Tobacco use in Massachusetts 2021

• In 2020, 11.1% of adults smoked. Nationally, the rate was 15.5%.¹
• In 2019, 5.0% of high school students in Massachusetts smoked cigarettes on at least one day in the past 30 days. Nationally, the rate was 6.0%.²

• In 2018, 5.6% of adults in Massachusetts used e-cigarettes. ³
• In 2020, 1.6% of adults in Massachusetts used smokeless tobacco.³
• In 2019, 32.2% of high school students in Massachusetts used electronic vapor products on at least one day in the past 30 days. Nationally, the rate was 32.7%.²
• In 2019, 4.8% of high school students in Massachusetts used chewing tobacco, snuff or dip on at least one day in the past 30 days. Nationally, the rate was 3.8%.²
• In 2019, 5.1% of high school students in Massachusetts smoked cigars, cigarillos or little cigars on at least one day in the past 30 days. Nationally, the rate was 5.7%.²

• Massachusetts received $793.9 million (estimated) in revenue from tobacco settlement payments and taxes in fiscal year 2021.⁴
• Of this, the state allocated $5.1 million in state funds to tobacco prevention in fiscal year 2021, 7.7% of the Centers for Disease Control and Prevention’s annual spending target.⁴
• Smoking-caused health care costs: $4.08 billion per year.⁴
• Smoking-caused losses in productivity: $2.40 billion per year.⁵

Tobacco taxes

• Massachusetts is ranked 6th in the U.S. for its cigarette tax of $3.51 per pack (enacted July 2013), compared to the national average of $1.91. (The District of Columbia has the highest tax at $4.50 and Missouri has the lowest at 17 cents.)^6-8
• Little cigars are taxed at $3.51 per 20 cigars. Smokeless tobacco is taxed at 210% of the wholesale price. Cigars and smoking tobacco are taxed at 40% of the wholesale price.^6,7

Clean indoor air ordinances

• Smoking is prohibited in all government workplaces, private workplaces, schools, childcare facilities, restaurants, bars (allowed in smoking bars), retail stores and recreational/cultural facilities.⁷
• E-cigarettes are included in the state’s definition of smoking.⁹

Flavor restrictions

• The sale of all flavored tobacco products is prohibited, except in smoking bars. Smoking bars, which include cigar lounges and hookah bars, are establishments that exclusively occupies an enclosed indoor space and is primarily engaged in the retail sale of tobacco products for consumption by customers on the premises.¹⁰

Licensing laws

• Retailers and wholesalers are required to obtain a license to sell tobacco products.⁶
• A license is required to sell e-cigarette products.⁹
• The sale of tobacco products in pharmacies is prohibited.¹¹

Youth access laws

• Effective December 2019, the United States adopted a law raising the federal minimum age of sale of all tobacco products to 21.  Some states have not yet raised their state minimum age of sale, however, the federal law takes precedence.
• Establishments are required to post signs stating that sales to underage persons are prohibited.⁶
• Self-service tobacco product displays are prohibited except in adult-only retail stores.⁶
• The sale or distribution of electronic smoking devices to persons underage persons is prohibited.⁹
• The sale or distribution of flavored electronic nicotine delivery systems or flavor enhancers restricted to sales by a smoking bar for on site consumption and sales of flavored electronic nicotine delivery devices to out-of-state purchasers.⁹
• The sale of electronic nicotine delivery systems with nicotine content greater than 35 mg/ml is restricted to specialty tobacco stores and smoking bars.⁹
• Redemption of discount coupons for electronic smoking devices is prohibited.⁹
• Sampling or free distribution of electronic smoking devices is prohibited.⁹
• Distribution of free samples in a retail or other commercial establishment is prohibited (except in retail tobacco stores and smoking bars).⁹
• The sale of electronic cigarettes in health care institution buildings or grounds is prohibited.⁹
• Mail-order or internet sales of electronic smoking devices are prohibited unless retailer requires age-verification and signature by person of legal sales age upon receipt.⁹

