The American Lung Association released its 2024 State of Tobacco Control report Wednesday, which evaluates state efforts to eliminate tobacco use. Indiana scored failing grades in most categories.

The report compares state policies to evidence-based practices known to prevent youth from using tobacco and help smokers quit.

Data shows Indiana’s tobacco prevention and cessation programs are working, but the state still doesn’t have the number of programs recommended by the Centers for Disease Control and Prevention for a state of this size and population.

That’s one of the five evidence-based strategies the American Lung Association analyzed to assess states’ efforts to prevent youth from using tobacco and help adults to quit.

Tiffany Nichols, director of advocacy for the American Lung Association in Indiana, said the state’s grades look similar to some southern states.

Indiana scored the following grades: 

1. Funding for state tobacco prevention programs – Grade F
2. Strength of smoke-free workplace laws – Grade C
3. Level of state tobacco taxes – Grade F
4. Coverage and access to services to quit tobacco – Grade C
5. Ending the sale of all flavored tobacco products – Grade F

Over the past decade, the state has seen an uptick in e-cigarette usage, not dissimilar to the rest of the country. However, Indiana’s cigarette consumption has decreased 13% from 2020 to 2023. 

There are multiple reasons why Indiana has struggled to curb tobacco usage, according to the report. 

The state’s prevention and cessation programs are drastically underfunded at roughly $10.9 million a year. That’s 14.9% of the level recommended by the CDC, which is $73.5 million annually.

Indiana’s cigarette tax, which is just under $1, hasn’t been increased since 2007. The highest cigarette taxes of more than $4 are in Connecticut, New York and Rhode Island.

Advocates have tried to increase the cigarette tax for nearly a decade. Lawmakers considered a bill last year to increase the tobacco tax up to $2, but the legislation failed. Nichols thinks some lawmakers might believe it’s a tax on people who are low-income, one of the demographic groups that typically uses tobacco.

“We’re not trying to tax the poor, but we know that it’s an evidence-based strategy that will help many, many Hoosiers finally decide to quit,” Nichols said. “And it will help a lot of young people decide that smoking just isn’t something that they want to do once the price hits a certain threshold.”

According to the report, smoking costs the state around $2.9 billion annually in healthcare costs.

This year Nichols said she’s focused on educating lawmakers so they’re prepared for the budget session next year. She recommends Indiana add e-cigarettes to the state’s existing smoke-free air law. 

According to the report, menthol cigarettes and flavored cigars stand in the way of tobacco prevention efforts because more young adults start using cigars with flavored versions compared to older adults.

“Data from the 2023 National Youth Tobacco Survey (NYTS) show that 64.8% of middle and high school students who smoke cigars use flavored cigars, amounting to 270,000 kids. Menthol flavored little cigars can also easily act as substitutes for menthol cigarettes if their sale is not prohibited at the same time,” according to the report.

Menthol cigarettes are also popular among Black people who smoke, with over 80% of them using method cigarettes.

Nichols hopes President Joe Biden’s administration will approve an FDA rule to eliminate menthol and other tobacco flavorings.

The Indiana Tobacco Quitline can be accessed here.

Contact WFYI’s health reporter Elizabeth Gabriel at egabriel@wfyi.org.