States can help finish the fight against tobacco by boosting funding for tobacco prevention

The states are missing a golden opportunity to save millions of lives and billions of dollars in health care costs because they continue to shortchange proven programs that prevent kids from smoking and help smokers quit, according to a report released today by a coalition of public health organizations. The report challenges states to do more to fight tobacco use – the nation’s No. 1 preventable cause of death – and help make the next generation tobacco-free.

This year (fiscal year 2017), the states will collect $26.6 billion from the 1998 tobacco settlement and tobacco taxes. But they will spend less than two percent of it – just $491.6 million – on tobacco prevention and cessation programs, according to the annual report assessing state funding of such programs.

The report – “Broken Promises to Our Children: A State-by-State Look at the 1998 Tobacco Settlement 18 Years Later” – was released by the Campaign for Tobacco-Free Kids, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, the Robert Wood Johnson Foundation, Americans for Nonsmokers’ Rights and Truth Initiative.

The U.S. continues to make great strides in reducing cigarette smoking, with smoking rates falling to record lows in 2015 – 15.1 percent among adults and 10.8 percent among high school students. If recent progress in reducing adult smoking continues, the United States would eliminate smoking by around 2035, according to a recent analysis in The New England Journal of Medicine.

To achieve this goal, today’s report calls for full implementation of proven strategies to reduce tobacco use, as recommended by the U.S. Surgeon General and other public health experts. These recommendations include funding state tobacco prevention and cessation programs at levels recommended by the Centers for Disease Control and Prevention (CDC).

Another key recommendation is to continue and expand national media campaigns such as the CDC’s Tips From Former Smokers campaign. Launched in 2012, the Tips campaign has helped at least 400,000 smokers quit for good and saved at least 50,000 lives at a cost of less than $400 per year of life saved, making it a public health “best buy,” according to the CDC. However, continuation of this campaign is threatened by a proposal in Congress to cut funding for the CDC’s tobacco prevention and cessation efforts by more than half (from $210 million to $100 million).

Other strategies recommended by the Surgeon General include increasing tobacco taxes; enacting comprehensive smoke-free laws; providing health insurance coverage for tobacco cessation treatments; and effective FDA regulation of all tobacco products. A new strategy gaining momentum across the country is to increase the legal sale age for tobacco products to 21. California, Hawaii and more than 200 cities and counties across the country have raised the tobacco age to 21.

“Because of the tremendous progress our nation has made, it is now truly within our reach to win the fight against tobacco and make the next generation tobacco-free,” said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. “But progress is not inevitable. It will require bold action by all levels of government, including robust funding of proven tobacco prevention and cessation programs at the state and federal levels. And policymakers must reject the relentless efforts of the tobacco industry to roll back the gains we’ve made.”

This year’s report also found:

• The $491.6 million the states have budgeted for tobacco prevention amounts to just a small fraction of the $3.3 billion recommended by the CDC. It would take less than 13 percent of total state tobacco revenues to meet the CDC’s recommendations in every state.
• Only two states – North Dakota and Alaska – currently fund tobacco prevention programs at the CDC-recommended level. (Alaska meets that standard when a federal grant is included along with state funds.). Only one other state – Oklahoma – provides even half the recommended funding. Twenty-nine states and the District of Columbia are spending less than 20 percent of what the CDC recommends. New Jersey, which ranks last in the report for the third year in a row, and Connecticut have allocated no state funds for tobacco prevention programs. Find out how each state ranks.
• Tobacco companies spend more than $18 to market tobacco products for every $1 the states spend to reduce tobacco use. According to the most recent data from the Federal Trade Commission (for 2014), the major cigarette and smokeless tobacco companies spend $9.1 billion a year – more than $1 million each hour – on marketing.
• States with well-funded, sustained tobacco prevention programs continue to deliver impressive results. Florida, with one of the longest-running programs, reduced its high school smoking rate to just 5.2 percent in 2015, one of the lowest rates ever reported by any state. North Dakota, which ranks first in this report for the fourth year in a row, cut smoking among high school students by nearly half from 2009 to 2015 (from 22.4 percent to 11.7 percent).

Tobacco use kills more than 480,000 Americans and costs the nation about $170 billion in health care spending each year. Without strong action now, 5.6 million kids alive today will die prematurely from smoking-caused disease, according to the U.S. Surgeon General.

“It is inexcusable that states are not spending their tobacco settlement money and tobacco taxes as intended – to invest in proven tobacco control programs that will save lives and reduce health care costs,” said Chris Hansen, President of the American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the American Cancer Society. “Lawmakers play a key role in the comprehensive approach needed to reduce death and suffering from tobacco use in this country. We urge them to fully fund tobacco cessation and prevention programs, increase the price of tobacco products to deter harmful consumption, and pass and implement comprehensive smoke-free laws. Doing so will maximize our potential to help people quit smoking and prevent new users from starting.”

“It’s extremely disheartening to report that year after year, states have the means to bolster tobacco prevention efforts and save lives, but simply choose to divert their settlement funds elsewhere,” said Nancy Brown, CEO of the American Heart Association. “Far too many Americans are needlessly at risk for heart disease, stroke or even an early death in the absence of sufficient funding for effective tobacco prevention initiatives. We must continue to push lawmakers to right this wrong and do more to protect lives from the dangers of tobacco. Our association sincerely hopes this report shines a bright light on the missed opportunity to invest in tobacco prevention to fundamentally alter the course of our nation’s fight against tobacco.”

“Tobacco use kills. Lung disease is our nation’s third leading cause of death and lung cancer is the top cancer killer. And while we have proven-effective strategies to reduce tobacco use, this report makes clear states still have a lot of work to do,” said Harold P. Wimmer, National President and CEO of the American Lung Association. “States can start by providing more funding for tobacco prevention programs from tobacco settlement payments and tobacco taxes to prevent the next generation of youth from getting hooked on a lifetime of addiction to tobacco.”

“No one should have to get sick from breathing at work, yet millions of nonsmokers are still exposed to secondhand smoke in their job because of weak state smoke-free laws,” said Cynthia Hallett, President and CEO of Americans for Nonsmokers' Rights. “Big Tobacco has spent decades trying to undermine smoke-free protections through schemes like preemption and loopholes.  We urge state lawmakers to close gaps that leave casino workers and other hospitality sector workers exposed to secondhand smoke. Smoke-free laws are successful, popular and save lives.”

“With youth smoking rates at a historic low of 5.9 percent, we are on the brink of realizing the greatest public health victory of our time – creating a tobacco-free generation. States need to fund programs that accelerate our progress toward this historic and achievable goal, not slow it down,” said Robin Koval, CEO and President of Truth Initiative. “It is up to state leaders to counteract the billions of dollars Big Tobacco continues to spend every year searching ever harder to find replacement smokers. Well-funded youth and young adult prevention programs make a tremendous difference and will help make this the generation that ends tobacco for good.”