Pennsylvania isn’t doing enough to combat tobacco use and the dangers it poses, according to the American Lung Association.

The ALA issued failing and incomplete grades for the state’s funding of tobacco control programming, tobacco taxes and age requirements for tobacco purchases in its annual State of Tobacco Control report. This year’s summary includes health concerns around vaping, which has been linked to the death of at least 60 people and the hospitalization of nearly 3,000, says the Centers for Disease Control and Prevention.

While smoking nationwide has decreased in recent years, vaping — its often-perceived safer counterpart — has spiked. The Truth Initiative reports almost 30% of high school students admit to using e-cigarettes, a tobacco-free alternative that health experts say still carries consequences. The number of young adults (aged 18-24) using e-cigarettes is also on the rise.

Pennsylvania Attorney General Josh Shapiro has filed a lawsuit against one of the leading e-cigarette producers, Juul Labs. In it, Shapiro alleges Juul misled customers about the dangers of e-cigarette use and marketed to teens with its candy and fruit-inspired flavors.

PA’s poor grades

Sarah Lawver, director of advocacy for the ALA in Pennsylvania, said this year’s results reflect statewide inaction when it comes to tobacco and e-cigarette regulation.

“Pennsylvania’s report card shows that much more work needs to be done here by legislators in the commonwealth,” Lawver said.

The ALA’s report rates federal and state governments in five different categories: tobacco prevention and cessation funding, smoke-free air, tobacco taxes, access to cessation services and minimum age thresholds for tobacco purchases (Pennsylvania received either F, D or incomplete grades in each.)

The ALA grades not the effectiveness of tobacco control programs, but how much the state puts into them. Pennsylvania allocates a little over $15 million for said programs, whereas the CDC recommends it should set aside $140 million. That’s less than 13% of the amount the CDC suggests.

Pennsylvania’s Medicaid program and state health plans cover some cessation counseling. But the commonwealth falls short on its quitline, a free telephone service for people trying to stop smoking. The nation’s median investment per smoker is $2.14; Pennsylvania’s is $1.30.

The general assembly passed legislation last November raising the minimum age for tobacco purchases to 21, but the new law doesn’t take effect until July 1.

Compared to surrounding states, Pennsylvania’s performance was neutral. New Jersey received three failing marks but did achieve high ranks for restricted smoking areas and age requirements on tobacco purchases — two categories in which Pennsylvania fared poorly (the commonwealth received a D grade in the former and an incomplete in the latter.) West Virginia, on the other hand, failed four of five sections.

Municipalities’ options for deterring tobacco use are limited to a handful of programs. Under the ALA, groups like the Pennsylvania Alliance to Control Tobacco try educating the public about tobacco regulation and taxes. Youth can join the Tobacco Resistance Unit. Schools can participate in the ALA’s Intervention for Nicotine Dependence: Education, Prevention, Tobacco and Health (INDEPTH) program, which aims to inform students who smoke of tobacco and vaping dangers.

But beyond that, Lawver said, the state’s pre-emption laws cap local governments in enacting efficient tobacco legislation of their own.

“This has become a significant barrier in tobacco control,” Lawver said. “Unfortunately, localities are really limited.”

Tips for quitting tobacco

The side effects of smoking are well known; the CDC says it claims the lives of 480,000 Americans annually. Smoking can lead to lung disease, cardiovascular problems, various types of cancers and fertility issues.

Adults in rural areas — like Carbon County — are nearly 5% more likely to smoke than those in urban ones, the ALA states. Veterans, Native Americans and people living in poverty also smoke at higher-than-average rates.

Using data from the Behavioral Risk Factor Surveillance System, a countrywide health survey administered through the telephone and sponsored by the CDC, the County Health Rankings & Roadmaps program reports that 17% of adults in Carbon County are smokers. The County Health Rankings & Roadmaps program is headed by the Robert Wood Johnson Foundation, a philanthropic health organization, and the University of Wisconsin Population Health Institute.

The program estimates 18% of adults in Pennsylvania are smokers. The commonwealth trails slightly behind the nation’s top performing states.

A nicotine addiction is the same as other drug addictions, said Mia Giordano, smoking cessation coordinator in the St. Luke’s Health Network.

“It’s very powerful and potent, and it results in a really powerful addiction,” Giordano said of the stimulant drug. “It really is a more complex issue than just a habit or just throwing away cigarettes.”

Those hoping to kick a nicotine addiction can talk to their doctor about a prescription for one of the seven medications designed to aid in smoking cessation. Giordano also recommends tracking your smoking routine to identify stressors and healthier ways to deal with them.

Giordano added that addiction rewires the brain; quitting will not happen overnight.

“Quitting is a process,” she said, “not an isolated event.”