders of the and 2009 personal healthcare expenditure data. Deaths and expenditures
statewide Veterans of Foreign Wars (VFW), engineers should not be compared by state.

from the American Society of Heating, Refrigerating,

and Airconditioning Engineers (ASHRAE), and our own
Lung Association Chief Mission Officer Deb Brown
told lawmakers what we have long known; that there
is no safe exposure to secondhand smoke or aerosol,
that there is no ventilation system that can remove
the dangers of secondhand smoke, and that no one
should have to choose between their health and their
paycheck. The Lung Association hopes to continue
to work with lawmakers and workers to advance this
legislation in 2024.
Another policy priority for the Lung Association is
increasing tobacco taxes and equalizing rates across
all tobacco products – a proven policy to reduce
tobacco use. If the cigarette tax alone was raised, not
only would Pennsylvania’s projected annual revenue

111 Lung.org American Lung Association “State of Tobacco Control” 2024

 Rhode Island Report Card
2024
D

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: B
N

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $429,205
A

Tax Rate per pack of 20: $4.25

FY2024 Federal Funding for
OTHER TOBACCO PRODUCT TAXES:
L

State Tobacco Control Programs: $1,383,858*

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
S

State Tobacco Control Programs: $1,813,063 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes
I

State Spending Recommendation: $12,800,000

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 14.2%
Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A
E

State Tobacco-Related Revenue: $188,900,000

For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
D

from the Centers for Disease Control and Prevention.

O

Smokefree Air: C Access to Cessation Services: B

H

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

R

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: All 7 medications are covered
Schools: Prohibited Medicaid Counseling: All 3 types of counseling are covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Some barriers exist to access
care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited (allowed in smoking bars)
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: Allowed in designated
areas Medications: All 7 medications are covered
Retail stores: Prohibited Counseling: All 3 types of counseling are covered
E-Cigarettes Included: Yes Barriers to Coverage: No barriers exist to access care
Preemption/Local Opt-Out: Yes STATE QUITLINE:
Citation: R.I. GEN. LAWS §§ 23-20.10-1 et seq. (2018). Investment per Smoker: $1.91; the median investment per
smoker is $1.93
D Thumbs down for Rhode Island for failing to pass
legislation to close the loophole for casinos in its OTHER CESSATION PROVISIONS:
smokefree air law. Private Insurance Mandate: Partial mandate
Tobacco Surcharge: Prohibits tobacco surcharges
Citation: See Rhode Island Tobacco Cessation Coverage
page for coverage details.

Flavored Tobacco Products: D

Restrictions on Flavored Tobacco Products: All flavored
e-cigarettes prohibited in all locations

112 Lung.org American Lung Association “State of Tobacco Control” 2024

Rhode Island State Highlights:
2024
Tobacco use remains the leading cause advocates gathering at the State House for a press

R
of preventable death and disease in conference with medical professionals, legislator

H
the United States and in Rhode Island. champions, and youth speakers. Following the press
To address this enormous toll, the conference, advocates found their legislators on

O
American Lung Association calls for the the House and Senate floor to educate them on the
following actions to be taken by Rhode Island’s elected importance of smokefree casinos and adequately

D
officials: funding tobacco control and prevention.

E
1. Ensure all Rhode Islanders have a smokefree Looking ahead to 2024, the American Lung
workplace by establishing smokefree casinos; Association calls on Rhode Island policy makers now
2. Establish tax parity for all tobacco products and more than ever, to adequately fund tobacco control
efforts at or above the CDC-recommended level

I
fund tobacco control programs at the Centers
for Disease Control and Prevention (CDC)- to ensure all Rhode Islanders are protected from a

S
recommended level; and lifetime of tobacco dependence and disease.

L
3. Establish pharmacists prescribing authority for Rhode Island State Facts
U.S. Food and Drug Administration (FDA)-approved

A
Health Care Cost Due to Smoking: $639,604,224
cessation medication.

N
Adult Smoking Rate: 11.8%
During the 2023 Rhode Island legislative session the
American Lung Association weighed in on seven High School Smoking Rate: 3%

D
tobacco-related bills. During the early days of session,
High School Tobacco Use Rate: 17.5%
the Lung Association advocated for increased
tobacco control, prevention, and enforcement funding Middle School Smoking Rate: 1.6%
to be included in the Governors fiscal year 2024 Smoking Attributable Deaths: 1,780
proposed budget and had successful hearings on
legislation that would enable pharmacists to prescribe Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking and tobacco use data come
FDA-approved smoking cessation therapies. The from the 2021 Youth Risk Behavior Surveillance System. Middle school
smoking rate is taken from the 2019 Rhode Island Youth Risk Behavior
pharmacists prescribing authority passed in the House Survey.
of Representatives but was never moved forward for a Health impact information is taken from the Smoking Attributable Mortality,
vote in the Senate. In Spring 2023, there were multiple Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
hearings on legislation that would close a nearly are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
20-year-old loophole and make casinos smokefree. and 2009 personal healthcare expenditure data. Deaths and expenditures
The Lung Association worked to support dozens of should not be compared by state.zzzZZZz

casino employees and share their stories in hopes of

successful passage – neither Chamber held a vote
before session ended.
Tobacco Free Rhode Island (TFRI), a grant funded
through the Department of Health and administered
by the Lung Association, led Rhode Island’s statewide
youth tobacco movement by empowering individuals
aged 12-21 to become Tobacco Free Ambassadors.
The youth-led program focused on tobacco’s impacts
on health, the environment, and social justice, inspiring
“Gen Zer’s” to educate their peers at school, out in
the community, and at a state-level. Ambassadors
marched to the statehouse in April using their voices to
educate lawmakers.
In April 2023, the Lung Association led a Day of
Action alongside state partners at the Rhode Island
State House. The day started with a day-long training
of youth advocates and ended with more than 60

113 Lung.org American Lung Association “State of Tobacco Control” 2024

 South Carolina Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
N

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $5,000,000
I

Tax Rate per pack of 20: $0.57

FY2024 Federal Funding for
L

State Tobacco Control Programs: $1,720,878* OTHER TOBACCO PRODUCT TAXES:

Tax on Little Cigars: Equalized: No; Weight-Based: No
O

FY2024 Total Funding for

State Tobacco Control Programs: $6,720,878 Tax on Large Cigars: Equalized: No; Weight-Based: No
R

CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: No

State Spending Recommendation: $51,000,000
Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: No
A

Percentage of CDC Recommended Level: 13.2%

Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A
State Tobacco-Related Revenue: $222,300,000
C

For more information on tobacco taxes, go to:

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.
H

Smokefree Air: F Access to Cessation Services: B

T

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

U

Government work sites: Restricted STATE MEDICAID PROGRAM:

Private work sites: No provision Medicaid Medications: All 7 medications are covered
O

Schools: Restricted Medicaid Counseling: All 3 forms counseling are covered

S

Child care facilities: Prohibited Medicaid Barriers to Coverage: Minimal barriers exist to
access care
Restaurants: No provision
Medicaid Expansion: No
Bars: No provision
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: N/A
Medications: Some medications are covered
Retail stores: No provision
Counseling: All three forms of counseling are covered
E-Cigarettes Included: Only in K-12 Schools and on School
Property Barriers to Coverage: No barriers exist to access care
Preemption/Local Opt-Out: No STATE QUITLINE:
Citation: S.C. CODE ANN. §§ 44-95-10 et seq. & 59-1-380 Investment per Smoker: $6.49; the median investment per
(2019). smoker is $1.93
Note: The Smokefree Air grade only examines state law and does not OTHER CESSATION PROVISIONS:
reflect local smokefree ordinances. South Carolina has made great
strides in protecting people from secondhand smoke by passing Private Insurance Mandate: No provision
comprehensive local smokefree ordinances that cover 32% of the state’s
population. Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See South Carolina Tobacco Cessation Coverage
page for coverage details.

