Health advocates say state government needs to do a lot more about tobacco, including letting local governments regulate sales

Map by Bridging Research Efforts & Advocacy Toward Healthy Environments, University of Kentucky

As the state legislature ponders allowing local governments to again regulate tobacco sales, the Lexington Herald-Leader has produced a comprehensive report showing the damage done to Kentucky's health by the crop that once accounted for almost half the state's farm income – and politicians' unwillingness to do much to limit the damage.

"The state’s response has been among the most anemic in the country, tobacco control advocates say. The state spends a fraction of what’s recommended to prevent people from starting to smoke and help smokers quit, and its tax rate on cigarettes is among the lowest in the country," Bill Estep reports.

High-school students in Kentucky smoke more than in any other state, 8.9 percent of them, according to the American Lung Association. The adult smoking rate, 21.4 percent, is the nation's second highest, trailing only West Virginia's 22.6%; the national rate is 14%. In Monroe, Metcalfe and Wolfe counties, the adult rate is 45%, 44% and 42%.

Kentucky's lung-cancer rate of 88 annual cases per 100,000 residents is the highest in nation; the U.S. rate is 57. The state also has the highest death rate from lung cancer.

The Campaign for Tobacco-Free Kids estimates that 8,900 Kentucky adults die each year due to smoking, "and that health-care costs tied to smoking total $1.92 billion a year, not counting any impact from secondhand smoke," Estep reports. "The organization said nearly $600 million of that spending is through Medicaid, a taxpayer-funded program. The state and federal tax burden per household in Kentucky from smoking is $874."

But the tobacco industry usually wins in Frankfort. In the mid-1990s, the General Assembly prohibited cities and counties "from having their own rules on the use, display, sale and distribution of tobacco products," Estep notes. "The law means communities can’t limit the visibility of cigarettes in convenience stores, for example, or prevent vape shops from locating close to schools."

Sen. Wil Schroder

The ban would be repealed by Senate Bill 166, filed by Sen. Wil Schroder, a Northern Kentucky Republican. The tobacco industry is against it. David B. Sutton, a spokesman for Altria Group, the nation's leading cigarette maker, "said the state should avoid a confusing patchwork of local rules and taxes," Estep reports. Sutton said a varying rulebook “makes operating a business more complex and confusing for retailers trying to operate within the bounds of the law.”

Last year, when two similar bills were introduced, "Supporters had counted heads and thought they had the votes to pass the bills," Estep writes. "But the bills died a quick death. They didn’t get a hearing, much less a vote. Altria, a leading tobacco company, spent $73,627 on lobbying in the first three months of the legislative session as two bills were bottled up in committee."

As in many other states, the legislature has also refused to spend more money on tobacco cessation and prevention programs, keeping the about at $2 million a year. The state gets tobacco-related revenue of almost $500 million a year, and the Centers for Disease Control and Prevention recommends that it should spend $56 million of it to help people quit and keep others from starting.

The Foundation for a Healthy Kentucky estimates the tobacco industry spent $246 million in 2020 in Kentucky promoting its products, Estep notes.

It all adds up to a need to act on many fronts, said University of Kentucky nursing professor Ellen Hahn, director of a project called BREATHE (Bridging Research Efforts and Advocacy Toward Healthy Environments) that has led anti-tobacco efforts in the state.

“Tobacco’s an addiction. It’s really rampant across Kentucky, so to fix it we need every tool in the toolbox,” Hahn told Estep. “If local communities have their hands tied and they can’t pass rules for instance that make it harder for youth to purchase tobacco products, it just limits our ability to fix the problem.”

Estep's story is accompanied by others. He has a story about the continued but slow expansion of local governments that ban smoking in workplaces and public indoor spaces, and another one about the benefits of quitting smoking and resources that are available to people who want to quit.

Alex Acquisto writes that the main battle over tobacco in Kentucky has shifted to teenagers' use of electronic cigarettes: "In 2019, the last year the data was available, more than one in four high school-aged students (over 30%) used e-cigarettes, also known as vaping, as did 20% of middle schoolers – the highest rate of any of the 11 states surveyed that year. At least 50% of high school students at each grade level admitted to ever having used tobacco products, and closer to 30% said they vaped frequently." The local-regulation bill is intended partly to enable local governments to discourage youth use of tobacco products.