Lung Association Report: Cuts to Federal Tobacco Prevention Efforts Put U.S. Lives at Risk

"State of Tobacco Control" report urges states to step up and protect residents as federal progress stalls

CHICAGO, Jan. 28, 2026 /PRNewswire/ -- The American Lung Association released its 24th annual "State of Tobacco Control" report today, warning that the largest federal rollback of tobacco prevention efforts in decades is putting hard-won progress at risk. Tobacco use remains the nation's leading cause of preventable death and disease, claiming the lives of more than 490,000 people each year. The report evaluates state and federal efforts to prevent and reduce tobacco use and issues urgent recommendations for action.

In 2025, the tobacco control and prevention landscape fundamentally changed when the administration took a series of actions that weakened enforcement and jeopardized public health efforts across the country. These included the virtual elimination of the U.S. Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health, major staffing cuts to the U.S. Food and Drug Administration's (FDA) Center for Tobacco Products and delaying Congressionally appropriated funding for nearly six months. As a result, tobacco control and quitline programs in all 50 states and the District of Columbia were left at risk of shutting down, with some states drastically reducing lifesaving services.

"These unprecedented disruptions will embolden the tobacco industry to expand its predatory marketing and put more lives at risk," said Harold Wimmer, President and CEO of the American Lung Association. "These decisions are not abstract—they directly affect whether people can access quitline counseling, whether states can run prevention programs that help communities, and whether kids are protected from the next generation of tobacco products. With the federal government reversing long-established tobacco prevention efforts, states must now take the lead. We urge everyone to join our effort and tell policymakers that protecting health must come first."

Tobacco use exacts a staggering toll across the nation. Cigarette smoking costs the U.S. more than $600 billion each year in healthcare expenditures and lost productivity, placing a massive burden on the nation's healthcare system and economy. Though youth tobacco use is at the lowest level in 25 years, 2.25 million middle school and high school students still use highly addictive and dangerous tobacco products, including e-cigarettes. Close to 90% of youth who use e-cigarettes use flavored products.

Adult smoking rates have dropped from 23.3% in 2000 to 10.8% in 2023—proof that sustained prevention and quit tobacco efforts work. However, the report warns that without strong federal and state prevention efforts, this progress could quickly unravel.

Federal Grades Overview
The 2026 "State of Tobacco Control" report grades the federal government in five areas:

• Federal Regulation of Tobacco Products – Grade D
• Federal Coverage of Quit Smoking Treatments – Grade D
• Level of Federal Tobacco Taxes – Grade F
• Federal Mass Media Campaigns to Prevent and Reduce Tobacco Use – Grade I*
• Federal Funding for Tobacco Prevention and Control – Grade B

*The federal government gets an I for Incomplete in this category due to data not being able to be obtained about the duration, reach and frequency of the Real Cost campaign in 2025.

In the "State of Tobacco Control" report, the Lung Association identified five key actions for the Trump administration and Congress to take in 2026 that will help ultimately eliminate the death and disease caused by tobacco use:

1. Congress and the U.S. Department of Health and Human Services (HHS) must restore and fully staff the CDC's Office on Smoking and Health (OSH) to ensure that states receive tobacco prevention and cessation funding, that comprehensive federal surveillance and evaluation of tobacco can continue, and that the nation regains a functioning federal tobacco control and prevention infrastructure to reduce tobacco-related chronic disease;
2. Congress and HHS must reestablish and adequately fund the Tips from Former Smokers campaign so CDC can once again deliver proven, lifesaving tobacco prevention and cessation messages to people across the country;
3. Congress and HHS must protect the independence of the United States Preventive Services Task Force (USPSTF) to ensure access to evidence-based services, including quit tobacco treatments and lung cancer screening with no cost-sharing;
4. Congress must pass legislation requiring e-cigarette manufacturers to pay user fees to provide the FDA with the resources needed for robust oversight and enforcement. With these resources, FDA, the U.S. Department of Justice (DOJ) and other members of the multi-agency taskforce must act decisively to remove illegal e-cigarettes from the marketplace; and
5. FDA must maintain a strong, science-based public health standard when reviewing and authorizing tobacco products, ensuring decisions protect kids and public health rather than expanding access to addictive products.

State Grades Overview
The 2026 "State of Tobacco Control" report grades states and the District of Columbia in five areas that have been proven to prevent and reduce tobacco use and save lives:

• Strength of Smokefree Workplace Laws – 13 states and Washington, D.C. earned A grades
• Ending the Sale of All Flavored Tobacco Products – 46 states earned F grades
• Funding for State Tobacco Prevention Programs – 40 states and Washington, D.C., earned F grades
• Level of State Tobacco Taxes – 35 states earned F grades
• Coverage and Access to Services to Quit Tobacco – 18 states and Washington, D.C. earned A or B grades

Best Graded States

• California: Tobacco Program Funding: D, Smokefree Air: B, Tobacco Taxes: C, Access to Cessation: A, Flavored Tobacco Products: B
• Colorado: Tobacco Program Funding: A, Smokefree Air: B, Tobacco Taxes: C, Access to Cessation: A, Flavored Tobacco Products: F
• Delaware: Tobacco Program Funding: A, Smokefree Air: A, Tobacco Taxes: D, Access to Cessation: A, Flavored Tobacco Products: F
• District of Columbia: Tobacco Program Funding: F, Smokefree Air: A, Tobacco Taxes: A, Access to Cessation: C, Flavored Tobacco Products: A
• Maine: Tobacco Program Funding: A, Smokefree Air: A, Tobacco Taxes: B, Access to Cessation: A, Flavored Tobacco Products: F
• Massachusetts: Tobacco Program Funding: F, Smokefree Air: A, Tobacco Taxes: B, Access to Cessation: C, Flavored Tobacco Products: A

Worst Graded States

• Alabama, Georgia, Mississippi and Texas rated the worst in the nation, scoring Fs in all five categories.
• Missouri, New Hampshire, North Carolina and Tennessee received 4 Fs and 1 D grade.

Most Improved States

• Maine increased its Tobacco Taxes grade from a C to a B and its Smokefree Air grade from a B to an A due to passing a $1.50 cigarette tax increase and fully adding e-cigarettes to its smokefree workplace law.
• Montana increased its Funding for Tobacco Prevention and Control grade from an F to a D and its Smokefree Air grade from a B to an A due to passing a nearly $2 million increase in tobacco prevention and control funding and adding e-cigarettes to its smokefree workplace law.

"The administration has said it wants to reduce chronic disease in both children and adults. This goal cannot be achieved without funding and staffing to address the nation's leading cause of preventable death and disease: tobacco use. We call on Congress to restore these lifesaving investments," said Wimmer.

In the "State of Tobacco Control" report, the American Lung Association calls on the federal government to fully restore critical tobacco control programs, including CDC's Office on Smoking and Health. Federal leadership is essential. In the current absence of federal leadership, the organization is calling on state legislatures to advance strong, fact-based tobacco control policies that protect communities and reduce tobacco use.

To learn more about this year's "State of Tobacco Control" grades and take action, visit Lung.org/sotc.

About the American Lung Association
The American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease through education, advocacy and research. The work of the American Lung Association is focused on four strategic imperatives: to defeat lung cancer; to champion clean air for all; to improve the quality of life for those with lung disease and their families; and to create a tobacco-free future. For more information about the American Lung Association, which has a 4-star rating from Charity Navigator and is a Platinum-Level GuideStar Member, call 1-800-LUNGUSA (1-800-586-4872) or visit: Lung.org. To support the work of the American Lung Association, find a local event at Lung.org/events.

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SOURCE American Lung Association