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New Report: As Youth E-Cigarette Epidemic Worsens, States Continue to Shortchange Prevention Programs That Could Help

December 19, 2019

WASHINGTON, D.C. – Despite a worsening e-cigarette epidemic that threatens the nation’s progress in reducing youth tobacco use, most states continue to shortchange programs designed to prevent kids from using tobacco products, according to a report released today by a coalition of public health organizations. The report is a challenge to states to do more to fight tobacco use – still the nation’s No. 1 preventable cause of death – and prevent e-cigarettes from addicting a new generation of kids.

This year (fiscal year 2020), the states will collect $27.2 billion from the 1998 tobacco settlement and tobacco taxes. But they will spend less than 3% – just $739.7 million – on programs to prevent kids from using tobacco and help smokers quit. While this is a small increase from last year, it is less than a quarter (22.4%) of the total funding recommended by the Centers for Disease Control and Prevention (CDC). No state currently funds its tobacco prevention and cessation programs at CDC-recommended levels and only six states provide even half the recommended amount.

The report – “Broken Promises to Our Children: A State-by-State Look at the 1998 Tobacco Settlement” – was released today by the Campaign for Tobacco-Free Kids, American Cancer Society-Cancer Action Network, American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights, Robert Wood Johnson Foundation and Truth InitiativeThis year marks the 21st anniversary of the landmark legal settlement between 46 states and the major tobacco companies, which – along with individual settlements with four other states – required the companies to pay more than $246 billion over time as compensation for tobacco-related health care costs.

View the report, including state-by-state information and a ranking of the states.

Driven by skyrocketing youth use of e-cigarettes, the percentage of high school students who use tobacco products is at its highest level in 19 years. This year, 31.2% of high school students and 12.5% of middle school students – 6.2 million kids altogether – used some type of tobacco product, according to the 2019 National Youth Tobacco Survey. The number of kids who use e-cigarettes has skyrocketed to over 5.3 million, including more than one in four (27.5%) high school students, and recent trends indicate that nearly 5,000 more kids start using e-cigarettes each day.

“The e-cigarette epidemic is disrupting the lives of kids and families in every community, so it is critical that every state step up and do its part to end this crisis. That includes properly funding proven tobacco prevention programs, as well as prohibiting the flavored products that have fueled this epidemic,” said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. “We need a comprehensive, all-hands-on-deck strategy to prevent e-cigarettes from addicting a generation of children.”

To stem the youth e-cigarette epidemic, the Trump Administration in September announced a plan to clear the market of all flavored e-cigarettes, but seems to be backtracking and has taken no action to do so yet. In the meantime, a growing number of states and cities have acted. Massachusetts recently became the first state to prohibit the sale of all flavored tobacco products, including flavored e-cigarettes and menthol cigarettes.

In addition to the youth e-cigarette epidemic, the U.S. is also facing large disparities in who still smokes. While the smoking rate among U.S. adults has fallen to 13.7%, smoking rates remain the highest among people with lower income and less education, residents of the Midwest and the South, American Indians/Alaska Natives, LGBT Americans, those who are uninsured or on Medicaid, and those with mental illness.

To accelerate progress, the federal government and states should fully implement proven strategies to reduce tobacco use. In addition to funding tobacco prevention programs and prohibiting flavored tobacco products, these strategies include significant tobacco tax increases, comprehensive smoke-free laws, hard-hitting mass media campaigns, and barrier-free insurance coverage for tobacco cessation treatments.

The U.S. Food and Drug Administration has a critical role to play. In addition to implementing the Administration’s plan to clear the market of flavored e-cigarettes, the FDA must enforce a May 2020 deadline for e-cigarette manufacturers to apply to the FDA and submit their products for public health review in order to keep them on the market. The FDA should also move forward with its proposals to prohibit menthol cigarettes and flavored cigars and to limit nicotine in cigarettes to minimally addictive or non-addictive levels, as well as meet a court-ordered deadline of March 15, 2020, for issuing a final rule requiring graphic cigarette warnings.

Other key findings of this year’s report include:

  • California is the only state to come close (93.7%) to providing the CDC-recommended funding for tobacco prevention and cessation programs. The $326 million California is spending dwarfs what other states spend and amounts to almost half the total amount for all the states.
  • At the other end of the scale, Connecticut did not spend any funding on these programs.
  • 33 states and DC are providing less than 25% of what the CDC recommends.
  • Tobacco companies spend more than $12 to market tobacco products for every $1 the states spend to reduce tobacco use. According to the most recent data from the Federal Trade Commission (for 2017), the major cigarette and smokeless tobacco companies spend $9.4 billion a year – over $1 million each hour – on marketing.

“Twenty-one years after the Master Settlement Agreement, our communities face a new addiction crisis caused by Big Tobacco,” said Lisa Lacasse, President of the American Cancer Society Cancer Action Network. “State lawmakers can help reverse the youth tobacco use epidemic by fully investing in prevention programs that are proven to keep kids from starting to use tobacco products like e-cigarettes and help current users to quit. Our kids deserve nothing less than swift, comprehensive action that will protect them from addiction and empower them to live full and healthy lives.”

“The youth e-cigarette epidemic has parents, teachers, school administrators and community leaders demanding action to protect kids from this new threat. Young people are becoming addicted and finding it very difficult, if not impossible, to quit on their own,” said Mark Schoeberl, executive vice president of advocacy for the American Heart Association. “This public health crisis must be addressed as soon as possible. Sustained investments in tobacco prevention and cessation by our elected officials, combined with government action removing all characterizing flavors in all tobacco products – including cigarettes, cigars and smokeless tobacco – are essential to break the cycle and foil the industry’s best efforts to addict another generation to tobacco use.”

“With youth vaping at an all-time high – we need states to pass proven tobacco control policies that save lives,” said American Lung Association National President and CEO Harold P. Wimmer. “States continue to receive billions of dollars from tobacco settlement payments and tobacco taxes, but are shortchanging vital programs that can help prevent and reduce youth tobacco, including e-cigarette use. We ask state leaders to recommit to fully funding tobacco control efforts to prevent another generation of kids from being addicted to tobacco."

“Youth tobacco use is at the highest it has been in nearly 20 years, primarily driven by e-cigarettes,” said Robin Koval, CEO and President, Truth Initiative. “It’s more important than ever for all states to remove youth appealing flavored tobacco, and continue to invest in the combined proven strategies—higher taxes, smoke-free air laws, prevention programs and Tobacco 21 policies—to help achieve a culture where all youth and young adults reject tobacco in all its forms.”

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