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U.S. Progress in Reducing Smoking At Risk Unless States Increase Funding For Tobacco Prevention Programs, Report Warns

Report by Campaign for Tobacco-Free Kids, American Heart Association, American Lung Association and American Cancer Society Cancer Action Network
December 12, 2007

Washington, D.C. — With smoking rates at a standstill after nearly a decade of decline, the nation's progress in reducing smoking is at risk unless states significantly increase funding for programs to prevent kids from smoking and help smokers quit, warns a report released today by a coalition of public health organizations.

The annual report assesses whether states are keeping their promise to use proceeds from the 1998 state tobacco settlement to combat tobacco use. This year, the report finds that the states have increased funding for tobacco prevention and cessation programs by 20 percent to $717.2 million, the highest level in six years. However, most states still fail to fund these programs at minimum levels recommended by the U.S. Centers for Disease Control and Prevention (CDC), and the states combined are providing less than half what the CDC has recommended. (The CDC recently updated its funding recommendations. This report will begin to use the new recommendations next year—see note at the end of this release.)

The report, 'A Broken Promise to Our Children: The 1998 State Tobacco Settlement Nine Years Later,' was released by the Campaign for Tobacco-Free Kids, American Heart Association, American Lung Association and American Cancer Society Cancer Action Network.

The report's findings include:

  • Only three states—Maine, Delaware and Colorado—currently fund tobacco prevention programs at CDC minimum levels.
  • Only 17 other states fund tobacco prevention programs at even half the CDC’s minimum amount.
  • Thirty states and the District of Columbia are spending less than half the CDC minimum, while Connecticut has appropriated no funding for tobacco prevention this year.
  • Total state funding for tobacco prevention amounts to less than 3 percent of the record $24.9 billion the states will collect this year from the tobacco settlement and tobacco taxes. Just 6.4 percent of this tobacco revenue would fund prevention programs in every state at CDC minimum levels.
  • The states’ funding of tobacco prevention pales compared to the $13.4 billion a year spent on tobacco marketing and the nearly $100 billion spent each year on health care bills due to tobacco use.

The report comes as recent surveys have found that the nation’s progress in reducing smoking has stalled among both youth and adults. The CDC recently reported that 20.8 percent of adults smoked in 2006, about the same as the 20.9 percent in 2004 and 2005. This follows a steady decline between 1997 and 2004. High school smoking rates have similarly stalled after declining from a high of 36.4 percent in 1997, and 23 percent of high school students still smoke, according to the most recent CDC data.

The CDC has attributed this stall to several factors, including cuts in tobacco prevention funding, increases in tobacco marketing and stagnant cigarette prices due to industry discounting.

States cut tobacco prevention funding by 28 percent between 2002 and 2005, from $749.7 million to $538.2 million, before funding rebounded to current levels. At the national level, the American Legacy Foundation had to reduce its highly successful truth® media campaign because most of its funding under the 1998 tobacco settlement ended after 2003. In contrast, tobacco marketing has nearly doubled since the 1998 settlement to $13.4 billion in 2005, according to the Federal Trade Commission. More than 80 percent of tobacco marketing is now spent on price discounts, which have kept cigarette prices from increasing despite state cigarette tax increases and encourage smoking especially by youth, who are the most price-sensitive customers.

Entering the 10th year of the tobacco settlement, today’s report challenges every state to keep the promise of the settlement and fund a tobacco prevention program at CDC-recommended levels. It also calls on Congress and the states to follow the recommendations of landmark reports issued this year by the Institute of Medicine and the President’s Cancer Panel. These reports recommended that Congress enact legislation granting the U.S. Food and Drug Administration authority over tobacco products, significantly increase the federal tobacco tax and fund a national public education campaign and that states fully fund tobacco prevention programs, increase tobacco taxes and enact smoke-free workplace laws.

'It is unacceptable to stand still in the fight against the number one preventable cause of death in our country,' said William V. Corr, Executive Director of the Campaign for Tobacco-Free Kids. 'As the Institute of Medicine and the President's Cancer Panel found, we know what works to reduce smoking, save lives and save money by reducing tobacco-related health care costs. What's needed is the political leadership to fund and implement these measures as aggressively as the tobacco companies continue to market their deadly and addictive products.'

'Tobacco use kills more than 170,000 people each year from heart disease, stroke and other cardiovascular diseases alone. These deaths can be prevented if our nation's leaders implement proven measures to reduce tobacco use, including funding tobacco prevention programs in every state at minimum levels recommended by the CDC,' said M. Cass Wheeler, CEO, American Heart Association.

'Funding tobacco prevention programs is one of the smartest and most fiscally responsible investments that state governors and legislators can make,' said John R. Seffrin, PhD, national chief executive officer of the American Cancer Society. 'Yet, far too many states are missing this golden opportunity to not only prevent disease and death, but also save money by lowering tobacco-related health care costs. States must do better in funding programs that help reduce tobacco use and protect the health of our youth.'

'States must commit to funding these life-saving programs,' said Bernadette Toomey, President and CEO of the American Lung Association. 'The tobacco companies have not stopped targeting children—especially girls and young women—with their deadly products. A very small investment in these programs today will reap huge rewards tomorrow. It is unfortunate that only a few states are willing to take the steps necessary to save lives and reduce health care costs. Leaders in Maine, Colorado and Delaware are to be commended for their wise investment decision.'

The report cites conclusive evidence that tobacco prevention programs work, including the findings of the IOM and President’s Cancer Panel. Maine, which ranks first in funding tobacco prevention for the fifth year in a row, reduced smoking by 64 percent among middle school students and by 59 percent among high school students from 1997 to 2005. The successes of tobacco prevention programs in Mississippi (before funding was cut), New York, Ohio, Washington and other states provide further proof that these programs have worked in every state in which they were adequately funded.

The multi-state tobacco settlement, signed by 46 states and the major tobacco companies on November 23, 1998, requires the tobacco companies to make annual payments to the states in perpetuity as reimbursements for health care costs related to tobacco use. Four states—Mississippi, Texas, Florida and Minnesota—reached earlier, individual settlements. Payments under the settlements were estimated to total $246 billion over the first 25 years.

Tobacco use is the nation's leading preventable cause of death, killing more than 400,000 people and costing nearly $100 billion in health care bills each year. Every day in the U.S., more than 1,000 kids become regular smokers; one-third of them will die prematurely as a result.

(NOTE: In October 2007, the CDC for the first time since 1999 updated its recommendations for the amount each state should spend on tobacco prevention programs. This update takes into account new scientific evidence, state experience and cost factors such as inflation and population growth. For most states, the new funding recommendations are significantly higher than current ones. Next year, this report will begin to assess the states based on these new recommendations.)