The 2025 American Lung Association’s “State of Tobacco Control” report was recently released. It finds that federal and state governments are not adequately protecting the public from tobacco.
There were virtually no positive developments at the federal level in 2025; state performance was concerning in most areas.
The ALA reports that the “tobacco prevention and control landscape has been fundamentally altered” during Donald Trump’s second term.
The headline is the evisceration of the Centers for Disease Control and Prevention’s Office on Smoking and Health, which has been the guiding light for the nation’s tobacco control efforts for many years. Nearly all staff were fired, and the office was dismantled.
The office was responsible for tobacco education; information, assistance and best practices for state tobacco-control programs; and the issuance of key reports on tobacco use. Its closure represents a substantial loss of federal capacity and possibly the most significant setback in tobacco control in decades.
This enhances the tobacco industry’s efforts to expand its reach and influence and target new users, mostly children.
Simply stated, the administration’s actions weaken tobacco prevention efforts mandated by two acts of Congress.
The administration delayed the distribution of funds to state tobacco-control programs, resulting in extensive damage to some state programs, including cessation services.
Additionally, the removal of a significant number of staff from the Food and Drug Administration, including top leadership, caused disruption of regulatory operations.
The administration also terminated one of the most effective anti-smoking media campaigns ever implemented, the CDC’s Tips from Former Smokers, which was responsible for about a million smokers quitting and saved billions in health care costs.
Left unused was $65 million intended to counter the tobacco industry’s aggressive marketing.
The bad news continues with FDA fast-tracking of applications for, and authorization of, flavored Zyn and other nicotine pouches, as well as approval of additional Juul and other menthol-flavored e-cigarettes. These actions appear to have been made without regard to whether these products appeal to children.
They coincide with the tobacco industry’s strategy of promoting “reduced harm” products designed to keep people addicted while enticing new, young users.
E-cigarettes and pouches are the products most used by youth. This FDA approach also appears to be inconsistent with its “Public Health Standard,” which requires manufacturers of new products to demonstrate a significant public health benefit to obtain approval.
Concurrently with these developments, Medicaid cuts will threaten smoking cessation treatment for low-income individuals, and the congressionally required implementation of graphic warning labels remains stalled in the courts.
Lastly, action on the FDA’s proposed rule to reduce nicotine levels in tobacco to non-addictive levels will now be delayed for years.
Meanwhile, the situation at the state level is mixed.
Twelve states increased funding for their tobacco control programs by $1 million or more, while 11 states eliminated or reduced funding by $1 million. Indiana’s funding did not change.
No state passed new smoke-free laws or prohibited the sale of flavored tobacco products. On a positive note, no state passed preemption laws preventing local governments from enacting more stringent tobacco-control measures.
The report was not very complimentary of Indiana’s situation, especially regarding the prohibition of flavored tobacco products, tobacco prevention funding, and smoke-free air policy.
However, Indiana, along with Maine, passed significant increases in cigarette taxes. Indiana had the largest increase, at $2 per pack.
Impressive.
Unfortunately, the motivation for the increase was not to address Indiana’s miserable health status or high smoking rates, but rather a massive budget shortfall.
Dr. Richard Feldman is a former Indiana state commissioner of health.