Smoking cigarettes is the leading cause of preventable death in the United States, accounting for one in five fatalities. More than 16 million Americans are also living with a disease associated with tobacco use, including stroke, heart disease, cancer, and emphysema.

In the rapidly evolving tobacco market, e-cigarettes and newer vaping products are being marketed to appeal to new customers, targeting youth in particular.  In December 2016, a report by the Surgeon General concluded that e-cigarette use by young people is a public health concern, noting youth use of e-cigarettes has surpassed that of regular cigarettes. In addition, high school boys now smoke cigars at a slightly higher rate than cigarettes.  Local health departments are taking innovative approaches to fighting tobacco use every day, saving countless lives.

Related Content

Advocacy & Policy

  • BCHC joined health groups to write to Senators on Tobacco 21 legislation.

  • The Coalition signed a letter to Representatives to support the Tobacco to 21 Act 2019 and the Reversing the Youth Tobacco Epidemic Act 2019

  • The Coalition signed a letter to Rep Frank Pallone and Rep Donna Shalala to support the introduction of the Reversing the Youth Tobacco Epidemic Act 2019 Act.

  • In a letter to Scott Gottlieb, MD, Commissioner of the Food and Drug Administration (FDA) members of the Big Cities Health Coalition (BCHC) urged the agency to use its regulatory authority to ban flavors in e-cigarettes, or vaping products.

  • The Big Cities Health Coalition signed on to a letter to the U.S. Food and Drug Administration Commissioner Dr. Scott Gottlieb in support of the FDA initiative moving toward a product standard to reduce the nicotine level in cigarettes to non-addictive or minimally addictive levels.

  • Along with 54 other public health organizations, the Big Cities Health Coalition sent letters to relevant House and Senate Appropriations Subcommittees, requesting user fees the Tobacco Control Act authorizes the FDA to collect.

  • BCHC 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.

  • BCHC 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

Click below to explore data on tobacco use and its impact on health on our data platform.

Click below to read about tobacco policies and practices being implemented by BCHC member cities.

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. 


Preventing the Habit Anchors the Big Apple's Tobacco 21 and 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.