Hawaii has made significant strides in its work to end tobacco use but continues to falter in its efforts to reduce the sale of flavored tobacco and vaping products targeting youths.

The American Lung Association’s 20th annual “State of Tobacco Control” report released last week gave Hawaii an “F” grade on ending the sale of all flavored tobacco products.

The state received “C” grades for funding state tobacco prevention programs and for tobacco taxes.

The smoking rate in the Aloha State remains at 11.6% of the adult population, and the high school tobacco-use rate at 23.2%. Results from a federal Hawaii Youth Risk Behavior Survey last year found youth vaping rates rising, with more high school students trying it and getting hooked.

Across the U.S., more than 2 million high school and middle school students use electronic cigarettes, and over 80% of those kids use flavored e-cigarettes, according to the 2021 National Youth Tobacco Survey.

The American Lung Association noted that Hawaii tobacco-control advocates have for several years tried and failed to advance legislation that would restrict flavored tobacco products — including flavored vapes and menthol cigarettes — which have been shown to get kids addicted.

“While we have seen considerable progress in Hawaii, tobacco use remains our leading cause of preventable death and disease, taking over 1,400 estimated lives each year,” said Pedro Haro, executive director of American Lung Association in Hawaii, in a news release. “Unfortunately, with the lack of state regulations on e- cigarettes and restrictions on tobacco flavors that addict youth, we are seeing a recession of the gains we had made over the last decades of tobacco control.”

The annual “State of Tobacco Control” report evaluates state and federal policymakers on actions taken to eliminate tobacco use.

This year’s report found Hawaii to have made substantial progress in advancing tobacco control policies over the past 20 years, with smoke-free laws in workplaces, schools and restaurants, and increased access to counseling and treatment.

However, Hawaii has set aside only about $7.4 million this fiscal year for tobacco control programs, when the Centers for Disease Control and Prevention recommends $13.7 million.

Hawaii, along with most of the nation, is also grappling with how to effectively restrict flavored tobacco products. The Lung Association says Hawaii policymakers need to focus on ending the sale of all flavored tobacco products, including menthol cigarettes.

“We have the danger of erasing all the progress we’ve made in the last 20 years,” Haro told the Honolulu Star-Advertiser.

Haro said it’s obvious that candy-flavored cigarettes or e-liquids would be enticing to youths, and that tobacco companies know this and target them in their advertisements. Also, menthol is the preferred flavor for many young, beginner smokers because it masks the taste of tobacco and provides a cooling sensation to cover up burning in the throat.

The rates of e-cigarette use among Native Hawaiians and Pacific Islanders is also higher, which is a concern, he said.

During the 2021 legislative session, there was no major progress in tobacco control policy. Instead, the Lung Association said it joined forces with other advocates to protect against the raiding of the Tobacco Prevention and Control Trust Fund, its primary source of funding for tobacco prevention and cessation programs.

A number of bills seeking to restrict the sale of flavored tobacco products, including e-liquids, were introduced, but failed to pass out of their respective committees.

Haro, however, said he is optimistic lawmakers will address the issue this year.

“I think all lawmakers are concerned about (youth vaping) and want to do something,” he said. “There just hasn’t been a legislative consensus on how to go about and do it.”

Studies are still being conducted on the relationship between smoking and the coronavirus, but it is a proven risk factor for cardiovascular and lung diseases, which can put one at higher risk for a severe case of COVID-19.

The CDC includes smoking on a list of medical conditions that increase the chances of being hospitalized or requiring intensive care from the coronavirus.

A Stanford University study in 2020 examined 4,300 young people across the U.S. and found that those who vaped regularly were five to seven times more likely to test positive for the coronavirus than those who did not.

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Hawaii Facts

>> Adult smoking rate: 11.6%

>> High school smoking rate: 5.3%

>> High school tobacco-use rate: 23.2%

>> Middle school smoking rate: 3.1%

>> Economic cost due to smoking: $526.3 million

>> Smoking attributable deaths per year: 1,420

Source: American Lung Association