U Thumbs up for South Carolina for providing

comprehensive coverage for all tobacco cessation
medications and types of counseling with minimal
barriers to Medicaid enrollees.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

114 Lung.org American Lung Association “State of Tobacco Control” 2024

South Carolina State Highlights:
2024
Tobacco use remains the leading cause

S
South Carolina State Facts
of preventable death and disease in the
Health Care Cost Due to Smoking: $1,906,984,487

O
United States and in South Carolina.
To address this enormous toll, the Adult Smoking Rate: 15.4%

U
American Lung Association calls for
High School Smoking Rate: 3.3%
the following actions to be taken by South Carolina’s

T
elected officials: High School Tobacco Use Rate: N/A

H
1. Increase state funding for the tobacco prevention Middle School Smoking Rate: 3.2%
and control program and ensure that funding is
spent according to Centers for Disease Control Smoking Attributable Deaths: 7,230

C
and Prevention (CDC)’s Best Practices for Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Comprehensive Tobacco Control Programs; Surveillance System. High school smoking data come from the 2021 Youth
Risk Behavior Surveillance System. Middle school smoking rate is taken

A
from the 2017 Youth Tobacco Survey. A current high school tobacco use
2. Strengthen tobacco retail licensing laws, including rate is not available for this state.
electronic cigarette retailers; and

R
Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
3. Increase the cigarette tax to the current average deaths reflect average annual estimates for the period 2005-2009 and

O
are calculated for persons aged 35 years and older. Smoking-attributable
cigarette tax and equalize taxes for all tobacco healthcare expenditures based on 2004 smoking-attributable fractions
products, including e-cigarettes. and 2009 personal healthcare expenditure data. Deaths and expenditures

L
should not be compared by state.
After years of working with partners to fight the

I
tobacco industry’s efforts to take away authority
from local governments, the South Carolina General

N
Assembly succumbed with the passage of House Bill

A
3681. This legislation preempts communities from
passing local ordinances regulating the ingredients,
flavors and licensing of tobacco products, including
e-cigarettes. It also includes the establishment of a
weak tobacco control retail licensing program that is
unlikely to hold retailers accountable for illegal sales of
tobacco products to individuals under age 21.
In 2024, the American Lung Association is calling on
public officials at the state level to increase funding
for South Carolina’s Division of Tobacco Prevention
and Control to $10 million annually as well as invest all
$11 million from the Juul settlement to its vital tobacco
prevention and cessation program to reduce taxpayer
costs, protect kids, and save lives. We will continue
to educate state legislators about the health and
economic benefits of strong tobacco control policies,
including the state policy goals highlighted above.

115 Lung.org American Lung Association “State of Tobacco Control” 2024

 South Dakota Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
T

FY2024 State Funding for CIGARETTE TAX:

O

Tobacco Control Programs: $4,500,000

Tax Rate per pack of 20: $1.53
FY2024 Federal Funding for
K

State Tobacco Control Programs: $1,046,792* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
A

State Tobacco Control Programs: $5,546,792 Tax on Large Cigars: Equalized: Yes; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No
D

State Spending Recommendation: $11,700,000

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 47.4%
Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A
State Tobacco-Related Revenue: $80,300,000
H

For more information on tobacco taxes, go to:

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.
T

D
U

Smokefree Air: B Access to Cessation Services:

O

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

S

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: Minimal medications are covered
Schools: Prohibited Medicaid Counseling: Minimal counseling is covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Some barriers exist to access
care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited (smoking of certain tobacco products
allowed in certain bars) STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: Prohibited (tribal Medications: Covers all 7 medications
establishments not subject to state law)
Counseling: Some counseling is covered
Retail stores: Prohibited
Barriers to Coverage: Some barriers exist to access care
E-Cigarettes Included: Yes
STATE QUITLINE:
Preemption/Local Opt-Out: Yes
Investment per Smoker: $19.46; the median investment per
Citation: S.D. CODIFIED LAWS §§ 34-46-1 & 34-46-13 to 34- smoker is $1.93
46-19 (2019).
OTHER CESSATION PROVISIONS:
* If South Dakota repealed preemption of stronger local smokefree
ordinances, the state’s grade would be an “A.” Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See South Dakota Tobacco Cessation Coverage
page for coverage details.

D Thumbs down for South Dakota for providing the worst

cessation coverage for standard Medicaid enrollees in
the country.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

116 Lung.org American Lung Association “State of Tobacco Control” 2024

South Dakota State Highlights:
2024
Commercial tobacco use remains the Native American people), and Vaping Sucks (youth

S
leading cause of preventable death prevention). These media campaigns are doing very

O
and disease in the United States and in well and have increased traffic to a new consolidated
South Dakota. To address this enormous website.

U
toll, the American Lung Association calls The program also developed a new multi-unit housing
for the following actions to be taken by South Dakota’s toolkit to help landlords and property owners establish

T
elected officials: tobacco free policies and understand why they are

H
1. Increase the tax on cigarettes and other commercial important. In summer 2024, the program will launch a
tobacco products, including e-cigarettes; new K-12 tobacco control toolkit that will help schools
2. Fully fund South Dakota’s tobacco control program; and youth organizations with tobacco prevention

D
and activities.

3. Amend the state law that prevents the state The coalition in South Dakota has tremendous reach

A
Medicaid program from covering all medications to across the state and is working together to support
tobacco control best practices and to implement the

K
treat tobacco use.
strategic plan to reduce the harm from commercial
During the 2023 legislative session, funding for the

O
tobacco in South Dakota in 2024. With your help, the
state’s tobacco control program was set at $4.5 million Lung Association will ensure that our leaders pay
from tobacco tax revenues, the same level as the

T
attention to lung health, as we advocate for action to
past few years. Protecting this funding is important to pass laws and put in place programs that will reduce

A
be able to serve the priority populations in the state commercial tobacco use and save lives.
strategic plan and to fund quit smoking services.
Medicaid coverage of quit smoking treatments in South Dakota State Facts
South Dakota is also far from comprehensive, and Health Care Cost Due to Smoking: $373,112,273
one of the main reasons is a state law that prevents
Adult Smoking Rate: 14%
the state Medicaid program from buying nicotine.
Unfortunately, without an exception this has the High School Smoking Rate: 5.5%
unintended consequence of preventing the state from
High School Tobacco Use Rate: 16.5%
buying FDA-approved nicotine replacement therapy
(NRT). The Lung Association encourages legislators Middle School Smoking Rate: 2%
to address this issue in 2024 by creating an exception
Smoking Attributable Deaths: 1,250
for FDA-approved tobacco cessation medications,
so Medicaid enrollees who smoke at higher rates can Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking and tobacco use data come
gain access to a fuller range of quit smoking treatment from the 2021 Youth Risk Behavior Surveillance System. Middle school
options. smoking rate is taken from the 2017 Youth Tobacco Survey.
Health impact information is taken from the Smoking Attributable Mortality,
During the past year, the South Dakota Tobacco Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
Control Program has been working on many different are calculated for persons aged 35 years and older. Smoking-attributable
projects. The program continues to try and find new healthcare expenditures based on 2004 smoking-attributable fractions
and 2009 personal healthcare expenditure data. Deaths and expenditures
ways to connect with South Dakota tobacco users should not be compared by state.
and get them to the South Dakota Quitline. At the end
of 2023, the Quitline rolled out a new hybrid texting
service due to many clients preferring to text rather
than talk in-person. The Quitline has begun to offer
up to eight weeks of personalized text messaging
communication (two weeks of phone calls) and up to
eight weeks of NRT patches, gum or lozenges.
The South Dakota Tobacco Control Program launched
five new media campaigns including: Watch Your
Mouth SD (aimed towards dental providers), More
Good Years (sending people to the Quitline), Make
Smoking History, Honor Every Breath (targeted towards

117 Lung.org American Lung Association “State of Tobacco Control” 2024

 Tennessee Report Card
2024
E

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
E

FY2024 State Funding for CIGARETTE TAX:

