Methodology
Tobacco Prevention and Control Spending
In August 1999, the Centers for Disease Control and Prevention (CDC) published "Best Practices for Comprehensive Tobacco Control Programs." Based on "best practices" as determined by evidence-based analysis of state tobacco programs, the CDC guidance document recommends that states establish programs that are comprehensive, sustainable and accountable. The CDC recommends a minimum level of funding for state programs in nine categories: Community Programs, Chronic Disease Programs, School Programs, Enforcement, Statewide Programs, Counter-Marketing, Cessation Programs, Surveillance and Evaluation, and Administration and Management. For the tobacco prevention and control spending area, the
CDC minimum state recommendation for funding of comprehensive programs
served as the denominator in the percentage calculation to obtain each
state’s grade.
After obtaining a state’s percentage, grades were assigned following the standard grade school system.
A = 90 percent or more of the CDC lower estimate
B = 80 percent to 89 percent
C = 70 percent to 79 percent
D = 60 percent to 69 percent
F = 59 percent or less
The funding allocation includes funds from CDC to states for tobacco control programs. Several states are funding their programs above 100 percent of the CDC recommendation: Arkansas, Delaware, Maine and Mississippi. Arizona and Hawaii are funding programs above 90 percent of CDC’s recommendation.
Cigarette Excise Tax
Establishing a basis to grade state cigarette excise taxes begged a question: "What is the appropriate level to tax tobacco to protect public health?" Our review of literature did not determine a magic level for an excise tax. We know that as the price of cigarettes increases, consumption decreases. For each 10 percent price increase, consumption drops 7 percent for youth and 4 percent for adults.3 So the answer for the cigarette excise tax is simple: The higher the better. Recently, the CDC reported that each pack of cigarettes sold in this country costs the economy $7.18 in health care and related expenditures.4
The average cigarette tax is often seen as an indication of where states are in their cigarette taxing policies. It was decided to have the cigarette tax grades based on the average (mean) of all state taxes as the midpoint, or the lowest C. The average state excise tax is $0.72. The range of state excise taxes ($0.025 to $2.05) is divided into quintiles.
The Excise Tax grades break down as follows:
A = over $1.40
B = $1.05 to $1.39
C = $0.72 to $1.04
D = $0.37 to $0.71
F = $0.36 and under
This methodology reflects the dynamic nature of cigarette excise taxes and the need to continue to increase taxes to keep up with inflation and decrease consumption. For instance, in 1996, Washington had the highest cigarette tax at $0.825 cents per pack. As cigarette taxes rise in the future the mean will change and the grades will be adjusted to reflect the new mean.
Limitation of Grading System
State Tobacco Control Expenditures
We do not evaluate each state’s expenditure in each of the CDC categories nor do we evaluate the efficacy of any element of any state’s program. Therefore, a state may receive a high grade but be significantly underfunding a component or components of a comprehensive program. It also may be true that a state with a low grade is adequately funding a specific component or program in one community. The CDC recommends a comprehensive program and simply funding an element of the program will not achieve the needed results. The CDC explicitly calls for programs that are comprehensive, sustainable and accountable. That said, we believe the total funding is a fair basis for grading state programs and a state’s tobacco control funding performance.
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