The federal government and states like Pennsylvania and New Jersey all share the blame for not taking action to stem the alarming rise in vaping among the nation’s youth last year, according to the American Lung Association’s annual report.

The State of Tobacco Control 2020, released Wednesday, grades states on key policies that could affect the rate of tobacco use, such as funding for tobacco prevention programs, access to services to quit tobacco, and setting the minimum age for sale of tobacco products to 21. This year’s report gives mostly failing or near-failing grades to Pennsylvania and New Jersey.

“This year’s report really illustrates the failure by the federal government and our states to enact policies to combat the youth epidemic of e-cigarette use and tobacco continuing to be the leading preventable cause of death in this country,” said Michael Seilback, American Lung Association assistant vice president for state public policy. “This report is a blueprint for decision makers on how to step forward and protect health.”

According to the report, vaping’s “dizzying rise” among American youth grew to 27.5% of all high schoolers and 10.5% of all middle schoolers in 2019. That amounted to about 6.2 million middle and high school students currently using tobacco products – an increase of nearly 3 million kids using the products, mostly e-cigarettes, in the last two years. That growth, the report notes, is in stark comparison to what had been a downward trend in youth usage of traditional tobacco products.

“At this rate, another generation could be lost to a life of nicotine addiction and ultimately more tobacco-caused death and disease,” said Harold P. Wimmer, ALA president, in the new report.

The lung association report blasted the Trump administration for the “dramatic reversal” of its September 2019 vow to “clear the market” of all flavored e-cigarettes.

“Instead, they issued a substantially weaker version that leaves menthol flavored e-cigarettes and the thousands of non-closed pod flavored products, including any product sold in vape shops, on the market,” the report said.

That’s significant because the federal Centers for Disease Control and Prevention’s 2019 National Youth Tobacco Survey found that among high school students who only use e-cigarettes, over 72% used flavored e-cigarettes, including 66% who used fruit flavors over 57% who said they used mint and menthol flavors, according to the report.

All states received letter grades for their performance on funding for tobacco prevention programs, strength of smoke-free workplace laws, level of state tobacco taxes, access to services to quit tobacco, and the minimum age for sale of tobacco products. States like California and Maine were among the highest scorers, but no states earned straight A’s. Three states – Alabama, Mississippi, and North Carolina – received all F grades.

Pennsylvania and New Jersey got Fs for their level of state tobacco taxes and as not adequately funding state tobacco prevention programs. Pennsylvania’s $17.9 million for prevention programs in 2019 was only 12.8% of the CDC’s recommended funding level, while New Jersey’s $10.9 million was just 10.5% of what the CDC called for.

On coverage and access to tobacco cessation services, Pennsylvania got a D, while New Jersey was given an F. For strength of smoke-free workplace laws, New Jersey earned an A. Pennsylvania, however, got a D.

Setting 21 as the minimum age for tobacco sales earned New Jersey its second A. Pennsylvania got a grade of “incomplete.” Its 21 minimum age restriction doesn’t go into effect until July 1, the report states.

What isn’t included in the new report, but New Jersey deserves praise for, said Seilback, is the state’s recently passed legislation banning the sale of all flavored vaping products.

The Garden State’s law, however, falls short of Massachusetts’, he said. In 2019, Massachusetts became the first state to ban all flavored tobacco products, according to the report. Communities in other states also passed similar laws. While not noted in the report, one of those was Philadelphia, banning the sales of flavored and high-nicotine e-cigarettes and vaping products in businesses that allow minors to enter.