Key Findings

“State of Tobacco Control” 2025: Tobacco Industry’s Aggressive Actions to Protect its Profits Slows Proven Policies to Prevent and Reduce Tobacco Use

“State of Tobacco Control” 2025 finds that the tobacco industry is taking more aggressive actions at the federal and state level to protect its profits at the expense of the health of the nation. In 2024, the most glaring example of this trend was the effort aimed at the Biden White House to stop them from finalizing the U.S. Food and Drug Administration (FDA) rules that would end the sale of menthol cigarettes and flavored cigars. At the state level, the industry sought to protect specific tobacco products from taxation and to pass legislation that would result in state governments pursuing penalties against smaller competitors that sell e-cigarette products illegally in the U.S. Lawmakers must resist these tobacco industry efforts and continue to pass proven policies to prevent and reduce tobacco use. 

The American Lung Association’s annual “State of Tobacco Control” report evaluates states' and the federal government’s actions to eliminate the nation’s leading cause of preventable death—tobacco use. These proven-effective and urgently needed tobacco control laws and policies save lives. In the report, the Lung Association assigns letter grades, A through F, to the state and federal policies best proven to prevent and reduce tobacco use.

* All references to tobacco use, tobacco control or tobacco products in this document refers specifically to the use of manufactured, commercial tobacco products and not to the sacred or traditional use of tobacco by American Indians and other communities.

Former President Biden Succumbs to Industry Pressure and Fails to Move Forward on Rules to End Sale of Menthol Cigarette and Flavored Cigars 

The year 2024 featured several major disappointments in the country’s efforts to prevent and reduce tobacco use, the biggest being former President Biden’s failure to finalize rules to end the sale of menthol cigarettes and flavored cigars in December 2023 or April 2024. This failure to act will result in continued death and disease caused by smoking, especially among historically marginalized communities and will put former President Biden’s Cancer Moonshot goal of preventing more than four million cancer deaths by 2047 out of reach. 

According to news reports, the tobacco industry and its allies played a major role in former President Biden’s decision not to move forward, having many meetings with the White House and conducting an opposition media campaign through outlets friendly to their position as the decision on whether to finalize the rules was being made. The industry has long engaged in these types of efforts to influence lawmakers but stepped up the intensity in opposition to these rules. 

Halting these rules is an effort to protect the industry’s profits from their decades-long targeted marketing of menthol cigarettes in Black, LGBTQ+ and other historically marginalized communities through the use of advertising, free samples and donations to community organizations including law enforcement organizations. Unfortunately, the industry has been highly successful, with close to 80% of Black individuals in the U.S who smoke using menthol cigarettes today,¹ up from only 5% prior to the beginning of the targeted marketing in the 1950s.² Menthol cigarette use also remains elevated among lesbian, gay and bisexual communities, Native Hawaiian and Pacific Islander communities, women and persons with lower incomes.³ It is important to note that there is nothing biologically that makes a menthol cigarette any more appealing to any group than another; the disparities in menthol tobacco use in these communities are a direct result of the industry’s intentional efforts to increase use.

FDA completed its review of almost all pending pre-market tobacco product marketing applications for e-cigarettes submitted on or before September 9, 2020. However, in a very troubling development, the FDA granted marketing authorization to several types of menthol e-cigarettes. The Lung Association condemned these decisions by FDA, which leaves these products on the market legally. Many pre-market tobacco applications for e-cigarettes and other tobacco products submitted after September 9, 2020, including for synthetic nicotine products and nicotine pouches, remain unaddressed by FDA as well. 

The federal government took several actions to increase its enforcement against illegal e-cigarette products during 2024. These efforts included FDA collaborations with U.S. Customs and Border Protection (CBP) to block the import of additional brands of e-cigarettes and to seize more e-cigarettes at the border; and FDA, CBP, U.S. Department of Justice and several other government agencies establishing a federal multi-agency task force focused on combatting illegal e-cigarettes. 

