Decreases in state spending on anti-smoking programs may be contributing to a leveling-off of a decline in teenage smoking in the United States, according to a federal analysis.
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The percentage of teenagers who were frequent smokers—those who smoked cigarettes on at least 20 of 30 days during a survey period—dropped from 16.7 percent in 1997 to 9.7 percent in 2003, the recent analysis of national data by the Centers for Disease Control and Prevention in Atlanta shows.
The federal health agency attributes the decline to increases in school-based efforts to prevent tobacco use, a 90 percent increase in the retail price of cigarettes, and broader exposure to anti-smoking campaigns in the mass media.
However, the CDC notes, several national surveys indicate that the rate of decline in teen smoking may be slowing.
One factor driving that slowdown may be the dramatic increases in tobacco-industry spending on advertising and promotion, which increased from $5.7 billion in 1997 to $11.2 billion in 2001, the CDC reports. At the same time, states are spending less on prevention.
“We’ve got terrific evidence that the more you spend on a comprehensive prevention program, the greater and longer-lasting the effects,” said Joel London, a spokesman for the CDC’s office on smoking and health. “But, as a science-based agency, we’re here to provide the evidence. We have to leave policy to the policymakers.”
Settlement Windfalls
Anti-smoking groups say state policymakers are falling down on the job, despite having a pot of money that could be dedicated solely to tobacco- use prevention.
In November 1998, 46 states settled lawsuits against the major tobacco companies to recover smoking-related health-care costs, joining the four states that had reached earlier settlements. The deal, called the Master Settlement Agreement, required the cigarette manufacturers to make continuing annual payments to the states, amounting to an estimated $246 billion in the first 25 years.
State governors unanimously passed a resolution in 1999 declaring that they were “committed to spending a significant portion of the tobacco-settlement funds on smoking-cessation programs, health care, education, and programs benefiting children.”
But anti-smoking efforts—including school-based programs—have gotten the short end of the stick in recent years.
Together, the states cut smoking-prevention funding from a high of $749.7 million in fiscal 2002 to $541.1 million in fiscal 2004, according to the Washington-based Campaign for Tobacco-Free Kids.
In a study last November, the advocacy organization found that only four states—Arkansas, Delaware, Maine, and Mississippi—were paying for prevention efforts at or above the minimum levels recommended for each state by the CDC.
Little has changed in the states’ 2005 budgets, said Peter H. Fisher, the director of state issues for the Campaign for Tobacco-Free Kids, though he sees that situation as somewhat positive.
“Everyone is spending pretty much at the same level—which is progress,” he said. “At least we’re not seeing the drastic cuts that we saw in many states over the past couple years.”
Money for Scholarships
Shortly after the tobacco money started flowing, the recent economic slowdown led many states to decide they had more pressing problems than smoking.
At least 20 states and the District of Columbia gave up their rights to all or part of their future tobacco-settlement payments for smaller, upfront payments, or passed laws authorizing such action, according to the Campaign for Tobacco-Free Kids’ 2003 report. Some used the revenue from those deals to balance budgets for just one year.
Michigan was one of a handful of states that committed none of the settlement money to tobacco-use prevention.
The Wolverine State’s initial payment from the tobacco industry was $104.5 million, to be followed by up to $365 million annually for 24 years. The CDC recommended the state spend a minimum of $53 million a year on a comprehensive tobacco education program, and as much as $149 million.
Instead, Michigan lawmakers passed a bill allocating 75 percent of the payments to support a college-scholarship program for students who perform well on the state’s standardized tests.
Anti- tobacco groups lobbied hard to redirect the award to anti-smoking efforts, winning a court battle in 2002 to put that option before voters in a ballot referendum—which ultimately failed.
“More needs to be done for tobacco prevention,” said T.J. Bucholz, a spokesman for the state health department. “But, like most states, we’ve been dealing with a crushing budget deficit.”
Meanwhile, Michigan—like four other states this year—increased its commitment to stamp out smoking by raising its tax on cigarettes. State health department officials project that the $2-a-pack tax, a 75-cent increase, will persuade 60,000 smokers to give up the habit and prevent 94,000 young people from starting.
‘Voters Said So’
Some of the states were forced to spend much of their settlements on anti-smoking efforts.
Mississippi, for example, was compelled by a court order to put its share of the award into a trust fund to support a statewide prevention program at about $22 million a year.
And in Arkansas, voters decided in a 2000 ballot referendum that a significant portion of that state’s settlement money would be spent directly on smoking-prevention efforts.
Of the Arkansas health department’s total $18.5 million budget for tobacco-use prevention in fiscal 2004, 4.5 percent was spent on school programs, said Linda M. Lehing, the director of the health department’s program for smoking prevention and education. That amounts to roughly $5 per student—well within the CDC’s recommendation that states spend $4 to $6 per student on school-based prevention.
“This is how we spend the money because our voters said so,” said Ed Barham, a spokes-man for the Arkansas health department.
“If it had been left up to the legislature here, guess what?” he said. “We’d be like most other states, spending the money on pet projects and all sorts of stuff that has nothing to do with tobacco prevention.”
