American Lung Association Releases 2023 “State of Tobacco Control” Report

New Report Reveals Best and Worst States for Tobacco Control Policies; Highlights Dramatic Differences from State to State

The American Lung Association’s 21st annual “State of Tobacco Control” report reveals the states with the best and worst policies to prevent and reduce tobacco use, and finds dramatic differences in the strength of states’ tobacco control laws.

The new report finds that the states doing the best to put in place proven tobacco control policies are California, Maine, Massachusetts and the District of Columbia, while the states with the most need to enact policies to reduce the burden of tobacco use are Alabama, Mississippi, North Carolina and Texas. The new report also shows new action at the federal level to prevent youth tobacco use, which resulted in improved federal grades.

The “State of Tobacco Control” report evaluates state and federal policies on actions taken to eliminate tobacco use and recommends proven-effective tobacco control laws and policies to save lives. These policies are critical, as tobacco use remains the leading cause of preventable death and disease in America, killing 480,000 people each year. Currently, 16 million Americans live with a tobacco-related disease.

“Our ‘State of Tobacco Control’ report shows how widely tobacco policies vary from state to state. For example, some states still allow smoking in workplaces like restaurants and bars, while others have had comprehensive smokefree laws in place for decades. The policies examined in our report have a direct impact on the health of state residents,” said Harold Wimmer, President and CEO of the American Lung Association. “Since no state received all ‘A’ grades, every state has the opportunity to improve their tobacco control policies and improve public health. This is also why federal tobacco control action is so important. Every person in America deserves the same protections.”

State Grades Overview
The “State of Tobacco Control” report grades states and the District of Columbia in five areas that have been proven to prevent and reduce tobacco use and save lives:

• Strength of Smokefree Workplace Laws – 23 states and Washington, D.C. received “A” grades in 2023
• Ending the sale of all flavored tobacco products – 45 states received “F” grades in 2023
• Funding for State Tobacco Prevention Programs – 40 states and Washington, D.C., received “F” grades in 2023
• Level of State Tobacco Taxes – 32 states received “F” grades in 2023
• Coverage and Access to Services to Quit Tobacco – 24 states received “D” grades or worse in 2023

Best Graded States

• California: Tobacco Program Funding: D, Smokefree Air: A, Tobacco Taxes: B, Access to Cessation: B, Flavored Tobacco Products: B
• District of Columbia: Tobacco Program Funding: F, Smokefree Air: A, Tobacco Taxes: A, Access to Cessation: B, Flavored Tobacco Products: A
• Maine: Tobacco Program Funding: A, Smokefree Air: A, Tobacco Taxes: C, Access to Cessation: A, Flavored Tobacco Products: F
• Massachusetts: Tobacco Program Funding: F, Smokefree Air: A, Tobacco Taxes: B, Access to Cessation: B, Flavored Tobacco Products: A

Worst Graded States

• Alabama, Mississippi, North Carolina and Texas rated the worst in the nation, scoring Fs in all five categories
• Georgia, Virginia and West Virginia received 4 Fs and 1 D grade

Federal Grades Overview
The report also grades the federal government on its efforts to eliminate tobacco use. In 2022, there were new actions taken by the government to prevent and reduce tobacco use, including 1) proposed rules to end the sale of menthol cigarettes and flavored cigars, 2) Congress passing a law requiring the U.S. Food and Drug Administration (FDA) to regulate tobacco products made with synthetic nicotine, and 3) increased federal enforcement of the Tobacco Control Act. In one example from last October, the U.S. Department of Justice announced that it filed complaints for permanent injunctions in federal district courts against six e-cigarette manufacturers on behalf of the FDA. More enforcement actions by the Justice Department and FDA will be needed in 2023 to reduce the explosion of illegal, flavored e-cigarettes on the market that continue to addict the country’s children.

As a result of these steps forward, the federal government’s grade for “Federal Regulation of Tobacco Products” improved from a “D” grade last year, to a “C” grade in the 2023 report.

The 2023 “State of Tobacco Control” report grades the federal government in five areas:

• Federal Government Regulation of Tobacco Products – Grade C
• Federal Coverage of Quit Smoking Treatments – Grade D
• Level of Federal Tobacco Taxes – Grade F
• Federal Mass Media Campaigns to Prevent and Reduce Tobacco Use – Grade: A
• Federal Minimum Age of Sale for Tobacco Products to 21 – Incomplete*

*FDA is overdue in publishing the final Tobacco 21 regulations as required by statute, which is why it earns an “incomplete.” 

“In 2023, it is imperative that FDA and the Biden administration finalize its proposed rules to end the sale of menthol cigarettes and flavored cigars. When finalized, these rules will be the most significant, lifesaving action FDA has taken in its almost 14-year history of regulating tobacco products,” said Wimmer.