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New Report: States Shortchange Tobacco Prevention Programs Proven to Save Lives and Health Care Dollars

States Challenged to Step Up Fight and Close Big Gaps in Who Still Smokes in America
December 13, 2017

WASHINGTON, D.C. – The states this year will collect a record $27.5 billion in revenue from the 1998 tobacco settlement and tobacco taxes, but will spend less than 3 percent of it – $721.6 million – on programs to prevent kids from smoking and help smokers quit, according to a report released today by a coalition of public health organizations. The report challenges states to do more to fight tobacco use – the nation’s No. 1 cause of preventable disease and death – in order to accelerate progress and address large disparities in who still smokes in the United States.

The report – “Broken Promises to Our Children: A State-by-State Look at the 1998 Tobacco Settlement 19 Years Later” – was released by the Campaign for Tobacco-Free Kids, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Robert Wood Johnson Foundation, Americans for Nonsmokers’ Rights and Truth Initiative.

The United States has made great strides and reduced cigarette smoking to record lows – 15.1 percent among adults in 2015 and 8 percent among high school students in 2016. But tobacco use still kills more than 480,000 Americans and costs the nation about $170 billion in health care expenses each year.

Today’s report highlights the need to address large disparities in who still smokes and who suffers from tobacco-related diseases in the United States. Smoking rates are especially high in a swath of 12 states in the Midwest and South, an area called “Tobacco Nation” in a recent report by Truth Initiative. Nationwide, smoking rates are highest among people who live below the poverty level and have less education, American Indians/Alaska Natives, LGBT Americans, those who are uninsured or on Medicaid, and those with mental illness. These differences are in large part due to the tobacco industry’s targeting of vulnerable populations through advertising, price discounting and other marketing strategies.

“Our progress shows that we can win the fight against tobacco and make the next generation tobacco-free, but we need bold action at all levels of government to finish the job,” said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. “We cannot become a nation of haves and have-nots in combating tobacco use, with some states, communities and vulnerable populations left behind and suffering higher burdens of tobacco-related death and disease. Nationally and in every state, policy makers must fully implement the proven strategies that can end this scourge once and for all.”

To accelerate progress, the report calls for full implementation of science-based strategies to reduce tobacco use, as recommended by the U.S. Surgeon General and other public health experts.

At the federal level, the Centers for Disease Control and Prevention (CDC) should continue and expand its highly successful Tips From Former Smokers media campaign, which has helped at least 500,000 smokers quit and saved at least 50,000 lives since its launch in 2012. However, continuation of this campaign is threatened by a proposal in Congress to cut funding for the CDC’s tobacco prevention and cessation efforts by nearly 25 percent.

In addition, the Food and Drug Administration (FDA) must fully utilize the authority it received under a 2009 law to regulate all tobacco products. The FDA should take several critical steps: implement its new plan to limit nicotine in cigarettes to minimally addictive or non-addictive levels, and apply this limit to other combustible tobacco products; require graphic warnings covering at least half of cigarette packs, as the 2009 law mandated; and prohibit the use of menthol in cigarettes and flavors in other tobacco products, which have been shown to promote youth use of these products.

In addition to funding tobacco prevention and cessation programs, state and local officials should implement other strong policies including: enacting significant tobacco tax increases; implementing comprehensive smoke-free laws; raising the legal sale age for tobacco to 21; requiring insurance coverage for comprehensive quit-smoking benefits; and, in the absence of FDA action, prohibiting and restricting the sale of menthol cigarettes and other flavored tobacco products.

Key findings of this year’s report include:

  • The $721.6 million the states have budgeted for tobacco prevention amounts to just a small fraction of the $3.3 billion recommended by the CDC. Not a single state currently funds tobacco prevention programs at the CDC-recommended level.
  • Only two states – California and Alaska – provide more than 90 percent of the recommended funding. Twenty-nine states and the District of Columbia are spending less than 20 percent of what the CDC recommends. Connecticut and West Virginia have allocated no state funds for tobacco prevention programs. Find out how each state ranks.
  • California is the one bright spot this year, having significantly increased funding for tobacco prevention and cessation as a result of a successful 2016 ballot initiative that raised the state’s tobacco tax by $2 per pack and earmarked part of the funding for tobacco control programs. Excluding California, the states cut tobacco prevention funding by 5 percent in the past year.
  • Tobacco companies spend more than $12 to market tobacco products for every $1 the states spend to reduce tobacco use. According to the most recent data from the Federal Trade Commission (for 2015), the major cigarette and smokeless tobacco companies spend $8.9 billion a year – $1 million each hour – on marketing.

“Lawmakers have a responsibility to put the health of their residents first by standing up to Big Tobacco, an industry that has been lying to the world about the harms of its deadly products for decades,” said Christopher W. Hansen, President of the American Cancer Society Cancer Action Network (ACS CAN). “In the 2018 legislative sessions, states should look for solutions to fully fund tobacco prevention and cessation programs, increase the price of tobacco products and pass and implement comprehensive smoke-free laws. Doing so will not only save lives, but critical health care dollars as well.”

“To sustain the fight against the insidious tobacco epidemic, we must keep all hands on deck, including leadership from every state in the nation. It’s absolutely essential that state officials invest this revenue where it belongs – in proven successful tobacco prevention programs that get results,” said Nancy Brown, CEO of the American Heart Association. “A commitment from our elected leaders to invest more on tobacco prevention, combined with tough smoking policies, will keep up the momentum until we reach our goal of becoming a nation that is 100 percent tobacco-free.”

“It is unacceptable that states continue to withhold the necessary funding for these vital prevention and cessation programs, despite having billions of dollars from tobacco settlement payments and tobacco taxes to fund them,” said Harold P. Wimmer, National President and CEO of the American Lung Association. “These prevention programs are particularly important in making sure we continue to reduce tobacco use for all Americans, including populations that have high tobacco use rates.”

“Smoke-free workplace laws are successful, popular and save lives,” said Cynthia Hallett, President and CEO of Americans for Nonsmokers' Rights. “Unfortunately, many states still fall far short on this basic public health protection. The tobacco industry knowingly lied for decades about the health hazards of secondhand smoke and lobbied extensively to keep smoking in casinos, bars, airports and more. We urge state lawmakers to take renewed action to strengthen weak smoke-free laws that leave millions of Americans exposed to secondhand smoke in their job.”

“While we have made tremendous progress in our mission to create the first tobacco-free generation, the historic low smoking rates don't tell the whole story. Millions of Americans, particularly in the South and Midwest, are being left behind. Big Tobacco continues to fully exploit those with health, education and economic disparities through aggressive spending and marketing tactics aimed at vulnerable populations,” said Robin Koval, CEO and President of Truth Initiative. “States have the power to impact price, access, and availability of tobacco with tools such as higher taxes, retail restrictions, flavor bans, and tobacco 21 policies – all proven strategies that counteract the tobacco industry and help those most at risk. Now is the time for states to continue to step up funding and accelerate our progress.”

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