Local tobacco laws

• Brookline prohibits the sale of tobacco or e-cigarette products to anyone born after January 1, 2000.¹²
• Blackstone, Brewster, Brookline, Canton, Chatham, Dedham, North Attleborough, Norwood, Sherborn, Wellesley, and Winthrop do not allow any retailer exemptions in their flavored tobacco laws.¹⁰
• Bellingham, Blackstone, Deham, and Hull prohibit the sale of all e-cigarettes. Malden prohibits the sale of all e-cigarettes, except in adult-only retail tobacco stores.¹⁰
• 173 cities and towns in Massachusetts, including Boston, require cigars to be sold for at least $2.50 and multi-packs of 2 or more cigars for at least $5.00.¹³
• 125 cities and towns in Massachusetts have caps on the number of tobacco licenses.¹³
• The use of smokeless tobacco and other tobacco products at baseball parks, including Fenway Park, and other professional and amateur sports venues is prohibited.¹⁴

• The CDC estimates 44.8% of daily adult smokers in Massachusetts quit smoking for one or more days in 2019.³
• In 2014, the Affordable Care Act required that Medicaid programs cover all tobacco cessation medications.^7**
• Massachusetts’s state quit line invests $1.25 per smoker, compared to the national average of $2.28.⁷
• Massachusetts does have a private insurance mandate provision for cessation.⁷

Updated August 2021

*National and state-level prevalence numbers reflect the most recent data available. This may differ across state fact sheets.

**The seven recommended cessation medications are NRT gum, NRT patch, NRT nasal spray, NRT inhaler, NRT lozenge, Varenicline (Chantix) and Bupropion (Zyban).

Fiore MC, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services. Public Health Service: May 2008.

1. CDC, Behavioral Risk Factor Surveillance System, 2020.

2. CDC, Youth Risk Behavioral Surveillance System, 2019.

3. CDC, Behavioral Risk Factor Surveillance System, State Tobacco Activities Tracking and Evaluation System, 2021.

4. Campaign for Tobacco-Free Kids, Broken Promises to Our Children: a State-by-State Look at the 1998 State Tobacco Settlement 22 Years Later FY2021, 2020.

5. Campaign for Tobacco-Free Kids, Toll of Tobacco in the United States.

6. American Lung Association, State Legislated Actions on Tobacco Issues (SLATI).

7. American Lung Association, State of Tobacco Control, 2021.

8. Campaign for Tobacco-Free Kids. State Cigarette Excise Tax Rates & Rankings. https://www.tobaccofreekids.org/assets/factsheets/0097.pdf. Accessed.

9. Public Health Law Center. U.S. E-Cigarette Regulation: 50-State Review. http://www.publichealthlawcenter.org/resources/us-e-cigarette-regulations-50-state-review. Accessed.

10. Truth Initiative, Local restrictions on flavored tobacco and e-cigarette products. https://truthinitiative.org/research-resources/emerging-tobacco-products/local-restrictions-flavored-tobacco-and-e-cigarette.

11. Americans Nonsmokers' Rights Foundation. Municipalities with Tobacco-Free Pharmacy Laws. http://no-smoke.org/pdf/pharmacies.pdf. Accessed.

12. The Commonwealth of Massachusetts Office of the Attorney General. Brookline Special Town Meeting of November 17, 2020 -- Case # 10029. https://2bark924ef5o2dk1z21reqtf-wpengine.netdna-ssl.com/wp-content/uploads/2021/07/Brookline-10029_-Art-14-_APP-.pdf. Published July 19, 2021. Accessed.

13. Massachusetts Association of Health Boards. Tobacco Maps of Massachusetts. http://www.mahb.org/tobacco-control/ma-tobacco-maps/. Accessed.

14. Knock Tobacco Out of the Park. https://tobaccofreebaseball.org/. Accessed.