Policy Initiatives

Public policy can play a major role in reducing smoking. Increasing taxes on cigarettes, prohibiting smoking in public places, and restricting tobacco marketing are examples of changes that can make a significant impact.

The following webinar from Dr. DiClemente and Mr. William Tilburg (MD Legal Resource Center) in now available for viewing by clicking here:  

"Addressing Tobacco Use in Behavioral Health Treatment Settings:  Policy and Practical Approaches".  


Do Policy Changes Work? Research suggests that local actions can sharply reduce smoking prevalence.1 For example, New York City's 2002 tobacco control strategy increased cigarette taxes, prohibited smoking in bars and restaurants, and increased cessation services. These policy initiatives resulted in an 11% decrease in smoking prevalence among adults from 2002 to 2003 (approximately 140,000 fewer smokers).

How Can I Get Involved? There are various coalitions throughout the state of Maryland that focus on changing smoking policies and reducing tobacco-related illness and death. You can contact your local health department to find out how to get involved with these organizations.

Tax Issues Research has suggested the single greatest policy determinant of youth smoking is the price of cigarettes.2 Maryland's state tobacco tax increased to $2.00 per pack in January, 2008. Now Maryland, along with 5 other states, ranks 4th in the U.S. in terms of highest tax rate per pack of cigarettes. New Jersey ranks 1st with $2.58 tax per pack of cigarettes. The lowest tax is $0.07 in South Carolina.5

  • At the time the legislation was created to increase the cigarette tax, the added revenue was intended to go toward:
  • Funding comprehensive prevention and cessation program for teens
  • Giving thousands of uninsured families access to care
  • Helping small businesses afford health care coverage for their workers
  • Increasing funding for community health centers

The MDQuit June 2009 Newsletter included the following article on the federal tobacco tax increase that went into effect April 1, 2009: Federal Tobacco Tax Increase: Will Smokers be Encouraged to Quit? A federal cigarette excise tax increase went into effect on April 1, 2009. This tax was implemented as part of the Children's Health Insurance Plan (CHIP) Reauthorization bill. The purpose of the tax is twofold - to increase revenue and to potentially decrease youth smoking. The federal tax on cigarettes was raised to $1.01 a pack, an increase of 62 cents. The tax on little cigars was raised to $1.01 a pack, an increase of 97 cents. This is the first time that little cigars and cigarettes have been equally taxed. Large cigars and "cigarillos", which are still sold as single items in many states have a maximum tax of $.40 per cigar.

What might this tax mean for cigarette consumption? For Youth? From 1991 to 2005 the Youth Risk Behavior Survey showed that large tobacco increases were associated with significant reductions in smoking by youth.1 For Minorities? Lower-income and minority smokers are more likely than other smokers to be encouraged to quit in response to cigarette price increases.2 Eight studies in New Zealand from 1981 to 1991 revealed that cigarette taxes reduced demand. Researchers indicated that tobacco taxation will likely provide overall health benefits to low-income residents.3

For Quitline Usage? In Maine, quitline reach jumped from 5% to 6.6% with the implementation of a cigarette tax. In years following, their quitline usage remained higher than in pre-tax years.4 The national quitline transfer number, 1-800-QUIT-NOW, which transfers calls to other local quitlines, registered 203,374 calls in March 2009, more than twice February's 91,316 calls, possibly reflecting smokers' interest in quitting before the tax increase would occur on April 1. An increase in quit attempts may have lasting impact; in 2000, researchers created a predictive model of tax increases and concluded that tax hikes have the ability to affect short-term smoking rates and that these effects grow over time. These findings suggest that tax increases could lead to substantial savings in health care costs, and in human lives.5

Recent Policy-Related Efforts:

  • Civil Citations for Tobacco Retail Violations in Maryland - October 2017 - NEW Toolkit Available!

    Effective October 1, 2017, local health departments or other designees may issue civil citations to retail clerks and/or licensees who sell tobacco products to a minor. The Legal Resource Center for Public Health Policy and the Maryland Department of Health developed "A Guide to Maryland Retail Tobacco Laws & Local Enforcement Programs," which contains resources to assist health and law enforcement officials to understand and implement the newly effective law. The toolkit is available here on the LRC website. 

  • On May 5, 2016  the U.S. Food and Drug Administration (FDA) issued a final rule extending its authority to all tobacco products, including e-cigarettes, cigars, hookah, and pipe tobacco. The rule, which takes effect on August 8, 2016, bans the sale of all tobacco products:

               -To anyone under the age of 18 (online or in-person);
               -Without checking valid ID (of anyone under the age of 27); and
               -In vending machines (except adult-only facilities).

       The FDA and the Tobacco Control Legal Consortium have put together the following summary
       materials on the final rule:

               -The Deeming Regulation: FDA Authority Over E-Cigarettes, Cigars, and Other Tobacco Products
               -FDA Press Release              
               -State and Local Tobacco Regulation in a Post-Deeming World

  • The American Lung  Association recently launched the tenth State of Tobacco Control report. The 2012 State of Tobacco Control informs about the current policy efforts at the state and federal level.  All 50 States and the District of Columbia are graded based on how current policies are adequately protecting the citizens from tobacco smoke effects. To see where Maryland's current policies and efforts stand see: MARYLAND Report Card.
  • The Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act - TCA) became law on June 22, 2009.  The TCA authorizes the FDA to regulate the manufacture, distribution, and marketing of tobacco products in order to protect the health of the American public.  The FDA has simplified the TCA to make it easier to understand -- visit the Searchable Tobacco Control Act at the FDA’s website, www.fda.gov/TobaccoControlAct.
  • The FDA released two draft guidance documents to help fight the tobacco epidemic and help prevent the initiation of tobacco in children. The draft guidance documents implement provisions of the Family Smoking Prevention and Tobacco Control Act (2009) that will allow the public to be privy to previously unknown information about the chemicals in tobacco products and help prevent misleading marketing about the risks associated with tobacco products.

Policy-Related Reports:

  • The Point-of-Sale Report to the Nation was recently released by researchers at the Center for Public Health Systems Science at Washington University in St. Louis, Stanford Prevention Research Center, and the UNC Gillings School of Global Public Health. The report provides information regarding the current state of the retail environment including the density and location of tobacco retailers, industry POS marketing tactics, and the availability of various types of tobacco products.

For more information about policy change:

Please review the following presentation by Kathleen Dachille, J.D., describing the various levels of policy legislation and regulations. 



1 Center for Substance Abuse Research. (2009). Federal Tobacco Tax to Increase by 62 Cents Per Pack; Increases in Tobacco Tax Have Been Shown to Reduce Youth Smoking. CESAR Fax, 18 (6). http://www.cesar.umd.edu/cesar/cesarfax/vol18/18-06.pdf

2 Centers for Disease Control & Prevention. (1998). Response to Increases in Cigarette Prices by Race/Ethnicity, Income, and Age Groups -- United States, 1976-1993. Morbidity & Mortality Weekly Report, 47, 605-609. http://www.cdc.gov/mmwr/preview/mmwrhtml/00054047.htm

3 Wilson, N., Thomson, G. (2005). Tobacco tax as a health protecting policy: a brief review of the New Zealand evidence. The New Zealand Medical Journal, 118.

4 Woods, S. S. (2007). Increasing reach of quitline services in a US state with comprehensive tobacco treatment. Tobacco Control, 16(suppl), i33-i36.

5 Levy, D.T., Cummings, K.M., Hyland, A. (2000). Increasing taxes as a strategy to reduce cigarette use and deaths: results of a simulation model. Preventive Medicine, 31, 279-86.