State of Tobacco Control 2022 Report

The American Lung Association (ALA) has released its 20th annual State of Tobacco Control report. The 2022 State of Tobacco Control report reflects on the collective progress in reducing tobacco use at the state and federal level in the last 20 years, discusses proven policies that reduce tobacco use and uses a grading system to assess the current state of tobacco control in all 50 states, the District of Columbia and at the federal level to highlight the further work to be done.

The report acts as a road map to tobacco control and prevention policies for state and federal governments to implement. It also reflects on “20 years of uneven change in State Tobacco Prevention Policies,” which highlights the fact that success in tobacco prevention and control policies has varied by decade, geographic region and policy.

One of the main focal points of the 2022 report is health disparities related to tobacco use. The overall adult smoking rate disguises tobacco-related disparities among different racial, ethnic, socio-economic and LGTBQ+ communities. While the overall smoking rate decreased significantly from 2003 – 2019, adult smoking rates in different populations remain almost as high as the overall rate was in 2003. In addition to higher adult and youth smoking rates in certain populations compared to overall rates, certain communities are exposed at a higher rate to secondhand smoke and use menthol cigarettes at a higher rate.

The State of Tobacco Control report evaluates federal and state tobacco control policies to determine if their laws and policies are adequately protecting their citizens from the immense toll tobacco use takes on lives, health and the economy. Letter grades “A” through “F” are given to the federal government and all 50 states, including the District of Columbia.

The 2022 report includes:

Key Findings

    • In the last 20 years, the nation has made progress toward making all 50 states smokefree. The latest data reveals an increase in the number of smokefree states from 2 to 28. However, people in 22 states still remaining unprotected from secondhand smoke in all public places and workplaces.
    • The adult cigarette smoking rate has decreased from 21.6% to 14% over 16 years. However, commercial tobacco use is still disproportionately higher in certain populations. For example, in 2019, the cigarette smoking rate among Native Americans and Alaskan Natives was 20.9% and among LGBTQ+ adults the rate was 19.2%.
    • While the COVID-19 pandemic’s impact on commercial tobacco use is still being evaluated, a report published in 2020 by the Federal Trade Commission stated that in 2020, cigarette sales increased for the first time in 20 years.
    • The average state cigarette tax has increased $1.29 since January 2003. However, from state to state there is a wide range of cigarette tax rates with the lowest at 17 cents and the highest at $4.50.

State Grades

States were graded on the five components listed below. State grading charts include all 50 states and the District of Columbia. The list below includes the number of states who received a B or higher for each graded category.

    • Tobacco prevention and cessation funding: Four 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: 19 states received a B or higher
    • Flavored tobacco product laws: One state received a B or higher

Federal Grades

The federal government was graded on five components:

    • Regulation of tobacco products: D
    • Mass media campaigns: A
    • Minimum age (tobacco 21): I (incomplete)
    • Tobacco taxes: F
    • Coverage for cessation treatment: D

The ALA also has a 2022 State of Tobacco Control website available which is in an interactive platform that provides detail on the key findings, state grades and federal grades. States can easily view their grades, how they compare to other states and the ALA offers suggestions for policies of focus for each state.