DES MOINES, Iowa, –Feb. 10, 2026– Today, Iowa’s top public health advocacy organizations announced the launch of the Iowa Health Initiative (IHI), a new coalition dedicated to reducing the death and disease caused by tobacco use in our state. IHI brings together dozens of public health, community, business, and health care organizations to advance proven, fact-based policies that save lives, improve health, and strengthen Iowa’s future.

Iowa has the second highest cancer rates in the nation, and tobacco use is linked to 31.4% of cancer deaths in our state. The leading cause of death in the nation, including Iowa, tobacco use is linked to at least 12 types of cancers and kills 5,100 Iowans yearly. Although these hazards are well established, data from the Centers for Disease Control and Prevention (CDC) show 12.9% of adults in Iowa smoke and 1,300 Iowa kids start to smoke daily each year. Tobacco use costs the state $1.49 billion annually in health care expenditures.

“This should be a clear wake up call for lawmakers to say it’s time for Iowa to stand up to Big Tobacco,” said Jackie Cale, Iowa government relations director for the American Cancer Society Cancer Action Network (ACS CAN). “For too long, Iowa has allowed the tobacco industry to addict people to deadly, cancer-causing products. It’s time to say, enough is enough.’ Iowans deserve better.”

Research shows that strong tobacco control policies, like significant and comprehensive tobacco tax increases are effective in helping people quit. Fewer people using tobacco products means less suffering and death from tobacco-related diseases like cancer, cardiovascular disease, and stroke.

“Lawmakers should immediately pass legislation to raise the tax on cigarettes by $1.50 per pack with a parallel tax on all other tobacco products. Increasing tobacco taxes is one of the most effective ways to support cessation and reduce tobacco use. Tobacco companies know how effective these policies are at preventing children from starting to smoke and helping adults quit and they have lobbied hard against them,” said Kristina Hamilton, MPH, director of advocacy for Iowa and Illinois for the American Lung Association.

Currently, Iowa has a $1.36 per pack tax on cigarettes, which is well below the national average. The tobacco tax increase IHI proposed would help 9,400 adult Iowans quit, prevent 2,500 Iowa kids from being adults who smoke, and generate $78.39 million in revenue for the state.

“As a pediatrician, I’ve seen the devastating effects of tobacco use on families across Iowa firsthand,” said Dr. Amy Kimball, Pediatrician, IHI member, and Iowa AAP E-Cigarette Chapter Champion. “Raising the cigarette tax and creating an e-cigarette tax are two of the most effective tools we have to reduce tobacco use, prevent kids from starting, and save lives. These policies aren’t just good public health interventions, they are life-saving measures that will reduce cancer and other chronic health conditions and protect the next generation from addiction in our communities.”

Rep. Brett Barker

Good morning!

Iowans have been loud and clear that they expect the legislature to take action regarding cancer in our state. And as a healthcare professional who happens to be a legislator, I feel it is my responsibly to bring solutions for conversation.

Tobacco use is the leading cause of preventable death in Iowa – and in our nation.

Smoking kills 5,100 Iowans EACH YEAR and sickens tens of thousands more. Nearly 13 percent of Iowa adults smoke.

Many of those deaths are caused by cancer. And sadly, Iowa ranks SECOND in the entire nation for cancer rates.

More than 1/3 of all these cancer cases are caused by tobacco use.

These are thousands of AVOIDABLE cases of cancer if we could just reduce tobacco use.

Smoking kills more Iowans than pretty much everything else COMBINED. And this doesn’t include all tobacco use – just cigarette smoking.

And while lawmakers, myself included, don’t like raising taxes, we have a responsibility to have this conversation when this specific tax is a proven way to protect our families.

This is why I have introduced a bill to increase Iowa’s cigarette tax by $1.50 and to modernize the tax to cover new products …

This will protect our kids and prevent them from ever picking up a cigarette, a vape or a nicotine pouch – protecting them from a lifetime of nicotine addiction.

Last year in Indiana, the state increased its cigarette tax by $2, bringing it up to nearly $3.00.

Currently Iowa’s cigarette tax is $1.36. A $1.50 increase in Iowa’s cigarette tax would place us squarely in the middle of our neighboring states.

It’s been nearly 20 years – since 2007 – since Iowa has increased its cigarette tax. But you know what has increased – SIGNIFICANTLY? Health care costs.

And smoking alone costs Iowa taxpayers nearly 1.5 BILLION, not million; BILLION dollars each year in Medicaid and Medicare.

And my bill reflects the reality of tobacco use in Iowa – We do not currently tax e-cigarettes or nicotine pouches – the most popular forms of tobacco use. This must change. The time is now.

Now, many of you may ask why $1.50, especially when the Governor has proposed a 65-cent increase. First, I am glad to hear the Governor supports increasing the tobacco tax.

The reason my bill calls for a $1.50 increase is because the data shows that a tax increase must be meaningful to produce real results in saving lives, reducing illness, protecting kids from addiction, encouraging folks to quit and decreasing taxpayer-paid tobacco-related healthcare costs.

