Key Findings

“State of Tobacco Control” 2026: Federal Government Largely Ends its Efforts to Prevent and Reduce Tobacco Use; Tobacco Industry Will Fill the Void

“State of Tobacco Control” 2026 finds that just over one year into the Trump administration, the tobacco prevention and control landscape has been fundamentally altered. On April 1, 2025, the main agency responsible for the federal government’s efforts to prevent and reduce tobacco use was effectively dismantled. Nearly all staff were terminated at the Centers for Disease Control and Prevention (CDC)’s Office on Smoking and Health (OSH), halting the highly successful Tips from Former Smokers media campaign, critical national coordination and assistance to state tobacco control programs, and key public health research and reports on tobacco use. This unprecedented loss of federal capacity marked one of the most significant setbacks in tobacco prevention and control in decades. It creates an opening for the tobacco industry to expand its reach and target new users, which will have consequences on tobacco use rates in the U.S.

The American Lung Association’s annual “State of Tobacco Control” report evaluates states and the federal government’s actions to eliminate the nearly 500,000 lives lost to tobacco use each year. 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 state and federal policies based on their effectiveness to prevent and reduce tobacco use.

New Administration Takes Several Actions in 2025 that Will Weaken Tobacco Prevention Efforts in the U.S.

The country’s efforts to reduce the 490,000 lives lost to tobacco each year have seen significant success over the past 25 years. Adult cigarette smoking rates declined from 23.3% in 2000 to a record low of 9.9%, according to the 2024 National Health Interview Survey¹. Overall, adult tobacco use decreased from 19.3% in 2022 to 16.4% in 2023 after increasing in previous years². Youth cigarette smoking rates dropped even more dramatically, from 28.5% in 2001 to 3.5% in 2023³. These reductions translate into millions of lives and billions of dollars in healthcare costs saved.

However, past performance is not an indicator of future success, especially when there is a predatory tobacco industry working relentlessly to keep smoking and tobacco use rates as high as possible to maintain their profits. In 2025, the Trump administration took a series of unprecedented actions that have weakened the federal government’s role in tobacco prevention and cessation, jeopardizing decades of progress. These actions included:

• Firing virtually all staff and contractors associated with CDC’s Office on Smoking and Health on April 1, 2025. The Office on Smoking and Health was the federal government’s primary mechanism for meeting its obligations to prevent and reduce tobacco by educating the public about the dangers of smoking and tobacco use under two laws passed by Congress: the Comprehensive Smoking Education Act of 1984 and the Comprehensive Smokeless Tobacco Education Act of 1986.
• Delaying the distribution of funds for grants to state programs to prevent and reduce tobacco use in all 50 states and the District of Columbia until the very end of the federal fiscal year in September 2025. These grants are usually issued by CDC in April each year, and the delay in 2025 caused extensive damage to several state tobacco control programs, including reductions in quitline or phone counseling services for tobacco users.
• Firing or otherwise removing a significant number of staff at the U.S. Food and Drug Administration (FDA) Center for Tobacco Products on April 1, 2025, including most top leadership. This did not save a dime in taxpayer dollars, as the Center is entirely funded by tobacco industry user fees. Some staff were eventually hired back, but it caused significant disruption to operations, and the Center is still not operating with full staff as of the release of this report.
• Terminating the Tips from Former Smokers campaign, one of the most successful public health media campaigns ever implemented. This campaign has helped over one million people quit smoking for good, saved lives and reduced healthcare costs by billions of dollars. The termination left at least $65 million in congressionally directed tobacco prevention and cessation funding unused in 2025—ceding ground to a tobacco industry that aggressively markets addictive products.

