Albert Rizzo, MD, on the 2021 State of Tobacco Control Report

In this podcast, Albert Rizzo, MD, from the American Lung Association, discusses the recently released State of Tobacco Control Report and the United States smoking epidemic.

Additional Resource:

Albert Rizzo, MD, is the chief medical officer of the American Lung Association and a clinical assistant professor of medicine at Thomas Jefferson University Medical School in Philadelphia, Pennsylvania. 



Leigh Precopio:  Hello everyone, and welcome to another installment of Podcasts360, your go‑to resource for medical news and clinical updates. I'm your moderator, Leigh Precopio, with Consultant360 Specialty Network.

Each year, the American Lung Association publishes their State of Tobacco Control Report, which examines how state and federal governments prevent and eliminate tobacco use within United States.

As the nation deals with the fallout of the COVID‑19 pandemic, addressing the US smoking epidemic is now more important than ever. This year's report urges legislators to create policies that will reduce or prevent tobacco use to diminish the number of preventable disease and death caused by smoking.

Here with us today to discuss the report is Albert Rizzo, who is the chief medical officer for the American Lung Association. Thank you so much for taking the time to speak with me today, Dr. Rizzo. Can you give us an overview of the State of Tobacco Control 2021 Report?

Dr. Albert Rizzo:  Yes. Before we talk about that, we need to realize that even amid the pandemic, tobacco use remains a serious public health threat. In addition to tobacco‑related death and disease, smoking increases the risk and most severe impact of COVID‑19, making ending tobacco use more important than ever now.

American Lung Association's State of Tobacco Control Report provides a roadmap for state and federal governments to pass proven policies to prevent and reduce tobacco use, like increasing tobacco taxes and making public places smoke‑free.

With 1 in 5 teens vaping, our children are becoming the next generation addicted to tobacco. This youth epidemic is largely driven by flavored e‑cigarettes. Our 19th annual report has added a new state grade supporting policies to end the sale of flavored tobacco products.

On January 27th, the American Lung Association released its 19th Annual State of Tobacco Control Report, which grades the states and federal government on key public policies to prevent and reduce tobacco use.

In addition to the grades, this year's report focused on several themes, including COVID‑19 and its relationship with smoking and secondhand smoke, and the disproportionate impact tobacco use and secondhand smoke have on certain communities and populations as well as what the new Biden administration needs to do to prevent and reduce tobacco use, including removing all flavored tobacco products from the marketplace.

Leigh Precopio:  Which states had the best and worst tobacco control laws and policies?

Albert Rizzo:  In this report, states are graded based on funding for state tobacco prevention programs, the strength of this smoke‑free workplace laws, the level of their state tobacco taxes, also the coverage and access to services to quit tobacco, and the new policy I mentioned about ending the sale of all flavored tobacco products.

If we look at those five grades, even the best states still have work to do. No state receives straight As across the board. The states that did the best, California, graded B with regard to funding smoke‑free air with A, tobacco taxes B, and access to cessation C, and flavored tobacco D.

The other states that did almost as well include Hawaii, Maine, Massachusetts. If we look at the other end, the states that were graded the worst included a number that had Fs across the board. This included Alabama, Mississippi, North Carolina, Texas, Virginia, and Wyoming.

Also, the states of Georgia and Missouri, Tennessee and West Virginia received four Fs and one D grade. The most improved state compared to our previous reports included California, Massachusetts, Oregon, and Utah.

Leigh Precopio:  What needs to be done to improve these numbers?

Albert Rizzo:  They mentioned the grades include things such as increasing state tobacco taxes. For example, Colorado and Oregon voters approved an increase in state cigarette taxes from $1.10 to $2 this past year.

Workplace smoke‑free situations need to be looked at as well. We know that 200 travel and non‑travel casinos we opened smoke‑free after being closed due to COVID‑19. The American Lung Association urges states and travel casinos to make these changes permanent to protect their workers.

Nebraska also passed legislation including e‑cigarettes to its state smoke‑free law. The other important aspect is Medicaid and tobacco cessation coverage. We know that a number of states including Missouri and Oklahoma voted to increase/expand Medicaid coverage in those states.

With this, the enrollees in Medicaid have increased access to comprehensive quit‑smoking benefit and other essential coverage.

The other big topic is prohibiting flavored tobacco products, including menthol cigarettes. The most aggressive state was California. It became the second state to pass a law prohibiting the sale of flavored tobacco products, including menthol cigarettes. However, unfortunately, days after the legislation was signed, the tobacco industry filed a referendum. Currently, it's tied up in courts pending appeals.

Other states and cities such as New York and New Jersey also passed laws prohibiting the sale of flavored e‑cigarettes.

Another big topic that we look at is the accessibility, availability, and discounting of tobacco products. New York became the second state to prohibit tobacco sales in all its pharmacies. New Jersey and New York became the first two states to eliminate the redemption of coupons and other tobacco industry discounts by retailers.

Leigh Precopio:  How do you hope the new US presidential administration addresses tobacco control?

Albert Rizzo:  We feel the Biden administration has a golden opportunity to act on both COVID‑19 and future pandemics, which is a concern of ours, but also take action on policies called for in our State of Tobacco Control.

In November 2020, the American Lung Association issued its 2021 federal action plan that outlined our tobacco control priorities for the federal government.

State of Tobacco Control 2021 provides a blueprint that the states and federal government can follow to put in place proven policies who will have the greatest impact on reducing tobacco use and exposure to secondhand smoke in the US.

The real question is, will the Biden administration and state lawmakers seize this opportunity and make 2021 year's significant progress has made and passing meaningful tobacco control policies, including addressing tobacco‑related health disparities?

In our report, the federal government is graded in five areas, federal regulation of tobacco products where it got a D, cessation coverage where it also got to D, overall tobacco taxes at the federal level got an F, mass media campaigns, however, did very well. We graded them as A and gave them an A for the federal minimum age law of 21 for tobacco sales, which was passed last year.

The American Lung Association identified four key actions for the Biden administration and Congress to take in 2021 that will help eliminate the death and disease caused by tobacco use.

First one is asking the FDA to adhere the Tobacco Control Act and reject product marketing applications. Any product that fails to prove is appropriate for the protection of public health, including all flavored products, and vigorously defending the graphic cigarette warning labels that are currently tied up in court.

Another step is to have Congress and the FDA act to remove all flavored tobacco products from the marketplace, including menthol cigarettes, cigars, and e‑cigarettes.

We're also asking the Department of Health and Human Services help ensure that all tobacco users have access to comprehensive tobacco cessation benefit without barriers and cost‑sharing. Congress must pass the Quit with COVID‑19 Act, which is currently in Congress.

Now, last one is to ask Congress to increase federal funding to the Centers for Disease Control Prevention Office on Smoking and Health to help states combat the youth cigarette epidemic and to further strengthen the Tips From Former Smokers campaign.

Leigh Precopio:  Thank you so much for speaking with me today.

Albert Rizzo:  Thank you very much. For more information, certainly refer to our report which can be found at