However, both large and small tobacco companies continue to introduce and sell flavored illegal e-cigarette products across the country. Especially egregious are the e-cigarette products that look like other everyday items for sale such as juice boxes or video games built into the e-cigarette. These deplorable industry actions contribute to the 2.25 million middle and high school students that continued to use tobacco products, including e-cigarettes in 2024 according to the Centers for Disease Control and Prevention (CDC)’s 2024 National Youth Tobacco Survey (NYTS).⁴

In the past several years, sales of nicotine pouch products such as Zyn have been skyrocketing, rising 641% between 2019 and 2022, according to a recent study.⁵ Many nicotine pouch products are currently on the market illegally in the U.S. as FDA has not authorized the products for sale. Given the increases in sales, continued close monitoring of nicotine pouch use among kids is required.

There were several positive developments from 2024 at the federal level that could result in significant reductions in tobacco use if fully implemented.

• In November 2024, the U.S. Supreme Court declined to hear an appeal of a March 2024 decision from the 5^th Circuit Court of Appeals upholding the cigarette graphic warning labels on constitutional grounds. The case now returns to the U.S. District Court to resolve other issues, but this decision clears a major hurdle toward these warning labels appearing on cigarette packs.
• In January 2024, the U.S. Food and Drug Administration issued a proposed rule that would significantly reduce nicotine levels in almost all combusted tobacco products.

Tobacco remains the leading cause of preventable death and disease in America, killing 490,000 people each year, including 50,000 Black adults, 15,000 Hispanic adults and 400,000 white adults.

Adult cigarette smoking rates continued to slowly decline, dropping to 10.8% in 2023 compared to 11.6% in 2022, according to results from the CDC’s 2023 National Health Interview Survey. Overall adult tobacco use decreased in 2023, from 19.3% to 16.4%.⁷ The Surgeon General also released a new report in November 2024 that documents persistent and in some cases widening tobacco-caused disparities in the U.S. These include disparities by race and ethnicity, level of income, level of education and sexual orientation and gender identity.⁸

Tobacco Industry Takes More Aggressive Actions at State Level Slowing Progress in Most States

During 2024, the tobacco industry was also quite busy at the state level, taking more aggressive actions than in years past to pursue industry-friendly legislation and ingratiate themselves with state lawmakers.

Major tobacco company efforts on the state legislative front included: 

1. Introducing legislation in almost all states that created a state directory of e-cigarettes based on FDA pre-market tobacco application (PMTA) status. E-cigarettes with pending PMTAs were specifically exempted from being listed on these directories, which protects the market share for bigger e-cigarette companies;
2. Introducing legislation that would completely exempt or reduce state excise taxes on heated tobacco products and cigars; 
3. Continuing efforts to enact state preemption of stronger local laws in place in select states, including Arizona and Missouri; and
4. Fighting ongoing efforts in many states and localities to stop the sale of flavored tobacco products, including menthol cigarettes. 

There were also troubling instances of state governors openly celebrating tobacco industry investments in their states, including new Zyn manufacturing facilities in Colorado and Kentucky; and a Phillip Morris International event announcing a new Women’s Economic Empowerment initiative during women’s history month. These are unfortunate examples of how the tobacco industry continues its efforts to whitewash its reputation and reduce public outcry over their youth marketing and the 490,000 deaths the products they sell cause each year.

These and other tobacco industry actions slowed progress in most states on the proven public policies called for in “State of Tobacco Control.” However, Maryland was the notable exception – multiple pieces of legislation passed that increased the cigarette tax by $1.25 per pack and added e-cigarettes to the state smokefree workplace law as well as made other smaller improvements – making the “Free State” the runaway winner of the most improved state in this year’s report.