Top 5 Threats to Federal Tobacco Reduction Efforts

1. Elimination of CDC’s Office on Smoking and Health
2. Tobacco Industry Attempts to Introduce New Products Without FDA Authorization
3. FDA’s Ongoing Authorization of Flavored E-Cigarettes and Nicotine Pouches
4. Delayed Federal Grants to States Causing Significant Disruption
5. End of CDC’s Tips from Former Smokers Campaign

FDA’s Center for Tobacco Products also took several concerning policy actions that will make tobacco products more available across the U.S. These include: 1) authorizing the sale of 20 different Zyn products, including flavored products, and setting up a fast track review process for premarket tobacco applications for nicotine pouches, which appears to be designed to authorize a wider variety of products for sale regardless of whether the products are appealing to kids, and 2) authorizing additional menthol flavored e-cigarettes for sale, including Juul menthol, reinvigorating the company largely responsible for starting the youth e-cigarette use epidemic.

All of these actions, combined with significant cuts to Medicaid and the Affordable Care Act in the reconciliation bill signed into law in July 2025, make a resurgence in tobacco use more likely. They also coincide with the tobacco industry’s strategy of promoting some of these tobacco products as “reduced harm” products, which is designed to: 1) keep people addicted; 2) encourage use of more than one tobacco product at once (“dual use”); and 3) entice new youth or young adult users. At the same time, the industry is also running a disinformation campaign to reframe nicotine as less harmful on its own. The truth is that nicotine is not harmless on its own; it is the addictive chemical that makes the other harms from tobacco products possible.

The federal government did take several enforcement actions against illegal e-cigarette products during 2025, including FDA collaborations with U.S. Customs and Border Protection (CBP) to seize more illegal e-cigarettes entering the U.S. However, both large and small tobacco companies continue to introduce and sell illegal flavored e-cigarette and nicotine pouch products across the country without obtaining the required marketing granted order from FDA. Earlier in 2025, major tobacco companies Altria and Reynolds American announced publicly that they intended to sell unauthorized tobacco products without FDA authorization, in clear violation of the federal law giving FDA the authority to regulate tobacco products. However, they backed off from these threats for now after FDA sent them letters regarding these announcements.

These deplorable industry actions contribute to the 2.25 million middle and high school students who continued to use tobacco products in 2024, according to the 2024 National Youth Tobacco Survey (NYTS). In the survey, e-cigarettes remained the most used tobacco product among kids, but nicotine pouches were the second most used in 2024⁴. Separate data from the CDC Foundation found that nicotine pouch use among youth ages 13-20 increased by nearly fourfold from 2022 to 2025. Alarmingly, close to 80% (78.5%) of these youth used at least one other tobacco product in addition to using nicotine pouches⁵. Given these increases in use, continued close monitoring of nicotine pouch use among kids is required.

There were several other noteworthy developments from 2025 at the federal level: 

• In April 2025, the U.S. Supreme Court unanimously upheld FDA’s authority under the Family Smoking Prevention and Tobacco Control Act to deny marketing orders for two flavored e-cigarettes, overturning a previous decision by the 5^th Circuit Court of Appeals.
• The comment period closed in September 2025 for a proposed rule from FDA that would significantly reduce nicotine levels in cigarettes and some other combusted tobacco products. The Lung Association submitted comments with several other organizations calling for the rule to be expanded to include all tobacco products, including e-cigarettes and nicotine pouches.
• Graphic warning labels on cigarettes remain stalled due to multiple court decisions. In August 2025, a U.S. District Court judge in Georgia vacated FDA’s rule requiring graphic warning labels on cigarettes because FDA did not share raw data from the studies it used with the plaintiff tobacco companies. This followed an earlier ruling in Texas that vacated the rule on different procedural grounds. Both cases have been appealed to the U.S. Court of Appeals for the 11^th Circuit and 5^th Circuit respectively. 

Despite Federal Chaos, States Enact Several Long-Overdue Tobacco Tax Increases

During 2025, state legislative sessions proved to be significantly more productive to tobacco prevention efforts than the federal level. Two states – Indiana and Maine – passed large and long overdue cigarette tax increases. Many state tobacco prevention and reduction programs did experience significant disruption from the delay in receiving federal funds, and in some cases had to furlough or lay off staff. Tobacco companies also continued their efforts to get taxes reduced on specific tobacco products and create state e-cigarette directories based on FDA pre-market tobacco application (PMTA) status with limited success.

