While the coronavirus pandemic has been the United States' most urgent health crisis this past year, tobacco use increases the risk for severe illness from COVID-19 and youth tobacco use remains pervasive, the American Lung Association notes in its new State of Tobacco Control report.
"Smoking is linked to COVID-19 in terms of causing more severe illness," says Thomas Carr, director for national policy at the American Lung Association. "The country needs to deal with COVID-19, but should remind people that smoking is still a major public health threat."
The Lung Association evaluates states for their tobacco control policies in its annual report and pointed out that California, Massachusetts, Oregon and Utah were among those that had made the strongest improvements in 2020.
The SOTC report evaluated states for their tobacco policy in several areas: tobacco control program funding, smoke-free air, tobacco taxes, access to cessation services, and this year's newest criterion: flavored tobacco products. These criteria were also assigned A through F grades.
California performed well for its policies on smoke-free air, tobacco taxes and regulation of flavored tobacco products. In August 2020, state lawmakers passed a bill outlawing the sale of flavored products that was quickly signed by Gov. Gavin Newsom. But the intended Jan. 1 implementation date was pushed back due to procedural concerns.
The Lung Association's report also highlighted Alabama, Mississippi, North Carolina, Texas, Virginia and Wyoming as the worst-performing states for tobacco regulation in the country, scoring Fs in all categories.
Due to the fairly new emergence of flavored tobacco products on the market, nearly all states earned an F in that category.
"We want state lawmakers to implement changes, and pass smoke-free workplace laws," Carr says. "There's not a small economic toll to this." He estimates that roughly 16 million people suffer from-tobacco related disease and 480,000 people die from complications of tobacco use in the U.S. each year.
The State of Tobacco Control report also evaluated the U.S.' federal tobacco policy along five metrics: regulation of tobacco products, coverage of cessation treatments, tobacco taxes, mass media campaigns and minimum purchasing age.
The federal government earned an F for its tobacco taxes. The report points out that at the federal level, an individual pack of 20 small cigarettes is taxed just over $1.
The U.S. government was given a D grade for cessation services – citing factors such as Medicare's coverage of up to eight visits for tobacco counseling – and for overall regulation of tobacco products. And the Lung Association gave the federal government As for its mass media campaigns and policy on minimum purchasing age, which was raised nationwide from 18 to 21 at the end of 2019.
While Carr credits the Trump administration for pushing for graphic warning labels on cigarette packs, he pointed out the federal government has made little progress when it comes to regulating flavored tobacco products.
"What we hope would happen is that the (Food and Drug Administration) would take products off the market that are most egregiously aimed at kids," he says. "We think no flavored product should qualify under FDA policy right now. (They should) take into account youth who might use it and people who used to use it."
Much of the middle- and high-school student use of tobacco products is centered on e-cigarettes and vaping, which saw substantial increases during the past several years, according to the report. The SOTC notes that although vaping declined from 27.5% among high-school students in 2019 to 19.6% in 2020 and from 10.5% to 4.7% for middle-school students during the same period, about 3.6 million middle- and high-school students continue to use e-cigarettes.
Carr says that part of their popularity stems from "a perception of less harm." He also cites the rise of e-cigarette manufacturer JUUL as a significant factor for vaping among students: They "can almost hide their use of it. There were many reports around the country of students being able to use it in class because teachers couldn't tell. The ability to use it surreptitiously" played a role in their appeal, he says.
"The Lung Association would like for there to be more alarm," Carr says.