The American Lung Association gave Connecticut mixed grades, including two "Fs," in an annual report on state efforts to curb smoking.

Tobacco use remains the leading cause of preventable death and disease in the state and nation. The nonprofit organization called on Connecticut leaders to protect and increase funding for prevention and cessation programs, defend the state's indoor air laws protecting residents from secondhand smoke, and reduce youth access to tobacco through local zoning rules and ordinances targeting flavored tobacco products.

"After a very promising year in the 2022 Connecticut General Assembly, the 2023 session had mixed results when it comes to tobacco control policy," the Lung Association reported in its State of Tobacco Control report.

The report lists health care costs in the state due to smoking at about $2 billion. About 4,900 Connecticut deaths each year are attributed to smoking, while about 10 percent of adults in the state continue to smoke, according to the report.

The association gave the state an "F" for tobacco prevention and cessation funding, but also applauded "champions in the state legislature" for allocating $12 million in funding this fiscal year for the state's Tobacco and Health Trust Fund. Last year, according to Attorney General William Tong, Connecticut received $124.6 million, part of a total of about $3 billion to date, from a 1998 settlement between tobacco companies and 52 states and territories to compensate for health care costs that states pay on behalf of residents suffering from smoking-related illnesses.

The Lung Association report lists annual state and federal funding to combat tobacco use in Connecticut at $13.8 million, well short of the $32 million the federal Centers for Disease Control and Prevention recommends.

State Sen. Saud Anwar, co-chairman of the legislature's Public Health Committee, noted that historically, the state has not used the settlement funding for its intended purpose. A physician who specializes in lung disease, the South Windsor Democrat said that in contrast, tobacco companies spent $57 million last year to market their products in the state.

"We are losing ground because they are fighting their battle to hurt us, to hurt our next generation," Anwar said.

The Lung Association report also references the state's $16 million share of settlement funds from JUUL, a vaping products company. The money is to be used to fight vaping and nicotine use among the state's youth. Connecticut led 34 states and territories in brokering the settlement, resolving a two-year bipartisan investigation into the company's marketing and sales practices.

Connecticut gets a "B" for "smoke-free air," but the Lung Association also noted that "unfortunately" the state legislature approved a law last year that ended the long-standing prohibition against the spread of cigar bars. Effective Oct. 1, 2023, the legislation rolled back parts of the state's Clean Indoor Air Act "to once again allow cigar bars in certain municipalities and under limited conditions to obtain a liquor permit and allow smoking or vaping in the business," according to an official summary of the amendments.

Public health advocates, as the Lung Association report noted, have expressed concerns "about what this will mean moving forward, especially considering proponents of the bill specifically stated they see this as a pilot program with the hope for growth in coming years."

The Lung Association gave the state another "F" in efforts to curb flavoring in tobacco products, particularly menthol cigarettes. Health advocates have focused on the particular harm menthols cause to the Black community, citing statistics that smoking kills 45,000 Black Americans each year, and lung cancer kills more Black Americans than any other type of cancer. In Connecticut, an estimated 8,200 adult smokers would quit if menthol cigarettes were no longer available, according to the CDC.

The Public Health Committee last year introduced a bill that would have prohibited the sale of flavored cigarettes, tobacco products, electronic nicotine delivery systems, and vapor products, but menthol cigarettes were excluded. The sticking point, Anwar said, has been the expected loss in tax revenue. In 2021, the Public Health Committee passed a bill that would have banned all flavored tobacco products, including menthol cigarettes. However, after nonpartisan budget analysts said the state could lose nearly $200 million in tax revenue in two years from a menthol ban, leaders of the finance committee removed the proposal.

Anwar said he has a meeting planned with leaders of organizations focused on heart and lung health to talk about strategies on the issue in the upcoming legislative session.

The Lung Association gave Connecticut a "C" for access to cessation services and a "B" for tobacco taxes. The tax on a pack of 20 cigarettes in the state is $4.35, third highest in the nation behind New York state at $5.35 and Washington, D.C., at $4.50.

Nationwide, the CDC puts the annual death toll from smoking at 480,000. That count should start to fall around 2030, according to a study published last year by the American Journal of Preventive Medicine, thanks in part to a decline in smoking rates (now about 11 percent in the U.S.) that began in the 1960s, when more than 42 percent of adult Americans smoked.