Why Texas gets failing grade when it comes to smoking prevention

Texas is one of the worst states in the country when it comes to cigarette smoking, according to the American Lung Association.

In its new "State of Tobacco Control Report," the advocacy group gives Texas — along with Alabama, Mississippi and North Carolina — failing grades on every category the report tracks.

Those are:

• Funding for tobacco prevention programs.

• Strength of smoke-free workplace laws.

• Level of state tobacco taxes.

• Coverage and access to services to quit tobacco.

• Ending the sale of all flavored tobacco products.

Texas "refuses to do most of what's recommended" by the group, said Charlie Gagen, the American Lung Association director of advocacy for Texas and Oklahoma.

Currently in Texas, 13% of adults smoke (slightly above national rates), 4.9% of high school students smoke (more than twice the national rate), and 18.7% of high-schoolers use e-cigarettes (4 percentage points above the national rate), according to the Campaign for Tobacco-Free Kids. That advocacy group estimates 27.1% of cancer deaths in Texas can be attributed to smoking, and that almost half a million kids alive today in Texas will die prematurely from smoking.

An F grade on funding for prevention programs

Texas spends only 2.6% of what the federal Centers for Disease Control and Prevention recommends for smoking cessation programs and prevention education. The state allocates about $3.5 million a year, which in addition to $3.3 million in federal funding, creates a program budget of about $6.8 million a year. The Texas Department of State Health Services has requested an additional $3 million annually this legislative session. The CDC recommends Texas spend $264.1 million.

The state receives $1.8 billion a year in funding from a tobacco settlement that is used for health care, but could be used in smoking cessation programs and education.

The tobacco industry spends about $670.9 million in Texas advertising its products.

An F grade in smoke-free workplace laws

Texas doesn't have state laws preventing smoking in most workplaces except child care facilities and some areas in schools and recreational facilities. Austin and the state's other major cities do have laws about smoking in public places, including bars and restaurants, as well as within 15 feet of pedestrian entrances.

This means that people in Texas can be surrounded by unfiltered secondhand smoke, which is leading to more lung cancer in nonsmokers, medical experts say.

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An F grade in state tobacco taxes

Texas charges $1.41 in state tobacco taxes for a pack of cigarettes. The national average in 2021 was $1.91, and Texas ranked 31st in smoking taxes, according to the Truth Initiative.

Texas does not have a state tobacco tax on e-cigarettes. The American Lung Association is recommending that Texas levy a tax on e-cigarettes that is the equivalent of a pack of cigarettes.

The Campaign for Tobacco-Free Kids estimates that every 10% increase in cigarette prices reduces youth smoking by about 7% and total cigarette consumption by about 4%.

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An F grade in coverage and access to services to quit tobacco

Texas doesn't have a state law that insurance companies have to cover counseling for quitting smoking or medications to help quit. People who have Medicaid or state employee health plans do have access to such medications and some counseling, but Texas has not expanded Medicaid, leaving a lot of people without access to affordable health insurance.

The Texas hotline to quit smoking is also funded $0.58 per smoker; the median for states is $2.37.

"The vast majority want to quit and have tried multiple times," Gagen said of smokers. The Quitline, 1-877-YES QUIT, is getting used, he said, but doesn't have enough people to handle the volume of calls.

"Texas has good programs," Gagen said of the prevention and cessation programs, "but they don't reach the number of Texans that need them."

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An F grade in sale of flavored tobacco products

Texas does not have a state law prohibiting flavored tobacco, such as what's found in e-cigarette cartridges.

"We are concerned that with the way the teenage brain works, they will become lifetime tobacco users," Gagen said.

For decades, the number of teens using tobacco products was falling, but now, because of e-cigarettes (aka vaping), especially the flavored products, the rates are back to where they were 20 years ago, Gagen said.

No bill has been proposed outlawing the sale of flavored tobacco products in this session of the Legislature. There is a House Bill 114, which would make it a Class B misdemeanor to possess five or more e-cigarettes on school property. That was introduced by Rep. Ed Thompson, R-Brazoria.

What else could Texas do?

In 2019, it became illegal for people younger than age 21 to buy cigarettes unless they are in the military. The American Lung Association recommends Texas put more money into the state's surveillance of tobacco retailers, including at least an annual compliance check to make sure that retailer is checking IDs before selling tobacco products.

This article originally appeared on Austin American-Statesman: Texas failing on smoking prevention, American Lung Association says