United States: “Disappointing” fight against smoking in 2022, despite some progress

In the United States, on the 21st^th The American Lung Association's annual "State of Tobacco Control" report looks back on a "disappointing" 2022 in tobacco control efforts and calls on U.S. governments to strengthen measures to stem the tobacco and nicotine epidemic at both the state and federal levels. The report highlights disparities in prevention policies across states and proposes a series of measures aimed at reducing smoking, particularly among younger generations.

The 2020 data on tobacco consumption in the United States, published in March, show good results, with the lowest prevalence ever recorded, with 12.5% adult smokers, while e-cigarette use also decreased compared to 2019. Despite these figures, tobacco remains the leading cause of preventable death and disease, killing 480,000 people in the country each year. In addition, more than 16 million Americans are living with a tobacco-related disease.

Menthol Ban in the United States, an Encouraging Step Forward

At the federal level, the American Lung Association's report supports the Food and Drug Administration's (FDA) rules, published in 2022, to remove menthol cigarettes and flavored cigars from the market. As the association mentions, such a measure will benefit public health, and in particular certain categories of the population, such as African-Americans. Indeed, the levels of consumption of these types of products contribute to widening health inequalities in the country, and to the development of the tobacco epidemic. In this way, the American Lung Association calls on the FDA as well as the Biden administration to close the file as quickly as possible.

Electronic cigarettes and synthetic nicotine, a major public health issue

In 2022, Congress expanded the FDA’s authority over new nicotine products, including both e-cigarettes and products containing synthetic nicotine or non-tobacco. This decision allowed the FDA to respond to the arrival on the market of new products such as the PuffBar, containing synthetic nicotine, whose very rapid commercial development was supported by a marketing strategy targeting younger generations. However, as the report notes, although the FDA set clear deadlines for removing illegally sold nicotine products from the market, the deadlines were not met, leaving many products still on sale, despite their recognized appeal to adolescents. According to the Centers for Disease Control and Prevention (CDC), 2.55 million U.S. middle and high school students used e-cigarettes in 2022.

A development in the regulatory framework to be highlighted

The American Lung Association noted several positive developments, such as the permanent injunction orders from the Justice Department to block six e-cigarette manufacturers from marketing their products in the country. The association also noted that the FDA’s first denial of a premarket application for a menthol e-cigarette is an encouraging decision for the coming years. However, the NGO said additional federal measures are needed to stem the vaping epidemic in the United States. These measures include legal actions initiated by the Justice Department against manufacturers selling illegal products, as well as Customs and Border Protection stopping the importation of illicit products to ensure that no unauthorized products enter the U.S. market.

The United States had a "disappointing" 2022, according to the American Lung Association

However, the American Lung Association points out that 2022 has been a "disappointing year" in terms of tobacco control, both at the state and federal levels. With the exception of significant increases in funding for tobacco prevention and reduction programs, the report points out that a number of measures have been completely absent over the past year. For example, no state increased taxes on tobacco products in 2022, even though this measure is one of the most effective tools in terms of public health. There are significant tax disparities between states, with a tax of 17 cents per pack in Missouri, compared to $4.50 in the District of Columbia. On average, a pack of cigarettes in the United States is taxed at $1.91.

A call for the limitation of tobacco retailers in the country

The report argues that the number of tobacco retailers remains too high in the United States. Indeed, a 2021 study in 30 cities across the country showed that the concentration of tobacco stores was 31 times higher than that of McDonalds, and 16 times higher than that of Starbucks. In addition, the study showed that these tobacco retailers were concentrated in the most disadvantaged neighborhoods. In light of this, the association calls on the public authorities to regulate in favor of a restriction on the number of tobacco retailers, and a ban on the establishment of stores near places frequented by young people, like schools.

FT