The tobacco industry knows how price sensitive kids are and fights tax increases tooth and nail. But if that increase is negligible, they will spend BILLIONS to undermine that small increase with coupons, promotions and marketing gimmicks to bring the price back down.

We need a tax increase that negates their ability to easily spend billions to make any small increase null and void.

Tobacco tax increases are a win-win solution – a health win that reduces tobacco use and saves lives. It’s also a revenue win for the state at a time when we are searching for critically needed funds in Medicaid. Iowa taxpayers are on the hook for paying for tobacco related health care expenses through Medicaid and other programs. This bill will allow for tobacco money to cover public tobacco related expenses.

Hopefully we will use some of these funds – an estimated nearly $80 million – to educate kids about the severe risks of using tobacco and the deadly consequences of smoking and to help people quit.

Iowa already has a great youth program called Iowa Students for Tobacco Education and Prevention (ISTEP). We need to make sure effective programs like that are adequately funded.

Currently, Iowa ranks 34th in the nation for spending on these types of programs. More than 16 percent of our high school students are vaping with about 4 percent of high schoolers smoking cigarettes. We don’t even have solid numbers yet on how many kids are using nicotine pouches – or Zyn as a lot of them call it – because this is such a new product and way for the industry to addict our kids.

This is exactly why my bill increases all tobacco taxes, not just the cigarette tax, because kids are increasingly using nicotine pouches and many more kids vape than smoke cigarettes.

To help protect as many kids as possible from ever starting, we must increase the price of these products across the board.

Kids are particularly sensitive to even modest price increases. And adults – nearly all will admit they want to quit – say that increasing the price is an effective way to finally quit.

But “protecting kids” isn’t just political rhetoric – Raising the price of tobacco products is a leading, and proven, way to not only prevent kids from picking up a deadly habit, but also to help current tobacco users finally quit.

As a healthcare professional, I have helped countless patients attempt to manage the lifelong, and often debilitating, effects of tobacco related illness.

This bill also is aligned with the priorities of Governor Reynolds.

I encourage my colleagues in the legislature to join me in passing this sensible and meaningful tax increase. Join me in protecting our kids from a lifetime of nicotine addiction.

Thank you to my bill co-sponsors and to the public health advocates joining me here today.

Rachel Manna, Certified Addiction and Drug Counselor

Good morning, and thank you for being here. My name is Rachel Manna, and I stand here today as a certified addiction and drug counselor and someone who has lived through addiction—tobacco and substance addiction—and who is grateful every day to be on the other side of it. Today, I’m here as a health advocate to share what I’ve learned and why changes that reduce tobacco use matter so deeply to me.

I have been clean from substances since July 28th 2016 and I have been in recovery from tobacco since December 3rd 2017. I used substances for 10 years and I smoked cigarettes for 14. I can’t count how many times I tried to stop smoking during that time period. I tried many things; cold turkey, gum, Chantix; I tried things more than once. Almost every time I couldn’t quit. I wanted to quit so badly when I got clean, and actually hadn’t smoked for over two months due to jail and inpatient treatment, but within days of being in a halfway house type facility that allowed smoking, I was back to it. I smoked for one last year. Finally, I gave Chantix another effort, and was able to be successful. I remember one time specifically in 2019 or 2020 I went to buy my friend a pack of cigarettes when he got to inpatient treatment and the cashier told me they were over $10 and I was so shocked! I was grateful I was able to quit when I did. No way could I have kept smoking with the price increase.

I also know firsthand that quitting tobacco is one of the hardest things a person can do. But I’ve watched friends and people in my recovery community quit because the cost finally forced them to pause and think. Increasing taxes on tobacco products doesn’t punish people who are addicted—it gives them an extra nudge toward quitting and reduces the number of new people who end up addicted in the first place.

We can’t ignore the impact tobacco has on our state. Every year, Iowa spends $1.49 billion on health care costs directly caused by tobacco use. That number represents hospital beds, lost loved ones, and communities carrying the weight of preventable disease. And over time, reducing tobacco use could prevent 3,000 premature deaths and save Iowa more than $156 million in long term health care costs.

Smoking takes a toll on both your mental and physical health, and the consequences can be devastating. According to the Substance Abuse and Mental Health Services Administration or “SAMSHA”, people with mental illness or a substance use disorder smoke more cigarettes. Despite only representing 25% of the U.S. adult population, they consume 40% of cigarettes sold in the U.S. — smoking two more packs per month than people without a mental health condition. People with mental illness who smoke die up to 15 years earlier than people without mental illness who do not smoke. People with mental illness are also four times more likely to die prematurely if they smoke cigarettes.

But for me, this isn’t just about money or statistics. It’s about giving people the chance I wish I’d had—to never start. It’s about creating communities where addiction is less likely to take root in the next generation.

