As Budget Constraints Prompt States to Trim Cessation Efforts,
Rate of Adult Smokers Stops Declining
Many
cash-strapped U.S. states are slashing budgets for tobacco-prevention programs,
raising alarms among public-health groups as the nation's progress toward
getting adult smokers to quit has stalled. The adult smoking rate was 20.6% in
2009, the same as a year earlier and largely unchanged since 2004, according to
the Centers for Disease Control and Prevention. That amounted to 46.6 million
adult smokers in 2009.States have cut their
combined funding for smoking prevention in the current fiscal year to the
lowest level since 1999, according to data gathered by a coalition of
antismoking groups for a report that will be released later this month. About
21% of U.S. adults smoke, according to federal government data. The $517
million allocated by states for tobacco prevention and cessation in fiscal-year
2011 is down 9.2% from $569 million a year earlier and 28% less than states
spent in 2008, according to the Campaign for Tobacco-Free Kids, a Washington
advocacy group preparing the report, along with the American Lung Association
and others.
The latest amount still exceeds the $300 million
spent by states in fiscal 1999, when many programs were getting under way or
accelerating their efforts following the landmark Tobacco Master Settlement
Agreement in 1998 between 46 states and cigarette companies that were designed
to help states recoup the cost of treating sick smokers. Under the agreement,
the tobacco companies were to pay an estimated $246 billion over 25 years to
the states, though states are allowed to spend their settlement dollars on
needs other than tobacco prevention. In fiscal
2010, tobacco-settlement revenue amounted to an estimated $8.1 billion for all
states. Public-health experts and tobacco-control
groups worry that states' recent spending reductions could further undermine
efforts to counter tobacco-industry marketing, persuade smokers to quit and to
deter young people from starting. Tobacco use is linked to an estimated 443,000
deaths a year in the U.S., making it the nation's leading cause of preventable
death, according to the DC. A decline in youth smoking rates has also slowed
since 2003."There's a risk of a
setback," CDC Director Thomas Friedan said of the funding cutbacks.
"The data are very clear. The more we invest in tobacco control, the fewer
people smoke, and that prevents illness, disability, deaths and healthcare
costs."
He cited California as an example. The state has
run a comprehensive tobacco-control program since 1989 that includes
anti-smoking advertising campaigns, toll-free "quit lines" that
people use to talk to cessation counselors, and other measures. California's
adult smoking rate fell to 12.9% in 2009—the second-lowest in the nation after
Utah—from 22.8% in 1988. Several other states reduced their smoking rates by a
third or more since the late 1990s after implementing similar programs, Mr. Friedan
said. The spending cutbacks come as the federal
government has increased spending on tobacco prevention, with more than $191
million of short-term grants to states and communities in recent months from
the stimulus bill and the national health-care overhaul. The Food and Drug
Administration also has new authority to regulate tobacco, including
restricting advertising and putting new warning labels on tobacco products.
Smoking-rate declines have stalled in several states that have cut prevention
dollars. Ohio trimmed its smoking rate by five percentage points between 2001
and 2005, when it was allocating as much as $60 million a year to tobacco
prevention. In the next four-year span, when its funding dropped to as low as
$6 million a year, its smoking rate fell by two points—to 20.3% in 2009.In its current fiscal year, Ohio has $2.3 million of
state funds—money unspent from previous master-settlement revenue—allocated to
prevention. It has about another $3 million from federal funds, some of which
are temporary. Mari-jean Sahel, chief of Ohio's tobacco-use prevention and
cessation program, said she doesn't have money to continue the state's tobacco
quit-line program in fiscal 2012. "With little to no marketing or
educational budget, it's really tough to get the word out about the quit line
and some of the other resources we have," Ms. Sahel said.
Shelly Kiser, an Ohio-based antismoking advocate
for the American Lung Association, said "the funding we have right now [in
Ohio] is like putting a drop of water on a burning fire. It doesn't have a lot
of impact. "Washington State slashed its
smoking rate 34% over a decade, seeing it drop to 14.8% in 2009, following
consistent funding of media campaigns targeting low-income people and other
high-risk groups, a quit line that has fielded 150,000 callers since 2000,
school programs, and other efforts. State spending on the program reached $27.2
million in 2007.
Now, with the state facing a projected $4.8
billion budget deficit for the next two fiscal years, it is redistributing
funding for the state tobacco-control program to local health departments for
their general use. The program will be left with about $1.4 million of federal
funding for fiscal 2012, said Mary Sleekly, the state's secretary of health.
Her team will pursue "very, very targeted work" to reduce smoking
among low-income groups, she said, adding, "We're going to do the best
with what we have."
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