Key Findings
State Tobacco Control Policy
The state report looks at four areas: Tobacco Prevention and Control Funding, Smokefree Air, Cigarette Taxes, and Youth Access. Below are the key findings by program area.
Tobacco Prevention and Control Spending
Every year since 1998, an opportunity has been lost to prevent the illness and deaths of thousands of Americans due to the failure of states to keep their promise and adequately fund tobacco prevention programs. In 1998, the states sued the tobacco industry to recover Medicaid funds spent on tobaccorelated illnesses (see box on the Master Settlement Agreement). At the time, state leaders repeatedly asserted that their intent was to use these funds for health-related programs, particularly for the 8.6 million persons suffering from at least one tobacco-related diseases, and to prevent tobacco use and exposure to secondhand smoke. Six years later, only five states--Arkansas, Delaware, Hawaii, Maine, and Mississippi--have sustained commitment to significant funding for tobacco prevention and cessation. i
It has been documented that well-funded, sustained and comprehensive tobacco prevention and cessation programs are among the best ways to combat tobacco use. Thousands of illnesses and deaths from tobacco use could be prevented and billions of dollars in medical expenses could be saved if all states made long-term investments in a sustained campaign to prevent tobacco-related disease and death.
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The Master Settlement Agreement:
In November 1998, 46 states and the tobacco industry settled the states' Medicaid lawsuits for recovery of their tobacco-related health care costs. The industry committed to pay the states approximately $206 billion over the next 25 years. Four states (Mississippi, Texas, Florida and Minnesota) settled their tobacco lawsuits separately for a total of $40 billion over 25 years. | A study in the Journal of Health Economics found that cigarette sales dropped more than twice as much in states with comprehensive tobacco control programs as in the United States as a whole. The study found that between 1990 and 2000, sales fell an average of 43 percent in four states with large investments--Arizona, California, Massachusetts, and Oregon--compared with only a 20 percent drop for all other states. This study confirms that sustained tobacco control programs have a significant impact on cigarette sales. Further, the impact grows as programs continue to dedicate resources to curbing tobacco use. The study states that programs become more efficient and "make better and better use of each additional dollar" over time.11
This study confirms earlier data from California and Massachusetts that shows that an investment in tobacco prevention programs results in dramatic decreases in tobacco use. For example, California’s comprehensive approach to smoking prevention and cessation yielded an astounding 14 percent decline in the incidence of lung cancer from 1988 to 1997, accounting for an estimated 11,000 fewer cases of lung cancer. 12 The very successful Massachusetts Tobacco Control Program released a study which showed that from 1999 to 2002 Massachusetts reduced high school smoking by 29.7 percent and middle school smoking by 13 percent.13 Maryland, also a former leader in funding tobacco prevention programs, saw a steep decline in youth smoking rates between 2000 and 2002. Smoking was reduced by 30.6 percent for middle school students and 23.5 percent among high school students.14
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The California Tobacco Control Program was associated with 11,000 fewer cases of lung cancer during its first decade. 15
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Despite evidence that tobacco prevention programs work, they continue to be cut with devastating consequences. In Minnesota, annual funding for tobacco control programs was severely reduced, resulting in the elimination of the successful Target MarketTM, a media campaign aimed at young people. As a result, the percentage of adolescents susceptible to cigarette smoking increased from 43 percent to 53 percent.16 Data recently released by the decimated Tobacco Free Massachusetts program indicates that communities which have experienced a dramatic reduction in tobacco control funding have seen an average increase of 74 percent in illegal sales of cigarettes to minors. Data from communities that have completely lost their programs show an even higher increase.17
2004 Highlights
Legislators in Arkansas, Delaware, Hawaii, Maine, and Mississippi were able to look beyond their immediate budget situations to see the fiscal wisdom of maintaining at least 90 percent of the CDC's minimum recommended funding level for tobacco control programs. Rather than face worsening budget shortfalls in the future with no programs left to raid, these states will see their health-related costs gradually drop as prevention and cessation programs reduce the prevalence of smoking and tobacco-related disease. In fact, Maine was successful in reducing high school smoking rates by 48 percent in just six years between 1997 and 2003. 18 Tobacco control programs translate into healthier citizens and reduced health care costs down the road.
Unfortunately, 36 states and the District of Columbia received an F for program funding. In 2004, many state legislatures continue to raid their tobacco settlement funds.
Looking Ahead
States still have the opportunity to live up to the promise made in 1998 through the Master Settlement Agreement by committing funds to tobacco prevention. Tobacco control is a sound investment for the future, one of the surest ways to protect health and decrease health care costs. Funding prevention programs makes both good health sense and good fiscal sense.
i Significant funding represents 90 percent or more of the minimum recommendation by the Centers for Disease Control and Prevention.
Key Findings Continued... |
