Anti-tobacco funding gone up in smoke

When it comes to tobacco use, there is a problem of willpower. It's not limited to smokers who can't resist the urge for one more cigarette. It also affects state lawmakers, most of whom can't summon the willpower to spend tobacco settlement and tax money on smoking prevention and cessation.

According to a report by the Campaign for Tobacco-Free Kids, states in fiscal year 2012 are collecting a near-record $25.6 billion in tobacco-related revenue. That total is a combination of a 1998 court settlement with tobacco companies and taxes on tobacco products.

The American Medical Association and others have pushed for maximizing spending on smoking prevention and cessation. But, as the Campaign for Tobacco-Free Kids notes, states will spend only 1.8% of tobacco revenues -- or $456.7 million -- on anti-tobacco programs. Worse yet, the spending is on a sharp decline -- down 36% in four years.

No one expects 100% of tobacco settlement and tax money to go toward anti-smoking efforts. But it's shameful that states can only muster up less than 2 cents out of every revenue dollar to fight the No. 1 preventable cause of death and disease in the United States. The campaign's report should wake up state legislators to the idea that anti-tobacco programs must be funded adequately if they want to eliminate tobacco-related health, social and economic consequences.

In areas other than funding, there is some good news to report. States and localities have gone a long way toward restricting where smokers can light up, with laws banning indoor smoking in many public places. And they've made it tougher to buy tobacco by raising taxes on it.

But what state legislators haven't done much is to help those smokers who want to quit. Anti-tobacco funding from the 1998 settlement and tobacco taxes doesn't even come close to the Centers for Disease Control and Prevention's recommended goals.

The CDC points out that states need only spend $3.7 billion -- 15% of their tobacco revenues -- to meet its recommended funding level (that's about one-quarter of what tobacco companies spend annually on advertising their products). Instead, states are spending barely more than one-tenth of what they should be spending, the CDC reports.

According to the Nov. 30, 2011, Campaign for Tobacco-Free Kids report, Alaska and North Dakota are the only states funding tobacco prevention programs at CDC-recommended levels. Only four other states reach half the recommended funding. Meanwhile, 33 states fund less than one-quarter, including four states -- Connecticut, Nevada, New Hampshire and Ohio -- and the District of Columbia, which budgeted nothing in fiscal year 2012 for tobacco cessation and prevention programs.

Some federal money has been available for states to use in anti-tobacco efforts. However, one source of that funding -- the 2009 American Recovery and Reinvestment Act, known as the stimulus bill -- is drying up, and money for tobacco prevention that was included in the health system reform bill is under threat of being slashed. And even at its maximum, federal funding can't come close to replacing the tobacco revenue states have on hand.

States have argued that their declining budget situations have necessitated spending tobacco revenues on more immediately pressing items. But evidence shows that spending the money on anti-tobacco efforts more than pays for itself -- right away.

For example, a study published Dec. 15, 2011, in the American Journal of Public Health found that between 2000 and 2009 in Washington state, $5 in health costs was saved for every $1 spent by the state on tobacco cessation and prevention. That $5 wasn't projected savings on future health costs -- that benefit was realized immediately. And yet, Washington in fiscal year 2012 cut its anti-tobacco funding to $750,000, or 1.1% of CDC-recommended funding, from $13.4 million, or 19.8% of CDC-recommended funding, in fiscal 2011.

The AMA is urging physicians and state medical societies to be active in educating elected officials on the public health and economic need to fund anti-smoking efforts. Lawmakers must understand the importance of tobacco prevention and cessation programs, and they must summon the political willpower to fund them at adequate levels.