New Report Highlights Big Tobacco’s Dangerous Attempts to Co-opt Promising Public Health Policies to Serve Their Own Agenda

Report Also Finds States Are Missing Opportunities to Reduce Suffering and Death from Cancer by Failing to Pass and Implement Evidence-Based Policies

August 1, 2019

WASHINGTON, D.C. – The American Cancer Society Cancer Action Network’s (ACS CAN) annual state-by-state report released today finds a majority of bills introduced in 2019 to combat youth tobacco use by raising the age of sale for tobacco to 21 were co-opted by the tobacco industry. ACS CAN’s 17th annual How Do You Measure Up? A Progress Report on State Legislative Activity to Reduce Cancer Incidence and Mortality, which grades states on the strength of evidence-based policies to help prevent and reduce the cancer burden, devotes its special section this year to Big Tobacco’s deceptive lobbying efforts playing out nationwide.

E-cigarettes have driven a dramatic 36% rise in youth tobacco product use over the last year—and in statehouses across the country, policymakers have prioritized efforts to keep tobacco products out of the hands of youth by introducing 88 bills to raise the age of sale for tobacco products. But state lawmakers’ good-faith efforts have been co-opted by the tobacco industry, who wants to use these laws to advance policies that will interfere with effective tobacco control—thereby protecting company profits. In fact, 51 out of the 88 age of sale bills introduced in 2019 included provisions that advance tobacco industry interests rather than public health.

“It is critical that our lawmakers act to end the youth e-cigarette epidemic and protect our kids from all tobacco products that threaten a lifetime of addiction,” said Lisa Lacasse, president of ACS CAN. “Efforts to raise the legal age of sale for tobacco products must be paired with proven tobacco control policies including regular and significant tobacco tax increases, comprehensive smoke-free laws and funding for tobacco cessation programming. Policymakers must live up to their responsibility to protect our kids by ensuring that the tobacco 21 policies they pass are designed according to public health best practices and are not being used as a stalking horse to advance the tobacco industry’s interests.”

The special section, Tobacco 21: Promising Policy or a Wolf in Sheep’s Clothing, draws attention to Big Tobacco’s insidious agenda—including approaches such as inserting language into popular Tobacco 21 laws that would preempt local governments’ ability to pass strong tobacco control laws—and provides lawmakers evidence-based principles that make Tobacco 21 policies effective. ACS CAN created this section to provide a blueprint for lawmakers to ensure any Tobacco 21 bills being considered will have the intended result of reducing youth tobacco use.

The report, an annual snapshot of key state policies, also shows many states are falling behind in their efforts to prevent cancer and promote access to health coverage. The report grades states in eight specific areas of public policy that can help fight cancer: increased access to health care coverage through Medicaid, passage of quality of life (palliative care) policies, implementation of balanced pain control policies, smoke-free laws, cigarette tax levels, funding for tobacco prevention and cessation programs, coverage of tobacco cessation treatment through Medicaid programs and prohibiting minors from using indoor tanning devices.

A color-coded system is used to identify how well a state is doing. Green represents the benchmark position, showing that a state has adopted evidence-based policies and best practices; yellow indicates moderate movement toward the benchmark; and red shows where a state is falling short. 

Overall, the report found:

  • Eighteen states reach benchmarks in only two or fewer of the eight legislative priority areas.
  • Twenty-nine states and the District of Columbia measure up in just three to five of the eight areas.
  • Only three states – California, Maine and Massachusetts – meet benchmarks in six of the eight categories.
  • No state meets benchmarks in seven or more policy areas.
  • Increased access to health coverage through Medicaid is the most met benchmark, with 35 states, in addition to the District of Columbia, having broadened Medicaid eligibility to cover individuals earning up to 138% of the federal poverty level.
  • Tobacco prevention program funding is the least met benchmark with only four states—Alaska, California, North Dakota and Oklahoma—funding their tobacco prevention programs at over 50% of the Centers for Disease Control and Prevention (CDC) recommended levels for FY2019.

“Everyone deserves the opportunity to live a healthy life,” Lacasse said. “But too many communities in our country are not covered by policies that are proven to help prevent cancer and reduce its burden. How Do You Measure Up? gives lawmakers a roadmap to fight cancer in their state; by implementing the eight policies laid out in this report, policymakers can not only save lives in their state, but also reduce health care expenditures and even generate needed revenue.”

Access to Health Care: Medicaid

Access to quality health coverage has been directly linked to cancer outcomes, yet 15 states still have not adequately increased access to their Medicaid programs to help provide low-income children and adults, seniors and people with disabilities comprehensive, affordable health coverage. These 15 states include Utah - where a ballot measure approved by Utah voters was disregarded by state lawmakers when they passed a bill to only partially expand the state’s Medicaid program and impose new administrative requirements for coverage. Research shows individuals without health care coverage are more likely than those with coverage to be diagnosed with cancer at a later stage, when it is costlier and more difficult to treat, and when individuals are less likely to survive. Roughly 2.3 million Americans with a history of cancer, including one-third of all childhood cancer patients at the point of diagnosis, rely on Medicaid coverage for their care.


Despite tobacco being the number one preventable cause of death nationwide, states continue to fall short when it comes to passing laws to prevent tobacco addiction and death. Only 28 states and the District of Columbia have implemented laws requiring 100% smoke-free workplaces including restaurants and bars and only four states are spending more than 50% of the CDC recommended funding level for their tobacco prevention and cessation programs. Furthermore, just 10 states offer the full spectrum of cessation services, including individual, group and telephone counseling and all seven Food and Drug Administration-approved tobacco cessation medications, in their Medicaid programs.

Quality of Life

Twenty-six states have passed legislation to increase access to and awareness of palliative care, specialized medical care that focuses on care coordination and relief from pain, stress and other symptoms of treatment for life-threatening diseases such as cancer. Palliative care alongside curative treatments can improve patient outcomes, reduce hospital readmittance and increase patient and family satisfaction. It is also shown to reduce medical costs.

The American Cancer Society estimates that more than 1.7 million people in the United States will be diagnosed with cancer and more than 600,000 will die from the disease this year alone.

Report Highlights and Available Resources:

  • Special report on efforts to stem youth tobacco product use by raising the legal age of sale for tobacco to 21.
  • Detailed look at access to health coverage and cancer screenings, cancer prevention, tobacco control and patient quality of life.
  • National trend information and in-depth analysis of more than a dozen specific state-level policy issues proven to help save lives from cancer and improve the financial health of states.
  • Local volunteer and patient stories, national and state policy experts on all issues covered in the report are available for interviews.
  • High resolution copies of each issue grade map in the report.
  • For interactive national and state-by-state details as well as a full copy of the report, visit

The American Cancer Society Cancer Action Network (ACS CAN) is making cancer a top priority for public officials and candidates at the federal, state and local levels. ACS CAN empowers advocates across the country to make their voices heard and influence evidence-based public policy change as well as legislative and regulatory solutions that will reduce the cancer burden. As the American Cancer Society’s nonprofit, nonpartisan advocacy affiliate, ACS CAN is critical to the fight for a world without cancer. For more information, visit


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