S

Tobacco Control Programs: $2,600,000

Tax Rate per pack of 20: $0.62
FY2024 Federal Funding for
S

State Tobacco Control Programs: $1,664,198* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
E

State Tobacco Control Programs: $4,264,198 Tax on Large Cigars: Equalized: No; Weight-Based: No
N

CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: No

State Spending Recommendation: $75,600,000
Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: No
N

Percentage of CDC Recommended Level: 5.6%

Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A
State Tobacco-Related Revenue: $403,500,000
E

For more information on tobacco taxes, go to:

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.
T

Smokefree Air: D Access to Cessation Services: F

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited (non-public workplaces with Medicaid Medications: All 7 medications are covered
three or fewer employees exempt) Medicaid Counseling: Some counseling is covered
Schools: Prohibited Medicaid Barriers to Coverage: Some barriers exist to access
Child care facilities: Prohibited care
Restaurants: Restricted* Medicaid Expansion: No
Bars: Restricted* STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: N/A Medications: All 7 medications are covered
Retail stores: Prohibited Counseling: All 3 forms of counseling are covered
E-Cigarettes Included: Yes Barriers to Coverage: Some barriers exist to access care
Preemption/Local Opt-Out: Yes STATE QUITLINE:
Citation: TENN. CODE ANN. §§ 39-17-1801 to 39-17-1810 Investment per Smoker: $0.46; the median investment per
(2021). smoker is $1.93
* Smoking is allowed in restaurants and bars that do not allow persons OTHER CESSATION PROVISIONS:
under 21 to enter at any time.
Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Tennessee Tobacco Cessation Coverage page
for coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

118 Lung.org American Lung Association “State of Tobacco Control” 2024

Tennessee State Highlights:
2024
Tobacco use remains the leading cause were also successful in defending funding for the

T
of preventable death and disease in Tennessee tobacco use prevention and control

E
the United States and in Tennessee. program at $2 million. During the November 2023
To address this enormous toll, the Governor’s Budget Hearings for FY 2024-2025,

N
American Lung Association calls for the Tennessee Department of Health Commissioner
following actions to be taken by Tennessee’s elected Alvarado presented a budget request that included an

N
officials: incremental $2 million for vaping prevention program
expansion. The Lung Association was pleased to see

E
1. Support local comprehensive smokefree laws
covering age-restricted venues, including this proposal and will work with lawmakers in the

S
e-cigarettes; upcoming session in strong support of this additional
funding.

S
2. Increase funding for the state tobacco prevention
and cessation program to $13 million, allocate As the legislature begins its work in 2024, the Lung

E
the $13 million in Juul settlement funds the state Association will continue its efforts to educate
will receive over 6 years to the state program and policymakers, business leaders and media on the

E
ensure that funding is spent according to the importance of the American Lung Associations goals
Centers for Disease Control and Preventions Best to reduce all tobacco use, including e-cigarettes, and
Practices for Comprehensive Tobacco Control to protect public health.
Programs; and Tennessee State Facts
3. Require all tobacco retail businesses to obtain Health Care Cost Due to Smoking: $2,672,824,085
licenses, provide for and fund specific enforcement
measures and establish a meaningful penalty Adult Smoking Rate: 18.5%
structure for underage sales violations. High School Smoking Rate: 4.9%
With the support of the Lung Association and partner
High School Tobacco Use Rate: 20.7%
organizations, the Tennessee General Assembly
passed legislation in 2022 to allow local governments Middle School Smoking Rate: N/A
to adopt smokefree ordinances covering age- Smoking Attributable Deaths: 11,380
restricted establishments such as music venues and
bars, thereby helping close a significant loophole in the Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking and tobacco use rates are
state’s smokefree workplaces law. taken from the 2021 Youth Risk Behavior Surveillance System. A current
middle school smoking rate is not available for this state.
Nashville became the first metropolitan area in Health impact information is taken from the Smoking Attributable Mortality,
Tennessee to pass an ordinance, with certain Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
exemptions, in 2022. In 2023, on a unanimous vote are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
and with no exemptions, Hendersonville became and 2009 personal healthcare expenditure data. Deaths and expenditures
the first non-metropolitan community to pass the should not be compared by state.

smokefree ordinance. A campaign is now underway in

the neighboring Sumner County city of Gallatin, as well
as in Knoxville and Memphis. The Lung Association
will continue to support these and other smokefree
proposals in communities across the state.
Also in 2023, the 113th session of the Tennessee
General Assembly adjourned, failing to advance any
of a variety of tobacco bills establishing penalties on
youth for purchase, use and possession of tobacco
products on school campuses and, separately, to
establish disparate taxes for various tobacco and
nicotine products. All of these bills were strongly
opposed by the Lung Association and partner
organizations.
The Lung Association and partner organizations

119 Lung.org American Lung Association “State of Tobacco Control” 2024

 Texas Report Card
2024
S

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
A

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $6,032,166
X

Tax Rate per pack of 20: $1.41

FY2024 Federal Funding for
OTHER TOBACCO PRODUCT TAXES:
E

State Tobacco Control Programs: $3,349,957*

FY2024 Total Funding for Tax on Little Cigars: Equalized: No; Weight-Based: Yes
T

State Tobacco Control Programs: $9,382,123 Tax on Large Cigars: Equalized: No; Weight-Based: Yes
CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: Yes
State Spending Recommendation: $264,100,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: Yes
Percentage of CDC Recommended Level: 3.6%
Tax on E-cigarettes: Equalized: N/A; Weight-Based: N/A
State Tobacco-Related Revenue: $1,741,200,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

U Thumbs up for Texas for increasing funding for its state

tobacco control program by over $2.5 million this fiscal
year.
Access to Cessation Services: D
OVERVIEW OF STATE CESSATION COVERAGE
Smokefree Air: F STATE MEDICAID PROGRAM:
Medicaid Medications: All 7 medications are covered
OVERVIEW OF STATE SMOKING RESTRICTIONS
Medicaid Counseling: All types of counseling are covered
Government work sites: No provision
Medicaid Barriers to Coverage: Some barriers exist to access
Private work sites: No provision care
Schools: Restricted Medicaid Expansion: No
Child care facilities: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Restaurants: No provision
Medications: All 7 medications are covered
Bars: No provision
Counseling: Some counseling is covered
Casinos/Gaming Establishments: No provision
Barriers to Coverage: No barriers exist to access care
Retail stores: No provision
STATE QUITLINE:
E-Cigarettes Included: Yes
Investment per Smoker: $1.31; the median investment per
Preemption/Local Opt-Out: No smoker is $1.93
Citation: TEX. PENAL CODE ANN. § 48.01 (2015); TX EDUC. OTHER CESSATION PROVISIONS:
CODE § 38.006 (2015); and TX ADMIN. CODE tit. 40, Part 19,
Subchapter S, Div. 1 §§ 746.3703(d) (1995) & 747.3503(d) Private Insurance Mandate: No provision
(1990). Tobacco Surcharge: No prohibition or limitation on tobacco
Note: The Smokefree Air grade only examines state tobacco control surcharges
law and does not reflect local smokefree ordinances. Texas has made
great strides in protecting people from secondhand smoke by passing Citation: See Texas Tobacco Cessation Coverage page for
comprehensive local smokefree ordinances that cover 44.1% of the coverage details.
state’s population.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

120 Lung.org American Lung Association “State of Tobacco Control” 2024

Texas State Highlights:
2024
Tobacco use remains the leading cause to ensure compliance with the law, which went into

T
of preventable death and disease in the effect January 1, 2024.

E
United States and in Texas. To address Several promising bills were filed to expand indoor
this enormous toll, the American Lung smokefree air protections that unfortunately did not

X
Association calls for the following become law. The Lung Association and partners were
actions to be taken by Texas’ elected officials:

A
able to stop several tobacco-industry led bills which
1. Increase funding for tobacco prevention and control would carve out new, extremely low taxes on certain

S
programs; nicotine products, including e-cigarettes. Lastly, a
2. Improve the state’s surveillance of tobacco retailers, new passed state law expands access to Medicaid
ensuring each retailer is subject to at least one services to women for 12 months following pregnancy,
annual compliance check; and expanding access to tobacco cessation services.

