Diversion of Tobacco Settlement Funds and Taxes Slows Anti-Smoking Progress

WASHINGTON -- Hundreds of thousands of Americans will die from preventable cancer and heart disease in coming years because states are short-changing proven anti-smoking programs, health experts say.

About $20 billion is available annually through tobacco lawsuit settlement funds and cigarette taxes, but only 3 percent of it is spent on anti-smoking programs, critics say.

The funding backslide is a primary reason that U.S. officials concede there is little hope of cutting smoking rates, now about 22 percent, to 12 percent by 2010, one of the federal government's top public health goals.

Only three states -- Delaware, Mississippi and Maine -- are investing the minimum recommended by federal health officials for anti-smoking programs. Thirty-eight states spend less than half of what's needed; six spend nothing.

States struggling with budget problems have shifted potential tobacco control money to pay for rising Medicaid costs and non-health expenditures on highways, schools and other items.

Public health experts say the consequences will be lethal and expensive. Avoidable cases of smoking-related lung cancer and heart disease will result not only in premature deaths, they note, but huge medical costs.

Larry Downs, executive director of New Jersey Breathes, a coalition of anti-smoking groups, says program funding in the state has dwindled from about $30 million in 2000 to $11 million today. That's about 25 percent of the minimum needed, according to the federal Centers for Disease Control and Prevention, which tailors recommendations to each state.

"Between 10,000 and 13,000 people die early in New Jersey each year from tobacco," Downs said. "Before they die, they wrack up huge health care costs. The numbers are so high they become incomprehensible to the average person."

A 2003 CDC survey found there were about 45 million adult smokers in the U.S. Of those, about 40 percent reported having tried to quit in the preceding year.

"If we were able to help all the people who want to quit be successful, we would meet the goal" of reducing the smoking rate to 12 percent, said Terry Pechacek, associate director of science for the CDC's office on smoking and health.

Federal officials say research has shown what works, including local education programs involving teens, parents, doctors and teachers; projects to promote clean air, restrict access to tobacco and provide addiction treatment; enforcement of laws against tobacco sales to minors and smoking in public places; media campaigns to counter tobacco advertising; and programs to help smokers quit.

In 2002, New York City passed a tobacco control program that outlawed smoking in public places, boosted taxes on cigarettes and expanded smoking cessation services. The smoking rate dropped 11 percent in the first two years, resulting in 140,000 fewer smokers in the city, according to a study this year in the American Journal of Public Health.

It is difficult to say how many deaths would be prevented if federal guidelines were adhered to, experts say. But a study this year of the population under age 18 concluded that funding at federal minimums would prevent 2 million kids from becoming smokers, saving 600,000 from premature smoking-related deaths. Better-funded prevention programs aimed just at kids would save $23.4 billion in long-term smoking-related health care costs.

"It's a travesty," said Daniel McGoldrick, research director for the Campaign for Tobacco-Free Kids, which conducted the study with the University of Illinois-Chicago. "We know the programs work. We know we have the money for them. But when there's money on the table, everybody goes after it."

In Alabama, the money devoted to CDC-recommended tobacco prevention efforts dropped from $6 million in 2000 to $360,000 in 2005. In Illinois, funding in the same period declined from $28.6 million to $11 million; in Florida, from $44 million to $1 million.

Arturo Perez, a fiscal analyst for the National Conference of State Legislatures, said at least three factors led states to spend potential tobacco funds elsewhere when they became available in 2002:

First, the 1998 multistate settlement with tobacco companies -- expected to yield $246 billion over 25 years -- did not mandate how the money should be spent. Second, some state politicians believed years of spending on rising health care costs had forced them to neglect non-health programs. And settlement money became available during a period of plummeting state revenues.

"States started looking for money everywhere, including seat cushions," Perez said.

Michigan commits tobacco settlement money to education and senior health care programs, but devotes $6 million in general revenue to anti-tobacco efforts. Some members of the state Legislature have pushed to reduce the general fund amount, said T.J. Bucholz, a spokesman for the Michigan Department of Community Health.

After cigarette taxes were raised to $2 per pack last year, Gov. Jennifer Granholm tried to dedicate $30 million to health promotion programs, including tobacco control. The proposal failed.

"We absolutely believe prevention is key to making Michigan a healthier place to live, but the Legislature doesn't seem to want to hear that," Bucholz said.