• Twelve states – Arizona, Colorado, Connecticut, Florida, Illinois, Minnesota, Missouri, Montana, New Mexico, Oklahoma, South Carolina and Tennessee – registered funding increases for programs to prevent and reduce tobacco use of close to $1 million and in some cases significantly more in fiscal year 2026. Monies from the recent state settlements with Juul contributed to the funding increases in some of these states. However, funding did get virtually zeroed out or decreased by $1 million or more in eleven other states – Alaska, California, Iowa, Maryland, New Hampshire, North Carolina, Ohio, Oregon, South Dakota, Washington and Wyoming almost canceling out the gains. Five states received “A” grades in this category in “State of Tobacco Control” 2026 while 39 states and the District of Columbia received “F” grades.
• Indiana increased its cigarette tax by $2.00 per pack and Maine increased its cigarette tax by $1.50 per pack, bringing their state cigarette taxes to $2.995 and $3.50 per pack, respectively. Hawaii and New Jersey also passed small increases in their state cigarette taxes. Alabama did pass a reduction in its tax on heated tobacco products. This is a policy that has been pushed by Philip Morris International in a number of states to help it sell more of its IQOS brand of products as it re-enters the U.S. market. Only the District of Columbia received an “A” grade in Tobacco Taxes in “State of Tobacco Control” 2026, while 35 states received “F” grades.
• No states passed laws eliminating smoking in public places and workplaces in 2025. This marks the 13th straight year where no state has passed a comprehensive smokefree law. Rhode Island did pass a law that originally would have prohibited smoking in casinos, but was weakened at the last minute to only limit smoking to designated areas. New Jersey also failed for the fourth year running to pass a proposed law prohibiting smoking in casinos. Thirteen states and the District of Columbia received “A” grades in this category in “State of Tobacco Control” 2026 for their existing comprehensive smokefree laws while 12 states received “F” grades.
• Despite vigorous campaigns in several states, including Oregon and Washington, no state approved laws ending the sale of flavored tobacco products in 2025. Opponents of Denver’s law ending the sale of flavored tobacco products put the measure up for a ballot referendum in November 2026, but voters overwhelmingly upheld the law with 70% support. Massachusetts and the District of Columbia received “A” grades in this category in “State of Tobacco Control” 2026, while 46 states received “F” grades.
• 2025 was a challenging year for access to tobacco use treatment. Some states reduced or suspended quitline services due to the pause in federal funding. Provisions in the 2025 budget reconciliation bill signed into law in July 2025, including work reporting requirements and cost-sharing for Medicaid programs, will kick people off Medicaid and make it more difficult to access treatment. Additionally, no state expanded Medicaid coverage in 2025. Georgia’s House of Representatives did pass a bill that would have required all Medicaid plans to cover comprehensive tobacco cessation treatment with few barriers, but the bill did not make it through the Senate in time. Eleven states received “A” grades in this category in “State of Tobacco Control” 2026, while eight states received “F” grades.

The Lung Association urges Congress and the Administration to restore federal efforts to prevent and reduce tobacco use in fiscal year 2026, including reestablishing CDC’s Office on Smoking and Health and ensuring grants to all 50 states and the District of Columbia are allocated on time. It is also imperative that state lawmakers continue to pass the proven public policies called for in “State of Tobacco Control” 2026 despite the uncertainty at the federal level. Preventing and reducing tobacco use is one of the most effective ways to reduce chronic disease in this country, and strong action is especially needed to combat youth use. The country has made important progress and cannot go back to the bad old days when tobacco industry profits were prioritized over the public’s health.

