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New Report: States Continue to Shortchange Tobacco Prevention Programs, Though a Few States Show a Welcome Increase

January 13, 2022

WASHINGTON, D.C. – As the nation continues to face dual health threats from an unprecedented respiratory pandemic and a youth e-cigarette epidemic that threatens millions of young people with a lifetime of addiction, a new report highlights how most states continue to shortchange programs designed to prevent kids from using tobacco products and help tobacco users quit. A handful of states, though, show a promising path forward for other states to follow.

The report is a challenge to states to do more to fight tobacco use – still the nation’s leading preventable cause of death – and prevent e-cigarettes from addicting a new generation of kids. 

This year (fiscal year 2022), the states will collect $27 billion from the 1998 tobacco settlement and tobacco taxes. But they will spend a paltry 2.7% – just $718.5 million – on tobacco prevention and cessation programs. This total is a 9.5% increase from last year but still barely a fifth (21.7%) of the total funding recommended by the Centers for Disease Control and Prevention (CDC). 

The overall increase in spending can be attributed primarily to three states – Oregon, California and North Carolina. Oregon’s increase is due to a $2-per-pack tobacco tax increase voters strongly approved in 2020, with some funds allocated for tobacco prevention and cessation programs. California’s spending has been strong since voters there overwhelmingly approved a $2-per-pack tobacco tax hike in 2016. North Carolina has additional funds from their recent legal settlement with Juul, the company most responsible for causing the youth e-cigarette epidemic. 

Despite these increases, not a single state currently funds its tobacco prevention and cessation programs at CDC-recommended levels, and only 10 states provide even half the recommended amount. And the top three states in actual spending (California, Florida and New York) spent a total of $365.4 million or more than the other 47 states and Washington, D.C. combined ($353.2 million). These low levels of funding are even more alarming when compared to the more than $8.4 billion the tobacco industry spends annually to market their deadly and addictive products. 

The report – “Broken Promises to Our Children: A State-by-State Look at the 1998 Tobacco Settlement” – was released today by the Campaign for Tobacco-Free Kids, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights and Truth Initiative. These organizations have issued annual reports since the November 1998 landmark legal settlement between 46 states and the major tobacco companies, which – along with individual settlements with four other states – required the companies to pay more than $246 billion over time as compensation for tobacco-related health care costs.

View the report, including state-by-state information and a ranking of the states.

The report comes as youth use of e-cigarettes remains a serious public health problem. With 2 million U.S. kids using e-cigarettes, including 11.3% of high school students, states should be devoting more of their tobacco dollars to help fight this epidemic. 

Government surveys show that 20.8% of U.S. adults and 23.6% of high school students still use some form of tobacco, with cigarette smoking rates at 14% for adults and 4.6% for high school students. The U.S. also faces large disparities in who still smokes. Adult smoking rates remain the highest among people with lower income and less education, residents of the Midwest and the South, American Indians/Alaska Natives, LGBTQ Americans, those who are uninsured or enrolled in Medicaid, and those with mental illness. In addition, Black Americans die at higher rates from smoking-caused diseases, in large part due to the tobacco industry’s predatory targeting of Black communities with menthol cigarettes. Altogether, tobacco use kills over 480,000 people and is responsible for over $226 billion in health care expenditures in the U.S. each year.

“The tobacco companies remain as relentless as ever in marketing their addictive and harmful products – including menthol cigarettes, flavored e-cigarettes and flavored cigars – so it is critical that the states step up their efforts to protect our kids and help tobacco users quit,” said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. “We know how to win the fight against tobacco, but most states are falling woefully short. They are literally sacrificing the health of their children and costing taxpayers billions by refusing to properly fund tobacco prevention efforts and ignoring the mountain of evidence that these programs save lives and money. Policymakers need to step up and implement the proven strategies that can end the grip Big Tobacco has had on this country for far too long.”

To accelerate progress, policymakers at all levels should fully implement proven measures to reduce tobacco use. In addition to funding tobacco prevention programs, these strategies include ending the sale of all flavored tobacco products, significant tobacco tax increases, comprehensive smoke-free laws, hard-hitting mass media campaigns, and barrier-free insurance coverage for tobacco cessation treatment. 

Other key findings in the report:

  • Oregon (93.9%) and Alaska (89.6%) are the only states to provide even three-quarters of the CDC-recommended funding for tobacco prevention and cessation programs.
  • Only 10 states (Oregon, Alaska, Utah, California, North Dakota, Oklahoma, Delaware, Wyoming, Hawaii and Maine) provide more than half of the CDC-recommended funding.
  • 33 states and DC are providing less than 25% of what the CDC recommends; 19 states provide less than 10%.
  • Connecticut has again allocated no state funds for tobacco prevention programs.
  • Tobacco companies spend more than $11 to market tobacco products for every $1 the states invest to reduce tobacco use. According to the most recent data from the Federal Trade Commission (for 2020), the major cigarette and smokeless tobacco companies spend $8.4 billion a year – almost $1 million per hour – on marketing.

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