• Six states – Colorado, Florida, Kentucky, Michigan, Oklahoma and South Carolina – registered funding increases for programs to prevent and reduce tobacco use of close to $1 million and in some cases significantly more. Monies from the recent state settlements with Juul contributed to the funding increases in some of these states. However, funding did decrease by $1 million or in some cases significantly more in Connecticut, Illinois and New York. Four states received “A” grades in this category in “State of Tobacco Control” 2025 while 40 states and the District of Columbia received “F” grades.
• Maryland increased its cigarette tax by $1.25 per pack, making it the second highest state cigarette tax in the country at $5.00 per pack. Rhode Island also passed a small increase and Colorado implemented a scheduled increase in tobacco taxes approved by voters in previous years. Only the District of Columbia received an “A” grade in Tobacco Taxes in “State of Tobacco Control” 2025 while 31 states received “F” grades.
• No states passed laws eliminating smoking in public places and workplaces in 2024. This marks the 12th straight year where no state has passed a comprehensive smokefree law. Efforts to close loopholes in state smokefree workplace laws for casinos failed in several states, including New Jersey and Rhode Island. Maryland added e-cigarettes to its comprehensive smokefree law. Eleven states and the District of Columbia received “A” grades in this category in “State of Tobacco Control” 2025 while 12 states received “F” grades.
• Despite robust campaigns in a number of states, including Maine, Minnesota, New York and Vermont, no state approved laws ending the sale of flavored tobacco products. The city of Denver passed a comprehensive flavored tobacco law, again demonstrating the leadership of local communities on this issue. Massachusetts and the District of Columbia received “A” grades in this category in “State of Tobacco Control” 2025 while 46 states received “F” grades.
• Access to tobacco use treatment improved marginally in 2024. While some states made improvements to their Medicaid coverage, no new state expanded Medicaid this year, leaving about 1.5 million people in the coverage gap without access to healthcare, including tobacco cessation treatment. Thirteen states and the District of Columbia received “A” grades in this category in “State of Tobacco Control” 2025 while eight states received “F” grades.

It is imperative that federal and state lawmakers resist the pressure from a more aggressive tobacco industry and pass the proven public policies called for in “State of Tobacco Control” 2025. The country has made important progress in its efforts to prevent and reduce tobacco use and cannot go back to the bad old days when tobacco industry profits were prioritized over the public’s health.

Former President Biden misses opportunity to finalize menthol cigarette and flavored cigar rules; action on flavored tobacco products now moves to state and local level

Former President Biden had an opportunity to fundamentally alter and improve the health of our nation by finalizing rules to eliminate menthol as a characterizing flavor in cigarettes and prohibit all characterizing flavors in cigars. Unfortunately, the President bowed to tobacco industry pressure, postponing action on the two rules until after the November 2024 election and missing the window of opportunity to move forward. This also means that the country will not be able to achieve former President Biden’s Cancer Moonshot goal of reducing cancer deaths by half in 25 years.

Action on ending the sale of flavored tobacco products will now shift to states and localities. However, the Lung Association will continue to advocate for these rules in future administrations. Those future administrations must stand up to the tobacco industry and their paid surrogates by ending the sale of menthol cigarettes and all flavored tobacco products.

Menthol flavoring has been marketed and falsely perceived as a healthier alternative to non-menthol tobacco products.⁹ For generations, the tobacco industry has intentionally targeted youth along with Black, Brown, LGBTQIA+ and other historically marginalized communities with the marketing of menthol cigarettes. This false perception of less risk and relentless marketing has resulted in increased initiation with menthol cigarettes and high usage of menthol cigarettes, contributing to more tobacco-related death and disease as well as tobacco-related health disparities. Close to 80% of Black individuals who smoke use menthol cigarettes.¹⁰ Menthol cigarette use has also been historically elevated among lesbian, gay and bisexual (LGB)¹ individuals compared to heterosexual individuals who smoke.¹¹ There is no biological reason for the differences in use between these communities and the broader population; it is only the intentional marketing of the products by the industry to these populations, which has led to these disparities.

FDA finishes review of most premarket tobacco applications and takes several important enforcement actions against illegal e-cigarettes in 2024; future actions to protect kids in 2025 and beyond highly uncertain

As of December 2024, FDA finished review of almost all pending premarket tobacco product marketing applications for e-cigarettes submitted on or before September 9, 2020. Out of millions of applications received, FDA has authorized 34 e-cigarette products for sale. This demonstrates how many products on the market were unable to meet the public health standard under the Tobacco Control Act, in large part due to their appeal to kids. In March 2024, FDA launched a searchable tobacco products database that can be used to determine what tobacco products are authorized for sale in the U.S.

