Local health departments are on the front lines of America's battle against chronic diseases, such as obesity, diabetes and heart disease. Tobacco use remains a significant public health issue. 

In the ever-evolving tobacco market, e-cigarettes and newer vaping products, are being marketed to appeal to youth in particular. While many local health departments have taken steps to curb sales and use of e-cigarettes, not all localities have this regulatory authority and there are additional areas, such as marketing, manufacturing and labeling, where the Food and Drug Administration is responsible for oversight. 

In addition, a national consensus is growing around raising the age of so-called traditional tobacco products to prevent addictions and future health problems by supporting Tobacco 21. Tobacco 21 is a policy that has been put in place by localities throughout the U.S. to raise the age of tobacco sale from 18 to 21. Nearly all (95 percent) of adult smokers started before they were 21, demonstrating the critical importance of keeping young people from ever starting.Three-quarters of Americans favor raising the tobacco age of sale to 21 years, including seven in ten smokers.

A report by the Institute of Medicine (IOM) concluded that raising the tobacco sale age to 21 could significantly reduce the number of adolescents and young adults who start smoking, and over time will reduce adult smoking by about 12 percentIt would also result in 223,000 fewer premature deaths, 50,000 fewer deaths from lung cancer, and 4.2 million fewer years of life lost for those born between 2000 and 2019. Tobacco 21 will also reduce medical costs. Tobacco use costs the United States approximately $170 billion in direct medical costs and $156 billion in lost productivity every year.

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Advocacy & Policy

  • The Big Cities Health Coalition and public health groups joined to write a letter to U.S. House and Senate Appropriations Committee leaders, requesting that they protect the Centers for Disease Control and Prevention’s Office on Smoking and Health. 
  • The Coalition held Tobacco 21: Raise the Age to Save Lives, a Congressional briefing, in collaboration with Trinity Health and the Campaign for Tobacco-Free Kids.

City Data

Explore data on tobacco use and it's impact on health on the Big Cities Health Inventory (BCHI) Data Platform:

The Mitigating Tobacco Policy Page puts the BCHI data in context and outlines policies and practices being implemented by BCHC member cities:

Read about King County's ban of e-cigarette devices

Read about King County's ban of e-cigarette devices

Early E-Cigarette Ban Reignited Seattle-King County's Effort to Snuff Out Tobacco Smoking

In 2010, when electronic cigarettes were little more than novelties, King County, home to Seattle, Washington, restricted their sale and use, along with nicotine electronic juices and other unapproved nicotine delivery devices. In doing so, Seattle became the first big-city jurisdiction to: 1) prohibit the sale of e-smoking devices to those under 18; and 2) ban the devices in restaurants and other public places and workplaces, mirroring tobacco smoking restrictions already in place. 

Find out how NYC gained the upper hand in fighting tobacco use. 

Find out how NYC gained the upper hand in fighting tobacco use. 

Preventing the Habit Anchors the Big Apple's Tobacco 21 & Minimum Price Laws

Seeing youth smoking rates stall at 8.2 percent in 2013 after slashing them by half in the early 2000s, New York City took big steps in 2013 to regain the upper hand in fighting tobacco use. The Big Apple boosted the minimum sales age for tobacco products from age 18 to 21—the first big city to do so—and raised the minimum sales price on cigarettes and little cigars to $10.50 a pack throughout the five boroughs.