American Lung Association Grades the Government

On January 10 2008, The American Medical Association released a tobacco product report by the American Lung Association . This report, "State of Tobacco Control" applied a grading system for the year 2007 at both a federal and state level. The report, with new topics entering the close Presidential race, is finally coming to light. The ALA hopes the results will spark debate and leadership in the current Presidential Candidates. Though their has been a slight progress in change since the original report 6 years ago, the Lung Association urges consumers and governments agencies to do more. With an annual death rate of more than 450,000 Americans, from tobacco related cancers, the agency sees an immediate need for accelerated adherence to the necessary roles of the U.S. government to protect its citizens.

The American Lung Associations report on tobacco grades at both a federal and state level. The Federal Level is graded in four areas; cigarette taxes, regulation of tobacco products by the U.S. Food and Drug Administration (FDA), cessation and the Framework Convention on Tobacco Control, and on (FCTC)-the international tobacco control. The states are graded on the four areas of taxation, control and prevention, smoke free air, and youth prevention/control. The Association has specific criteria the federal government and each state must meet to pass or fail their testing areas. Among the tested states, only 10 were considered to have fully passed. In the area of cessation, which the ALA considered a top and proven priority, only six states passed. The American Lung Association is urging consumers to work with their government agencies to bring about change. They also encourage the state and federal governments to strive for A's across the board in the coming years.

The American Lung Association awarded point values for specific tobacco related tasks in the federal and state governments. As well, points are awarded based on the governments' attempts to comply with recommendations, specifications, and researched reports. Bonus points are awarded in many areas and most evaluations are balanced on a sliding scale.

THE FEDERAL GOVERNMENTS TABACCO REPORT CARD

Cigarette Tax (Grade: F)
A states average excise tax on cigarettes was taken into account for this portion of the grading system.
The Excise Tax grades break down as follows:
A = $2.21 and over
B = $1.66 to $2.209
C = $1.11 to $1.659
D = $0.555 to $1.109
F = Under $0.555

Food and Drug Regulation of Tobacco (Grade: F)
The ALA used the criteria set forth in their developed guidelines, "Essential Elements of FDA Regulation" and can be further explored with the document "Critical Elements of Any legislation to Grant FDA Authority to Regulate Tobacco Products" (refer to link at article end). This report has long been provided to the U.S. government.
A = Meets target
F = does not meet target

Framework Convention on Tobacco Control (Grade: D)
The Framework Convention on Tobacco Control (FCTC) is a set of standards for the United States and other countries to address and control addition to tobacco products and to control initial use.
A = Ratification by the S. Senate.
B = FCTC approved by the Senate Foreign Relations Committee.
C = President sends FCTC to Senate for ratification.
D = President signs FCTC.
F = No action on FCTC.

Cessation (Grade: F)
The American Lung Association used the criteria set forth by the Secretary of Health in 2002. The Secretary demanded bold and scientific based initiatives. Initiatives the federal government could adopt to lower the use of tobacco products nationally. Some of the initiatives set out in the final report by the Secretaries sub-committee later formed the American Lung Association State of Tobacco Control 2007
A = 18 to 20
B = 16 to 17
C = 14 to 15
D = 12 to 13
F = under 12

STATE GOVERNMENT REPORT CARD

Tobacco Prevention and Control Spending:
A small amount of states received good or middle ground grades in the category of control and prevention. Among the (A) states were Alaska, .Delaware, Wyoming, Colorado, and Arkansas. A great many states failed the prevention and spending criteria, greatly frustrating the American Lung Association. Among the failing (F) states were Tennessee, Utah, Nebraska, Wisconsin, Nevada, and Illinois.
The CDC (Center for Disease Control) in 1999 developed a set of nine categories that would best allow states to control tobacco use among its citizens. The report ""Best Practices for Comprehensive Tobacco Control Programs" and its minimum requirement is what the ALA used as a percentage calculator in grading each state.
A = 90 percent or more of the CDC lower estimate
B = 80 percent to 89 percent
C = 70 percent to 79 percent
D = 60 percent to 69 percent
F = 59 percent or less

State Cigarette Excise Tax:
The only states to receive an (A) in taxation were New Jersey and Rhode Island. Some states fell in between in the grading system. However many states received poor grades in this category. The failing grade of (F) included Florida, Utah, Louisiana, Virginia, and Kentucky.
Grading on the tax, the ALA had to take into account inflation and fluctuating prices on tobacco per state. The American Lung Association strongly believes high taxes can discourage youth smoking. They also believe the taxes can provide cessation encouragement nationally.
A = $2.21 and over
B = $1.66 to $2.209
C = $1.11 to $1.659
D= $0.555 to $1.109
F = under $0.555

Smoke free Air Laws:
Among the (A) grade of states in the smoke free air categories were Arizona, Nevada, Ohio, Delaware, California, and New Mexico. Receiving a failing grade of (F) were states including Pennsylvania, Iowa, Alabama, Texas, and Kentucky.
A study by the National Cancer Institute presented in the article Application of a Rating System to State Clean Indoor Air Laws, outlined nine categories to look in studying Smoke Free Air. The ALA used the number 36 as the common denominator for their study.
A final score of Zero (0) was attributed to any states that required smoking to be permitted or had laws without and restrictions.
A= 33 to 36
B = 29 to 32
C = 26 to 28
D = 22 to 25
F = 21 and below

Youth Access Laws:
The access of youth to tobacco products is a leading concern for associations and governments. The American Lung Association was especially disappointed in this categories grade. Some of the states who scored high with an (A) average were Vermont, Hawaii, Alaska, Idaho, and Connecticut. Among the states returning a failing grade of (F) were Ohio, Colorado, Maryland, Michigan, and North Dakota.
The youth access grading system relies on a paper published by the American Cancer institute called "State Laws on Youth Access to Tobacco in the United States: Measuring Their Extensiveness with a New Rating System," the paper looked at nine areas including sampling, law enforcements, and photo Id requirements. The ALA used a point system that took into account the 9-category list in the Cancer Institute paper and awarded points. For example, 4 points were available for states that had an entire ban on vending machines that allowed the sale of tobacco products.
A = 26 to 24
B = 21 to 23
C = 19 and 20
D = 16 to 18
F = 15 and below

The American Lung Association admits that specific laws or programs may have been established since their original 2007 study changing the degree of their grading system. As well, the study does not take all areas of state and federal programs, compliance, and statistics into account. Therefore, a state that scored very high may very well be weak in a number of other important areas pertaining to tobacco. A state scoring very low may have data, which could make it more to the center within the grading scale. Most middle grades in the report would most likely not sway dramatically either way.

To see your states grade, link to The American Medical Association's website.

The American Lung Association refers those interested in making a difference to educated themselves on the facts. They also urge those interested in change to write letters to their public officials and representatives in Washington.

For further reading, or to read the reports and documents referred to in this news article, choose a link below.

CDC "Best Practices For Comprehensive Tobacco Control"

"Critical Elements of Any legislation to Grant FDA Authority to Regulate Tobacco Products"

"Application of a Rating System to State Clean Indoor Air Laws"

The Framework Convention on Tobacco Control