The tobacco industry has continued to challenge a large number of FDA marketing denial orders for e-cigarettes in court. In January 2024, the 5^th Circuit Court of Appeals issued a damaging decision in one of these cases that found FDA’s issuance of a marketing denial order to the e-cigarette company Triton Distribution arbitrary and capricious. The decision was contrary to seven other circuit courts of appeals that had upheld other FDA marketing denial orders for e-cigarettes. Given the circuit court split, the U.S. Supreme Court has agreed to hear the Triton distribution case. Oral arguments occurred in December 2024 and appeared favorable to upholding FDA’s marketing denial order. A decision is expected by June 2025.

The federal government has taken several actions to increase its enforcement against illegal e-cigarette products during 2024, including:

• The U.S. Department of Justice and FDA established a federal agency task force focused on combatting illegal e-cigarettes that includes U.S. Customs and Border Protection; the Bureau of Alcohol, Tobacco, Firearms and Explosives; the U.S. Marshals Service; the U.S. Postal Inspection Service; the Federal Trade Commission and several other government agencies.
• FDA worked with U.S. Customs and Border Protection to block the import of additional brands of e-cigarettes and to seize more e-cigarettes at the border. 
• FDA issued a proposed rule to speed up FDA’s review of imports that would require companies seeking to import e-cigarettes to submit a tracking number they receive from FDA.
• The U.S. Department of Justice filed for a permanent injunction against an additional e-cigarette manufacturer in July 2024, the eighth manufacturer to receive a permanent injunction overall.

With the Trump Administration taking office on January 20, it is unclear if FDA’s Center for Tobacco Products will continue to conduct its pre-market tobacco application review in the same way and how enforcement actions against tobacco products illegally on the market might change. The Lung Association will continue to advocate for FDA to follow the public health standard in the Tobacco Control Act and for robust enforcement against all tobacco products illegally on the market, including any products on the market with pending applications.

“To help address the continuing youth e-cigarette epidemic, the American Lung Association and the Ad Council launched the “#DoTheVapeTalk youth vaping awareness campaign to provide parents with the facts to address the dangers of vaping with their kids, while they’re still willing to listen."

Surgeon General Releases Important Report Detailing Tobacco-Caused Disparities

In November 2024, former U.S. Surgeon General Vivek Murthy released the 35th Surgeon General’s report on tobacco, on the 50-year anniversary of the first Surgeon General’s report in 1964. It is a critically important report on the disparities caused by commercial tobacco use – the outcome and consequences of the tobacco industry’s predatory marketing. Important findings and conclusions from the report include:

• Cigarette smoking remains a major cause of death and disease, causing more than 490,000 deaths per year, including 50,000 Black adults, 15,000 Hispanic adults, and 400,000 white adults.
• The breadth of tobacco-caused disparities continues to persist and expand within race and ethnicity, level of income, level of education, sexual orientation and gender identity, occupation, geography, behavioral health status, and disability status. Some have widened further since the last Surgeon General’s report on tobacco-related disparities in 1998. 
• The tobacco industry’s targeted marketing of its deadly products is largely responsible for these disparities. Tobacco marketing in general and marketing for menthol cigarettes in particular is more common in neighborhoods with greater percentages of African American residents and residents with lower incomes.¹²

Achieving health equity requires knowing where these disparities exist and acting to eliminate them. This report is an important addition to help us continue to move our work forward to eliminate tobacco use and tobacco-caused diseases at the federal, state and community levels

Fifth Circuit ruling threatens access to tobacco cessation treatment; HHS issues smoking cessation framework; FDA and NIH hold meeting on Advancing Smoking Cessation Priorities

The Affordable Care Act’s (ACA) preventive services provision requires most health plans to cover a comprehensive tobacco cessation benefit without cost-sharing. A lawsuit, formerly known as Braidwood v. Becerra, threatens this coverage and coverage to all preventive services under ACA. In March 2023, a federal district judge limited the number of preventive services required to be covered without cost-sharing. In June 2024, the 5^th Circuit Court of Appeals issued a ruling that limits the initial decision to the individual plaintiffs that brought the case. In September 2024, the U.S. Justice Department filed a petition to the Supreme Court asking for them to hear the case. The Lung Association has been a part of numerous amicus briefs on this case and will continue to be involved as it moves through the courts to protect preventive services, including tobacco cessation.

