A new report on lung cancer has mixed news for Central Appalachian states.

The American Lung Association says Kentucky and West Virginia continue to have the nation’s highest lung cancer rates — and the highest smoking rates — according to its 2025 State of Lung Cancer report.

Kentucky ranks worst in the nation for new lung cancer cases, while West Virginia ranks second. Both states also lead the country in adult smoking — with West Virginia at just over 20 percent and Kentucky at 17 percent.

Despite those numbers, both states are seeing progress. The report shows five-year survival rates have improved in recent years — up to 32 percent in Kentucky and 27 percent in West Virginia. Kentucky also ranks above average in screening, with more than 21 percent of high-risk residents getting checked, while West Virginia remains below average at just 15 percent.

The American Lung Association is calling on both states to expand access to screening, increase funding for tobacco prevention, and ensure insurance coverage for biomarker testing — which helps match patients with targeted treatments.

You can read the full report on the American Lung Association’s website.

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Has KY House Bill 11 had any effect?

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WASHINGTON, D.C. — Back in December of 2019, Republican Sen. Mitch McConnell and Democratic Sen. Tim Kaine, of Virginia, teamed up to pass a bill to raise the minimum age to buy tobacco and vaping products from 18 to 21.

Now the two are joining forces again, this time to urge the Food and Drug Administration to begin implementing and enforcing the new requirement.

“There have already been significant delays in the rulemaking process and limited communication about these delays, resulting in a lack of clarity on enforcement,” the letter reads. “We urge the FDA to act swiftly to issue a final rule and to increase transparency around enforcement of Tobacco 21.”

The two senators sent a letter to the FDA, asking for information on when new regulations will be finalized.

“We are concerned about the impact that the delay in issuing the final rule has had on enforcement of Tobacco 21,” the letter reads. “The Tobacco 21 legislation, if properly enforced, is an important tool to reduce the number of children in our country who attempt to access an age-restricted product, which if accessed, may lead to addiction to tobacco and nicotine products. However, without updated sales compliance regulations from the FDA, Congress cannot ensure retailers are abiding by the law.” 

McConnell and Kaine say they understand that the pandemic resulted in some delays, but they are concerned the age-requirement is not being followed without compliance and enforcement numbers.

A full copy of the letter follow:

Dear Commissioner Califf,

            We write to you to express concern about the delays in finalizing regulations related to the Tobacco 21 legislation and the lack of transparency around the implementation and enforcement of that legislation. This legislation, signed into law on December 20, 2019, raised the federal minimum age for sale of tobacco products from 18 to 21.[1] While this change became effective immediately, the Food and Drug Administration (FDA) was also required to promulgate a final rule to conform regulations to that statutory change.[2] There have already been significant delays in the rulemaking process and limited communication about these delays, resulting in a lack of clarity on enforcement. We urge the FDA to act swiftly to issue a final rule and to increase transparency around enforcement of Tobacco 21.

In addition to raising the minimum age for the sale of tobacco products, Tobacco 21 required the FDA to report back to Congress on its progress in implementation and enforcement of the legislation. Specifically, the FDA was required to provide a report on its progress in March 2020, 90 days after the legislation was enacted, and a separate report justifying any delay if a final rule was not issued by June 2020.[3] To date, the FDA has not issued any rules. While we understand and appreciate the FDA’s work to help fight the COVID-19 pandemic, more than two years have passed since enactment, and 20 months have passed since the rules should have been promulgated. In the Fall 2021 Unified Agenda for the Department of Health and Human Services, the new target date for the final rule was set for March 2022.[4] However, there has been limited communication about the FDA’s progress in meeting this target date.

We are concerned about the impact that the delay in issuing the final rule has had on enforcement of Tobacco 21. The Tobacco 21 legislation, if properly enforced, is an important tool to reduce the number of children in our country who attempt to access an age-restricted product, which if accessed, may lead to addiction to tobacco and nicotine products. However, without updated sales compliance regulations from the FDA, Congress cannot ensure retailers are abiding by the law. For example, the FDA has indicated that a final rule is necessary to raise the federal threshold for checking a tobacco product purchaser’s age from under age 27 to under age 30.[5] In Fiscal Year 2019, the FDA was able to conduct 146,905 compliance checks through the Tobacco Retailer Inspection Program and issued 14,673 warning letters.[6] While in Fiscal Year 2020, the FDA conducted 65,716 compliance checks and issued 4,906 warning letters, a more limited number of inspections due to public health considerations during the COVID-19 pandemic.[7] Robust enforcement action is needed to adequately monitor the approximately 400,000 retailers in the country and ensure that the Tobacco 21 legislation is being implemented as Congress intended.[8]

To increase transparency, we specifically ask that the FDA respond to the following by March 25, 2022:

1.                   Please provide a timeline for issuance of the final rule to update regulations to reflect Tobacco 21, including details on the rule’s current status in the review process and an explanation for why FDA did not meet the statutory deadline for issuing a final rule.

2.                   How has the delay in issuing a rule impacted the agency’s ability to conduct enforcement around Tobacco 21?

3.                   How does the FDA determine how many compliance checks it will conduct in a given year?

4.                   How does the Center for Tobacco Products determine which states or retailers to conduct compliance checks in? What steps is the Center taking to ensure that robust enforcement occurs in all states? What metrics, if any, does the Center use to target enforcement efforts geographically?

5.                   What are the Center for Tobacco Products’ protocols for Undercover Buy inspections when underage individuals attempt to purchase tobacco products? Has the lack of a final rule impacted the FDA’s approach to Undercover Buy inspections?

Thank you for your continued efforts to protect young people from harmful tobacco products, and we look forward to your timely response.

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