American Lung Association gives Arizona a failing grade for lack of regulation on tobacco products targeting teens

(Video by Liz Flores/Cronkite News)

PHOENIX – Arizona gets an F for its attempts to regulate flavored tobacco products popular among young people and in spending on programs to control and prevent use of tobacco, which still is the No. 1 preventable cause of death in the United States, the American Lung Association says.

According to the association’s 20th annual State of Tobacco Control, 20.7% of Arizona high school students use tobacco in some form, including cigarettes, vaping and smokeless products.

From 2011 through 2019, the number of American high school students who used e-cigarettes increased by more than 1,000%, according to the lung association website. Wednesday’s report found that the majority of high schoolers who use tobacco do so by vaping flavored tobacco distillates, which the U.S. Surgeon General has labeled an “epidemic.”

“There’s still a lot we don’t know about e-cigarettes,” JoAnn Strother, American Lung Association director of advocacy, told Cronkite News. “We really don’t know what we’re putting in our lungs. We’re still continuing to study that. But the most important thing is trying to keep youth from becoming addicted.”

The annual report evaluates states and the federal government on their efforts to curb tobacco use. Arizona received an A in smoke-free air and mixed reviews for access to programs for people who want to quit smoking.

Strother said one of Arizona’s most prominent issues is its lack of regulation for tobacco sales. Arizona is among a handful of states that don’t have a tobacco retailer law, “so we don’t even really know who can sell tobacco, who’s allowed to and who’s doing it,” she said.

Phoenix, Tempe and other cities have attempted to regulate the sale of flavored tobacco products to reduce the number of youth becoming tobacco users. However, some tobacco companies have lobbied the Legislature to shut down these city ordinances at the state level.

Tobacco companies argue that e-cigarettes are a safer alternative to leaf tobacco and a path to eventually quitting.

Altria, a company whose business portfolio includes several of the leading tobacco product companies in the U.S., including Marlboro and JUUL, did not respond to a request for comment.

On its website, Altria says its goal is to “responsibly lead the transition of adult smokers to a smoke-free future … by taking action to transition millions to potentially less harmful choices – believing it is a substantial opportunity for adult tobacco consumers, our businesses and society.”

A no-smoking sign is displayed Wednesday on the shuttered Even Stevens sandwich shop in downtown Phoenix. The American Lung Association gives Arizona an A for creating smoke-free spaces over the past 20 years, but it faults the state for not doing more to prevent the No. 1 cause of preventable deaths in the U.S. (Photo by Genesis Alvarado/Cronkite News)

“Some of the best public health ordinances are done on the local level,” Strother said. “Local communities need to be able to have that control because they need to do what’s best for their communities. There is a bill circulating that would preempt cities from doing that, and we’re really trying to shut that down and make sure that cities have a voice.”

Alex Muñoz, 23, started smoking when he was 14, after discovering a pack of cigarettes with some of his friends.

“We saw everyone else doing it,” Muñoz said. “We just wanted to experience it.”

Now he uses tobacco every day, regular cigarettes and e-cigarettes, as well as nicotine patches. But his favorite product is vaping because “it’s more refreshing and it smells better.”

The rate of adult smokers in Arizona is 13.1%, according to the report. No information was available about the rate of use for other tobacco products among Arizona adults.

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The report stated that although the adult smoking rate nationally has decreased by 35% from 2003 to 2019, “significant disparities” exist along racial, ethnic and socioeconomic lines.

The cigarette-smoking rate among Native American adults is 20.9% and 19.2% among LGBTQ+ adults. The report says African Americans also face higher exposure to tobacco use, including secondhand smoke, although it gives no numbers.

“A tactic of the tobacco industry is to market their products towards certain groups,” Strother said. “Certainly African Americans get targeted with menthol products, our LGBTQ+ community gets targeted with certain products, just teens in general. The industry knows what products will appeal to these groups, and they sink a lot of money into trying to addict new customers.”

Despite Arizona receiving a failing grade in regulation of flavored e-cigarette products, the state’s numbers are slightly lower than those at the national level, where high school tobacco use is reported to be 23.6%. Strother said she believes this likely is due to the state’s attempts to educate youth about the health risks of using tobacco.

Muñoz knows he has a bad habit and plans to quit someday, “but as of right now, I just don’t see that happening.”

Endia Fontanez end-ee-uh fohn-tawn-ayz (she/her)
News Reporter, Phoenix

Endia Fontanez expects to graduate in May 2022 with a bachelor’s degree in journalism and a minor in women and gender studies. Fontanez, who is in Barrett, the Honors College and interning with The Arizona Republic, is working for the Phoenix news bureau.

Lizbet Flores Liz-bet Floor-ehz (she/her/hers)
News Broadcast Reporter, Phoenix

Lizbet Flores expects to graduate in December 2022 with a bachelor’s degree in journalism and mass communications and a minor in business studies. Flores, who has reported for The State Press, is working for the Phoenix news bureau.

Genesis Alvarado Jeh-nuh-suhs Aal-vr-aa-dow (he/him)
News Visual Journalist, Phoenix

Genesis Alvarado expects to graduate in May 2022 with a bachelor’s degree in journalism and mass communication. Alvarado, who was a photojournalist for The Arizona Western Voice in Yuma, is working for the Phoenix news bureau.

Michelle Ailport mi-SHEL AYL-port (she/her/hers)
News Digital Producer, Phoenix

Michelle Ailport expects to graduate in May 2022 with a master’s degree in mass communication. Ailport, who graduated from ASU in May 2021 with a degree in journalism and mass communication, is working for the Phoenix news bureau.

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