On March 8, 2024, HHS released its Framework to Support and Accelerate Smoking Cessation. While the framework includes key priorities for smoking cessation, it failed to include the need to end the sale of menthol cigarettes and flavored cigars. Additionally, in October 2024, the National Institutes of Health (NIH) and FDA held a meeting “Advancing Smoking Cessation Priorities.” The meeting was a step to improve cessation treatments in the United States. The Lung Association submitted comments on ways FDA and NIH can work to improve cessation treatments.

Graphic cigarette warning labels upheld on constitutional grounds; rule to reduce nicotine levels in cigarettes and some other tobacco products proposed by FDA

In November 2024, in a major victory for public health, the U.S. Supreme Court declined to hear an appeal of a Fifth Circuit Court of Appeals decision that upheld FDA’s graphic warning labels on cigarettes on constitutional grounds. The ruling from the three-judge panel of the 5^th Circuit was originally handed down in March 2024. The case now goes back to the U.S. District Court in the 5^th Circuit to resolve several other issues raised by the tobacco industry plaintiffs in the lawsuit against FDA. In January 2025, the District Court issued a ruling stopping FDA from implementing the rule and ruling in favor of the tobacco industry plaintiffs on some claims.

In December 2024, a separate lawsuit was also filed by Philip Morris against the graphic cigarette warnings in the southern District of Georgia to try to delay implementation of the warnings further. No further activity in this lawsuit beyond introduction had occurred when this report went to press.

In January 2024, FDA issued a proposed rule that would reduce nicotine levels in cigarettes and some other combusted tobacco products. The Lung Association appreciates FDA proposing this rule; reducing nicotine levels in tobacco products could prevent many youth from becoming addicted and make it easier for tobacco users to quit. The Lung Association supports reducing nicotine levels in all tobacco products, including e-cigarettes and smokeless tobacco.

Tobacco industry activity stymies progress in most states in 2024

No states passed statewide comprehensive smokefree workplace laws or comprehensive flavored tobacco product laws in 2024 despite hard fought campaigns in many states. The tobacco industry and their front groups were especially active and aggressive in opposing flavored tobacco product laws, demonstrating the importance of flavored products to their continued profits. No states expanded their state Medicaid programs in 2024, and major threats to the Medicaid program are in store for 2025, including limiting federal funding and reducing the number of people eligible for the program, regardless of need. One bright spot: Maryland increased its cigarette tax by a $1.25 per pack, in addition to several states with small cigarette tax increases. Funding for state tobacco prevention programs stayed steady or increased in most states in fiscal year 2025 as well.