3. Increase taxes on all tobacco products, including Despite a budget surplus of $33 billion, Texas
implementing a tax on e-cigarettes at parity with continues to significantly underfund programs that are
cigarettes. proven to reduce tobacco use. Lawmakers must build
on their momentum by significantly increasing funding
After more than a year of advocacy, the state of Texas for tobacco prevention and cessation programs as well
increased its funding for the Department of State as funding for retailer compliance with existing laws.
Health Services tobacco prevention and cessation A potential source of funding would be increasing the
programs by more than $2 million annually, the first cigarette tax, which has not been raised since 2006.
increase in several legislative sessions. The increased Additionally, momentum on local smokefree indoor
funding resulted in two significant changes: an air ordinances has stalled, with some cities seeing
expansion of the Texas Tobacco Quitline with more a regression as the city of Waco voting to weaken
free nicotine replacement therapy available as well their ordinance to allow new cigar lounges. The Lung
as an increase in availability of phone coaching, and Association calls on lawmakers to revisit efforts to pass
a relaunch of a youth-focused media campaign: a comprehensive statewide indoor smoking law.
“Vapes Down”. While this increase is to be celebrated,
Texas tobacco control programs remain severely Texas State Facts
underfunded and the Lung Association calls on
Health Care Cost Due to Smoking: $8,855,602,443
lawmakers to create a dedicated source of significant
revenue to fund more robust programs to ensure Adult Smoking Rate: 11.8%
all Texans across 254 counties receive tobacco High School Smoking Rate: 1.8%
prevention and cessation resources.
High School Tobacco Use Rate: 15.3%
A concerning new law was passed, House Bill 114,
which now mandates any student caught with Middle School Smoking Rate: 0.9%
an e-cigarette on a school campus be sent to a
Smoking Attributable Deaths: 28,030
disciplinary alternative education program (DAEP).
While the DAEP program may provide educational and Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking and tobacco use and middle
support services to students, the Lung Association school smoking rates are taken from the 2022 Texas School Survey.
opposes this expansion of penalties for youth and the Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
removal from traditional classroom instruction. The deaths reflect average annual estimates for the period 2005-2009 and
focus should be on tobacco retailers who continue are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
to sell non-FDA approved e-cigarettes to underage and 2009 personal healthcare expenditure data. Deaths and expenditures
persons, with more resources for youth prevention and should not be compared by state.

cessation.
The Legislature also passed House Bill 4758 which
prohibits the sale of any e-cigarette product with
containers that clearly market to underage persons.
This criteria includes cartoons, trademark symbols,
celebrity images and products that resemble candy or
juice products. Unfortunately, no funds were included

121 Lung.org American Lung Association “State of Tobacco Control” 2024

 Utah Report Card
2024
H

Tobacco Prevention and

Control Program Funding: A Tobacco Taxes: F
A

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $15,435,456
T

Tax Rate per pack of 20: $1.70

FY2024 Federal Funding for
U

State Tobacco Control Programs: $1,256,406* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
State Tobacco Control Programs: $16,691,862 Tax on Large Cigars: Equalized: Yes; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: Yes
State Spending Recommendation: $19,300,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 86.5%
Tax on E-cigarettes: Equalized: Yes; Weight-Based: No
State Tobacco-Related Revenue: $139,000,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

Smokefree Air: B Access to Cessation Services: C

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: Some medications are covered
Schools: Prohibited Medicaid Counseling: Some counseling is covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Some barriers exist to access
care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited
Casinos/Gaming Establishments: N/A STATE EMPLOYEE HEALTH PLAN(S):
Medications: All 7 medications are covered
Retail stores: Prohibited
Counseling: Some counseling is covered
E-Cigarettes Included: Yes
Barriers to Coverage: Some barriers exist to access care
Preemption/Local Opt-Out: Yes
Citation: UTAH CODE ANN. §§ 26-38-1 et seq. (2020). STATE QUITLINE:
Investment per Smoker: $7.18; the median investment per
smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: Insurance Commissioner bulletin
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Utah Tobacco Cessation Coverage page for
coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: Flavored
e-cigarettes prohibited except in retail tobacco specialty
businesses.

122 Lung.org American Lung Association “State of Tobacco Control” 2024

Utah State Highlights:
2024
Tobacco use remains the leading cause

U
Utah State Facts
of preventable death and disease in the
Health Care Cost Due to Smoking: $542,335,526

T
United States and in Utah. To address
this enormous toll, the American Adult Smoking Rate: 6.7%

A
Lung Association in Utah calls for the
High School Smoking Rate: 1.9%
following actions to be taken by our elected officials:

H
1. Increase the cigarette tax by $1.00 per pack, with High School Tobacco Use Rate: 9.5%
parity across all tobacco products; and Middle School Smoking Rate: N/A
2. Eliminate the sale of all flavored tobacco products. Smoking Attributable Deaths: 1,340
The American Lung Association in Utah supports
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
evidence-based policy interventions to reduce Surveillance System. High school smoking and tobacco use rates are
taken from the 2021 Youth Risk Behavior Surveillance System. A current
tobacco use rates and prevent youth initiation. middle school smoking rate is not available for this state.
Together with our partners, the Lung Association Health impact information is taken from the Smoking Attributable Mortality,
works to ensure tobacco control and prevention Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
deaths reflect average annual estimates for the period 2005-2009 and
remains a priority for state legislators and local are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
decisionmakers. and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
The Lung Association continued to educate elected
officials and the general public about the negative
public health impacts of tobacco use in Utah, and the
ongoing importance of providing adequately funded
tobacco prevention and cessation programs. In
2023, the legislature passed House Bill 460, directing
revenue resulting from a multi-state lawsuit settlement
with Juul Labs to fund evidence-based vaping
prevention. Utah’s portion of the settlement is $8.6
million.
In fiscal year 2024, Utah maintains its standing
among the top states in the country for state tobacco
prevention and cessation funding at $15.4 million,
close to 90% of the Centers for Disease Control and
Prevention (CDC)-recommended level when federal
CDC funding is included. The program is funded by a
combination of tobacco Master Settlement Agreement
dollars, tobacco tax revenue and e-cigarette tax
revenue.
Moving forward, the American Lung Association in
Utah will continue to educate policymakers about the
dangers of tobacco use and the importance of a well-
funded tobacco prevention and cessation program in
2024. A significant increase on taxes for all tobacco
products remains the top tobacco control policy goal
in Utah. Utah’s legislature last raised the cigarette tax
in 2010.

123 Lung.org American Lung Association “State of Tobacco Control” 2024

 Vermont Report Card
2024
T

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: B
N

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $2,692,021
O

Tax Rate per pack of 20: $3.08

FY2024 Federal Funding for
State Tobacco Control Programs: $1,101,504* OTHER TOBACCO PRODUCT TAXES:
M

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
State Tobacco Control Programs: $3,793,525
R

Tax on Large Cigars: Equalized: Yes; Weight-Based: No

CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: Yes
E

State Spending Recommendation: $8,400,000

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 45.2%
V

Tax on E-cigarettes: Equalized: Yes; Weight-Based: No

State Tobacco-Related Revenue: $104,500,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

Smokefree Air: A Access to Cessation Services: A

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: All 7 medications are covered
Schools: Prohibited Medicaid Counseling: Some counseling is covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Minimal barriers exist to
access care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited
Casinos/Gaming Establishments: N/A STATE EMPLOYEE HEALTH PLAN(S):
Medications: Some medications are covered
Retail stores: Prohibited
Counseling: Some counseling is covered
E-Cigarettes Included: Yes
Barriers to Coverage: Some barriers exist to access care
Preemption/Local Opt-Out: No
Citation: VT STAT. ANN. tit. 18, §§ 28-1421 to 28-1428 (2016) STATE QUITLINE:
& 37-1741 et seq. (2018). Investment per Smoker: $8.05; the median investment per
smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: Yes
Tobacco Surcharge: Prohibits tobacco surcharges
Citation: See Vermont Tobacco Cessation Coverage page for
coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

124 Lung.org American Lung Association “State of Tobacco Control” 2024

Vermont State Highlights:
2024
Tobacco use remains the leading cause e-cigarettes at the highest rates while e-cigarettes

V
of preventable death and disease in are most used among young adults ages 18-24.

