States are falling behind in tabacco cessation funding
States are falling behind in tabacco cessation funding
Only Colorado, Delaware, and Maine are funding tobacco prevention programs at minimum levels recommended by the Centers for Disease Control and Prevention (CDC), according to the latest annual report from a coalition of public health organizations that assesses whether states are keeping their promise to use proceeds from the 1998 state tobacco settlement to fund tobacco prevention and cessation programs.
The report, "A Broken Promise to Our Children: The 1998 State Tobacco Settlement Eight Years Later," was released by the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society, and American Lung Association, and comes as the CDC's most recent surveys have found that the nation's progress in reducing smoking has stalled among youth and adults.
According to the CDC, 23% of U.S. high school students smoked in 2005, up from 21.9% in 2003. Public health officials writing in the report said that statistic is a "worrisome turnaround after high school smoking declined by 40% between 1997 and 2003. (The national youth smoking rate peaked at 36.4% in 1997.) Among adults, 20.9% smoked in 2005, the same as in 2004. That was the first time the adult smoking rate has not declined since 1997, when 24.7% of adults smoked."
CDC said the leveling-off of the decline in smoking rates is due to 1) states cutting tobacco prevention funding from $749.7 million in fiscal year 2002 to $538.2 million in fiscal year 2005, before rebounding slightly to $597.5 million in the current year, fiscal year 2007; and 2) a more than doubling in tobacco marketing since the 1998 settlement.
"It is no coincidence that progress in reducing smoking has stalled at the same time that tobacco marketing has skyrocketed to record levels and states have cut funding for tobacco prevention programs," said Campaign for Tobacco-Free Kids executive director William Corr. "For the sake of our nation's health, we cannot become complacent about reducing tobacco use. We know that tobacco prevention programs work to reduce smoking, save lives, and save money by reducing tobacco-related health care costs. What's needed is the political will to fund and implement these programs as aggressively as the tobacco companies continue to market their deadly and addictive products."
Price discounting
The report says more than 80% of cigarette marketing now is concentrated on price discounts, undermining state efforts to reduce smoking by increasing tobacco taxes. Discounts also have the greatest impact on youth, the report says, since they are the most price-sensitive customers.
"The tobacco companies persist in their price discounting despite knowing full well that increasing the price of cigarettes is one of the most effective ways to reduce smoking, especially among youth," the report concludes.
Officials of the public health organizations that issued the report said there is no lack of evidence that state solutions such as funding for tobacco prevention and cessation programs, higher tobacco taxes, and smoke-free workplace laws work. And given the $21.7 billion states will collect in tobacco tax and settlement revenues this year, there should be no lack of resources to implement the programs.
"Likewise, all these solutions have broad public support," the report contends. "What's needed is the political will to implement these solutions as aggressively as the tobacco companies continue to market their deadly and addictive products."
Mississippi challenge
The report particularly challenges Mississippi, and what it describes as "the relentless attack by Gov. Haley Barbour, a former tobacco lobbyist, on Mississippi's highly successful tobacco prevention program." It said Mississippi in 1997 became the first state to settle its lawsuit against tobacco companies and was one of only two states required by court order to use some of its tobacco settlement money to fund a sustained tobacco prevention program. As a result, for eight years it was one of only a few states that funded tobacco prevention programs at levels recommended by CDC. Between 1999 and 2004, the Partnership for a Healthy Mississippi reduced smoking by 48% among public middle school students (from 23% to 12%) and by 32% among public high school students (32.5% to 22.1%).
Barbour wants to end program
Mr. Barbour, the report says, ignored this success and filed suit to overturn the court order setting aside settlement money for the program, saying the state legislature should determine fund allocation. But when the legislature approved a bill to authorize continued funding for the tobacco prevention programs, and state audits to ensure accountability, Mr. Barbour vetoed the bill, just as he also vetoed two bills to increase the state's cigarette tax, which at 18 cents a pack is third-lowest in the nation.
The report says a county judge granted the governor's motion to deny additional settlement funding to the prevention program, citing a lack of agreement between the legislative and executive branches. While an appeal works its way through the state Supreme Court, the governor obtained an order from that court freezing settlement funds already allocated to the Partnership.
"These court orders effectively shut down most Partnership programs and may force the Partnership to close down completely," the report said. "As this report goes to press, Mr. Barbour appears to have succeeded, at least for now, in decimating one of the nation's most effective tobacco prevention programs. … The destruction of the Mississippi program unfortunately continues a recent trend in which several of the most effective state tobacco prevention programs have been decimated by budget cuts. Other pioneering programs that have faced deep budget cuts include those in Florida, Massachusetts, and Oregon, while funding for California's program has been cut to barely half the CDC's minimum recommendation."
On the other side, the report said New York and Maryland have significantly increased funding for tobacco prevention and cessation programs, and Colorado, Delaware, and Maine deserved recognition for sustaining their commitment to funding tobacco prevention programs at CDC-recommended levels.