The Destruction of CDC’s Office on Smoking and Health Is a Major Setback for Public Health

The CDC’s Office on Smoking and Health (OSH) has played a large role in the progress the country has made toward reducing cigarette smoking rates to near-record lows in the U.S. and stopping the worst of the impacts of the youth vaping epidemic that was ignited by the e-cigarette company Juul. OSH is responsible for the Tips from Former Smokers media campaign, which helped over one million people quit smoking in its first six years on the air⁶, as well as other activities that significantly contributed to reductions in tobacco use:

• Providing grants to all 50 states, the District of Columbia and U.S. territories to aid in state and local efforts to reduce tobacco use as part of its National Tobacco Control Program;
• Establishing best practices for running tobacco prevention and control programs and providing technical assistance and expertise to states;
• Ensuring that the country had an accurate picture of how many people in the U.S. used tobacco products by coordinating a comprehensive tobacco use surveillance system to collect information on adult and youth tobacco use as well as exposure to secondhand smoke;
• Helping to write Surgeon General’s reports on tobacco use and otherwise contribute to and synthesize scientific findings on tobacco use and exposure to secondhand smoke.

The dismantling of OSH is devastating for public health. No other agency or organization inside or outside the federal government will be able to fully fill this void. Unless reversed, this will degrade the country’s efforts to fight tobacco use and lead to a resurgence of tobacco use in the U.S.

FDA Center for Tobacco Products Shifts Focus to Authorizing New Products with Seemingly Little Regard for Impact on Kids

Throughout 2025, FDA’s Center for Tobacco Products (CTP) allowed new tobacco products on the market and granted more modified risk or modified exposure orders for tobacco products. They issued marketing granted orders for multiple new e-cigarette products, including several brands of menthol e-cigarettes and 20 Zyn nicotine pouch products, many of which were flavored products. Then, CTP announced an accelerated review process for premarket tobacco applications for nicotine pouches with almost no details about how the process will work. Finally, they seem poised to continue a modified exposure order for the IQOS heated tobacco product, and they scheduled an initial meeting of the Tobacco Products Scientific Advisory Committee for January 22, 2026, for a modified risk tobacco product application for many types of Zyn nicotine pouches.

Prior to 2025, CTP had only authorized one type of menthol flavored e-cigarette for sale, demonstrating how much has changed in the course of a year. The tobacco industry has already noticed this shift and more applications for new tobacco products and modified risk orders will likely be forthcoming in 2026. Recent decisions seem to have ignored the potential impact on kids from authorizing these new tobacco products, particularly flavored products. This is especially true of nicotine pouches given the increasing use by kids seen in the 2025 Monitoring the Future Survey released in December 2025⁷.

The Lung Association will continue to advocate for FDA to follow the public health standard in the Tobacco Control Act and still maintains that flavored tobacco products should not be able to meet that standard given the impact on youth use.

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.

Congress Places Requirements on and Gives Additional Authorities to FDA Center for Tobacco Products in FY2026 Budget; Yet to Act on E-Cigarette User Fees

In November 2025, as part of the legislation that ended the 43-day government shutdown, Congress passed, and President Trump signed into law, the fiscal year 2026 Agriculture-FDA bill that includes funding for FDA’s CTP. The bill maintains level funding for CTP through September 30, 2026, but for the first time places requirements on how CTP must spend the funds. CTP is required to spend not less than $200 million in enforcement against illicit e-cigarettes, including at least $2 million to support the federal multi-agency taskforce created in 2024. The bill also granted CTP destruction authority for illegal tobacco products seized at the border, allowing them to be disposed of rather than returned. FDA possesses similar authority for drugs and devices, and this authority will hopefully serve as an additional disincentive to illegal sales.

One related issue that Congress has yet to act on is giving CTP the authority to collect user fees on e-cigarettes. CTP currently collects $712 million in user fees from tobacco products; however, due to provisions in the Tobacco Control Act, cannot collect such user fees from e-cigarettes. Given the new Congressional requirements in the fiscal year 2026 budget involving enforcement against illicit e-cigarettes, now would be the perfect time for Congress to allow FDA to collect these user fees.

