New Report Gives Texas ‘F' Grade for Tobacco Control Efforts

The American Lung Association released a major report on tobacco control on Wednesday.

The 20^th annual State of Tobacco Control report evaluates state and federal policymakers on actions taken to eliminate tobacco use, the nation’s leading cause of preventable death. The report also recommends proven-effective tobacco control laws and policies to save lives.

While the U.S. federal government overall fared better scoring this year, individual states were also given grades on its tobacco control efforts.

According to the report, the state of Texas received an ‘F’ grade across the board:

• Funding for State Tobacco Prevention Programs – Grade F
• Strength of Smokefree Air Laws – Grade F
• Level of State Tobacco Taxes – GradeF
• Coverage and Access to Services to Quit Tobacco – Grade F
• Ending the Sale of All Flavored Tobacco Products – Grade F

Click here to read the full report.

It especially highlighted a need to invest in prevention campaigns for the ongoing youth vaping epidemic.

“Despite receiving $1.87 billion from tobacco settlement payments and tobacco taxes, Texas only funds tobacco control efforts at 2.7% of the level recommended by the Centers for Disease Control and Prevention (CDC),” said Charlie Gagen, Director of Advocacy at the Lung Association. “The Lung Association believes the funds should be used to support the health of our communities, and to prevent tobacco use and help people quit, and not switch to e-cigarettes. These programs are also critical for helping to end tobacco-related health disparities.”

The Warning on Vaping

It's not say Texas hasn't made strides in reducing tobacco use. In the last 20 years, lawmakers have raised the age of sale to 21 and required e-cigarette businesses to be licensed by the state.

But according to the report, the adult smoking rate in Texas is still over 13% and the high school tobacco use is 19%.

Experts like Dr. Devika Rao, Pediatric Pulmonologist at Children's Health and Assistant Professor at UT Southwestern, said that rate is way too high.

“I think that that high rate is mostly due to e-cigarette product use,” she said.

Dr. Rao has conducted extensive research on e-cigarettes and the effect on youth. She said the number of teens using e-cigarettes has exploded in the last 10 years.

“E-cigarettes kind of came on the market as this alternative to combustible cigarette use because of all the risks to traditional cigarette use. And it was felt that this could be an aid to help adults with smoking,” she said. “But in the process, teenagers and adolescents were attracted to different types of flavorings like fruit flavors. These products are completely unregulated and made its way into the adolescent population.”

She said marketing through the internet and social media over the years, in addition to the myth that vaping is harmless, has contributed to the rise of e-cigarettes. Data is even showing that vaping is leading teens into smoking actual cigarettes.

"We know that nicotine is incredibly addictive. For the adolescent brain, it’s actually primed to become more addicted to various substances, including nicotine,” Dr. Rao said. “And so it's not surprising that use of tobacco nicotine products in youth leads to an increased likelihood of smoking solely because of how the adolescent brain is primed to become addicted."

Dr. Rao said smoking cigarettes had generally been on the decline among youth in recent years but starting in the mid-2010s, the overall use of tobacco use started to increase due to e-cigarettes.

"It definitely concerns us in the medical community because we are essentially seeing a whole new generation of adolescents become addicted to tobacco products," she said.

In contrast, new data from the University of Michigan's Monitoring the Future study shows that youth smoking dropped to an all-timelow of 2.3% in 2021 across the country, down from nearly 23% in 2000.

According to the MTF study, vaping nicotine among teens also dropped in 2021 to 13.3% from its 2019 peak of 18.1%.

But experts are keen to point out that the data might be reflecting a time period where many youth were spending more time at home with relatives during lockdowns and virtual learning, cutting them off from the social circles where temptations exist.

"Many of us in the medical community are concerned now that schools are open and social networks have been reestablished, that adolescents do have more access to these products. We are concerned that adolescents are using newer and more attractive products, things like disposable vapes," said Dr. Rao.

Even though it's illegal for teens to buy tobacco products, Dr. Rao says they're finding a way to get it.

“You can buy these products online. You don’t have to tell the truth about your age. And I also worry that some vape shops are not strictly following these age guidelines when they’re selling their products,” she said.

So it's crucial for parents to open up to their kids about these concerns.

“Parents need to be aware that these products are out there and they’re attractive and that your children definitely know about them,” said Dr. Rao.

Experts suggest using open ended questions like: What do you know about these products? Do you know that they could be harmful? Have you seen them? Have your friends been using them?

Groups like the Truth Initiative also contain resources for parents on how to begin these conversations.

“I recommend that parents start the conversation at age 10, because we’re seeing that even middle schoolers have access to these products, and that they’re making the decision to experiment and start using these products," said Dr. Rao.

Health Impacts on Youth

Doctors have shared concerns about the increase of tobacco use among youth because of what they know about the long-term effects of use in adults.

"That’s very well-established. We have decades worth of research suggesting and providing good evidence that those who use tobacco products in the long term are at risk for chronic lung disease, COPD, cancers, risk for cardiovascular disease, and other different diseases," said Dr. Rao.

The short term effects of e-cigarettes can include chronic cough, worsened asthma symptoms, chronic bronchitis, and cardiovascular issues affecting blood pressure.

"We certainly see that in the clinics that we run, we see kids who use e-cigarettes and they have worse breathing problems," said Dr. Rao.

A growing short term effects of e-cigarette use is a condition called vaping-associated lung injury.

"We continue to see cases in our institution even during the pandemic. This disease is characterized by system wide inflammation and a whole set of issues like respiratory distress, diarrhea, weight loss, fevers, night sweats, and all kinds of symptoms," said Dr. Rao. "It's indicating that even e-cigarette use can affect many different body systems."

Future Solutions

The American Lung Association noted in its report that in order to reduce the negative health impact of tobacco use, Texas policymakers need to increase funding for tobacco prevention and "Quit Smoking" programs, eliminate the e-cigarette tax loophole by taxing them like other tobacco products, and increase the cigarette tax by $1.00 per pack or more.

The association said studies have shown that every 10 percent increase in the price of cigarettes has reduced consumption by 4% percent in adults and 7% in youth.

Texas has not increased its tobacco tax since 2006, and has no excise tax on e-cigarettes.

“To protect kids from a lifetime of nicotine addiction, the Lung Association in Texas encourages lawmakers to increase cigarette taxes and equalize the tax on other tobacco products, including e-cigarettes and cigars with its cigarette tax,” said Gagen.

For more resources about the impacts of tobacco use, click here.