The fifth state on the list, Tennessee, has 18 percent more young adult e-cigarette users than the national average. As of January 2020, Tennessee’s Department of Health reported 78 lung injury cases as a result of vaping and e-cigarette usage, with two confirmed deaths. Additionally, the tobacco settlement payments received by the Volunteer State in 2019 exceed the national average by 29 percent, signaling that tobacco-related public health outcomes in the state are grim. As of June 2020, Tennessee also has not raised their minimum tobacco purchasing age to 21, but given the nature of the state’s youth vaping rates, this may be due to change in the future.
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