H.R. 1 Threatens Access to Tobacco Cessation Treatment; Future Independence of U.S. Preventive Services Task Force in Doubt

Over the past 13 years, access to tobacco cessation treatment has increased due to expansion of state Medicaid programs and the availability of healthcare coverage through the Affordable Care Act (ACA). Unfortunately, in July 2025, Congress passed legislation with devastating cuts to healthcare coverage, thereby impacting access to tobacco cessation treatment. The Congressional Budget Office (CBO) estimates that 10 million people will lose their healthcare coverage as a result of H.R. 1⁸. Congress also failed – in H.R. 1 and other legislation throughout the year – to extend enhanced healthcare tax credits that help millions of people afford quality, affordable coverage through the ACA marketplace. This will result in an additional four million people losing coverage, with premiums skyrocketing for millions more.

The Supreme Court upheld the ACA’s requirement that most insurers cover any service that receives an A or B from the United States Preventive Services Task Force (USPSTF) without cost sharing in the Braidwood case. However, the Court also reaffirmed that the Secretary of Health and Human Services has the authority to accept or deny any recommendations received, and to appoint, supervise and remove USPSTF members, leaving open the possibility of future changes to preventive services by the Secretary. Press reports during 2025 speculated that the current members of USPSTF would be replaced⁹, but that had not occurred at the time the content for this report was finalized. Tobacco cessation currently has an A grade from USPSTF.

Graphic Cigarette Warning Labels Delayed Indefinitely; FDA Proposes Rule to Reduce Nicotine Levels in Cigarettes and Some Other Tobacco Products

Congress required FDA to implement graphic warning labels on cigarettes as part of the Tobacco Control Act over 15 years ago. In November 2024, after the U.S. Supreme Court declined to hear an appeal of an earlier Fifth Circuit Court of Appeals decision that upheld FDA’s graphic warning labels on cigarettes on constitutional grounds, it seemed likely that the warning labels might finally become a reality.

However, graphic cigarette warning labels now look far less likely to move forward, with two adverse decisions by District Court judges in the 5th and 11th Circuit on different procedural grounds in 2025. The decision in the 5th Circuit in a lawsuit filed by the tobacco company Reynolds American was based on FDA putting forward a different number of warnings in its final graphic cigarette warning rule (11) than outlined in the Tobacco Control Act (9). The decision in the 11th Circuit in a case filed by the tobacco company Altria was based on FDA not providing the raw data in the studies used to support the graphic cigarette warnings rule to the tobacco company plaintiffs. The Department of Justice has appealed both decisions to the 5th and 11th Circuit Court of Appeals, but no decisions had been issued in either case when the content for this report was finalized.

In January 2025, FDA issued a proposed rule to 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 to nonaddictive levels could prevent many youth from becoming addicted and make it easier for tobacco users to quit. In September 2025, the Lung Association filed comments supporting the rule with 76 other public health, medical and civil rights organizations, as well as additional comments with the American Academy of Pediatrics and the American Thoracic Society calling for the rule to be expanded to include all tobacco products, including e-cigarettes and nicotine pouches. We do not anticipate action on the proposed rule in the next few years.

States Make Some Forward Progress on Tobacco Taxes, Adding E-Cigarettes to Smokefree Laws; Make Little Progress in Other Areas

In 2025, Indiana and Maine passed large tobacco tax increases, and Maine and Montana fully added e-cigarettes to their smokefree laws. Despite a more challenging environment for state budgets, funding for state tobacco prevention programs stayed steady or increased in many states in fiscal year 2026 as well. On the negative side, no states passed statewide comprehensive smokefree workplace laws or comprehensive flavored tobacco product laws. No states expanded their state Medicaid programs in 2025, and new, costly policies in H.R. 1 that will reduce access to care in state Medicaid programs could begin to impact state budgets in 2026.

