Wisconsin lawmakers need to do more to reduce a smoking rate that causes almost 8,000 annual deaths, says the American Lung Association. But its prescription for the state involves reducing access to safer substitutes for deadly cigarettes.
The American Lung Association (ALA) recently published its 2026 State of Tobacco Control report, which awards Wisconsin a series of failing grades. These include “F” grades for tobacco prevention funding, access to cessation services and “Ending the Sale of All Flavored Tobacco Products”—plus a “D” for “Level of State Tobacco Taxes.”
The ALA’s main recommendations for the state include: “Raise Wisconsin’s legal age of sale for tobacco products to 21” and “Create tax parity between e-cigarettes and cigarettes.”
Molly Collins, the ALA’s Wisconsin advocacy director, told Wisconsin Public Radio that the grades are based on whether states are implementing policies “proven to prevent or reduce tobacco use and save lives.”
She went on to name counseling and nicotine replacement therapy (NRT) as things that aid smoking cessation. These options are offered by the Wisconsin Tobacco Quit Line, funded by the Wisconsin Department of Health Services.
What Collins didn’t mention—and what the Quit Line doesn’t offer—are other safer nicotine products that have been proven more effective at helping people quit smoking.
Why are the ALA and Wisconsin’s health department promoting one type of safer nicotine product—NRT—while seeking to reduce access to others that do a better job?
The prestigious Cochrane review, for instance, found “high certainty” evidence that “quit rates were higher in people randomized to nicotine [vapes] than in those randomized to nicotine replacement therapy.”
Real-world experiences match that. Vapes are the most popular and effective smoking-cessation method in the United States and the United Kingdom. The contrast in smoking-cessation trajectories between New Zealand, where vapes are widely available, and Australia, where they are heavily restricted, tells the same story.
Many people who smoked find vapes work for them as substitutes because the inhalation and hand-to-mouth action mimic smoking, while the flavors are enjoyable.
Meanwhile, widespread uptake of nicotine pouches and snus, also available in a range of flavors, has enabled Sweden to achieve the world’s lowest smoking rate.
So why are the ALA and Wisconsin’s health department promoting one type of safer nicotine product—NRT—while seeking to reduce access to others that do a better job?
“We know that preventing kids from trying these products has a significant impact on how many go on to develop a lifelong addiction,” Collins told Filter.
The health department did not respond to Filter’s request for comment. But when Filter put it to Collins, she replied that, “vapes and nicotine pouches are engineered to be highly addictive, easy to start and difficult to quit.”
“We know that preventing kids from trying these products has a significant impact on how many go on to develop a lifelong addiction,” she added.
This implies preventing “addiction”—a dubious concept when applied to activities without severe harms—is important enough to weigh against the priority of saving lives.
Many public health bodies, in the US and globally, have increasingly emphasized youth and addiction—rather than their original missions of reducing smoking-related disease and death—to justify portraying safer nicotine options as public health threats.
“They are profoundly challenged by safer products,” advocate Clive Bates recently commented; “after all, what is the point of tobacco control if there is no harm, and therefore no reason to control things? It would be like coffee control. So they are determined to find harm wherever they look.”
In line with its priorities, the ALA is urging Wisconsin to tax vapes as heavily as it taxes cigarettes. Harm reductionists and researchers have condemned such measures for discouraging people from switching to safer options.
“Wisconsin should use taxation as a way to incentivize smokers to use e-cigarettes rather than real ones.”
“Wisconsin should use taxation as a way to incentivize smokers to use e-cigarettes rather than real ones,” Michael Siegel, a professor of public health and community medicine at the Tufts University School of Medicine, told Filter. Siegel fears people who vape will return to smoking if Wisconsin follows the ALA’s advice.
Neighboring Minnesota provides a grim template. In 2010, it became the first state in the country to tax vapes. Research suggests that from 2013-2015, the tax dissuaded over 32,000 Minnesotans who smoke from quitting.
“If ALA truly means what it says when it argues that Wisconsin should invest in strategies that work to help smokers quit, then it should actually be promotion of e-cigarettes in addition to nicotine replacement therapy,” Siegel said. “If Wisconsin invests in anything, it should be programs that encourage smokers to quit by any means they can, including by switching to vaping.”
Other tobacco harm reduction proponents note that just allowing adults to make their own decisions, without trying to restrict and discourage certain choices, would be a big improvement on Wisconsin’s status quo.
“The fastest way to accelerate progress would be to simply allow responsibly marketed, lower-risk alternatives to remain available to adults,” Gregory Conley, a longtime THR advocate, told Filter.
“Instead,” he continued, “the state moved in the opposite direction by passing a PMTA registry that threatens retailers with $1,000 per-day fines for selling popular safer nicotine products.”
A bill implemented in Wisconsin in 2025 banned sales of vapes that are not FDA-authorized. Like other PMTA registry bills around the US, this greatly minimized the range of legally available flavors, which are key to helping people quit cigarettes.
One of the ALA’s grading measures, of course, is “Ending the Sale of All Flavored Tobacco Products,” which in this parlance includes vapes.
“In recent years,” Conley said, the ALA “has focused less on helping smokers switch to lower-risk options and more on taxing and restricting those alternatives.”
Another of the ALA’s recommendations for Wisconsin is making 21 the legal minimum age for all “tobacco products” sales. State law currently has it at 18, but this is superseded by the federal minimum age of 21.
“Tobacco use almost always begins during adolescence and young adulthood. About 95 percent of adult smokers began smoking before they turned 21,” Collins told Filter, saying that raising Wisconsin’s legal age would “curb tobacco use.”
She acknowledged that the federal minimum age, established by a bill President Donald Trump signed in 2019, means it’s “already illegal” to “sell or distribute tobacco products to people under the age of 21 in Wisconsin.”
“However, aligning the state’s sales age for tobacco products, including e-cigarettes, to 21 to match federal law would be beneficial and allow our local law enforcement to address problem retailers who are selling to underage people,” Collins said.
Conley sees this as a red herring; while Wisconsin has a high rate of high schoolers using tobacco, recent data show a reduction in sales. He said compliance data suggest the vast majority of Wisconsin retailers are following federal law. “In other words, access restrictions are not the main issue.”
The American Lung Association has a record of opposing safer nicotine products and spreading misinformation about them, so its anti-vape recommendations for Wisconsin are unsurprising. That doesn’t mean they should be normalized.
Conley commented that the ALA’s annual grades “function more as advocacy tools than neutral analysis.”
“In recent years,” he said, “the organization has focused less on helping smokers switch to lower-risk options and more on taxing and restricting those alternatives.”
Photograph by Vaping360 via Wikimedia Commons/Creative Commons 2.0