I’m grateful to stand here today alongside other advocates, medical professionals, and youth leaders to call for a meaningful increase in the price of tobacco products. And I’m grateful for the opportunity to use my lived experience to help create a healthier Iowa. I’m here to tell the truth of what addiction looks like, and to share why strategies that reduce tobacco use save lives, including lives like mine.

Thank you for listening, and thank you for caring about the health and future of our communities.

Dr. Amy Kimball, Pediatrician 

Good Morning. I am Dr. Amy Kimball. I am a pediatrician in Winterset and am the Iowa Chapter of the American Academy of Pediatrics’ resource for youth E-cigarette and tobacco use. I am thrilled to be a part of the Iowa Health Initiative coalition and partnering with organizations such as Campaign for Tobacco-Free Kids, to champion increasing the tax on cigarettes and tobacco products in Iowa.

No level of tobacco smoke or tobacco exposure is safe. This is especially true for young brains and bodies that are still growing and developing. Developing brains are exceptionally vulnerable to forming tobacco and nicotine dependence. The nicotine in tobacco products and vapes is not only incredibly addictive, but also particularly detrimental to the parts of a developing brain that control attention, mood, learning, and impulse control. Tobacco and nicotine products are unique in that, when used as intended, they are known to lead to disease and premature death. Tobacco exposure causes health harms at all levels of a child’s development – leading to premature birth, low birth weights, childhood obesity, respiratory illnesses including asthma and pneumonias, as well as increased risk of developing childhood cancers and cancers as an adult.

Youth nicotine addiction and all-form tobacco use is a critical public health issue. Iowa youth tobacco use is above the national average. This is not an area where we want to excel. In Iowa, 16.4% of high school students report using e-cigarettes. An additional 4.1% smoke cigarettes, and 3.9% report smoking cigars. We know that many youth, over 10% of high school students and over 5% of middle school students, use multiple tobacco products. The use of e-cigarettes in combination with oral nicotine pouches has increased considerably since 2023. Our Iowa youth are at significant risk for nicotine dependence and the long-term health complications that result from tobacco use.

During my training, I learned about the risks of tobacco exposure for children and ideals of preventing youth from initiating tobacco use. I never imagined how high the number of young people that I encounter in my practice, who utilize at least one form of tobacco, would be. Most initiated their use with Vapes, but many have now added nicotine pouches, like Zyn, to their regimen because they are already so addicted. I expected to spend a significant amount of time in clinic visits counseling parents on the risks of second and third-hand smoke and encouraging them to quit. I didn’t expect to be helping so many young Iowans navigate tobacco cessation resources. As a pediatrician, I know prevention in all realms of children’s health, is our best approach. That is especially true in tobacco exposure and use.

Iowa’s current tobacco tax rate is 33rd in the nation and hasn’t been adjusted in over a decade. As a pediatrician and a parent, I firmly believe the health of Iowa children is worth way more. Increasing tax on cigarettes, vape products and nicotine pouches in Iowa, and nationwide, is an incredibly effective way to prevent and reduce all-form tobacco use in young people. Raising Iowa’s tax rate by $1.50 is an excellent first step in protecting Iowa youth, and all Iowans, from the risk of tobacco use.

Lakshmi Kommineni

Hello, my name is Lakshmi Kommineni, and I’m a 10^th grade student at Waukee Northwest High School and I serve on the ISTEP Council, but today I’m speaking for myself. Thank you for giving me the chance to share a youth perspective today.‑grade student

ISTEP stands for the Iowa Students for Tobacco Education and Prevention. In ISTEP, members stand up and speak out about youth tobacco and nicotine use among their peers. We learn about how tobacco and nicotine products affect people—especially people my age. One of the things I’ve learned is that when these products become more expensive, fewer young people start using them. For someone my age, price isn’t just a number. It can be the difference between trying something harmful and deciding it isn’t worth it.

Research shows that making tobacco products less affordable for youth could help prevent around 2,500 Iowa kids from becoming adults who smoke and reduce smoking among teens by more than 10%. As a teenager living in this state, that number feels personal, because those “2,500 kids” are people I go to school with, sit next to in class, or stand next to at football games.

I’ve watched classmates struggle with nicotine addiction—especially with vapes. Many of them started because they wanted to “fit in” or because it seemed cheap or harmless. But once they were hooked, it was really hard for them to stop. Hearing their stories makes me grateful that ISTEP helps students learn how addiction works and how tobacco companies target youth. It also makes me think about how important it is to support initiatives that ensure fewer students start using these products in the first place.

I’m really glad to be here with leaders who bring additional perspectives—like medical professionals, people who have lived through addiction, and lawmakers. I may be a high school student, but young people are part of this conversation too. We see firsthand the way tobacco and nicotine products show up in our schools, and we see how much stronger our peers can be when they get the right support and information.

I’m grateful that ISTEP gives students like me the chance to learn, to educate others, and to speak about why protecting youth health matters.

Thank you for listening, and thank you for caring about the health of young people in our state.