E
the United States and in Vermont. The American Lung Association in Vermont will
To address this enormous toll, the continue to work with the Coalition for a Tobacco Free

R
American Lung Association calls for the Vermont and many more organizations as we grow our
following actions to be taken by Vermont’s elected

M
numbers to educate policy makers, business leaders
officials: and the media of the importance of advancing strong

O
1. Eliminate the sale of all flavored tobacco products; tobacco control and prevention efforts and to build
2. Increase funding for comprehensive tobacco upon our past successes in the Green Mountain State.

N
prevention and cessation; and Vermont State Facts

T
3. Increase the tobacco tax by a minimum of $1.00 per Health Care Cost Due to Smoking: $348,112,248
pack.
Adult Smoking Rate: 13%
The 2023 legislative session of the Vermont General
Assembly was active on tobacco prevention policy. High School Smoking Rate: 5.4%
Senate bill 18, a bill to end the sale of flavored tobacco
High School Tobacco Use Rate: 16.2%
products, including menthol, passed the Senate. The
Lung Association provided testimony in support of the Middle School Smoking Rate: 1%
legislation. Further action was stalled in the House, but Smoking Attributable Deaths: 960
the bill can be taken up again next year.
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
The Lung Association will continue to build on the Surveillance System. High school smoking and tobacco use data come
from the 2021 Youth Risk Behavior Surveillance System. Middle school
initial groundwork and work to advance measures to smoking data comes from the Vermont 2021 Youth Risk Behavior
address the use of flavored tobacco products. Enticed Surveillance System; results are rounded to the nearest whole number.

by kid-friendly flavors that also mask the harshness Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
that comes with inhalation, Vermont’s youth are being deaths reflect average annual estimates for the period 2005-2009 and
are calculated for persons aged 35 years and older. Smoking-attributable
set up for a lifetime of nicotine addiction. The state healthcare expenditures based on 2004 smoking-attributable fractions
must act now to end all sales of flavored tobacco and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
products.
Additionally, Vermont added additional, one-time
funding for the tobacco control program for fiscal
year 2024. Currently, Vermont remains several million
dollars short of the funding recommendation from the
Centers for Disease Control and Prevention.
The 2021 Tobacco BRFSS Data Brief has been
published and serves as the annual update on adult
tobacco use trends across Vermont, presenting
cigarette, e-cigarette and quit attempt data by several
key demographics in the state.
• In Vermont, cigarette smoking rates remain stable,
with one in six Vermonters currently smoking while
attempts to quit smoking cigarettes have decreased
to 47%, the lowest level in the past decade.
• Adult e-cigarette use continues to rise to 5%, with
16% of young adults ages 18-24 using e-cigarettes,
over three times the statewide rate.
• Adults who use other substances, are uninsured,
or have poor mental health use cigarettes and
e-cigarettes at two to three times the statewide rate.
• Adults ages 25-34 use both cigarettes and

125 Lung.org American Lung Association “State of Tobacco Control” 2024

 Virginia Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
I

FY2024 State Funding for CIGARETTE TAX:

N

Tobacco Control Programs: $10,671,993

Tax Rate per pack of 20: $0.60
FY2024 Federal Funding for
I

State Tobacco Control Programs: $1,847,658* OTHER TOBACCO PRODUCT TAXES:

Tax on Little Cigars: Equalized: Yes; Weight-Based: No
G

FY2024 Total Funding for

State Tobacco Control Programs: $12,519,651 Tax on Large Cigars: Equalized: Yes; Weight-Based: No
R

CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes
State Spending Recommendation: $91,600,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
I

Percentage of CDC Recommended Level: 13.7%

Tax on E-cigarettes: Equalized: No; Weight-Based: Yes
V

State Tobacco-Related Revenue: $408,000,000

For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

Smokefree Air: F Access to Cessation Services: B

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Restricted STATE MEDICAID PROGRAM:

Private work sites: No provision Medicaid Medications: All 7 medications are covered
Schools: Prohibited (public schools only) Medicaid Counseling: All 3 types of counseling is covered
Child care facilities: Prohibited (excludes home-based Medicaid Barriers to Coverage: Minimal barriers exist to
childcare providers) access care
Restaurants: Restricted Medicaid Expansion: Yes
Bars: Restricted STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: No provision Medications: All 7 medications are covered
Retail stores: Restricted Counseling: Some counseling is covered
E-Cigarettes Included: Only in K-12 Schools and on School Barriers to Coverage: Some barriers exist to access care
Property
STATE QUITLINE:
Preemption/Local Opt-Out: Yes
Investment per Smoker: $2.43; the median investment per
Citation: VA. CODE ANN. §§ 15.2-2820 to 15.2-2828 (2009) & smoker is $1.93
22.1-79.5 & 22.1-279.6(H) (2014).
OTHER CESSATION PROVISIONS:
Private Insurance Mandate: Yes
Tobacco Surcharge: Prohibits the tobacco surcharge
Citation: See Virginia Tobacco Cessation Coverage page for
coverage details.

U Thumbs up for Virginia for enacting legislation to

prohibit the tobacco surcharge and for providing
comprehensive coverage for all tobacco cessation
medications and types of counseling with minimal
barriers to Medicaid enrollees.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

126 Lung.org American Lung Association “State of Tobacco Control” 2024

Virginia State Highlights:
2024
Tobacco use remains the leading cause license suspension and revocation. Another important

V
of preventable death and disease in the component of any legislation would be to remove

I
United States and in Virginia. To address the youth purchase, use and possession penalties
this enormous toll, the American Lung targeted at kids which have not been shown to be

R
Association calls for the following effective in reducing youth use of tobacco.

G
actions to be taken by Virginia’s elected officials: The Virginia Foundation for Healthy Youth, established
1. Close loopholes in the Virginia Clean Indoor Air act in 1999 by the Virginia General Assembly using MSA

I
to protect more residents from secondhand smoke; funding has a mission that empowers Virginia’s

N
2. Require tobacco product retailers to obtain a youth to make healthy choices by reducing and
license; and preventing tobacco and nicotine use, substance use

I
and childhood obesity. VFHY has used this funding
3. Increase the cigarette tax by at least $1.00 per pack

A
to conduct sustained prevention messaging which
and create parity between the tax on cigarettes and includes award-winning and fully evaluated marketing
other tobacco products. campaigns to children annually.
During the 2023 legislative session, the Lung The American Lung Association in Virginia will continue
Association and public health partners successfully to educate lawmakers on the ongoing fight against
advocated for the passage of a bill that would repeal tobacco. Our goal is to build new champions within
Virginia’s tobacco surcharge. Tobacco surcharges the legislature and a grassroots advocacy network to
are increased rates that health insurers are allowed advance our goals of establishing a comprehensive
to charge participants who use tobacco. Tobacco retail licensing program and addressing loopholes in
surcharges have not been proven effective in Virginia’s Clean Indoor Air Act.
encouraging smokers to quit and can cause tobacco
users to opt out of health coverage all together. Virginia State Facts
Repealing the surcharge is an integral component in
Health Care Cost Due to Smoking: $3,113,009,298
ensuring that people can get the assistance they need
to help them quit and end their addiction to nicotine. Adult Smoking Rate: 12.1%
The bill to repeal the surcharge passed both chambers High School Smoking Rate: 2.8%
with overwhelming bipartisan support and was signed
by Governor Youngkin. High School Tobacco Use Rate: 15.5%

