North Carolina took aim at teen smoking Wednesday, approving a three-year, anti-tobacco campaign that critics say isn't aggressive enough.

North Carolina teens smoke and use tobacco at higher rates than the national average: 38 percent of N.C. high school students use some form of tobacco, compared to 35 percent nationally. The gap is even bigger among middle school students. At the same time, the state ranked last nationally in tobacco prevention spending, a 2001 study found. On Wednesday, the N.C. Health and Wellness Trust Fund Commission voted to spend $6.2 million a year on a variety of tobacco prevention programs, including an advertising campaign and programs targeting minority youth. The expenditure is the largest commitment of state funds ever to combat teen smoking in North Carolina, which currently spends about $750,000 on prevention efforts. The new money will come from payments received in the national tobacco settlement. "North Carolina is taking a major step in reducing the rate of teen smoking," said Lt. Gov. Beverly Perdue, chairwoman of the health commission. "We must do what we can to prevent teens from smoking and help them quit if they have already begun." The health commission controls one-quarter of the money North Carolina receives from major tobacco companies to settle health cost claims. The rest goes into economic development and aid programs for tobacco farmers and their communities. The state is part of a 46-state settlement agreement that is expected to bring $4.6 billion to North Carolina over 25 years. The N.C. health commission previously voted to spend most of its available funds -- $35 million annually -- on a three-year drug program for poor seniors, expected to begin this summer. The remaining $6.2 million is now slated for teen tobacco prevention, beginning in July. South Carolina -- which also tops the national average in teen tobacco use -- spends $1.6 million of its settlement money on tobacco prevention annually. Health advocates hailed Wednesday's decision as a good start in North Carolina. Plans call for developing new school and community prevention programs, boosting law enforcement to stop tobacco sales to minors and advertising aimed at teens. Also included is money for education programs aimed at minority populations that use tobacco at disproportionately high rates. But North Carolina's plan still falls far short of the minimum $43 million a year recommended by the federal Centers for Disease Control for an effective program. "If North Carolina was serious about tobacco prevention it would have moved faster and spent a lot more," says Amy Barkley, a regional coordinator for the National Center for Tobacco-Free Kids. "You need an aggressive, comprehensive plan... to combat the tobacco companies' ever-present advertising." Health advocates say it will take much more to bring down tobacco use. They question the health commission's spending priority for a drug plan over tobacco prevention, which could save the state millions in Medicaid costs. "I wish we'd spend more of our money on tobacco and disease prevention instead of on treatment for people who are already sick," says Bob Parker, a former public health director and a member of the health commission. Still, he called the tobacco plan "a great victory." The three-year plan may be cut short if Gov. Mike Easley sticks with his decision to divert some of the tobacco company payments from the health commission to help balance the state budget. Commission members want Easley to release $30 million he placed in escrow last month or find new money to ensure the prevention plan receives funding for a third year.

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