March 2003 • Volume 9 • Number 3 |
BY TONI LAPP
How incensed are AAFP members about states' use of tobacco settlement funds? Incensed enough to pass a resolution at the 2002 Congress of Delegates asking the AAFP to establish a scorecard on how each state is using the money -- estimated to total $206 billion over 25 years.
Greeneville, Tenn., family physician Michael Hartsell, M.D., author of Resolution No. 510, "Tobacco Settlement Monies and State Legislative Accountability," said he was motivated by growing anger with lawmakers' failure -- particularly in his own state -- to respond to what he calls the "tobacco pandemic."
"There should be collective embarrassment that our state is perceived as turning a blind eye to a generation of adolescents who are going to become addicted and their lives forever changed by this decision to use tobacco," said Hartsell. "In states that have used funds to make inroads against tobacco influence, there's going to be less addiction in that cohort of kids."
FACT: Every year nearly 2 million children under 18 try their first cigarette, and more than 730,000 become regular smokers, one-third of whom will die prematurely as a result. These children are the tobacco companies' valued "replacement smokers." (Source: Campaign for Tobacco-Free Kids)
AAFP's Commission on Legislation and Governmental Affairs followed through on Resolution No. 510 by sending a memo to chapter executives. The memo provided links (see box below) to the latest information on how the windfall is being used in a time of economic hardship for many states.
The information shows Hartsell is justified in his criticism: His own Tennessee, as well as Michigan, Missouri and the District of Columbia, contribute nothing from their settlement coffers for tobacco-use prevention.
"States have squandered the opportunity to counteract the marketing of tobacco companies by 'securitizing' settlement payments" -- selling bonds backed by settlement funds to investors, providing a quick infusion of cash that trades in on future payments -- said Tony Iallonardo of the Campaign for Tobacco-Free Kids.
FACT: The annual cost of treating tobacco-related disease exceeds $75 billion. (Source: Campaign for Tobacco-Free Kids)
Massachusetts, formerly lauded for its prevention and cessation programs, has had deep cuts in the programs -- 90 percent in 2002, said Iallonardo -- and the governor's proposed 2003 budget suggested eliminating funding altogether.
Most states have mixed records. In Illinois, educational materials funded by grants now sit on pallets. The state no longer has money to ship them. This is despite collecting $820.5 million in 2002 on tobacco revenue from cigarette taxes and tobacco settlement funds.
The news is only a little better two states east. Ohio, ranked 24th in tobacco prevention spending, has put 10 percent of its tobacco settlement funds into a trust fund and used the interest for prevention programs, said Ann Spicer, EVP of the Ohio AFP. Anti-tobacco marketing targets youths 11 to 15 years of age.
But there's still room for improvement in Ohio, said one Columbus family physician.
"I had a patient ask me the other day if he could get some tobacco settlement money help to quit smoking," said Sarita Salzberg, M.D. "Marlboro had just sent him a gas card! He had a very valid point -- at least Marlboro gave him something. All the tobacco lawsuit has done for him has made him pay more for cigarettes."
And although Ohio has not mortgaged its future settlement payments by securitizing, the funds are still in danger every time the state budget is negotiated, said Spicer. The Ohio Academy belongs to a coalition that fights to ensure that the legislature keeps its commitment to use 10 percent of settlement funds for prevention and cessation. Nevertheless, in 2001 the state diverted $240 million from the fund to fill a hole in the state budget, said Spicer, and the governor's budget proposal suggests diverting two years of payments to the trust fund to apply toward a state budget deficit. Diversion of the money for a third straight year is a setting a very dangerous precedent and calls into question the commitment of the state to prevention and cessation programs, said Spicer.
FACT: Tobacco use is the number one cause of preventable death in the United States, claiming more lives every year 400,000 than AIDS, alcohol, car accidents, murders, suicides, illegal drugs and fires combined. (Source: CDC)
There are some bright spots on the tobacco-prevention landscape: A few states have increased prevention funds. Hawaii more than doubled its funding to about $10 million, putting it at 95 percent of the CDC's recommended funding level. State Tar Wars coordinator Marti Taba, M.D., of Kailua said she has secured a grant for the anti-tobacco education program this year. "We've had Tar Wars in Hawaii for four years and never had significant outside funding until this year," she said.
Go online for tobacco information*Campaign for Tobacco-Free Kids special report on how states are spending their tobacco settlement proceeds: http://tobaccofreekids.org/reports/settlements/2003/fullreport.pdf Campaign for Tobacco-Free Kids report card on the rankings of state funding for tobacco prevention: http://www.tobaccofreekids.org/reports/settlements/2002mid/spendingchart.pdf CDC's Best Practices for Comprehensive Tobacco Control Programs: http://www.cdc.gov/tobacco/bestprac.htm CDC's tips on how to quit smoking: http://www.cdc.gov/tobacco/how2quit.htm AAFP patient education materials on smoking: http://familydoctor.org/ (enter "smoking" or "tobacco" in the search field) *Visit http://www.aafp.org/pdf.xml for information on accessing and reading PDF files. |
Four states -- Maine, Minnesota, Mississippi and Maryland -- meet CDC guidelines for state funding of tobacco prevention.
But health officials are poised to defend this record in Maine, ranked No. 1 by the CDC for meeting funding recommendations. "We are preparing for a very interesting fight in this next legislative session," said chapter executive Deborah Halbach. The Maine Academy belongs to a coalition that will lobby against diverting any settlement funds.
The anti-tobacco campaign in Maine includes cessation assistance in the form of a quit-smoking hot line that is staffed seven days a week. The idea is that smokers who are encouraged to quit by rising prices should be able to get assistance. In addition, community grants support stop-smoking programs, and anti-tobacco marketing that targets teens is found in publications and on the airwaves.
The bottom line, said Iallonardo, is that smoking is a public health problem, and state spending in response to health problems posed by tobacco pales in comparison to the enormity of the problem. But it's not too late to act, he said. "Even states that have securitized their settlement still have a need and responsibility to fund tobacco prevention."
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
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Copyright © 2003 by
American Academy of Family Physicians.