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Northeast Receives Mixed Reviews In Lung Association's 'State Of Tobacco Control'

A "Smoke Free" sign in Pittsfield, Massachusetts.
Jim Levulis
A "Smoke Free" sign in Pittsfield, Massachusetts.

The Northeast garnered mixed reviews in the American Lung Association’s annual “State of Tobacco Control” report out Wednesday. 

The 19th edition of the report grades all 50 states on their tobacco control efforts, from smoke-free workplace laws to tobacco taxes and prevention programs. Director of National Policy Thomas Carr says while smoking is on the decline, it remains the leading preventable cause of death in the U.S., killing 480,000 people a year. 

“COVID-19 is certainly taking a lot of attention in terms of public health right now — and for good reason, of course. But it’s important to keep in mind that tobacco use and secondhand smoke are still leading public health threats. And then also, smoking is linked to COVID-19 as well," Carr explains. "States need to keep their eye on the ball to make sure that all public health threats are still tackled.” 

So is New York keeping its eye on the ball? Well, sort of. As in years past, New York got an “A” for its laws mandating smoke-free worksites, schools, restaurants, etc. For those trying to quit, the state’s Medicaid program improved coverage of cessation treatments, including all seven medications approved by the FDA. Furthermore, in 2020 New York ended tobacco sales in pharmacies, restricted coupon use for tobacco products, and outright banned the sale of flavored e-cigarettes in the state (more on that later). 

But the Lung Association says New York still fails in one category: its funding for tobacco control programs. Michael Seilback is the Lung Association’s national assistant vice president for state public policy.

“New York spends under $40 million a year on its state tobacco control program. The CDC says New York should be spending over $200 million a year," says Seilback. "And the fact is, New York takes in over $2 billion in tobacco taxes and master settlement agreement dollars from the tobacco companies.” 

To be fair, Seilback says most states — except Alaska, Maine, and Utah — are missing the mark. Massachusetts and Vermont allocate less than $8 million combined, and Connecticut doesn’t provide any state funding at all. Still, Seilback would like to see New York raise its tax on tobacco products, which, for a pack of a pack of cigarettes, has remained $4.35 since 2010. 

"Invest some of that money to help smokers quit and to prevent kids from ever starting. We know that increasing the price of cigarettes is the most important thing you could do to prevent kids from starting to smoke, and reduce consumption," he adds. 

Like New York, the rest of the Northeast fared well for its clean air laws – with the exception of Pennsylvania and New Hampshire, which both received a “D” for allowing certain businesses to permit smoking.

Massachusetts received one of the best overall report cards in the country, the only state to ace the Lung Association’s new category on flavored tobacco restrictions. According to the CDC’s Youth Tobacco Survey, 24 percent of high schoolers and 7 percent of middle schoolers used tobacco in 2020. That’s a decline from previous years, but electronic cigarettes are still largely their first choice. New York, New Jersey, and Rhode Island all prohibit flavored e-cigarettes, but Massachusetts took it a step further in 2019, when it banned all flavored tobacco products, including menthol cigarettes.

Connecticut lawmakers plan to discuss a similar move this year, and Seilback hopes other states will follow suit. 

“Kids chase the flavors. When Juul stopped selling mint flavored Juul pods, all of a sudden menthol became their number one product," Seilback explains. "The secondary problem when you look at a product like menthol cigarettes — menthol cigarettes have been marketed overwhelmingly in communities of color. Data has shown that the menthol actually makes it harder for smokers to quit, and there is some data that suggests the way that those cigarettes are inhaled actually leads to worse health outcomes as well.” 

Nationwide, six states (Alabama, Mississippi, North Carolina, Texas, Virginia, and Wyoming) failed across the board, and the federal government saw plenty of room for improvement itself. Despite raising the smoking age from 18 to 21 last year, Washington D.C. received an overall “D” for its tobacco regulation, as well as its coverage of cessation treatments. In the report, the Lung Association notes the Democratic House passed a ban on the sale of all flavored tobacco products in 2020 – but the Senate, then controlled by Republicans, never picked it up for a vote. The Lung Association also gives Washington D.C. an “F” for its tobacco tax, which hasn’t budged from $1.01 a pack since 2009. 

Where the U.S. does excel is in its mass media awareness and anti-smoking campaigns. Carr says the increased focus on healthcare driven by COVID-19 puts the Biden administration in a good place to act on tobacco as well.

“I’d say all the policies in the State of Tobacco Control combined really are the key,” he notes. 

You can find a link to the report, where you check out your state’s grades at the American Lung Association website. 

Jesse King is the host of WAMC's national program on women's issues, "51%," and the station's bureau chief in the Hudson Valley. She has also produced episodes of the WAMC podcast "A New York Minute In History."
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