Public Release: 

American Lung Association calls on governors and legislatures to stand up for public health

Report card shows many states failing to protect the public with proven tobacco policies

Cooney Waters Group, Inc.

January 6, 2004 - New York - While there were bright spots in 2003, the American Lung Association State of Tobacco Control 2003 report card clearly shows that most states are not taking the necessary measures to protect children and adults from the deadly effects of tobacco smoke. The American Lung Association looked at laws on smoking in the workplace, cigarette taxes, youth access to tobacco and funding of smoking prevention programs. Sadly, most states failed to make the grade, and the fact remains that more than 440,000 people die from tobacco-related illnesses each year.

"How many more preventable deaths must occur and how many more children must become addicted to cigarettes before we say enough?" asked John K. Kirkwood, CEO and president of the American Lung Association. "This report highlights that tough laws save lives and protect our children. From Maine to California, we have the data to prove that funding comprehensive prevention programs, raising cigarette taxes, providing smokefree air and preventing the sale of cigarettes to children can dramatically reduce tobacco use and disease. The American Lung Association calls on governors and legislatures stand up for public health, stand up for our children and support the solution."

January 11 marks 40 years since the first U.S. Surgeon General's report linked smoking with Chronic Obstructive Pulmonary Disease, lung cancer and other diseases, and the nation has made many gains in tobacco control. But the fight is not over. The American Lung Association State of Tobacco Control 2003 report card found:

• 38 states and the District of Columbia received an "F" in funding tobacco prevention and control programs;
• 35 states and the District of Columbia received an "F" in smokefree air laws;
• 13 states received an "F" in tobacco taxes; and
• 23 states received an "F" in laws limiting youth access to tobacco.

According to the American Lung Association report, these grades help illustrate why smoking costs the United States approximately $75 billion in direct medical costs and $82 billion in lost productivity each year.

The news is not all bad. Fifteen states throughout the country received an "A" for their laws in at least one of the four categories analyzed. Five states--California, Connecticut, Delaware, Maine and Rhode Island--achieved "A" grades in two areas. Only New York received an "A" grade in three areas.

"We commend states for making progress in clearing tobacco smoke from the air and increasing cigarette taxes, but we need a comprehensive approach to address the harm tobacco causes," said Kirkwood. "State legislators and governors must act quickly to prevent the 1,200 deaths now occurring each day from tobacco-related illnesses."

The American Lung Association State of Tobacco Control 2003 report card analyzes individual states' actions five years after the 1998 Master Settlement Agreement (MSA), through which the tobacco industry agreed to pay 46 states approximately $206 billion over 25 years, in recovery of the states' tobacco-related health care costs. Four states settled their tobacco lawsuits separately for a total of $40 billion over 25 years.

Programs in Nebraska, New Hampshire and Florida sustained huge funding cuts. Only six states - Arizona, Arkansas, Delaware, Hawaii, Maine and Mississippi - received an "A" for committing significant funds toward tobacco prevention and cessation. Arkansas, Maine and Mississippi received top marks for the second year in a row. Many states are allocating tobacco settlement funds to fill budget deficits and fund other programs.

Following on the heels of Delaware, four states - Connecticut, Florida, Maine and New York - passed or expanded laws protecting workers from the dangers of secondhand smoke. In late December the Massachusetts legislature passed a comprehensive smokefree air law. Municipalities in several states, including Hawaii, have passed local ordinances that ensure smokefree air. Tobacco control advocates continue to fight state initiatives that establish "preemption," whereby weaker statewide legislation would overrule stricter local ordinances. The American Lung Association strongly opposes preemption and supports communities' rights to pass ordinances protecting the health of their citizens.

Legislatures once again found that raising tobacco taxes made good public health and fiscal sense. The average state cigarette excise tax rose by a dime to $0.72 cents per pack in 2003. Sixteen states and the District of Columbia raised their cigarette tax. New Jersey now leads the nation with a cigarette tax of $2.05 - the first state to go above $2.00. Fifteen states and the District of Columbia are now at $1.00 or more.

Every day, 6,000 children under age 18 start smoking for the first time and close to 2,000 of them become established daily smokers. States are strengthening their youth access laws to close loopholes that allow children to buy cigarettes over the Internet. New York has passed the strongest law banning the delivery to individuals of tobacco products sold on the Internet or through mail order.

The American Lung Association State of Tobacco Control 2003 is a report card that evaluates state tobacco control laws against recognized criteria and translates each state's relative progress into a letter grade: A, B, C, D, or F. A grade of "A" is assigned for excellent state policy, while an "F" indicates inadequate state laws. The complete methodology and score calculations are included in the report, available online at The principle reference for all state tobacco laws is the American Lung Association's State Legislated Actions on Tobacco Issues, 2003 Edition. The American Lung Association has published this compendium of state tobacco laws since 1988.

Citizens can support the necessary changes in state laws and policies to protect everyone's health by visiting the American Lung Association's website at The website includes information for sending a personalized letter to state leaders demanding tough measures to combat tobacco use and addiction.

In addition to advocacy efforts to help protect everyone's health the American Lung Association offers Freedom From Smoking for those who want to quit smoking as well as other education programs to prevent children from starting to smoke. More information and copies of the American Lung Association State of Tobacco Control 2003 report card are available at

The second annual American Lung Association State of Tobacco Control report analyzes tobacco control laws at the state level in four key areas: tobacco prevention and control funding, smokefree air laws, tobacco taxes, and youth access laws. Following are selected findings from this year's report in these important areas:

Top Six States in Tobacco Prevention Spending (percent of CDC minimum recommendation)
1. Maine 137%
2. Delaware 125%
3. Mississippi 108%
4. Arkansas 103%
5. Arizona 93%
6. Hawaii 90%

Top Six Most Disappointing State Tobacco Prevention Program Cuts
1. New Hampshire -100%
South Carolina -100%
3. Florida -97.3%
4. Nebraska -80.0%
5. South Dakota -74.4%
6. Colorado -74.2%

Five States with Strongest Smokefree Air Laws
1. Delaware
2. California
3. New York
4. Connecticut
5. Maine

Top Five State Excise Tax Increases
1. New Mexico +$0.70
2. New Jersey +$0.55
3. Montana +$0.52
4. Wyoming +$0.48
5. Nevada +$0.45

Top Five State Excise Taxes
1. New Jersey $2.05
2. Rhode Island $1.71
3. Connecticut $1.51
Massachusetts $1.51
5. New York $1.50

Seven States That Got an "A" for Strong Youth Access Laws
1. California
2. Connecticut
3. Maine
4. New York
5. Rhode Island
6. Texas
7. Vermont


Additional Contacts:
Lance Longwell

Michelle Sawatka

About the American Lung Association
Celebrating its 100th anniversary, the American Lung Association works to prevent lung disease and promote lung health. Lung diseases and breathing problems are the leading causes of infant deaths in the United States today, and asthma is the leading serious chronic childhood illness. Smoking remains the nation's leading preventable cause of death. Lung disease death rates continue to increase while other leading causes of death have declined.

The American Lung Association has long funded vital research on the causes of and treatments for lung disease. It is the foremost defender of the Clean Air Act and laws that protect citizens from secondhand smoke. The Lung Association teaches children the dangers of tobacco use and helps teenage and adult smokers overcome addiction. It educates children and adults living with lung diseases on managing their condition. With the generous support of the public, the American Lung Association is "Improving life, one breath at a time."

For more information about the American Lung Association or to support the work it does, call 1-800-LUNG-USA (1-800-586-4872) or log on to

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