COVID-19 Pandemic Underscores Need for Tobacco Control Policies

September 16, 2020|4:20 p.m.| ASTHO Staff

The COVID-19 pandemic has further amplified the need for strong tobacco prevention and cessation policies. Research indicates that tobacco use is associated with increased rate of COVID-19 disease progression and increased likelihood of death among hospitalized patients, and that e-cigarette use is associated with a greatly increased risk of COVID-19 diagnosis in youth and young adults.

Additionally, tobacco pricing strategies remain an evidence-based method to discourage tobacco use and improve cessation rates while also presenting an opportunity for state and local governments to address declining public revenue bases due to the COVID-19 pandemic. An increased interest in racial justice and health equity throughout the nation has also renewed discussion of comprehensive tobacco flavor restrictions that are inclusive of menthol cigarettes, which greatly contribute to the disproportionate tobacco-related death and disease burdens shouldered by the Black community and by other underserved minority groups.

Tobacco control also remains a key public health priority despite COVID-19’s challenges. 480,000 Americans die annually from tobacco-related causes, and e-cigarette use remains an epidemic among young people in the United States. According to recent data from CDC and FDA, 19.6% of high school students and 4.7% of middle school students reported current e-cigarette use in the 2020 National Youth Tobacco Survey. These figures represent a significant decline from 2019, when 27.5% of high schoolers and 10.5% of middle schoolers reported current e-cigarette use. Despite this decrease, 3.5 million students remain current e-cigarette users, and they report using a wide variety of product types and flavors that are still legally on the market in most jurisdictions within the U.S.

Tobacco 21
Near the end of 2019, the federal government adopted legislation raising the minimum age of sale of tobacco products from 18 to 21. While not requiring states and territories to also raise their minimum age of sale laws to 21, the new legislation will require states that receive federal substance abuse prevention and treatment block grant funds to revise their age requirements for retail compliance inspections under the Synar Amendment from 18 to 21. With these changes, several states are choosing to align their law with the federal requirements. So far in 2020, 15 states have adopted laws raising the minimum age of tobacco sales to 21. This adds to the 21 other jurisdictions (i.e., 18 states, DC, Guam, and Palau) that had done so in preceding years. Included in the new tobacco 21 states is Nebraska which raised its minimum age of sale to 19 in 2019 and now, has increased the age to 21.

Flavor Restrictions
In 2019, Massachusetts became the first state to enact a ban on all flavored tobacco products, including menthol flavored products, with full implementation of the ban taking place on June 1 of this year. On August 28, California became the second state to ban the sale of all flavored tobacco products in retail stores when the governor signed bill SB 793. So far 2020 has seen three other states adopt flavor bans for vapor products, in New Jersey (S 3265), New York (S 7506B), and Rhode Island (via rulemaking). In Florida a bill (SB 810) that included a ban on the sale of flavored vapor products and raised the age of sale of tobacco products to 21 passed the legislature but was vetoed by the governor earlier this month.

E-Cigarette Pricing
States have regulated e-cigarette prices by applying a percentage price increase based on the sale price, pricing e-cigarettes and vapor products at the same rates as combustible cigarettes, and imposing a per milliliter (ml) price increase on liquid nicotine or consumable material.

In 2020, two states have increased prices of e-cigarettes, e-liquids or vapor products:

  • Utah (SB 37): 56% of the manufacturer's sales price is imposed on an electronic cigarette substance, a prefilled electronic cigarette, a nontherapeutic nicotine device substance, and a prefilled nontherapeutic nicotine device while $1.83 per ounce is imposed on an alternative nicotine product.
  • Wyoming (HB 73): Imposes upon wholesalers a fifteen percent (15%) excise tax on electronic cigarettes and vapor material purchased or imported into this state by wholesalers for resale. If the excise tax imposed upon wholesalers is not paid, the bill imposes a seven and one-half percent (7.5%) excise tax upon the use or storage by consumers. The new law also preempts local taxes on the products.

Legislation regulating tobacco, e-cigarettes, and vapor products can encourage users to seek and sustain cessation and prevent youth initiation. State health agencies can utilize data and community partnerships to advance policies to protect youth from the harms associated with e-cigarette use and nicotine addiction. ASTHO will continue to monitor legislative activity on this important public health issue and can help provide technical assistance on tobacco policy.


Andy Baker-White, JD, MPH, is the senior director of state health policy at ASTHO
Josh Berry, MPH, is a senior analyst of chronic disease prevention at ASTHO