More States Allocate Funds for Anti-Tobacco Programs in 2008

Nearly a decade ago, a historic multistate tobacco settlement promised a financial windfall for most U.S. states, and many public health organizations hoped the states would use a majority of the money to fund tobacco prevention and cessation programs. Now a new report outlines how well states have met that challenge.

According to the latest annual report (137-page PDF; About PDFs) issued by the Campaign for Tobacco-Free Kids, or CTFK; the American Heart Association; the American Lung Association; and the American Cancer Society Cancer Action Network, many states have used a portion of their share of these funds to bankroll anti-tobacco programs, but in most states, that funding still fails to meet minimum levels recommended by the CDC. Combined, states are providing less than half of CDC-recommended funding levels for tobacco prevention.

According to the report, some states are making progress in using the settlement funds, as well as other revenues, to beef up anti-tobacco efforts. Compared with last year, states overall increased their fiscal year 2008 funding for tobacco prevention and cessation programs by 20 percent to a total of $717.2 million, the highest level in six years. Three states -- Maine, Delaware and Colorado -- currently fund tobacco prevention programs at CDC minimum levels. Maine has ranked first in funding these programs for six years.

Florida had the greatest increase in funding, from $1 million for fiscal year 2007 to $58 million this budget year. That increase was driven by a state constitutional amendment approved by voters in 2006 that requires Florida to spend 15 percent of its annual tobacco settlement revenue on tobacco prevention.

Also among states that have increased tobacco prevention funding for 2008 are Indiana, Iowa, Oklahoma, South Dakota, Tennessee and Wisconsin.

Unfortunately, the report includes a lot of bad news. Aside from the three states funding the programs at the minimum level recommended by the CDC, only 17 other states fund tobacco prevention and cessation programs at even half the minimum level. Even worse, 30 states and the District of Columbia are spending less than half of the CDC's recommended amount for these activities. Connecticut currently appropriates no funding for tobacco prevention at all.

This year, states are spending less than 3 percent of the $24.9 billion of revenue they will collect from the tobacco settlement and tobacco taxes on tobacco cessation and prevention. Meanwhile, tobacco companies spend at least $13.4 billion each year to market tobacco products, which means that they spend almost $19 on tobacco marketing for every $1 states spend to prevent kids from smoking and to help smokers quit.

FP Saria Carter Saccocio, M.D., of Fort Lauderdale, Fla., a member of the AAFP Tobacco Cessation Advisory Committee and a former state coordinator for the Academy's Tar Wars tobacco-free education program, called the report's findings "something to be excited about, but depressing because we're so excited about such a small change." Even so, she said, she has "guarded optimism" that things are going in the right direction, partly because of legislation such as that passed in Florida, as well as smoke-free workplace bills passed in many states. Moreover, she noted, tobacco taxes have been raised in several states.

Patricia Sosa, vice president for constituency relations at CTFK, and Carter Saccocio both see the report as a wake-up call for the nation, and they said that family physicians can play critical roles in the fight against tobacco use, both by persuading lawmakers to increase anti-tobacco program funding and by staging interventions at the patient level.

Sosa lauded the AAFP as a key medical organization in helping to secure more funding for these programs. The Academy, which is a member of CTFK's "Partners for Effective Tobacco Policy" coalition, currently has the largest number of constituent chapters that are active in the campaign's efforts, compared with participation among other medical organizations, she said.

Of all of CTFK's goals for 2008, Sosa said, the organization's number one priority is to pass legislation granting the FDA the power to regulate tobacco products. By doing so, it would give the FDA and public health organizations access to the ingredients included in tobacco products and could lead to less-addictive products. This legislation already has been introduced in both houses of Congress. In the House of Representatives, it currently has 217 sponsors; in the Senate, it has 55 sponsors.

Carter Saccocio encouraged members to use AAFP's Speak Out to contact federal and state legislators regarding all tobacco-related legislation. She also urged AAFP members to get involved in Tar Wars and the AAFP's Ask and Act program. Both Tar Wars and Ask and Act offer downloadable educational materials on their Web sites; physicians can use these materials in their practices when talking with patients. Carter Saccocio encouraged all family physicians to "give tobacco awareness 30 seconds during each patient encounter."