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(The District of Columbia has the highest tax at $4.50 and Missouri has the lowest at 17 cents.)6-8 Cigars and pipe tobacco are taxed 28% of the wholesale price, chewing tobacco is taxed at 16 cents per ounce and snuff is taxed 60 cents per ounce.6,7 Clean indoor air ordinances Smoking is prohibited in government workplaces, private workplaces, schools, childcare facilities, restaurants, bars, casinos/gaming establishments (tribal establishments exempt), retail stores and recreational/cultural facilities.6,7 E-cigarettes are included in the states definition of smoking.9 Licensing laws Retailers and wholesalers are required to obtain a license to sell tobacco products.6 A license is not 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

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In addition, CD patients who smoke have a worse course of illness and quality of life, and are more likely to develop complications, have a higher rate of hospitalization, show a worse response to treatments, and have a greater need for surgery (59)