Although fewer US adults are smoking cigarettes than ever, smoking remains the cause of the most preventable disability and death, and the nation's smoking regulations are getting mixed grades from the American Lung Association.
The association's annual State of Tobacco Control report, published Wednesday, gives the federal government an A grade for its media campaigns that encourage people to quit smoking or vaping, or to avoid starting in the first place.
But the government gets a failing grade for its tobacco tax policy. Taxes are considered one of the most effective ways to reduce smoking, particularly among children, studies have found. However, Congress hasn't raised federal tobacco taxes in 14 years. The federal cigarette tax remains $1.01 per pack, and taxes vary for other tobacco products. No state increased its cigarette taxes in 2022, either.
"There is still much room for improvement," said Erika Sward, assistant vice president of national advocacy for the American Lung Association.
Fewer adults used e-cigarettes from 2019 to 2020, the report says. Cigarette smoking rates among adults in 2022 were the lowest ever recorded. But in some communities -- including Native Americans, Alaska Natives and members of the LGBTQ community -- rates remain "alarmingly high," according to the report.
The government took several notable steps to prevent and reduce tobacco use in 2022, according to the group.
In April, the FDA proposed eliminating two tobacco products popular with children: flavored cigars and menthol cigarettes. But it could be years before that becomes a reality. Even if the rule is finalized this year, manufacturers will probably sue to keep it from going into effect.
Tobacco companies have long used menthol to mask the unpleasant flavors of their products. Studies show that it makes the products more attractive to new users and makes it harder for people to quit.
The American Lung Association says it will take many more significant law enforcement actions to end the youth vaping epidemic.
In 2022, nearly 17% of high school students -- or more than 2.14 million high schoolers -- reported that they currently used e-cigarettes, according to the US Centers for Disease Control and Prevention. And 1 out of every 30 middle school students, about 3.3%, said that they used an e-cigarette in the past 30 days. For high schoolers, it was 1 in 7 students, the CDC said.
The American Lung Association urges the FDA to finalize the menthol rule quickly and says it hopes the agency will finalize its review of all premarket applications for both tobacco-derived and synthetic nicotine products.
The sale of e-cigarette products without regulation has been allowed in the US for years, but the FDA asked companies to submit applications by September 2020 to keep their products on the market. The agency has been reviewing millions of applications, but advocates have criticized it as moving too slowly.
The American Lung Association's report also praises Congress for its efforts in March to close a loophole that allows popular synthetic nicotine products to stay on the market. It's become known as the Puff Bar loophole, after one particularly popular brand.
The new legislation created clear deadlines for the FDA to act, but many of the products remain on the market, and the report criticizes the Biden administration's "inaction."
In its report, the association urges Congress to pass the Resources to Prevent Youth Vaping Act to increase funding for the FDA's Center for Tobacco Products and to send more money to the CDC's Office on Smoking and Health.
The report also gives state governments a mixed review.
On the positive side, for the first time in a decade, there were significant increases in funding for state programs that prevent or reduce tobacco use, the report says. Eight states increased funding for tobacco control programs by $1 million or more, but most states do not meet the level of funding the CDC recommends.
In South Dakota, a law that isn't even aimed at tobacco may give one of the biggest boosts to get people to quit: Voters there decided to expand Medicaid in 2022. Quit attempts in states that expanded Medicaid increased by more than 20%, research shows. But eleven states still refuse to expand Medicaid.
However, at the local and state level, 2022 was a disappointing year when it came to anti-tobacco public policy, the report says.
Four states -- Alabama, Mississippi, North Carolina and Texas -- get straight Fs from the association. They failed in terms of tobacco prevention and control program funding, smoke-free air, tobacco taxes, access to cessation services and regulating flavored tobacco products. Georgia, Virginia and West Virginia get four Fs and a D.
States with failing grades tend to have the highest rates of death and disease caused by tobacco use, Sward said.
"These programs and these policies are proven to reduce tobacco use and to make the population healthier," she said. "This is in the state's best interest to reduce tobacco control."
Over the past decade, no states approved a comprehensive law to restrict smoking in public places or in the workplace. In parts of the US, mostly in the South and in Appalachia, many people are still exposed to secondhand smoke in these venues.
Anti-tobacco policies save lives, Sward said. She hopes to see more A grades when the association comes out with its 2023 report.
"There's a lot of work that remains to be done to reduce the death and disease caused by tobacco use in our nation," she said."We want to make sure that we're all able to breathe smoke-free air."
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