Despite years of warnings, smoking still has draw
■ Most states get failing grades for smoking prevention efforts despite receiving millions of tobacco settlement dollars, says a new report.
By Susan J. Landers — Posted Feb. 16, 2004
Washington -- Forty years after the first surgeon general's report exposed the dangers of smoking, there are still 47 million American smokers and no shortage of finger-pointing as to why.
A recent American Lung Assn. report charged that few states are making serious efforts to control tobacco use. The report calls for more comprehensive state prevention and education programs and the passage and enforcement of additional clean air laws.
"This report highlights that tough laws save lives and protect our children," said John K. Kirkwood, CEO and president of the lung association. "How many more preventable deaths must occur and how many more children must become addicted to cigarettes before we say enough?"
The group's report meted out "F's" to 38 states and the District of Columbia for their failure to adequately fund tobacco prevention and control programs; to 35 states and the District of Columbia for failing to pass smoke-free air laws; to 13 states for insufficient tobacco taxes; and to 23 for inadequate laws to limit access by young people to tobacco.
But there was some good news. The lung association gave "A's" to 15 states in at least one of its four categories. Five -- California, Connecticut, Delaware, Maine and Rhode Island -- received A's in two categories and New York received three A's.
These ratings come five years after a master settlement agreement between major tobacco companies and 46 state attorneys general. The agreement called for the tobacco industry to pay the states more than $200 billion over 25 years to recover health costs lost to illnesses caused by smoking. The four remaining states settled their tobacco lawsuits independently for a total of $40 billion over 25 years.
Many of the states are drawing fire for using most of their settlement funds to plug budget gaps instead of funding smoking-prevention programs. During a Senate hearing last fall on states' use of settlement funds, Sen. John McCain, (R, Ariz.), said he hoped to determine why states are ignoring the problem of youth smoking. "Isn't an ounce of prevention better than a pound of cure?" he asked.
The lung association's findings reveal that only six states -- Arizona, Arkansas, Delaware, Hawaii, Maine and Mississippi -- committed significant amounts of money toward tobacco prevention and cessation efforts.
But many states are using their settlement funds for health services, said Deborah Hudson, a Republican member of the Delaware House of Representatives and co-sponsor of a law that banned most indoor smoking in her state. In fiscal years 2000 and 2001, states spent a third of their tobacco settlement money for health care services, she said during the hearing.
Meanwhile, the federal government is using the anniversary of Surgeon General Luther Terry's 1964 report to step up its anti-smoking efforts. A new surgeon general's report on smoking is due out soon -- the 28th report to date -- and a database is under construction that will highlight and update information on tobacco-caused diseases and proven tobacco use prevention approaches.
But anti-tobacco advocates view progress as too little, and the federal government is often criticized. In the Jan. 15 New England Journal of Medicine, Steven A. Schroeder, MD, chair of the American Legacy Foundation, wrote that weak federal efforts hinder anti-smoking progress. "Although U.S. smoking rates are slowly declining, progress toward that end would be faster if federal policy-making matched both the rigor of the scientific evidence against tobacco use and the resolve of anti-tobacco advocates."
But the blame doesn't stop there. Alan Blum, MD, director of the Center for the Study of Tobacco and Society at the University of Alabama in Tuscaloosa, Ala., recommends that anti-smoking advocates put their money where their mouth is.
"While the [American Lung Assn.] looks at the state legislatures as the latest culprits, I'm afraid that we think we have met the enemy and he -- and she -- is us," he said. "Rather than training more nicotine addictionologists and epidemiologists, we need to cultivate more creative strategists," he wrote with colleagues in a Jan. 10 editorial in The Lancet. "We need less research and more action."