Tobacco use in Tennessee 2021

• In 2020, 19.5% of adults smoked. Nationally, the rate was 15.5%.¹
• In 2019, 7.1% of high school students in Tennessee 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 Tennessee used e-cigarettes. ³
• In 2020, 6.5% of adults in Tennessee used smokeless tobacco.³
• In 2019, 22.1% of high school students in Tennessee used electronic vapor products on at least one day in the past 30 days. Nationally, the rate was 32.7%.²
• In 2019, 8.2% of high school students in Tennessee 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, 9.1% of high school students in Tennessee smoked cigars, cigarillos or little cigars on at least one day in the past 30 days. Nationally, the rate was 5.7%.²

• Tennessee received $405.6 million (estimated) in revenue from tobacco settlement payments and taxes in fiscal year 2021.⁴
• Of this, the state allocated $0.0 in state funds to tobacco prevention in fiscal year 2021, which is 0.0% of the Centers for Disease Control and Prevention’s annual spending target.⁴
• Smoking-caused health care costs: $2.67 billion per year.⁴
• Smoking-caused losses in productivity: $3.59 billion per year.⁵

Tobacco laws

• Tennessee is ranked 43rd in the U.S. for its cigarette tax of 62 cents per pack (enacted July 2007), 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
• All other tobacco products are taxed at 6.6% of the wholesale cost price.^6,7

Clean indoor air ordinances

• Smoking is prohibited in government workplaces, private workplaces (non-public workplaces with three or fewer employees exempt), schools, childcare facilities, retail stores and recreational/cultural facilities.^6,7
• Smoking is allowed in restaurants and bars that do not allow persons under 21 to enter at any time.^6,7
• There are no restrictions for casinos/gaming establishments.⁷  
• The use of e-cigarettes is prohibited in areas where children are allowed in child care centers, any room or area in a community center while the area is used for children’s activities, in group care homes, healthcare facilities, museums, schools, school grounds, residential treatment facilities for children and youth, youth development centers, and zoos.⁹
• The use of e-cigarettes is prohibited at Tennessee Technological University and nearby Cookeville student housing.⁹
• The use of e-cigarettes is prohibited in Sullivan County courts. ⁹
• E-cigarettes are included in the state’s definition of smoking. ⁹

Licensing laws

• Retailers and wholesalers are required to obtain a license to sell tobacco products.
• Retailers and wholesalers are not required to obtain a license to sell e-cigarette products.⁹

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.
• Underage persons are prohibited from buying bidis and/or buying and possessing e-cigarettes.^{6, 9}
• Establishments are required to post signs stating that sales to underage consumers are prohibited.⁶
• The sale or distribution of vapor products to underage persons is prohibited.
• Underage persons are permitted to handle vapor products in the course of employment when under the supervision of someone at least 21 years of age.
• Vending machine sales of vapor products are required to be inaccessible to underage persons, or other places that are under continuous supervision or are operated by token. ⁹
• Self-service displays of vapor products are prohibited. ⁹
• The distribution of free vapor products and samples is prohibited on “any public street, sidewalk, or park.” ⁹
• The distribution by mail of vapor products requires that the distributor obtain an affirmative statement from the recipient that the person is at least 21 years old. ⁹

• The CDC estimates 47.0% of daily adult smokers in Tennessee 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**
• Tennessee’s state quit line invests $0.46 per smoker, compared to the national average of $2.28.⁷
• Tennessee does not 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, 2017.

2. CDC, Youth Risk Behavioral Surveillance System, 2020.

3. CDC, Behavioral Risk Factor Surveillance System, State Tobacco Activities Tracking and Evaluation System, 2019.

4. Campaign for Tobacco-Free Kids, Broken Promises to Our Children: a State-by-State Look at the 1998 State Tobacco Settlement 20 Years Later FY2019, 2018.

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.