Put the tobacco settlement money in smoking cessation

Nov. 23, 1998, was a notable and optimistic day in the fight against smoking. Forty-six states settled their lawsuits against the major tobacco firms to recover smoking-related medical costs. They, along with the four states -- Mississippi, Florida, Texas and Minnesota -- that had reached earlier individual settlements would receive annual payments from the tobacco companies far into the future, including a collective $246 billion in the first 25 years.

The settlement didn't dictate how the states were to spend that money. But many state leaders promised to use the bulk of it for smoking cessation and prevention to fight the No. 1 preventable cause of death in the United States -- diseases associated with the use of tobacco products.

So 10 years after the settlement, how have the states done in following through on the promises of that auspicious November day?

Very poorly, according to a report recently issued by the Campaign for Tobacco-Free Kids.

The report by the campaign, which includes the American Medical Association among its members, found that with hundreds of billions of dollars collectively available each year from settlement money and tobacco tax revenue, states do not even come close to their promises for spending on smoking cessation and prevention. They don't even come close to the Centers for Disease Control and Prevention-recommended levels of spending, which would be merely 15% of that money.

AMA policy supports using tobacco settlement money almost exclusively for smoking prevention and cessation programs -- even the balance of the money has to be spent on health services. The AMA also supports tobacco tax increases, with a "substantial" amount of the proceeds to be used for health programs, smoking cessation and efforts to counter tobacco company advertising.

In the last 10 years, states have received $79.2 billion of settlement money, along with another $124.3 billion from tobacco taxes. Yet the report found that only $6.5 billion -- 3.2% -- was devoted during that time to smoking prevention and cessation programs. No state has reached the CDC-recommended funding level, though North Dakota could do so in 2010 after voters passed an initiative dictating that amount of spending on tobacco programs.

This lack of spending persists even though there is ample evidence that every dollar spent makes a huge impact.

As an example, the report cites a study in the August 2008 PloS Medicine, a peer-reviewed journal published by the Public Library of Science, finding that the $1.8 billion California spent fighting tobacco use over the last 15 years resulted in $86 billion in health care savings. That is $50 saved for every $1 spent on smoking prevention and cessation.

Even at current rates of spending, states in theory should be able to make more progress, as there is an extra $1 billion spread out each of the next 10 years in tobacco litigation settlement payments. But other money marks a threat to that progress.

Tobacco companies, themselves, are increasing their marketing budgets -- they nearly doubled from $6.9 billion in 1998 to $13.4 billion in 2005, according to the latest information available from the Federal Trade Commission.

Meanwhile, the current economic recession has state budgets in crisis. States will be greatly tempted to raid tobacco money to fill budget holes, as many did between 2002 and 2005. That's when smoking-related spending was cut 28% during a time of fiscal pressure. It is a temptation that should be avoided. The CDC found that when that spending was cut, the rate of adult smoking stopped falling.

Spending money on tobacco cessation and prevention is like a vaccine -- effective prevention against having to treat the diseases associated with smoking. If states pay now, they won't have to pay later. Regrettably, had they properly spent settlement money earlier, they wouldn't have as much of the costly and tragic smoking-related disease they face today.