Additionally, the Lung Association worked to defeat Middle School Smoking Rate: 3.1%
a bill that would lower the tax on cigars from 20% of
Smoking Attributable Deaths: 10,310
the manufacturers’ sales price to 10% or $0.30 per
cigar, whichever is lower. The bill passed the House of Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school smoking and tobacco use data
Delegates but failed to receive the needed votes in the come from the 2021 Youth Risk Behavior Surveillance System. Middle
Senate Finance and Appropriations committee. school smoking rate is taken from the Virginia 2021 Youth Risk Behavior
Surveillance System.
Recently in Virginia, a number of new casinos have Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
opened across the Commonwealth which have deaths reflect average annual estimates for the period 2005-2009 and
highlighted the loopholes that exist in Virginia’s Clean are calculated for persons aged 35 years and older. Smoking-attributable
healthcare expenditures based on 2004 smoking-attributable fractions
Indoor Air Act. Protecting casino workers and patrons and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
is a priority for the Lung Association and its partners
in the coming year as no amount of exposure to
secondhand smoke is safe.
Currently, Virginia does not require tobacco and
e-cigarette retailers to obtain a tobacco retail license.
Without a comprehensive tobacco retail license
program, Virginia cannot effectively enforce, educate,
monitor, or penalize illegal sales of tobacco products
to people under age 21. This includes monitoring
retailer compliance through required compliance
checks and graduated penalties for violation, including

127 Lung.org American Lung Association “State of Tobacco Control” 2024

 Washington Report Card
2024
N

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: C
O

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $4,636,500
T

Tax Rate per pack of 20: $3.025

FY2024 Federal Funding for
OTHER TOBACCO PRODUCT TAXES:
G

State Tobacco Control Programs: $1,828,532*

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
N

State Tobacco Control Programs: $6,465,032 Tax on Large Cigars: Equalized: No; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: Yes
I

State Spending Recommendation: $63,600,000

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
H

Percentage of CDC Recommended Level: 10.2%

Tax on E-cigarettes: Equalized: No; Weight-Based: Yes
State Tobacco-Related Revenue: $480,600,000
S

For more information on tobacco taxes, go to:

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.
A

D
W

Smokefree Air: C Access to Cessation Services:

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Prohibited STATE MEDICAID PROGRAM:

Private work sites: Prohibited Medicaid Medications: All 7 medications are covered
Schools: Prohibited Medicaid Counseling: Minimal counseling is covered
Child care facilities: Prohibited Medicaid Barriers to Coverage: Minimal barriers exist to
access care
Restaurants: Prohibited
Medicaid Expansion: Yes
Bars: Prohibited
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: Prohibited (tribal
establishments not subject to state law) Medications: Some medications are covered
Retail stores: Prohibited Counseling: Most types of counseling are covered
E-Cigarettes Included: Only in a few specific public places Barriers to Coverage: Minimal barriers exist to access care
and workplaces
STATE QUITLINE:
Preemption/Local Opt-Out: Yes
Investment per Smoker: $0.68; the median investment per
Citation: WASH. REV. CODE § 70.345.150 (2016). smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: Yes
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Washington Tobacco Cessation Coverage page
for coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

128 Lung.org American Lung Association “State of Tobacco Control” 2024

Washington State Highlights:
2024
Tobacco use remains the leading cause

W
Washington State Facts
of preventable death and disease in
the United States and in Washington. Health Care Cost Due to Smoking: $2,811,911,987

A
To address this enormous toll, the Adult Smoking Rate: 10%

S
American Lung Association calls for the
High School Smoking Rate: 1.9%
following actions to be taken by Washington’s elected

H
officials: High School Tobacco Use Rate: N/A
1. Increase funding for tobacco prevention and quit

I
Middle School Smoking Rate: 1.3%
programs;

N
Smoking Attributable Deaths: 8,290
2. End the sale of flavored tobacco products; and

G
Adult smoking data come from CDCs 2022 Behavioral Risk Factor
3. Defend Washington’s Clean Indoor Air law. Surveillance System. High school (10th grade only) and middle school
(8th grade only) smoking rates are taken from the 2021 Washington
Senator Saldaña once again championed legislation

T
State Healthy Youth Survey. A current high school tobacco use rate is not
available for this state.
to eliminate all commercial tobacco youth possession,

O
Health impact information is taken from the Smoking Attributable Mortality,
use, and purchase (PUP) laws and all enforcement Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
actions against youth under the age of 18 and deaths reflect average annual estimates for the period 2005-2009 and

N
are calculated for persons aged 35 years and older. Smoking-attributable
increasing penalties on retailers. This legislation, healthcare expenditures based on 2004 smoking-attributable fractions
and 2009 personal healthcare expenditure data. Deaths and expenditures
Senate Bill 5365 had a similar bill, House Bill, 1497 in should not be compared by state.
the House sponsored by Representative Paul Harris.
Key legislators in the Senate were uncomfortable
removing all PUP provisions. The resulting compromise
is a substantive step towards more equitable
enforcement. The resulting compromise is a
substantive step towards more equitable enforcement.
The legislation passed the House 57 to 39 and in
the Senate 29 to 19. The legislation was signed by
Governor Inslee on May 9, 2023. Passage of this bill
was the culmination of a multi-year effort; advocacy for
this policy began during the work on the Tobacco 21
legislation passed in 2019.
The final 2024-2025 Operating Budget (Senate Bill
5187) appropriated $5.0 million from the state general
fund to tobacco prevention and cessation programs.
This appropriation represents the first dedicated
ongoing dollars from the state general fund in over
ten years, but does represent a cut from the $5 million
allocated for one year last fiscal year .
The American Lung Association will continue to work
with volunteers and stakeholders to advocate for
additional dedicated dollars for tobacco prevention
and quit programs. In addition, the Lung Association
will continue growing public awareness and support
for ending the sale of all flavored tobacco products.

129 Lung.org American Lung Association “State of Tobacco Control” 2024

 West Virginia Report Card
2024
A

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
I

FY2024 State Funding for CIGARETTE TAX:

N

Tobacco Control Programs: $451,404

Tax Rate per pack of 20: $1.20
FY2024 Federal Funding for
I

State Tobacco Control Programs: $1,229,006* OTHER TOBACCO PRODUCT TAXES:

Tax on Little Cigars: Equalized: No; Weight-Based: No
G

FY2024 Total Funding for

State Tobacco Control Programs: $1,680,410 Tax on Large Cigars: Equalized: No; Weight-Based: No
R

CDC Best Practices Tax on Smokeless Tobacco: Equalized: No; Weight-Based: No

State Spending Recommendation: $27,400,000
Tax on Pipe/RYO Tobacco: Equalized: No; Weight-Based: No
I

Percentage of CDC Recommended Level: 6.1%

Tax on E-cigarettes: Equalized: No; Weight-Based: Yes
V

State Tobacco-Related Revenue: $227,600,000

For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.
T

Smokefree Air: D* Access to Cessation Services: F

S

OVERVIEW OF STATE CESSATION COVERAGE

E

OVERVIEW OF STATE SMOKING RESTRICTIONS

Government work sites: Restricted STATE MEDICAID PROGRAM:
W

Private work sites: No provision Medicaid Medications: All 7 medications covered

Schools: Prohibited (public schools only) Medicaid Counseling: Minimal counseling is covered
Child care facilities: Restricted Medicaid Barriers to Coverage: Some barriers exist to access
care
Restaurants: No provision
Medicaid Expansion: Yes
Bars: No provision
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: No provision
Medications: All 7 medications are covered
Retail stores: No provision
Counseling: Some counseling is covered
E-Cigarettes Included: Only in Most Parts of K-12 Schools
and School Property Barriers to Coverage: Minimal barriers exist to access care
Preemption/Local Opt-Out: No STATE QUITLINE:
Citation: W. VA. CODE §§ 16-9A-4 (1987) & 31-20-5b (1997); Investment per Smoker: $0.98; the median investment per
WV Div. of Personnel Policy, Smoking Restrictions in the smoker is $1.93
Workplace (2004); WV CSR §§ 64-21-10 (1997), 64-21-20
(1997) & 126-66-1 et seq. (1998). OTHER CESSATION PROVISIONS:

* West Virginia has 59.4% of the state’s population covered by Private Insurance Mandate: No provision
comprehensive local smokefree workplace regulations. If a state has Tobacco Surcharge: No prohibition or limitation on tobacco
more than 50% of its population covered by local smokefree ordinances/
regulations, the state is graded based on population covered by those surcharges
local ordinances/regulations rather than the statewide law.
Citation: See West Virginia Tobacco Cessation Coverage
page for coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

130 Lung.org American Lung Association “State of Tobacco Control” 2024

West Virginia State Highlights:
2024
The American Lung Association calls for the following funding for tobacco prevention and control programs,

W
actions to be taken by West Virginia’s elected officials protecting local control of smokefree air laws, and
to reduce tobacco use and exposure to secondhand eliminating ineffective punitive policies that fail to

E
smoke: address youth initiation of tobacco products.