New York is most improved state
New York was cited as being the most improved state for nearly doubling funding for tobacco prevention and cessation efforts from $43.4 million to $83.3 million. New York City provides an additional $3.7 million for its programs. The report says both the state and city programs have contributed significantly to smoking declines. New York state reduced smoking by 40% among high school students between 1999 and 2005 and by 15% among adults between 2001 and 2004. And New York City has reduced high school smoking by 52% since 1997 to just 11% in 2005, less than half the national rate of 23%.
Maryland doubles funding
Maryland also has more than doubled tobacco prevention funding, going from $9.2 million to $18.7 million. But its funding is still shy of the $21 million annually called for by state law and the $30.3 million annual minimum recommended by CDC, which Maryland did achieve in 2003.
This is the fifth straight year that Maine ranked first in the nation in funding tobacco prevention, the report said. It claims the investment has delivered tremendous health benefits for the state, which has reduced smoking among middle school students by 64% and among high schools by 59% between 1997 and 2005.
There are no excuses
The Campaign for Tobacco-Free Kids says states lack credible excuses for failing to do more to protect children from tobacco addiction and help smokers quit.
"When the public health problems posed by tobacco are compared to other health problems, it is clear that the amount the states are spending on tobacco prevention pales in comparison to the enormity of the problem," the report says. "Tobacco use is the No. 1 cause of preventable death in the United States, claiming more lives every year — 400,000 — than AIDS, alcohol, car accidents, murders, suicides, illegal drugs, and fires combined. Tobacco use costs the nation more than $96 billion a year in health care bills. Some 23% of high school students and 20.9% of adults still smoke. Every day, more than 1,000 additional kids become regular smokers, and one-third of them will die prematurely as a result.
Plenty of funding available
With states collecting a record $21.7 billion from the tobacco settlement and tobacco taxes this year, the report contends that just 7.3% of the total receipts would fund tobacco prevention and cessation programs in every state at CDC minimum levels. But the states are spending only 2.7% of their tobacco revenue on tobacco prevention and cessation.
Revenue continues to increase
The tobacco-generated revenue available to states continues to increase because, since Jan. 1, 2002, 42 states, Puerto Rico, and the District of Columbia have increased tobacco taxes, some more than once. Those increases have increased the average state cigarette tax from 43.4 cents to $1 per pack; six states now have cigarette tax rates of $2 or more and 22 states have taxes rates of $1 or more.
In addition, a little-known provision of the multistate tobacco settlement calls for the 46 states, the District of Columbia, and the U.S. territories that are party to the settlement to receive bonus settlement payments of almost $1 billion per year beginning in 2008 and continuing for at least 10 years. Coincidentally, the report says, the annual bonus payments nearly equal the difference between what the states currently spend on tobacco prevention and cessation programs and what they need to spend to meet the CDC's minimum recommendations.
"By allocating these new windfall funds to tobacco prevention and cessation, the states can finally keep the promise of the tobacco settlement to aggressively confront the tobacco problem," the report said. "Rarely do elected officials get such a second chance to keep a promise."
The report concludes that evidence from the states themselves demonstrates that prevention and cessation programs work and the resulting smoking declines translate into lives and health care dollars saved. Maine, for example, estimates that its smoking declines have prevented more than 26,000 youth from becoming smokers, saving more than 14,000 of them from premature, smoking-caused deaths, and already saved more than $416 million in future health care costs, a significant return on investment for a program funded at $14.7 million this year. Savings estimates are based on research showing that smokers have, on average, $16,000 more in long-term health care costs than nonsmokers. Washington State says its smoking declines (57% among sixth graders, 48% among 10th graders, 49% among eighth-graders, and 44% among 12th-graders) translate into 65,000 fewer youth smokers, 130,000 fewer adult smokers, and $2.6 billion in long-term health care cost savings.
Success in California
Studies have shown, the report says, that California, which started the nation's oldest tobacco prevention program in1990, has saved tens of thousands of lives by reducing smoking-caused birth complications, heart disease, stroke, and lung cancer. And other studies have indicated that California and Massachusetts, which started their tobacco prevention programs in 1990 and 1993, respectively, are saving as much as $3 in smoking-caused health care costs for every dollar spent on tobacco prevention when their programs were adequately funded.
"Our nation has made significant progress in reducing tobacco use with a comprehensive approach that includes well-funded tobacco prevention and cessation programs, tobacco tax increases, and smoke-free air laws," the report says. "Continued progress will not occur, however, unless more states use more of the billions of dollars they receive from the tobacco settlement and tobacco taxes to fund comprehensive tobacco prevention and cessation programs, based on the CDC recommendations. If they do, the 1998 state tobacco settlement could yet mark a historic turning point in the battle to reduce tobacco's terrible toll. If they do not, it will be a tragic missed opportunity for the nation's health.
Download the report from www.tobaccofreekids.org/reports/settlements/2007/spendingrevenues.pdf. Contact the Campaign for Tobacco-Free Kids at (202) 296-5469 or e-mail [email protected].
Only Colorado, Delaware, and Maine are funding tobacco prevention programs at minimum levels recommended by the Centers for Disease Control and Prevention (CDC).Subscribe Now for Access
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