Policy and Position Statements


Tobacco Use Prevention and Control Position Statement

I. ASTHO Supports State Efforts in Tobacco Use Prevention and Control

The Association of State and Territorial Health Officials (ASTHO) supports aggressive efforts to reduce tobacco use, tobacco-attributable health disparities, and tobacco-related morbidity and mortality.

II. Within This Context, ASTHO Recommends that State Public Health Agencies:

  • Implement evidence-based programs and policies to reduce tobacco use and related illness and death, as stated in the Guide to Community Preventive Services1 and CDC's Best Practices for Comprehensive Tobacco Control Program,2 and identify priorities among the topics that are identified that align with recommended best practices and are also evidence based.
  • Consider innovative efforts in tobacco control (example: raising the minimum age for tobacco purchases).
  • Support the Food and Drug Administration's implementation of the Family Smoking Prevention and Tobacco Control Act.
  • Support national surveillance efforts and develop state surveillance efforts specifically focused on new products and identifying the emerging issues in tobacco prevention and control efforts.
  • Support legislation and programs that address inequities in tobacco use, use of flavored tobacco or menthol tobacco, and access to cessation programs based on gender, education, health conditions, income, sexual orientation or racial/ethnic status.
  • Advocate for sustained funding at levels recommended by CDC for comprehensive tobacco prevention and control programs at the state level.
  • Work with state partners to implement tobacco prevention and control provisions in the Patient Protection and Affordable Care Act such as public and private coverage with no cost-sharing of tobacco use counseling and interventions.
  • Increase prices on all tobacco products, including electronic cigarettes, to reduce consumption.
  • Support efforts promoting cessation among pregnant women.
  • Allocate payments from the Master Settlement Agreements, revenue from tobacco excise taxes, and other tobacco funding sources to fund public health programs including comprehensive tobacco control programs.
  • Prohibit sellers from making any tobacco product, including electronic cigarettes, accessible to minors—this includes online accessibility.
  • Support safety measures for production, packaging, storage, disposal, and sale of tobacco products to include liquid nicotine to prevent unintentional poisonings.
  • Limit advertising and promotion of tobacco products, including electronic cigarettes, by regulating the time, place and manner of such advertisements.
  • Prohibit the sampling of electronic-cigarettes and couponing to minors.
  • Support efforts to advance tobacco-free and smoke-free campuses.
  • Support legislation and policies to eliminate exposure to second-hand smoke, which includes vapors from electronic cigarettes, in workplaces and public places, including restaurants, bars, public housing units, institutions of higher education, beaches, parks, cars, and all other places where a harmful impact is probable.
  • Support and promote coverage of tobacco cessation programs, including the use of quit line services, evidence-based cessation interventions that support both individual and group counseling, and all FDA-approved pharmacotherapy.
  • Advocate for effective, hard-hitting media campaigns that educate the public about the health effects of tobacco use, tobacco policies, cessation resources, and tobacco industry marketing tactics.
  • Support strong legislative and regulatory autonomy to address exposure to tobacco. This includes the preservation of local government autonomy to adopt tobacco control ordinances and regulation.
  • Support efforts at the federal, state, and local level to regulate new and emerging tobacco products, including electronic-cigarettes, cigars, "little cigars," hookah, and other tobacco products currently free of federal regulation.
  • Advocate for further research to be conducted on emerging tobacco products and tobacco products currently free of regulation.
  • Utilize existing resources available within ASTHO, CDC, CMS (such as administrative matches), and national organizations dedicated to tobacco prevention and control efforts to network, share best practices, and advance tobacco prevention and control efforts.

III. Background: Improving States' and Territories' Tobacco Prevention and Control Efforts

Tobacco use is the single most preventable cause of disease, disability, and death in the United States. An estimated 480,000 people die prematurely each year from smoking or exposure to secondhand smoke, and another 8.6 million have a serious illness caused by tobacco use. Coupled with this enormous health toll is the huge economic burden associated with tobacco use. More than $96 billion per year is spent on medical expenses and another $97 billion per year is spent on lost productivity.