S
1. Increase funding for tobacco prevention and
West Virginia State Facts
cessation programs aligned with the Centers

T
for Disease Control and Prevention (CDC)- Health Care Cost Due to Smoking: $1,008,474,499
recommended level; Adult Smoking Rate: 21%

V
2. Preserve local control of smokefree laws throughout High School Smoking Rate: 7.6%
the state; and

I
High School Tobacco Use Rate: 27%
3. Eliminate punitive youth possession, use and

R
purchase laws and implement evidence-based Middle School Smoking Rate: 4.5%
policies that deter youth initiation of tobacco Smoking Attributable Deaths: 4,280

G
products.
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor

I
Public health advocates were on high alert going into Surveillance System. High school smoking and tobacco use rates are
taken from the 2021 Youth Risk Behavior Surveillance System. Middle
the 2023 legislative session following recent efforts

N
school smoking rate is taken from the 2017 Youth Tobacco Survey.
to undermine local smokefree laws by the passage of Health impact information is taken from the Smoking Attributable Mortality,
bills that prevented local boards of health from passing Morbidity and Economic Costs (SAMMEC) software. Smoking attributable

I
deaths reflect average annual estimates for the period 2005-2009 and
strong regulations. Fortunately, these efforts did not are calculated for persons aged 35 years and older. Smoking-attributable

A
healthcare expenditures based on 2004 smoking-attributable fractions
advance, and the Lung Association will continue to and 2009 personal healthcare expenditure data. Deaths and expenditures
track attempts to restrict local communities from should not be compared by state.

protecting public health. Smokefree regulations

currently protect over one million West Virginians
from the dangers of secondhand smoke; the Lung
Association along with the dedication of partner
organizations will continue to oppose state preemption
and protect local, comprehensive smokefree air laws.
The Lung Association and West Virginia’s youth
tobacco prevention group, Raze, have worked tirelessly
to address the high rates of tobacco use in the state
along with the skyrocketing e-cigarette use rates
amongst young people. Through ongoing education,
local and statewide events, youth continue to fight
the disproportionately high burden of tobacco across
West Virginia. Additional state funding for tobacco
control programs could help with these efforts. West
Virginia’s state funding of $461,000 is too low given the
scale of the problem in the state, and woefully short
of the CDC-recommended level of funding. To further
prevent youth from starting tobacco or switching
products, the Lung Association will also continue to
recommend evidenced-based polices to reduce youth
tobacco use such as increasing the cigarette tax
and equalizing the rates across all tobacco products,
including e-cigarettes.
The American Lung Association in West Virginia will
continue to work with our partners in 2024 to educate
lawmakers and the public on the ongoing fight against
tobacco through proven policies such as increasing

131 Lung.org American Lung Association “State of Tobacco Control” 2024

 Wisconsin Report Card
2024
N

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: D
I

FY2024 State Funding for CIGARETTE TAX:

S

Tobacco Control Programs: $6,702,756

Tax Rate per pack of 20: $2.52
FY2024 Federal Funding for
N

State Tobacco Control Programs: $1,588,681* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
O

State Tobacco Control Programs: $8,291,437 Tax on Large Cigars: Equalized: No; Weight-Based: No
C

CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: No

State Spending Recommendation: $57,500,000
Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
S

Percentage of CDC Recommended Level: 14.4%

Tax on E-cigarettes: Equalized: No; Weight-Based: Yes
State Tobacco-Related Revenue: $691,000,000
I

For more information on tobacco taxes, go to:

* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
W

from the Centers for Disease Control and Prevention.

U Thumbs up for Wisconsin for increasing funding for its

state tobacco control program by close to $1.4 million
from Juul settlement funds this fiscal year.
Access to Cessation Services: D
OVERVIEW OF STATE CESSATION COVERAGE
Smokefree Air: B STATE MEDICAID PROGRAM:
Medicaid Medications: All 7 medications are covered
OVERVIEW OF STATE SMOKING RESTRICTIONS
Medicaid Counseling: All three types of counseling are
Government work sites: Prohibited covered
Private work sites: Prohibited Medicaid Barriers to Coverage: No barriers exist to access
Schools: Prohibited care
Child care facilities: Prohibited Medicaid Expansion: No
Restaurants: Prohibited STATE EMPLOYEE HEALTH PLAN(S):
Bars: Prohibited (allowed in existing tobacco bars) Medications: All 7 medications are covered
Casinos/Gaming Establishments: Prohibited (tribal Counseling: Most counseling is covered
establishments not subject to state law)
Barriers to Coverage: Some barriers exist to access care
Retail stores: Prohibited
STATE QUITLINE:
E-Cigarettes Included: No
Investment per Smoker: $1.07; the median investment per
Preemption/Local Opt-Out: Limited smoker is $1.93
Citation: WI STAT. ANN. § 101.123 (2010). OTHER CESSATION PROVISIONS:
Private Insurance Mandate: No provision
Tobacco Surcharge: Medicaid enrollees are subject to a
tobacco surcharge
Citation: See Wisconsin Tobacco Cessation Coverage page
for coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

132 Lung.org American Lung Association “State of Tobacco Control” 2024

Wisconsin State Highlights:
2024
Commercial tobacco use remains the e-cigarette shop licensing and to identify champions

W
leading cause of preventable death in both political parties. We will also be working
and disease in the United States and in to stop a state bill which proposes to create new

I
Wisconsin. To address this enormous “tobacco bars” which would be exempted from the

S
toll, the American Lung Association calls Wisconsin smokefree air law. Wisconsin has been a
for the following actions to be taken by Wisconsin’s leader in protecting all of its citizens from the known,

C
elected officials: indisputable hazards of secondhand smoke in the
workplace and public places. Our law protecting both

O
1. Raise Wisconsin’s legal age of sale for tobacco
products to 21; workers and patrons at all indoor public places has

N
been in place since 2009, and it’s working! We must
2. Protect the statewide smokefree air law; and send a message to Big Tobacco that Wisconsinites

S
3. Protect tobacco prevention and control funding. are not softening their stance, we understand the
In 2023, the American Lung Association and other detrimental impact of commercial tobacco products,

I
tobacco control advocates in Wisconsin worked and will continue to fight against these harmful

