With infusions of cash from the national tobacco settlement and new cigarette taxes, Pennsylvania and New Jersey are promoting aggressive new programs to discourage people from smoking, but both states will still fall short of federal recommendations for

Each will fall short this year by about $15 million. The targets - $65.5 million a year for Pennsylvania and $45 million for New Jersey - are considered minimum amounts to provide the comprehensive tobacco-prevention program suggested by the Centers for Disease Control and Prevention. Still, Pennsylvania and New Jersey are planning to spend more per person than most states. New Jersey was lauded recently for its commitment to prevention by the Campaign for Tobacco-Free Kids, a Washington-based advocacy group. And Pennsylvania was among nearly 20 states to allocate more money this fiscal year. The new money has allowed Pennsylvania and New Jersey to launch such programs as phone lines to help people quit smoking, youth groups to spearhead anti-tobacco efforts, and counter-marketing ads to offset pro-smoking advertising. Both states also raised their tobacco taxes over the summer. More than a dozen other states have slashed funding, including long-time pacesetters Massachusetts and California. Only three states - Maine, Minnesota and Mississippi - are expected to meet the CDC's minimum spending threshold, according to Tobacco-Free Kids data. Maryland is almost there. Voters in Arizona last week approved an increase in the state cigarette tax to help restore funding to its prevention program. Meanwhile, Montana voters earmarked money from its tobacco settlement to beef up its program. Prevention programs started cranking up several years ago with proceeds that tobacco companies agreed to pay states to settle claims against them. While the states were encouraged to use part of the $200 billion windfall for tobacco prevention and cessation, the master settlement didn't spell out a specific amount. About 5 percent of the settlement money so far has been dedicated to tobacco control, according Lee Dixon, director of health policy tracking service for the National Conference of State Legislatures. Not only do public-health proponents consider that share insufficient, they are concerned that it will shrink as states scramble to plug up holes in their budgets. "I am worried because states are feeling real budget crunches because the economy is turning down," said Steven Schroeder, executive director of the Robert Wood Johnson Foundation. "Here is an irresistible pot of money... and it is very tempting to divert it to other purposes." The issue has generated enough concern that it will be taken up this week at the annual meeting of the American Public Health Association in Philadelphia. On the table will be a policy resolution to encourage more public scrutiny of settlement funds, especially for tobacco control and prevention. A second resolution would urge the states to dedicate their settlement funds primarily to public health programs and tobacco control. Tobacco use is the leading preventable cause of death and disease in the United States. It is linked to more than 430,000 deaths a year, costing more than $50 billion just in direct medical costs. Most first-time tobacco use occurs in early adolescence, typically by the age of 16, according to the CDC. While the tobacco-settlement money boosted prevention initiatives, several states launched broad programs much sooner. Their experience in lowering smoking rates - and even smoking-related disease - served as models for the CDC's guidance for tobacco control programs. New Jersey used some of its tobacco windfall to help balance its budget this year. It sold a portion of its anticipated income from the tobacco settlement to investors by issuing tobacco bonds. The bond sale raised $1.5 million, of which $1.1 billion went to balance the budget. The remaining $400 million is in reserve. So now, the state will rely on higher cigarette taxes, instead of the tobacco-settlement revenues, to fund its $30 million stop-smoking and smoking-prevention programs. Last summer, the cigarette tax was raised by 70 cents a pack to $1.50. "Now there is essentially a dedicated funding stream," said George DiFerdinando, a medical doctor and the state's deputy commissioner for public health services. "Everyone wanted to use the tobacco settlement to fund any new idea they had." New Jersey, which started to plan for a prevention program in the late 1990s, has counted among its successes: A 42 percent reduction in cigarette smoking among middle school students between 1999 and 2001. Owners of nearly 1,000 restaurants last year voluntarily adopted smoke-free policies. And business has been brisk for the state's cessation programs - Quitline (phone), Quitnet (Internet) and Quitcenters (clinics). Vernon R. Daly will receive about $100,000 this year from the state to aid his efforts to get cigarettes out of pharmacies. Of the state's 2,100 pharmacies, he said, about 145 have agreed to stop selling cigarettes since 1996. "It is an uphill struggle," said Daly, a medical doctor and president of Heureka Center for Disease Prevention and Health Promotion in Burlington City. The state funding "is making a big difference. Before, I was trying to do this without resources." After a slow start, Pennsylvania expects to spend slightly more than $50 million in its anti-tobacco efforts this fiscal year. (The state had earmarked just over $40 million last year but used only $14.8 million because it spent most of the year putting together its program, according to a health department spokesman). Judy Ochs, who oversees Pennsylvania's tobacco-control program, views the state's late start as a "positive thing." "We have looked at what other states have attempted to do and the barriers they have faced," she said. "We learned it takes a village to put all the pieces together." Ochs attributed a crackdown on illegal sales to minors this summer as a key component to a reduction in such sales from 28 percent to 14.5 percent in the past year. The state also has embarked on a number of educational campaigns and raised the tobacco tax (from 31 cents per pack to $1) last summer. "Because of the initiatives we have put in place, we are going to see measurable reduction in tobacco use," Ochs said.

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