TUESDAY, Jan. 7 (HealthScoutNews) -- Despite the influx of hundreds of millions of dollars from settlements reached with tobacco companies, most states are still failing to protect the health of their citizens with effective tobacco prevention and cessati

The lung association graded each state on four criteria believed to affect smoking rates: how well they provide their citizens with smoke-free air; how much tax they charge on cigarettes; how well they restrict youth access to cigarettes; and how well they fund tobacco-control programs, like those for prevention and cessation. Ten states failed all four measures: Alabama, Georgia, Kentucky, Montana, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, and West Virginia. "What we found was that there are major shortcomings," says John Kirkwood, president and CEO of the American Lung Association. "Theoretically, the states should be doing well [in tobacco control]. They've had a huge chunk of money coming in, and initially a large portion of that money went into prevention. Now, many states are using this money to fill in holes in their budgets." Much of the money coming in is from the 1998 Master Settlement Agreement with the tobacco companies. The attorneys general from 46 states agreed to accept a settlement of $206 billion over 25 years to offset the additional health-care costs of caring for sick smokers. Four other states entered into earlier agreements totaling $40 billion in settlements. Kirkwood says that while there were no guarantees or legal requirements on spending this money, it was expected that much of it would go toward tobacco control measures. But that doesn't appear to be what's happening. Forty-three states along with the District of Columbia received an "F" in providing smoke-free air through statewide smoking restrictions. Delaware and California were far ahead of the rest of the states in passing comprehensive smoking bans in public areas, says the report. Seventeen states failed to implement large cigarette tax increases, a measure that the lung association says reduces the number of youngsters who start smoking and may encourage adult smokers to quit. Twenty-one states did, however, raise their cigarette excise taxes in 2002. More than 30 states received an "F" in tobacco program funding from the lung group. Only six states managed to earn an "A" for their tobacco prevention and cessation programs: Arkansas, Indiana, Maryland, Maine, Minnesota, and Mississippi. The U.S. Centers for Disease Control and Prevention (news - web sites) (CDC) recommends that each state spend a certain amount per capita on these programs, but states are falling far short. As an example, one small state should have spent about $27 million on tobacco control programs if it followed the CDC recommendations, yet actual funding for these programs was less than $2 million, according to Kirkwood. Over half of the states need to do more to limit youth access to tobacco products, the report finds. Some effective strategies for preventing youth access include placing cigarettes behind the sales counter, stiff penalties for selling tobacco to minors, and restricting the use of vending machines that sell tobacco products. Only seven states garnered top honors in this category: California, Connecticut, Maine, New York, Rhode Island, Texas, and Vermont. Dr. Gilbert Ross, the medical director for the American Council on Science and Health, a consumer education group that produced the book Cigarettes: What the Warning Label Doesn't Tell You, says he's not surprised by the lung association's findings. "The temptation to divert those funds is too great for most state politicians to ignore when faced with budgetary shortfalls," says Ross. But, he cautions, "We're mortgaging the future health of the public to meet short-term budgetary goals." Ross says the news isn't all bad. He says both adult and youth smoking rates have been gradually going down. But if funds are continually diverted away from tobacco control programs, he warns, that trend will likely reverse. "The less attention that's devoted to this insidious behavior, the more likely there will be a rebound in smoking in young people and a lowering of cessation rates in adults," explains Ross. Kirkwood says he hopes the report will focus more attention on the problem. "There are effective strategies out there to drive the smoking rates down. We have the resources available to accomplish these goals from the settlement money and cigarette taxes. Let's get on with it," he says.

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