N
extremely hard to increase funding for tobacco products.
prevention and control efforts in the state budget. With your help, the Lung Association will ensure
Wisconsin is only allocating $5.315 million through the that our leaders pay attention to lung health, as we
state budget for tobacco prevention and cessation advocate for action to pass laws and put in place
programs, which is significantly less than the $57.5 programs that will reduce commercial tobacco use
million recommended for Wisconsin by the Centers and save lives.
for Disease Control and Prevention. While these efforts
were unsuccessful during the budget process, the Wisconsin State Facts
Attorney General directed the Juul settlement funds Health Care Cost Due to Smoking: $2,663,227,988
of $1.39 million for this fiscal year to go to youth
Adult Smoking Rate: 14.3%
e-cigarette prevention and tobacco use treatment.
At the end of 2023, the state legislature passed a law High School Smoking Rate: 4.5%
which will add e-cigarette retailers into Wisconsin’s High School Tobacco Use Rate: 15.9%
existing tobacco licensing structure. While we would
Middle School Smoking Rate: 1.4%
generally like to see stronger licensing practices, this
closes a loophole and imposes some accountability on Smoking Attributable Deaths: 7,850
these retailers.
Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
While the legislative session continues into 2024, Surveillance System. High school smoking and tobacco use rates are
taken from the 2021 Youth Risk Behavior Surveillance System. Middle
thus far we have not seen the reintroduction of the school smoking rate is taken from the 2018 Wisconsin Youth Tobacco
Survey.
bill to raise Wisconsin’s legal age of sale for tobacco
Health impact information is taken from the Smoking Attributable Mortality,
products to 21 to match the federal law. This will help Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
eliminate confusion from retailers about who they deaths reflect average annual estimates for the period 2005-2009 and
are calculated for persons aged 35 years and older. Smoking-attributable
can legally sell to and is an important component of healthcare expenditures based on 2004 smoking-attributable fractions
and 2009 personal healthcare expenditure data. Deaths and expenditures
a comprehensive public health approach to reducing should not be compared by state.
tobacco use.
There was an important local victory in Milwaukee,
which passed a zoning ordinance that restricts where
new tobacco retailers can open, prohibiting them from
locating within 1,000 feet of a school, park, playground,
library, or childcare facility, and within 500 feet of
another tobacco retailer. This ordinance could be a
model for other municipalities.
In the coming months, the Lung Association will work
with our local volunteers and coalition partners on
our 2024 legislative priorities, including strategizing
to garner additional support for Tobacco 21 and

133 Lung.org American Lung Association “State of Tobacco Control” 2024

 Wyoming Report Card
2024
G

Tobacco Prevention and

Control Program Funding: F Tobacco Taxes: F
N

FY2024 State Funding for CIGARETTE TAX:

Tobacco Control Programs: $2,461,440
I

Tax Rate per pack of 20: $0.60

FY2024 Federal Funding for
M

State Tobacco Control Programs: $1,020,771* OTHER TOBACCO PRODUCT TAXES:

FY2024 Total Funding for Tax on Little Cigars: Equalized: Yes; Weight-Based: No
O

State Tobacco Control Programs: $3,482,211 Tax on Large Cigars: Equalized: Yes; Weight-Based: No
CDC Best Practices Tax on Smokeless Tobacco: Equalized: Yes; Weight-Based: Yes
Y

State Spending Recommendation: $8,500,000

Tax on Pipe/RYO Tobacco: Equalized: Yes; Weight-Based: No
Percentage of CDC Recommended Level: 41.0%
W

Tax on E-cigarettes: Equalized: Yes; Weight-Based: No

State Tobacco-Related Revenue: $40,000,000
For more information on tobacco taxes, go to:
* Includes tobacco prevention and cessation funding provided to states www.lung.org/slati
from the Centers for Disease Control and Prevention.

Smokefree Air: F Access to Cessation Services: C

OVERVIEW OF STATE SMOKING RESTRICTIONS OVERVIEW OF STATE CESSATION COVERAGE

Government work sites: Restricted STATE MEDICAID PROGRAM:

Private work sites: No provision Medicaid Medications: All 7 medications are covered
Schools: No provision Medicaid Counseling: Some counseling is covered
Child care facilities: No provision Medicaid Barriers to Coverage: Some barriers exist to access
care
Restaurants: No provision
Medicaid Expansion: No
Bars: No provision
STATE EMPLOYEE HEALTH PLAN(S):
Casinos/Gaming Establishments: No provision
Medications: Few medications are covered
Retail stores: No provision
Counseling: All 3 forms of counseling are covered
E-Cigarettes Included: N/A
Barriers to Coverage: No barriers exist to access care
Preemption/Local Opt-Out: No
Citation: Wyoming State Govt. Non-Smoking Policy (1989). STATE QUITLINE:
Investment per Smoker: $11.65; the median investment per
smoker is $1.93

OTHER CESSATION PROVISIONS:

Private Insurance Mandate: No provision
Tobacco Surcharge: No prohibition or limitation on tobacco
surcharges
Citation: See Wyoming Tobacco Cessation Coverage page
for coverage details.

Flavored Tobacco Products: F

Restrictions on Flavored Tobacco Products: No state law or
regulation

134 Lung.org American Lung Association “State of Tobacco Control” 2024

Wyoming State Highlights:
2024
Tobacco use remains the leading cause programs, and other crucial public health needs.

W
of preventable death and disease in
the United States and in Wyoming. Wyoming State Facts

Y
To address this enormous toll, the Health Care Cost Due to Smoking: $257,674,019

O
American Lung Association calls for the
Adult Smoking Rate: 15.5%
following actions to be taken by Wyoming’s elected

M
officials: High School Smoking Rate: 4%
1. Increase the cigarette tax by $1.00 per pack, with High School Tobacco Use Rate: N/A

I
parity across all tobacco products;
Middle School Smoking Rate: 1.3%

N
2. Support state and/or local smokefree workplace
Smoking Attributable Deaths: 800
laws; and

G
3. Increase funding for tobacco prevention and Adult smoking data come from CDC’s 2022 Behavioral Risk Factor
Surveillance System. High school (10th and 12th grade only) and middle
cessation programs. school (6th and 8th grade only) smoking rates are taken from the 2022
Wyoming Prevention Needs Assessment Survey. A current high school
The American Lung Association in Wyoming supports tobacco use rate is not available for this state.

evidence-based policy interventions to reduce Health impact information is taken from the Smoking Attributable Mortality,
Morbidity and Economic Costs (SAMMEC) software. Smoking attributable
tobacco use rates and prevent youth initiation. deaths reflect average annual estimates for the period 2005-2009 and
are calculated for persons aged 35 years and older. Smoking-attributable
Together with our partners, the Lung Association healthcare expenditures based on 2004 smoking-attributable fractions
works to ensure tobacco control and prevention and 2009 personal healthcare expenditure data. Deaths and expenditures
should not be compared by state.
remains a priority for state legislators and local
decisionmakers.
The Lung Association continues to educate elected
officials and the general public about the negative
public health impacts of tobacco use in Wyoming,
and the ongoing importance of providing adequately
funded tobacco prevention and cessation programs.
The most important tobacco control measure that
Wyoming policymakers can pursue is raising the
cigarette tax by at least $1.00 per pack and ensuring
parity for tax rates among all tobacco products.
In 2023, the Lung Association joined with partners to
oppose a cigar industry bill that would have limited
taxes on cigars. The bill eventually passed, but the
objectionable parts of the legislation were removed.
The Lung Association is also committed to advocating
for evidence-based tobacco prevention programs
though the disbursement of Wyoming’s $5.8 million
portion of settlement funds resulting from a multi-state
lawsuit against Juul Labs.
2023 marked 20 years since the last time Wyoming
legislators raised the cigarette tax. At $0.60 per
pack, it remains among the lowest in the country.
The Lung Association will continue working with
partners to support a significant increase in taxes on
cigarettes and all tobacco products. Raising tobacco
taxes is one of the most effective ways to drive down
smoking rates and prevent many young people from
ever smoking at all. Additionally, funding generated
from raising tobacco taxes provides a steady source
of revenue for tobacco prevention and cessation

135 Lung.org American Lung Association “State of Tobacco Control” 2024

 About the American Lung Association
The American Lung Association is the leading organization working to save lives by
improving lung health and preventing lung disease through education, advocacy and
research. The work of the American Lung Association is focused on four strategic
imperatives: to defeat lung cancer; to champion clean air for all; to improve the quality of
life for those with lung disease and their families; and to create a tobacco-free future.
For more information about the American Lung Association, a holder of the coveted
4-star rating from Charity Navigator and a Gold-Level GuideStar Member, or to support
the work it does, call 1-800-LUNGUSA (1-800-586-4872) or visit: Lung.org.