Not only are most states devoting little or none of the $246 billion tobacco settlement income to tobacco control programs, they also are failing to fund the programs from other sources, a study by a Yale researcher has found.
"Because only a very small proportion of the tobacco settlement is being used for tobacco control programs, the settlement represents an unrealized opportunity to reduce morbidity and mortality resulting from smoking," said Cary Gross, M.D., assistant professor of internal medicine at Yale School of Medicine and lead author of the study published this week in the New England Journal of Medicine.
The payments are being made to states over a 25-year period to pay for damages done to smokers over the years.
Prior research has found that state tobacco control programs, which include strategies such as countermarketing, school programs and smoking cessation counseling, save lives and decrease healthcare costs. The Centers for Disease Control has recommended that states spend $5 to $15 per capita on tobacco control programs, based on the smoking rate and the population age. Gross and his colleagues found that the proportion of settlement funds allocated to tobacco control programs varied substantially between states, ranging from zero to 100 percent.
"The mean state spending on tobacco control programs was $3.49 per capita," Gross said. "And even though the tobacco settlement payments varied widely from state to state, in all 50 states the settlement income was substantially greater than the amount of tobacco control program funding that was recommended by the CDC."
"Our analysis demonstrates that the most important predictor of tobacco control program funding was not smoking prevalence or health needs, it was settlement fund allocation," Gross said. "The inverse correlation between state smoking rate and tobacco control program funding is of serious concern."
States have traditionally funded their tobacco control programs with cigarette taxes or with their general revenue. Because most states have invested few resources in tobacco control, it was hoped that the income that states received from their $246 billion settlements with the tobacco industry would provide a new source of revenue. The researchers scrutinized state legislatures to determine how their settlement funds are being allocated.
Gross and his collaborators compared state tobacco control program expenditures with the manner in which states had allocated their 2001 tobacco settlement revenue. They found that in 2001, the average state dedicated $3.49 per capita (the range was from 10 cents to $15.47) to tobacco control programs, while receiving on average $28.40 per capita from the tobacco settlement. Less than six percent of the settlement funds allocated in fiscal year 2001 were directed to tobacco programs.
Additionally, the authors found that the smoking-related health needs seem to have little impact on states' anti-tobacco funding. States with higher smoking rates tended to invest less per capita on tobacco control programs, as did tobacco-producing states. "This suggests that states that need anti-smoking programs the most are providing the least amount of funding to these efforts," Gross said.
He said the paucity of settlement funds being directed to tobacco programs is of concern for two reasons. The recent economic recession has tightened state budgets and preliminary reports suggest that state legislatures may view the settlement as an alternative to raising taxes or decreasing budgets.
Co-authors included Benny Soffer, M.D., Rahul Rajkumar, and Howard Forman, M.D., all of Yale School of Medicine, and Peter Bach, M.D., of Memorial Sloan-Kettering Cancer Center.
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