BOSTON — In the wake of the Trump administration’s rollback of tobacco prevention efforts, researchers are calling on state lawmakers to boost funding to help curb tobacco use.
In its annual “State of Tobacco Control” report released on Jan. 28, the American Lung Association delivered its assessment of steps taken by states and the federal government to reduce the number of tobacco-related deaths and gave recommendations to help prevent tobacco use.
The state’s health care costs as a result of smoking exceed $4 billion and tobacco use remains the leading cause of preventable death across the country and in Massachusetts, with 9,300 smoking-attributable deaths reported each year in the state, according to the report. Massachusetts’ adult smoking rate stands at 9.8% and the adult tobacco use rate is 15.5% while the high school smoking rate is 3.4%.
“While Massachusetts continues to be a national leader in tobacco control efforts, the report finds that 2026 will be critical to keep that momentum going,” said Daniel Fitzgerald, director of advocacy for the American Lung Association in Massachusetts.
The report graded each state, and the federal government, on a scale of “A” through “F” on five criteria: tobacco prevention and control program funding; smoke-free air; tobacco taxes; access to cessation services; and flavored tobacco products.
Researchers gave Massachusetts an “F” grade on tobacco prevention and control programs, finding the state “severely” underfunds the Massachusetts Tobacco Control Program and urged Gov. Maura Healey and the Legislature to dramatically increase funding.
In fiscal year 2026, total state and federal funding for tobacco control programs totaled about $13 million, approximately 19.5% of the $66,9 million recommended by the U.S. Centers for Disease Control and Prevention, according to the report. The state generated $551.3 million in tobacco related revenue from settlement payments and taxes.
Massachusetts received a “B” grade for its tobacco taxes, including $3.51 no a pack of 20 cigarettes. Researchers recommended the state increase the tax by a minimum of $1 per pack and tax non-cigarette tobacco products at a comparable rate.
The Bay State and the District of Columbia earned “A” grades for flavored tobacco product laws, with a majority of other states earning an “F.” Massachusetts bans flavored tobacco products in “virtually all locations,” the report said. Many states have no state law or regulations regarding flavored tobacco products.
Massachusetts also earned an “A” for the strength of smoke-free workplace laws. The report found smoking is prohibited in virtually all public places and workplaces in the state with e-cigarettes and marijuana included in the smoke-free law.
The state also earned a “C” grade for access to cessation services. The grade includes three components: state Medicaid coverage of tobacco cessation services, state employee health plan coverage of services and the investment per smoker the state makes in its quitline – a service available in all states that provides tobacco cessation counseling over the phone. All seven recommended medications and three types of counseling services for smoking cessation are covered by state employee health plans and Medicaid. The state’s investment per smoker is $1.06 while the median investment across all states is $2.62, the report said.
The report found that the country’s efforts to reduce tobacco-related deaths over the past 25 years have shown success. Adult cigarette smoking deaths fell from 23.3% in 2000 to a record low of 9.9%, according to the CDC’s 2024 National Health Interview Survey. Also, youth cigarette smoking rates fell from 28.5% in 2001 to 3.5% in 2023, according to the CDC’s Youth Risk Behavior Surveys from 2001 and 2023. However, the report said this progress has been stymied by a series of actions the Trump administration took in 2025.
The report noted that in April 2025 almost all staff and contractors at the CDC’s Office on Smoking and Health were terminated and a significant number of employees were fired or removed from the U.S. Food and Drug Administration’s Center for Tobacco Products. Also, distribution of grant funds for state programs to prevent and reduce tobacco use were delayed until September 2025. Usually, the CDC issues the funds in April each year, and the delay caused “extensive damage to several state tobacco control programs” including reducing quitline or phone counseling services for tobacco users, according to the report.
Additionally, a public health media campaign – Tips from Former Smokers – was terminated, leaving at least $65 million in congressionally directed funding unused in 2025. The report acknowledged that FDA collaborated with the U.S. Customs and Border Protection throughout 2025 to seize some illegal e-cigarettes.
“It’s devastating to see the federal government largely abandon its tobacco control efforts. Walking away from the incredible progress the nation has made on reducing tobacco use over the past 50 years is unacceptable,” said Fitzgerald. “Now more than ever, states need to ramp up their tobacco prevention efforts even more to protect residents from disease and addiction caused by tobacco use.”
Jason Lefevre, public affairs specialist for the CDC, acknowledged the News Service’s request for comment but did not provide one. A FDA spokesperson who declined to share their name said the agency is not able to comment on the report.
“The FDA is unable to comment on specific conclusions or questions related to data from third-party sources, for which the FDA cannot validate the values or methodology,” the spokesperson said in a statement. “The FDA continues to prioritize its tobacco regulation efforts, including through enforcement actions such as seizures to remove unauthorized products from the market and implementation of evidence-based strategies. Additionally, the FDA continues to regulate the tobacco product marketplace by conducting thorough premarket review and using the full scope of compliance and enforcement tools across the supply chain, including manufacturers, importers, distributors, and retailers. In coordination with federal partners including U.S. Customs and Border Protection, the FDA has successfully seized millions of dollars worth of illegal e-cigarettes.”
The report gave the federal government a “D” for regulation of tobacco products; “D” for federal coverage of quit smoking treatments; “F” for level of federal tobacco taxes; “B” for federal funding for tobacco prevention and control; and an “Incomplete” for mass media campaigns to prevent and reduce tobacco use because researchers could not obtain data on the duration, reach and frequency of the Real Cost campaign in 2025.