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New Report: States Continue to Shortchange Tobacco Prevention Programs Despite Collecting Additional Revenue from Juul Settlements

Only One State Fully Funds Prevention Efforts, While Others Lag Behind
January 10, 2024

WASHINGTON, D.C. – Most states continue to shortchange programs to prevent kids from using tobacco products and help tobacco users quit even as they have reached over $1.1 billion in legal settlements with e-cigarette maker Juul that could be used for this purpose, according to a new report released today. Maine is the only state to fully fund tobacco prevention and cessation programs at levels recommended by the Centers for Disease Control and Prevention (CDC). Only eight other states provide at least 50% of the CDC’s recommended funding, while 31 states and the District of Columbia are spending less than a quarter of the CDC recommendation.

The report challenges states to step up their efforts to fight tobacco use – still the nation’s number one cause of preventable death – and stop tobacco companies from addicting a new generation of kids with e-cigarettes and other 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. In addition to tobacco settlement funds, states collect billions more in tobacco taxes.

This year, states have additional revenues that could be dedicated to tobacco prevention programs because of more than $1.1 billion in recent legal settlements with Juul for its deceptive marketing practices and its role in the youth e-cigarette epidemic. To fully undo the harm caused by Juul, states should be using this money for youth prevention efforts.

Key findings of the report include:

  • Even without counting the Juul settlement funds, the states this year (fiscal year 2024) will collect $25.9 billion from the tobacco settlements and tobacco taxes. But they will spend just 2.8% – $728.6 million – on tobacco prevention and cessation programs, down from $733.1 million in FY2023. This funding amounts to less than a quarter (22%) of the total funding recommended by the CDC.
  • The amount states are spending on tobacco prevention pales in comparison to the $8.6 billion a year tobacco companies spend to market cigarettes and smokeless tobacco products in the United States. This means tobacco companies spend nearly $12 to market their deadly and addictive products for every $1 the states spend to fight tobacco use.

“We know what works to win the fight against tobacco, and states have plenty of resources from tobacco settlements and taxes to invest in programs that can accelerate progress. Unfortunately, most states are falling short in funding these lifesaving programs,” said Yolonda C. Richardson, president of the Campaign for Tobacco-Free Kids. “The tobacco industry continues to do everything it can to target our kids, Black communities, and other vulnerable communities, especially with flavored products like menthol cigarettes and flavored e-cigarettes. We know their playbook, and policymakers should be using every tool available to protect our kids and help those already addicted.”
The continuing need for well-funded tobacco prevention and cessation programs is clear. While the U.S. has made enormous progress in reducing use of cigarettes and other tobacco products, tobacco use still kills over 480,000 people and is responsible for over $241 billion in health care expenditures in the U.S. each year. 

The latest government survey results show that 2.8 million U.S. middle and high school students reported current (past 30-day) use of any tobacco product in 2023, including 2.1 million who used e-cigarettes. Flavors play a key role in youth use, with 89% of youth e-cigarette users and 87% of youth who use any tobacco product reporting that they used flavored products.

Among U.S. adults, the CDC has reported that 18.7% (46 million) were current tobacco users in 2021, including 11.5% who smoked cigarettes. The U.S. also faces large disparities in who still smokes. Adult smoking rates are 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 health conditions. In addition, Black Americans die at higher rates from smoking-related diseases like cancer, heart disease and stroke, in large part due to the tobacco industry’s predatory targeting of Black communities with menthol cigarettes. 

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

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