THURSDAY, May 24 (HealthDay News) -- Only a small percentage of
the billions of dollars states take in from tobacco revenues goes
to anti-smoking efforts, a new federal report finds.
Under the 1998 Tobacco Master Settlement Agreement, tobacco
companies agreed to reimburse states for Medicaid costs related to
tobacco use. According to background information in the new study,
the intent of the agreement was to use the money to also help
prevent youth smoking, although there was no stipulation that this
However, the new study finds that between 1998 and 2010, states
collected a combined total of almost $244 billion in tobacco
industry settlement payments and cigarette excise taxes, but have
invested only about $8 billion in effective state anti-smoking,
tobacco control programs.
The remainder of the money has been used to pay general expenses
or to fund programs other than tobacco control, according to
research led by John Francis of the National Center for Chronic
Disease Prevention and Health Promotion, part of the Centers for
Disease Control and Prevention.
If states had followed the CDC's published guidelines on using
the funds, they would have invested more than $29 billion in
tobacco control programs during that time, the researchers
The researchers noted that although total state and federal
investment in state tobacco control efforts did rise between 1998
and 2002, state investments in tobacco control have actually fallen
steadily every year since.
One expert said the findings were disheartening. "Not investing
the money in tobacco control programs is shortsighted and
demonstrates a lack of knowledge in the return on investment for
tobacco control programs," said Dan Jacobsen of the Center for
Tobacco Control at North Shore-LIJ Health System in Great Neck,
"If states funded tobacco control programs at the CDC
recommended level, I feel the results would be dramatic and
realized sooner than expected," he added. "By providing proper
funding to these programs it would help prevent tobacco-related
death and disease and greatly reduce the health care cost
associated with them."
Unfortunately, many states face substantial cuts and
near-elimination of tobacco control program funding, the study's
The CDC guidelines initially recommended that states invest a
combined $1.6 billion to $4.2 billion a year in tobacco prevention
programs and in 2007 the agency updated that recommendation to $3.7
For the entire study period, the ratio of state tobacco revenues
to state and federal tobacco control programs was about 30 to 1
(aproximately $244 billion in revenue compared to $8 billion in
expenditures on tobacco control). In 2010, that gap had grown to
approximately 37 to 1 ($240 billion vs. $640 million), the
The study also found that by 2010, states were using only 2.4
percent of their tobacco revenues for tobacco control.
"The results of this analysis show an increasing gap between
state investments in tobacco control and best practices
recommendations," the researchers wrote. "Although all states
derive revenues from cigarette excise taxes, few states have a
statutory requirement requiring that a portion of these revenues be
dedicated to tobacco control and prevention.
"Instead, most cigarette tax revenues are being used for general
purposes. In addition, although state cigarette excise taxes have
increased nationally, the Institute of Medicine has noted that
recent tax increases largely have come in response to shortfalls in
state budgets rather than as initiatives to increase spending on
The study appears in the May 25 issue of the CDC journal
Morbidity and Mortality Weekly Report.
Responding to the report, Dr. Donna Shelley, an associate
professor of medicine at NYU School of Medicine, said: "The tobacco
control community has been advocating for years, unsuccessfully, to
earmark even 5 cents for every dollar of tobacco tax collected, for
implementing CDC recommended programs and policies. With tight
budgets the problem has only gotten worse."
"However, there is no better return on investment in terms of
public health benefit than funding the full spectrum of policies,
media and other tobacco control program components recommended by
the CDC," she added. "New York state is a great example of what can
be achieved when tobacco funding is maintained, albeit not at the
CDC recommended levels. In New York we continue to see annual drops
in smoking rates from 21.6 percent in 2003 to 15.5 percent in
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