Last year, Michigan spent about $880 million to treat Medicaid patients with smoking-related illnesses, Bucholz said.

Ohio, while it has passed no statewide smoking restrictions, ranks fifth in the nation on smoking prevention spending. One element is a quit line that has received 40,000 calls since opening in September 2004.

About 25 percent of the callers succeed in staying "smoke-free" for at least six months, according to the Ohio Tobacco Use Prevention and Control Foundation. One of them is Joyce Szwagulak, 61, of Fairview Park, a Cleveland suburb.

Szwagulak said she smoked for 39 years -- mostly Doral 100s -- before she stopped cold turkey. She called the quit line about once a day for a month to get the job done.

"I talked to a gentleman, his name was Diego," Szwagulak said. "I told him why I wanted to quit: My niece had a little baby boy, and she wouldn't bring him over. I live in a small apartment, and you could smell it. I said, `It's time to do something."'

The longer she refused to light up, the more determined she became, Szwagulak said. "I called Diego and he said, `Joyce, another 24 hours. I am so proud of you.' It makes your chest raise another inch. And now I'm going to start crying."

Tabithia Engle, associate director of the Tobacco Free Coalition of Oregon, said that state was experiencing startling gains when tobacco prevention efforts were fully funded. During 1997-2003, the number of adult smokers in Oregon fell by 75,000. An estimated 2,700 fewer pregnant women were smoking.

But funds for the prevention programs, once about $7.5 million per year, have dropped to about $3.5 million despite continued revenue from the tobacco settlement and a $1.18 per pack tax on cigarettes.

"It's devastating to think that more than 7,000 die every year" in Oregon from smoking-related causes, Engle said. "That averages out to 18 people a day. Those are family members who won't get to see graduation, won't get to see weddings. If tobacco use is a disease, we have a vaccine for it. But we have a vaccine that we're not using."

The spectre of making an honest living must have pushed him over the edge.

How right you are. Losing their jobs is actually the impetus behind the whining about the use of settlement funds - those funds pay their salaries :)

Larry Downs, executive director of New Jersey Breathes, a coalition of anti-smoking groups, says program funding in the state has dwindled from about $30 million in 2000 to $11 million today. That's about 25 percent of the minimum needed........to pay the salaries of the slackers and hangers-on suckling off the teat of these organizations.

These people actually piss me off more than the "Homeless" racket.

Because the "experts" say so. Seems quitting doesn't save you from lung cancer if you have the tendency toward it. At least that is what they are saying in conversations surrounding Peter Jennings death. He smoked period no matter how long ago. Furthermore, had he not all those evil smokers exposed him to secondhand smoke. The experts are bent on tobacco being the cause of death period. Wonder if no one smoked if we would live forever and free of cancer?

Actually, I fully agree with this. As a smoker, I have paid the government and insurance companies thousands of dollars that other citizens are not required to pay. If this was for an established smoker's insurance program, then this money would have been wisely invested. Smoker's health costs would be self-funded and available to them when needed. Instead, smokers have been forced to pay thousands of dollars, which they will never see returned. When they do need health insurance, it will be denied them. This is a criminal action directed against 25 percent of the American population.

Under this premise smokers need to hold the State's liable for any "future" smoking related health care but that would then open the door to hold all others liable for like health related care, i.e., such as McDonalds, Smith & Wesson and so on. Makes no sense that the States are sucking from any sin/politically correct gravy train via taxes anyway. The taxes and false motives in my opinion are what need to be addressed. Until the States do not benefit in any way and are required to spend the tax on the related sin nothing will stop the targeting of certain individuals. Why do you suppose they do not go after beer--my guess is the votes from Joe six-pack (dems) they think they need to keep.

Wonder if no one smoked if we would live forever and free of cancer?

I think we probably would and we would no longer have to worry about global warming either, without those filthy cigarettes.

Everyone in my family smoked except my mother. An aunt and her son died of several kinds of cancer, one of which was lung cancer. She was 88, he was 61. My mother the non smoker died of natural causes at 88. Her mother smoked at least a pack a day of unfiltered cigarettes most of her life. She died at 87 of non smoking related causes. Same with my mom's dad. The three others died younger, one in her forties the two others in their seventies of non smoking related causes. All were heavy smokers. I am 67 and in good health although I have smoked for at least 50 years. I may develop lung cancer tomorrow but I suspect that most of that in in our genes rather than our environment unless the environment is an extreme one.

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