In its evidence-based Best Practices for Comprehensive Tobacco Control Programs, the Centers for Disease Control and Prevention (CDC) recommends a specific dollar amount for each state to spend to prevent and reduce tobacco use among its citizens. In 2010, nationwide, states invested $533.7 million overall in programs, with two states, Alaska and North Dakota, funding their programs at the levels recommended by CDC when federal funding was included. In 2011, the overall nationwide investment sank to $477.1 million – with only one state – Alaska – achieving its CDC-recommended level. The failure to invest in these proven programs cedes further ground to the tobacco industry and ultimately will cost states millions in lives and billions in healthcare costs.
A number of states notably slashed or eliminated their programs:
- Washington: Washington’s tobacco prevention and cessation program was funded at $27 million three years ago and had become a national model. A recent study showed that the state saved $5 in tobacco-related hospitalization costs for every $1 the state spent on the program from 2000-2009.1 Tragically, this exemplary program was virtually eliminated in fiscal year 2012. Small amounts of state dollars are allocated to several tobacco control-related initiatives such as providing a quit smoking benefit under the state Medicaid program. However, Washington’s remarkable progress in reducing adult and youth smoking rates over the past decade may stagnate or even reverse because of this near elimination of funding.
- Iowa: Legislators in the state House of Representatives originally proposed eliminating funding for the state tobacco control program. Thankfully, some funding was maintained in the final fiscal year 2012 budget; however, the 55 percent cut from the previous year’s budget brought the investment in program funding from $7.4 million to $3.3 million. This is the lowest level of funding for tobacco control programs in Iowa in a decade.
- Wisconsin: Having already decreased its investment in tobacco control and cessation programs by 55 percent over the two previous years, Wisconsin again cut funding from $6.85 million to $5.2 million in 2011.
Wisconsin Secretary of Health Services Dennis Smith also opposed efforts by public health officials and advocates to make up for some of those cuts by applying for federal funding for tobacco prevention and cessation efforts, stating, “Why are we asking for taxpayers’ money for stuff that we are already doing?” he asked. “How long have people been doing tobacco cessation, for heaven’s sake? This is stuff that goes on all the time.”2 Smith ultimately changed his position, allowing grant applications to be submitted.
Montana and Rhode Island’s tobacco control programs also sustained cuts of more than 40 percent to their budgets in fiscal year 2012.
Despite its long history as a tobacco-growing state, in 1999 North Carolina created a Health and Wellness Trust Fund and directed 25 percent of its annual Master Settlement Agreement dollars to the fund. This enabled North Carolina to make some notable progress in reducing tobacco use – including reducing teen smoking rates to the lowest level in North Carolina history.3 While it failed to reach CDC-recommended levels of spending, in fiscal year 2011, North Carolina spent over $18 million on its program.
However, state lawmakers voted to eliminate the Fund completely in the 2011 legislative session – the only source of recurring revenue for these programs. Funding was only reduced by $1 million in the current fiscal year (fiscal year 2012) budget, but it is unclear whether any funding will be available in future years.
- Dilley JA, Harris JR, Boysun MJ, Reid TR. Program, Policy and Price Interventions for Tobacco Control: Quantifying the Return on Investment of a State Tobacco Control Program. Am J Public Health. Published online ahead of print. December 15, 2011: e1–e7.
- Boulton, Guy. “State blocks plans to apply for federal health grants: Milwaukee, UW seek funds for lifestyle, disease management.” Milwaukee Journal Sentinel. June 29, 2011.
- 2009 North Carolina Youth Tobacco Survey. Available at: http://www.tobaccopreventionandcontrol.ncdhhs.gov/data/yts/index.htm.