Tackle the Ills of Smoking and Tobacco Use 

While tobacco use is decreasing, Texas still continues to have higher rates of death attributable to smoking — 273 per 100,000, which is 10 percent greater than the national average of 248.5 per 100,000.[39] A major way to decrease smoking-attributable illnesses and deaths is by preventing minors and young adults from ever taking up the tobacco habit. More than two out of three of Texas’ adult smokers started smoking regularly at age 18 or younger, and 85 percent started at age 21 or younger.[40] The Centers for Disease Control and Prevention (CDC) estimates about 23,000 Texas minors start smoking each year. 

 Smoking during pregnancy is of particular concern to physicians because of the increased risk of preterm births; it’s a factor in 20 to 30 percent of low-birth weight births. And while the percent of women who smoke during pregnancy has declined significantly, the highest rates are among teenagers (16.7 percent) and women aged 20-24 (18.6 percent).[41]

 While cigarettes, cigars, and smokeless tobacco (chewing tobacco and snuff) are the most widely used tobacco products, some new products are attracting the interest of minors. Electronic cigarettes or “e-cigarettes” are widely accessible and growing in popularity. Several states have already passed legislation to include e-cigarettes in nonsmoking laws or to restrict the sale of e-cigarettes to minors.[42] TMA is calling on lawmakers to restrict the purchase of e-cigarettes by minors, adopt appropriate regulations for e-cigarettes, and ensure the current smoking prohibitions include e-cigarettes. Physicians are concerned that the use of e-cigarettes by minors could be a pathway to future tobacco use and nicotine addiction. Tobacco use comes with a high consequential price tag; it’s estimated to be more than $20 billion every year, including $7.5 billion in direct health care expenditures, almost $5 billion in decreased workplace productivity, and $7.9 billion in premature death.[43] The American Cancer Society estimates Texas could save $207 million over five years by implementing comprehensive smoke-free legislation. Savings are achieved from fewer heart attacks, strokes, and lung cancer, and from decreased pregnancy complications associated with tobacco use.[44]


Texas has yet to enact any sort of statewide smoke-free legislation. TMA will continue its support of this legislation and local efforts to make Texas smoke free and to fund important state tobacco cessation programs.  

TMA's 2015 Recommendations   

Enact regulation of electronic cigarettes and associated products that includes:  

  • Restricting their sale to minors, 

  • Including these in smoking prohibition legislation and local policies, 

  • Providing school-based education for children on the hazards of electronic cigarettes, 

  • Assessing the feasibility of taxing electronic cigarettes and associated products to decrease the use of these products, and 

  • Encourage the U.S. Food and Drug Administration to assess the marketing of electronic cigarettes to minors. 

  • Maintain funding for the Texas Quitline and the state’s smoking cessation program and require monitoring of electronic cigarette use. 

  • Make Texas smoke free and encourage cities throughout the state to adopt uniform policies for smoke-free public places, workplaces, restaurants, and bars.  

Last Updated On

April 15, 2016