• Funding for State Tobacco Prevention and Cessation Programs: Momentum continued in 2024 for state funding for programs to prevent and reduce tobacco use with six states – Colorado, Florida, Kentucky, Michigan, Oklahoma, South Carolina – registering increases of close to $1 million or more. The monies from the settlement of the lawsuits against the e-cigarette company Juul continued to give boosts to funding in many states in 2024. Connecticut, Illinois and New York saw decreases of $1 million or more in funding. Adequately funding state tobacco control programs can bring crucial focus and resources to alleviate disparities in who uses tobacco products as the latest Surgeon General’s report on tobacco details. In the current fiscal year, 2025, one state – Maine – funded its state tobacco control program at or above the level recommended by CDC.
• Eliminating Sales of Flavored Tobacco Products: As finalizing the rules that would have required removal of menthol cigarettes and flavored cigars from the market by FDA are no longer a possibility, it is especially important that states and localities act to end the sale of all flavored tobacco products. Unfortunately, no states approved laws stopping the sale of flavored tobacco products in 2024, despite campaigns in a number of states, including Hawaii, Maine, Minnesota and Vermont. In addition, Rhode Island weakened its flavored e-cigarette restrictions by passing legislation to exclude menthol. A local ordinance was approved in one large city, Denver, in December 2024 and several smaller towns in other states. However, only two states and the District of Columbia earned grades better than a “D” in this category this year, showing how much work remains to be done by state and local lawmakers.
• Increasing State Tobacco Taxes: Increasing tobacco taxes by $1.00 per pack or more is one of the most effective ways to reduce tobacco use, especially among kids. One state – Maryland – passed a $1.25 cigarette tax increase this year, increasing its state tax to $5.00 per pack, now the second highest in the country. Colorado and Rhode Island implemented and approved smaller tobacco tax increases respectively. Currently, there is a wide variation in cigarette tax rates, with the lowest state cigarette tax in Missouri at a meager 17 cents per pack and New York now the highest at $5.35 per pack. The current state cigarette tax average is $1.97 per pack.
• Smokefree Public Places and Workplaces: Disappointingly, for the 12^th year running, no state approved a comprehensive law eliminating smoking in public places and workplaces, including restaurants, bars and casinos. Maryland added e-cigarettes to its comprehensive smokefree law in 2024. Unfortunately, one of the previous leaders in smokefree protections, California, approved a law giving communities the authority to allow marijuana smoking and vaping in restaurants, weakening the state’s strong smokefree protections. There was minor progress on passing additional local smokefree ordinances in several states, including Kentucky and Mississippi. This troubling lack of progress on smokefree laws means millions of people are still exposed to the myriad of harms caused by secondhand smoke.
• Expanding Medicaid and Tobacco Cessation Coverage: No state expanded Medicaid in 2024. The Affordable Care Act expanded Medicaid coverage to individuals at 138% of the federal poverty level ($34,307 per year for a family of three) or lower. Individuals with low incomes smoke at rate of 29.9%, significantly higher than the general population (11.3%).¹³ Research shows Medicaid quit attempts in expansion states increased by over 20%.¹⁴ Medicaid itself is also under threat in 2025. There are proposals to limit federal funding for the program and limit the number of people on the program. And numerous states are expected to seek work reporting requirements, which would limit the number of people on Medicaid. In fact, South Dakota passed a ballot measure to add work reporting requirements to their program in 2024.

Tobacco industry continues its efforts to stop stronger local tobacco control policies

In 2024, the tobacco industry and its allies continued their efforts to remove local control and prevent local governments from passing stronger tobacco control laws—called preemption. These types of laws deny local governments the ability to pass meaningful public policies to prevent and reduce tobacco use, including addressing youth vaping or tobacco-related disparities. Unfortunately, in January 2024, Ohio’s legislature overrode a gubernatorial veto of a provision in the state budget that essentially preempts all future local ordinances on tobacco use and nullifies existing ones. However, a lawsuit filed by Columbus and several other communities was successful at the Ohio district court level in overturning this provision based on home rule provisions in the state constitution. The decision has been appealed to Ohio’s state appeals court. Other efforts to establish preemption were successfully defeated by the Lung Association and other public health organizations in several other states, including Arizona and Missouri. The Lung Association expects the tobacco industry to continue its full court press on this issue in 2025.

Reducing the Availability and Accessibility of Tobacco Products 

Tobacco retailers are extensive in the United States, especially in urban areas. A study of tobacco product retailers in 30 cities in 2021 found that there are 31 times more tobacco retailers than McDonalds and 16 times more tobacco retailers than Starbucks. In addition, in most cities, tobacco product retailers were concentrated in the lowest-income neighborhoods.¹⁵ States and communities should enact legislation to reduce the number of tobacco product retailers and prohibit them from being clustered together or near youth-focused locations like schools and childcare facilities. Communities in several states, including Connecticut, Kentucky, New York, Texas and Wisconsin took action to restrict where new tobacco retailers can locate in 2024, which is a trend the Lung Association hopes will spread to additional states and communities.

“State of Tobacco Control” 2025 continues to provide a blueprint that states and the federal government can follow to put in place proven policies that will have the greatest impact on improving the nation’s health by reducing tobacco use and exposure to secondhand smoke in the U.S. The real question is: Will federal and state lawmakers take the actions needed in 2025 to stop tobacco companies from putting their profits ahead of the health of our country?