The Lone Star State is failing to discourage and reduce the smoking of tobacco, claims a recent report by the American Lung Association (ALA).

The report gave Texas an F-grade on all accounts, declaring it failed in categories that included “tobacco prevention and cessation funding, smoke-free air, tobacco taxes, access to cessation services, and flavored tobacco products.”

“Despite the improvements around tobacco and e-cigarette retail licensure, the state significantly cut funding for tobacco enforcement programs, leading to thousands fewer controlled buys on tobacco retailers,” asserted the organization in a news release.

Healthcare costs due to tobacco use in the state of Texas are estimated to be just under $9 billion, with the rate of adult smokers being about 13%, and the number of deaths per year that can be attributed to smoking is just over 28,000, per a 2020 survey cited in the report.

According to the Centers for Disease Control and Prevention, almost 500,000 people die from smoking-related illnesses yearly, though, while preventable, pales compared to the roughly 2.8 million that die due to obesity and related diseases.

Further, when the two epidemics coincide, it can compound the negative health effects; research suggests that a person who is both obese and a smoker demonstrates a greater risk of mortality.

As previously reported in The Dallas Express, North Texas’ high obesity rate means a large subsection of Texas residents are at greater risk for adverse health consequences if they use tobacco.

The ALA has called on Texas lawmakers to address their F grades and reduce the use of tobacco products and exposure to second-hand smoke by increasing funding for tobacco prevention programs, raising taxes on tobacco products, and improving surveillance of tobacco retailers to ensure compliance.

Texas state law currently restricts the use of tobacco products in areas such as schools, childcare facilities, as well as recreational and cultural facilities. However, there are no provisions for workplaces, restaurants, bars, stores, and casinos.

Charlie Gagen, the ALA director of advocacy for Texas and Oklahoma, said that Texas is failing these grades because the state “refuses to do most of what’s recommended,” according to the Austin American-Statesman.

The Texas Department of State and Health Services (TDHS) has previously recognized the dangers caused by smoking, noting that second-hand smoke can cause lung cancer, heart disease, and stroke.

TDHS said it intends to reduce the impact of tobacco across the state through measures such as prevention programs, enforcement of existing tobacco laws, and cessation programs.

The agency established Tobacco Prevention and Control Coalitions to reduce the use of tobacco across the state, specifically among Texas youths.

Additionally, Texas passed a law in 2019 raising the age of sale for tobacco products to 21 before a similar law was federally enacted.

State law also requires e-cigarette companies to be licensed by Texas regulatory agencies, something 17 other states have yet to do.

One expert noted that it could actually be the growing prevalence of e-cigarettes, especially among young people, that is undermining anti-tobacco efforts.

“We know that nicotine is incredibly addictive. For the adolescent brain, it’s actually primed to become more addicted to various substances, including nicotine,” said pediatric pulmonologist and UT Southwestern assistant professor Dr. Devika Rao, speaking with NBC 5.

“And so it’s not surprising that use of tobacco nicotine products in youth leads to an increased likelihood of smoking solely because of how the adolescent brain is primed to become addicted,” she said.