• Funding for State Tobacco Prevention and Cessation Programs: Funding for tobacco prevention and cessation programs is one of the most cost-effective investments states can make. One study of California’s long-running tobacco control program found the state saved an estimated $155 in healthcare costs for every $1 invested¹⁰. In fiscal year 2026, 12 states—Arizona, Colorado, Connecticut, Florida, Illinois, Minnesota, Missouri, Montana, New Mexico, Oklahoma, South Carolina and Tennessee— registered funding increases of close to $1 million or more, while funding got virtually zeroed out or declined by $1 million or more in 11 states—Alaska, California, Iowa, Maryland, New Hampshire, North Carolina, Ohio, Oregon, South Dakota, Washington and Wyoming.. Adequately funding state tobacco control programs is especially critical now given the uncertainty of federal funding for states going forward. It can also bring crucial focus and resources to alleviate differences in who uses tobacco products, as the November 2024 Surgeon General’s report on tobacco details¹¹. In the current fiscal year, 2026, only one state – Maine – funded its state tobacco control program at or above the level recommended by CDC.
• Eliminating Sales of Flavored Tobacco Products: With federal action restricting the sale of flavored tobacco products unlikely in the near future, 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 2025. In November 2025, Denver voters upheld their law restricting the sale of flavored tobacco products that was approved in December 2024 with approximately 70% support. Smaller communities in Colorado and Minnesota also passed comprehensive flavored tobacco product ordinances. 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. Two states – Indiana and Maine – passed cigarette tax increases of $2.00 and $1.50 per pack respectively. Hawaii and New Jersey approved smaller cigarette tax increases. 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 the highest at $5.35 per pack. The current state cigarette tax average is $2.05 per pack, surpassing $2.00 per pack for the first time.
• Smokefree Public Places and Workplaces: Disappointingly, for the 13th year running, no state approved a comprehensive law eliminating smoking in public places and workplaces, including restaurants, bars and casinos. New Jersey and Rhode Island failed once again to completely close loopholes in their smokefree laws that allow smoking in casinos. Maine and Montana did fully add e-cigarettes to their comprehensive smokefree laws in 2025. This troubling lack of progress on smokefree laws means millions of people are still exposed to the harms caused by secondhand smoke and aerosol.
• Medicaid and Tobacco Cessation Coverage: No state expanded its Medicaid program in 2025. The Affordable Care Act expanded Medicaid coverage to individuals with incomes below 138% of the federal poverty level ($36,777 per year for a family of three). Individuals with low incomes smoke at rate of 29.9%, significantly higher than the general population (11.3%)¹². Research shows Medicaid quit attempts in expansion states increased by over 20%¹³.
• Reducing the Availability and Accessibility of Tobacco Products. Tobacco retailers are extensive in the U.S., 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 neighborhoods¹⁴. Communities in a number of states, including Colorado, Iowa, Texas and Virginia, continued to enact ordinances to reduce the number of new tobacco product retailers and/or prohibit them from being clustered together or near youth-focused locations like schools and childcare facilities. Maine also passed legislation that prohibits the sale of tobacco products in pharmacies and retail stores with pharmacies.

Tobacco Industry Continues its Efforts to Stop Stronger Local Tobacco Control Policies; Reduce Taxes on Specific Tobacco Products

In 2025, 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. However, they were less successful than in previous years, with no new states passing preemption of stronger laws. In Ohio, a state appeals court upheld a state District Court decision from 2024 that overturned preemption that was passed by the state legislature based on home rule provisions in the state constitution. The decision was in a lawsuit filed by Columbus and several other communities. The state appeals court decision has been appealed to Ohio’s state Supreme Court.

The tobacco company Philip Morris International continued to introduce bills in multiple states in 2025 to reduce excise taxes on heated cigarettes, including the brand they sell, IQOS. They were successful in passing legislation in one state, Alabama, after passage of similar legislation in Mississippi in 2024.

Big tobacco companies, including Reynolds American and Altria, also continued to introduce costly and unnecessary legislation to establish e-cigarette directories based on FDA premarket tobacco application (PMTA) status. By proposing that states create directories that include products with pending PMTA applications, Reynolds American and Altria seek to legitimize the sale of their own illegal products that do not have marketing orders. In total, 12 states have passed these e-cigarette directories based on PMTA status.

“State of Tobacco Control” 2026 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 fund tobacco prevention and control programs and take the actions needed in 2026 to continue reducing tobacco use in the U.S.?