The American Lung Association (ALA) has released its 21st annual State of Tobacco Control report. The 2023 State of Tobacco Control report highlights the states with the best and worst policies to prevent and reduce tobacco use and details the differences between the strengths of states’ tobacco control laws. The report also highlights new rules and regulations made at the federal level to prevent youth tobacco use. 

The report serves as a blueprint for actions that should be taken at the state and federal levels to reduce death and disease caused by tobacco use. The ALA assigns state and federal policies letter grades, A through F, based on their effectiveness in preventing and reducing tobacco use.  

One of the main focuses in the 2023 report is the significant steps taken by the federal government to prevent and reduce tobacco use in 2022. One of the most crucial actions taken by the federal government last year was the U.S. Food and Drug Administration (FDA)’s proposal to end the sale of menthol cigarettes and other flavored tobacco products. In 2022, Congress also took action to extend the FDA’s authority in regulating tobacco products. The FDA was granted the authority to regulate e-cigarettes and other products containing synthetic nicotine. Even with new rules and regulations, significantly more federal-level enforcement of the tobacco industry is needed.  

The 2023 report includes:  

Key Findings  

  • 14.1% of high school students and 3.3% of middle school students reported using e-cigarettes in 2022, with overall youth tobacco use at 16.5% in high school students and 4.5% in middle school students.  
  • Flavored tobacco, including flavored e-cigarettes, continues to be a main driver of youth tobacco use, with 85% of children who use tobacco using flavored products. 
  • New regulations mandated that synthetic nicotine products without a pre-market tobacco authorization were to be removed from the market by July 13, 2022. Due to delays in enforcement, these products have remained on the market. 
  • No states increased cigarette taxes in 2022. The current state cigarette tax average is $1.91 per pack.  

State Grades  

Listed below are the number of states who received a B or higher for each category the states were graded in. The states were graded on five components. All 50 states and the District of Columbia received grades.   

  • Tobacco prevention and cessation funding: Six states received a B or higher 
  • Smokefree air policies: 30 states received a B or higher 
  • Tobacco taxes: Eight states received a B or higher  
  • Access to cessation services: 18 states received a B or higher 
  • Flavored tobacco product laws: Three states received a B or higher 

Federal Grades  

The federal government was graded on five components: regulation of tobacco products, mass media campaigns, minimum age for sale of tobacco products (21), tobacco taxes, and coverage for cessation treatment. Mass media campaigns was the only component the federal government received a B or higher in. Minimum age is marked as incomplete.  

The 2023 State of Tobacco Control website is in an interactive platform that provides details on the key findings, state grades, and federal grades. States can easily view their grades, how they compare to other states, and suggestions by the ALA for policies of focus for each state.  


Author: Emily Bell, Intern, GHEA