Nevada once again received failing grades for its tobacco control policies in the latest report card from the American Lung Association.

Last year, the state received “F” grades in all but one category. This year, the state again received a “C” for smoke-free air, while earning failing grades in every other category, including tobacco prevention and control program funding, tobacco taxes, access to cessation services and restrictions on flavored tobacco products.

“The surge in youth vaping combined with the fact that smoking increases the chance of severe COVID-19 symptoms, make it more important than ever for Nevada to implement the proven measures outlined in State of Tobacco Control to prevent and reduce tobacco use,” JoAnna Strother, the association's senior director of advocacy, said in a press release alongside the report.

The problems present in Nevada are also common throughout the rest of the country. The association’s 19th annual State of Tobacco Control report, released Wednesday, gave failing grades to 41 other states for tobacco prevention funding and to 32 states for their tobacco tax policies.

The report calls for significant policy changes to combat the use of tobacco and the ongoing youth vaping epidemic.

The latest data on youth smoking from 2019 shows that more than 21 percent of high schoolers in Nevada used tobacco, but a new federal law passed in late 2019 that raised the minimum age to 21 for tobacco product sales helped decrease youth tobacco sales in the state last year.

Even with decreased youth sales, the association still noted that the lack of restrictions on the sale of flavored tobacco products is a serious problem and recommends policies that remove them from the marketplace, as youth vaping and tobacco use is largely driven by flavored tobacco products.

“By removing that, we can really take a strong policy stance to protect these kids and youth from becoming lifelong addicted tobacco users,” Strother told The Nevada Independent.

The report also calls on the state’s elected officials to protect and expand the Nevada Clean Indoor Air Act, increase funding for tobacco prevention, and increase excise taxes on tobacco products.

Strother said that Nevada has already made some progress towards having comprehensive statewide smoke-free air laws, as Park MGM became the first smoke-free Las Vegas resort. But ties between smoking and the gaming industry could slow that progress.

Strother said the association is already in talks with lawmakers about increasing the statewide tobacco tax.

In Nevada, the tax on cigarettes is $1.80 per pack, which is higher than many other states including Missouri, where the per-pack tax is only 17 cents. But the rate falls far below the recommendations provided by the lung association, which gave its only “A” grade for tobacco taxes to the District of Columbia, where the tax on cigarettes is $4.50 per pack.

“We are below the national average when you look at tobacco taxes, and so that's something that we're definitely talking to policymakers about this legislative session is to increase that tax by at least a dollar,” said Strother.

As the youth vaping epidemic has worsened in the past few years, smoking has become more prominent in public health discussions. Earlier this year, public health experts met at the state’s cannabis and vaping summit to create a plan that could be used to address Nevada’s tobacco problem and prevent youth use of the substance.

With calls for tobacco policy change coming from the lung association and the summit, Nevada lawmakers may feel more pressure from public health advocates in the upcoming legislative session to address tobacco-related policy, such as raising the minimum age for tobacco product sales from 18 to 21 and bringing the state in compliance with the federal law.

Strother said that the policy change is important for enforcement because the state normally only checks that a business is complying with the state’s minimum age requirement and not the federal requirement.

“We know that retailers do fail compliance checks, they do sell to under the age of 21, and even 18, like state law. And so really, this is just to help bring retailers in compliance,” said Strother.