Tobacco use remains one of the leading preventable causes of death killing over an estimated 480,000 Americans annually. While youth smoking rates have declined, use of electronic cigarettes has skyrocketed among adolescents over the last decade. There are increasing efforts to regulate electronic cigarettes are happening all over country, but the perception of these products being a safe tobacco alternative make e-cigarettes more difficult to stigmatize among adolescents and young adults.

This is a priority because…

  • The Midwest has the highest adult tobacco use rate in the country.
  • There are significant gaps in tobacco use based on socioeconomic status; those with a GED are nine times more likely to smoke than those with a bachelor’s degree.
  • Tobacco control efforts have a significant return on investment, with states realizing savings of at least $2 for every dollar spend on tobacco control, though most studies show a $10 or more return on investment.

Iowa’s adult tobacco use rates mirror the national average of 17.1%; over 5,000 Iowans die each year from smoking. Tobacco control efforts at the state are funded well below the CDC’s recommended level and the $1.36 per pack tobacco tax ranks 30th in the country. 

Adults on Medicaid smoke at more than twice the rate of those on private insurance. Based on the CDC estimates, tobacco use costs Iowa Medicaid more than $400 million annually.


The long-term damage of vaping is coming to light after they became widely available a in the late 2000’s. In 2019, the CDC recorded 2,561 cases of E-Cigarette/Vaping Associated Lung Injury (EVALI). Early shows that teens who vape are more likely to use tobacco as adults. In 2018, about 9% of 11th graders in Iowa use electronic cigarettes, which is significantly lower than the national average of 13.2%.

The federal government recently raised the age to for tobacco and e-cigarette purchasing to 21 which should have an immediate impact on youth use and a long-term impact on adult use. However, IPHA advocates for additional best practices to lower tobacco and e-cigarette use, such as increasing state taxes on tobacco and electronic cigarettes, improving access to cessation medication, eliminating the sale of flavored e-cigarettes, and increasing the number of smoke-free/vaping-free locations.

Iowa resources

Iowa Department of Public Health – Tobacco Use Prevention and Control

Iowa Students for Tobacco Education and Prevention

National resources

Centers for Disease Control and Prevention – Smoking and Tobacco

Centers for Disease Control and Prevention – Electronic Cigarettes

Campaign for Tobacco Free Kids

American Public Health Association-Tobacco