Tobacco use in Missouri 2021

• In 2020, 17.8% of adults smoked. Nationally, the rate was 15.5%.¹
• In 2019, 6.5% of high school students in Missouri 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 Missouri used e-cigarettes.
• In 2020, 4.9% of adults in Missouri used smokeless tobacco.³
• In 2019, 20.7% of high school students in Missouri used electronic vapor products on at least one day in the past 30 days. Nationally, the rate was 32.7%.²
• In 2019, 5.5% of high school students in Missouri 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, 5.4% of high school students in Missouri smoked cigars, cigarillos or little cigars on at least one day in the past 30 days. Nationally, the rate was 5.7%.²

• Missouri received $255.8 million (estimated) in revenue from tobacco settlement payments and taxes in fiscal year 2021.⁴
• Of this, the state allocated $171,885 in state funds to tobacco prevention in fiscal year 2021, 0.2% of the Centers for Disease Control and Prevention’s annual spending target.⁴
• Smoking-caused health care costs: $3.03 billion per year.⁴
• Smoking-caused losses in productivity: $3.04 billion per year.⁵

Tobacco taxes

• Missouri is ranked 51st in the U.S. for its cigarette tax of 17 cents per pack (enacted August 1993) compared to the national average of $1.82. (The District of Columbia has the highest tax at $4.50).^6-8
• All other tobacco products are taxed at 10% of the manufacturer’s invoice price.^6,7

Clean indoor air ordinances

• Smoking is prohibited in schools (public schools only) and childcare facilities.⁷
• Smoking restrictions are required in government workplaces, private workplaces, restaurants, retail stores and recreational/cultural facilities.⁷
• There are no smoking restrictions for bars and casinos/gaming establishments.⁷
• Vaping is restricted to designated areas of public buildings and grounds occupied by state agencies.⁹

Licensing laws

• Wholesalers are required to obtain a license to sell tobacco products. Retailers are not required to obtain a license to sell tobacco products. ⁶
• A license is required 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.
• While the federal law takes precedence, under the state law, the minimum sales age for Missouri is 18.
• Underage consumers are prohibited from buying or possessing nicotine delivery products, including e-cigarettes.⁶, ⁹
• Sale or distribution of vapor products to underage persons is prohibited. ⁹
• Vending machine sales are restricted to places inaccessible to underage persons or through machines equipped with a lock-out device and under direct unobstructed supervision of an adults. ⁹
• Establishments are required to post signs stating that sales to underage persons are prohibited.⁶

Local tobacco laws

• St. Louis prohibits the use of smokeless tobacco products at all sports venues, including Busch Stadium.¹⁰

• The CDC estimates 44.4% of daily adult smokers in Missouri 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**
• Missouri’s state quit line invests 43 cents per smoker, compared to the national average of $2.28.⁷
• Missouri 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, 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. Knock Tobacco Out of the Park. https://tobaccofreebaseball.org/. Accessed.