Comprehensive and sustained state-wide tobacco control programs have been shown to reduce smoking rates, tobacco-related deaths, and diseases caused by smoking.3 A comprehensive program is a coordinated effort to prevent initiation of tobacco use, protect the public from secondhand smoke, and promote cessation. This approach combines social, economic, regulatory, clinical, and educational strategies, and also complements the MPOWER4 framework identified by the World Health Organization. CDC's Tobacco Control State Highlights 20105 is based on the MPOWER framework and guides states in implementing and evaluating high-impact strategies to:

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about the dangers of tobacco

Enforce ban on tobacco advertising

Raise taxes on tobacco.

The Institute of Medicine report "Ending the Tobacco Problem: A Blueprint for the Nation"6 reviewed tobacco prevention and treatment interventions and recommended a comprehensive set of strategies to increase the momentum of our nation's tobacco control efforts. Foremost among its recommendations is that each state should fund its tobacco control program at the level recommended by CDC in "Best Practices for Comprehensive Tobacco Control Program 2014." Strained economies have forced cuts for funding to support comprehensive tobacco control programs. However, new opportunities exist within ACA and the Family Smoking Prevention and Tobacco Control Act to strengthen the efforts of state tobacco control programs. State and territorial health agencies can use these resources to support disease prevention initiatives, insurance coverage of tobacco cessation, quit line services, and evidence-based policies to reduce tobacco use.

With the creation of incentives by federal agencies and the technical support provided by organizations such as ASTHO, state health agencies can make significant progress in preventing tobacco-attributable health inequities, ultimately leading to improved health outcomes.

Approval History

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and approved by the ASTHO Executive Committee. Position statements are not voted on by the full ASTHO membership.

Prevention Policy Committee Review and Approval: August 2014
Executive Committee review and approval: September 2014
This Position Statement supersedes the Position Statement approved October 2010, which expired October 2013.

Policy Expires: September 2017

For further information about this Position Statement, please contact ASTHO Prevention Policy staff at prevention@astho.org. For ASTHO policies and additional publications related to the Position Statement, please visit ASTHO's Policy and Position Statements page.

Related ASTHO Documents

Prevention Policy Statement

Comprehensive Tobacco Control: Guide for State and Territorial Health Officials

Smoking Cessation Strategies for Women Before, During, and After Pregnancy: Recommendations for State and Territorial Health Agencies

ASTHO Comprehensive Tobacco Cessation Expert Roundtable: Summary of Meeting and Expert Recommendations


  1. U.S. Preventive Services Task Force. Guide to Clinical Community Services. Available at http://www.thecommunityguide.org/tobacco/index.html. Last updated: 02/25/2014. Accessed 03-19-2014.
  2. U.S. Centers for Disease Control and Prevention (CDC), Best Practices for Comprehensive Tobacco Control Programs, 2014. Available at http://www.cdc.gov/tobacco/stateandcommunity/best_practices. Accessed 03-19-2014.
  3. U.S. Centers for Disease Control and Prevention (CDC), Tobacco Use: Targeting the Nation's Leading Killer, 2011. Available at http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2011/tobacco_aag_2011_508.pdf. Accessed 03-19-2014.
  4. World Health Organization, WHO Report on the Global Tobacco Epidemic, 2013. Available at http://www.who.int/tobacco/global_report/2013/en/. Accessed 03-19-2014.
  5. U.S. Centers for Disease Control and Prevention. Tobacco Control State Highlights 2012. Available at http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2012/. Accessed 03-19-2014.
  6. Institute of Medicine, Ending the Tobacco Problem: A Blueprint for the Nation, 2007. The National Academies Press. Available at http://www.iom.edu/reports/2007/ending-the-tobacco-problem-a-blueprint-for-the-nation.aspx. Accessed 03-19-2014.