The American Lung Association said that the federal agency and individual state governments simply aren't doing enough when it comes to tobacco prevention programs. According to the annual State of Tobacco Control Report, the federal government isn't taking the precautions they need to in order to protect kids from e-cigarettes and addiction.

Tobacco kills 480,000 people every year in the United States. It is the number one cause of preventable death and disease in our country. E-cigarettes have rapidly increased in popularity over recent years.  According to the CDC, e-cigarette use among middle and high school students tripled from 2013-2014.

Thomas Carr, an author of the Tobacco Control Report and national director of policy at the American Lung Association, gave the FDA an "F" rating due to "lack of action". Carr said that the FDA is "putting the lives and health of Americans at risk". He noted the "staggering 78% increase among high school students and e-cigarette use in 2017 to 2018."

Carr said that the rapid increase of vaping among kids "led both the US surgeon general and FDA commissioner to call teen e-cigarette use an epidemic" caused by the lack of regulation of the products. Currently, 20.8% of high school students are using e-cigarettes.

Back in 2011, the FDA claimed that they would regulate e-cigs. Carr said that "Back then, e-cigarette use was at 1.5% among high school students, so that really was the time for action." The FDA didn't start regulating e-cigs until 2016. This was when they first introduced the minimum sales age of 18, as well as, other requirements for retailers and manufacturers.

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The FDA wouldn't comment on the report or the findings and instead gave a general statement. "In the last year alone, the agency has advanced work to render cigarettes minimally or non-addictive, announced historic plans to ban menthol in cigarettes and cigars, and is exploring additional product standards," according to the FDA.

Carr commented on this statement saying "They've made a lot of announcements this [past] year, but there hasn't been a lot of concrete action. Yes, there has been an investigation of [e-cigarette giant] Juul, but that hasn't led to a lot of meaningful policy change." Regardless, the FDA still claims to have made "tremendous progress" on tobacco and nicotine regulation. They claim to also have "advanced policies to increase access to, and use of, medicinal nicotine products to help people quit smoking, and has launched several adult and youth-focused tobacco public education prevention and cessation campaigns."

Michael Shannon, a spokesman for R. J. Reynolds Tobacco Company said that the company is working to limit youth use of their products. They claim that they do not market to minors and they do support laws to raise the legal age of purchase to 21.

How the Association Graded the FDA

The association bases the grade off four areas. The first grade relates to how well the FDA regulates tobacco products in regard to production, marketing, and sales. They also determine whether Congress is providing enough funds to accomplish this.

The second grade is based on the effectiveness of the federal tobacco tax. Carr explained that the third grade "evaluates quit-smoking coverage and examines the requirements of the four major health insurance programs that the federal government runs -- Tricare, Medicaid, Medicare and federal employee health benefits -- as well as those of the Affordable Care Act state marketplaces."

The last factor they take into consideration is government-run mass media campaigns. There are two campaigns, one aimed at adults called the CDC's Tips from Former Smokers campaign and one aimed at kids 12-17 called the FDA's Real Cost campaign. Even though the feds received an A in media campaigns, they earned a D in coverage for quit-smoking programs and Fs for both regulation policies and taxation.

How the Association Graded States

The five areas that determine the states' grades are tobacco program funding, smoke-free air, tobacco taxes, access to cessation and "Tobacco 21". The six best states, Alaska, California, Hawaii, Maine, Massachusetts and District of Columbia, didn't even earn straight As across all five categories. The worst states, Mississippi, Missouri, Texas and Virginia, scored Fs all across the board.

The tobacco program funding grade is determined by how much money a state spends on programs intended to prevent kids from starting to smoke and to help other people quit smoking as compared to the funding levels recommended by the CDC for each state.

Smoke-free air refers to whether or not a state has made smoking at work and public places, including restaurants and bars, illegal. They also look to see if e-cigs are included in the law.

Report card on states' smoke-free laws

The American Lung Association graded states on whether they'd enacted laws that prohibit smoking in workplaces and public places, including restaurants and bars.

Source: American Lung Association Graphic: Will Houp, CNN

The tobacco taxes grade is similar to the smoke-free air evaluation but instead looks at how much each state taxes cigarettes and whether the state taxes other tobacco products, including cigars and snuff, but not e-cigs. The last category is about "Tobacco 21", which is based on whether the state has moved to raise the minimum age of sale of tobacco to 21.

The lung association has reported that not one state is funding its tobacco prevention efforts at the levels that are recommended by the US Centers for Disease Control and Prevention.

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