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A State-by-State Look at the
1998 Tobacco Settlement 22 Years Later

Despite receiving nearly $27 billion from the tobacco settlement and tobacco taxes, the states continue to severely underfund tobacco prevention and cessation programs proven to save lives and money. In the midst of a youth e-cigarette epidemic, such programs are as critical as ever.

Since the states settled their lawsuits against the major tobacco companies in 1998, our annual reports have assessed whether the states are keeping their promise to use a significant portion of their settlement funds – estimated at $246 billion over the first 25 years – to attack the enormous public health problems caused by tobacco use in the United States.

Despite receiving huge sums from the settlement and collecting billions more in tobacco taxes, the states continue to shortchange tobacco prevention and cessation programs that are proven to save lives and reduce health care costs. As the e-cigarette epidemic threatens the nation’s progress in reducing youth tobacco use, most states continue to shortchange the very programs designed to prevent kids from using tobacco products.

In the current budget year, Fiscal Year 2021, the states will collect $26.9 billion from the settlement and taxes. But they will spend just 2.4% of it – $656 million – on programs to prevent kids from smoking and help smokers quit.

Meanwhile, tobacco companies spend $9.1 billion a year – $1 million every hour – to market their deadly and addictive products. This means tobacco companies spend over $13 to market their products for every $1 the states spend to reduce tobacco use.

States must do more to fight tobacco use – still the nation’s No. 1 cause of preventable death and disease – to accelerate progress and confront the growing epidemic of youth e-cigarette use in America.
This report is issued by the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society Cancer Action Network, American Lung Association, Robert Wood Johnson Foundation, Americans for Nonsmokers’ Rights and Truth Initiative.

Map: State Funding for Tobacco Prevention

Click on each state to view the full data. Follow this link for information on the District of Columbia.

Other key findings include:

  • The $656 million the states have budgeted for tobacco prevention amounts to just 19.8% of the $3.3 billion the Centers for Disease Control and Prevention (CDC) recommends for all states combined.
  • Not a single state currently funds tobacco prevention programs at the level recommended by the CDC
  • Only three states – Alaska, Maine and Utah – provide even 75 percent of the recommended CDC funding.
  • Thirty-four states and the District of Columbia are spending less than 25 percent of what the CDC recommends.

Along with separate policy actions, including higher tobacco taxes and comprehensive smoke-free laws, state tobacco prevention programs have helped drive down smoking rates to record lows – 14.0 percent among adults and 4.6 percent among high school students. But tobacco use still kills more than 480,000 Americans and costs the nation over $225 billion in health care expenses each year.

Our progress shows that the battle against tobacco is entirely winnable if proven strategies are fully implemented. But enormous challenges remain. The latest 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. is also facing 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.

In addition, the youth e-cigarette epidemic, driven by the skyrocketing popularity of Juul, remains an urgent challenge that must be addressed to prevent yet another generation from becoming addicted to nicotine. The latest data show that youth use of e-cigarettes is still at epidemic levels with 3.6 million users, including about one in five (19.6%) high school students now using e-cigarettes.

On the 22nd anniversary of the tobacco settlement, it is time for a renewed national commitment to finish the fight against tobacco, eliminate the death and disease it causes, and end the youth e-cigarette epidemic threatening to addict a whole new generation. With bold action, our nation can make the next generation tobacco-free.




Last updated May 18, 2021