Despite earmarking millions for an initiative to snuff out cancer, Georgia ranks only fair to middling when it comes to spending its share of funds collected from a multibillion-dollar settlement against Big Tobacco.

A recent national report updating how states are spending their tobacco settlement dollars -- money that was intended to fund tobacco prevention programs -- shows Georgia in 22nd place in a state ranking of funding levels. The state also fails to meet minimum tobacco prevention funding recommendations set by the U.S. Centers for Disease Control and Prevention (CDC). Only five states are meeting those minimums, which are that 20 percent to 25 percent of a state's settlement funds be set aside for prevention programs. Georgia so far has collected more than $352 million of an approximately $4.8 billion settlement that is being paid out over 25 years. Last year alone, the state received $151.8 million. More than $20.7 million has been set aside for tobacco prevention this year, but the CDC has recommended that Georgia set aside closer to $42.6 million. "I think it's a huge disappointment overall to see how the master settlement dollars have been used," said Dr. Randolph Smoak, immediate past president of the American Medical Association. "Every dollar that is deviated from [tobacco] prevention and cessation programs is a dollar the tobacco industry has escaped paying," Smoak said. Although public health programs, such as the Georgia Cancer Coalition, are beneficial, they represent a missed opportunity, Smoak added. "I applaud the public and private leadership in Georgia for taking on such an enormous program, but at the same time there is a missed opportunity to educate people and impact a future generation of smokers," he said. But supporters of the new Georgia Cancer Coalition, a public health initiative that ultimately could use as much as $400 million of the state's tobacco settlement funds, say Georgia not only is diligent in its efforts to fund the fight against tobacco use, but also has an eye toward a bigger health picture. "Much of what we are doing is actually tobacco-related," said Russ Toal, president of the Georgia Cancer Coalition. "Tobacco is tied to almost 80 percent of all cancer. We are doing what the CDC has recommended -- attacking this disease in a multifaceted manner." Cancer is the second-leading cause of death in Georgia, causing almost a quarter of all deaths in the state. The Georgia Cancer Coalition was set up last year to establish a comprehensive cancer treatment and prevention network, including cutting-edge research projects and world-class treatment facilities. "While the recent report issued is certainly accurate, I think that if you isolate the funding you may be missing the bigger picture," said Andy Lord, director of Georgia tobacco initiatives for the American Cancer Society's Southeast division. "Overall, Georgia is addressing not just tobacco use but cancer prevention as a whole," Lord said. Indeed, the state's ranking actually improved this year, rising from 25th to 22nd from 2001 to 2002. Gov. Roy Barnes, in the fiscal 2002 state budget adopted last year, also committed to adding $5 million a year to funding tobacco prevention until Georgia meets the CDC's minimum recommendations. But in Barnes' proposed 2003 state budget, smoking prevention and cessation programs stand to take a cut of more than $5 million. Adding other adjustments and supplemental appropriations, funding for tobacco prevention likely will be flat next year, said Adele Cohen, director of the Georgia Alliance for Tobacco Prevention, formerly the Coalition for a Healthy And Responsible Georgia (CHARGE). "We very much support the Georgia Cancer Coalition," Cohen said. "We would really like to see Georgia approach the CDC's minimum recommendations. I think we are really beginning to get tobacco prevention off the ground in this state and it's starting to pay off." Georgia has organized three major, well-funded initiatives aimed at curbing tobacco use, Lord said. Last February the state launched its Unite Georgia television ad campaign, which attacks secondhand smoke and its effects on children. Because of the campaign, awareness about secondhand smoke has risen from 4 percent to 50 percent, he said. The state also began funding a quit smoking line last November. The toll-free number [(877) 270-STOP] received 5,500 calls in the first week, Cohen said. "We've surpassed all other states with the response to our quit line," she added. Georgia also has hired tobacco-use-prevention coordinators for each of the state's 19 health districts, Lord said. Those coordinators are supporting statewide tobacco prevention programs and can tailor them to fit each specific district, he said. Smoking among Georgia high school students has declined by 30 percent in the past three years, he added. Of the $20.8 million in settlement money earmarked for tobacco prevention in Georgia in 2002, $4.6 million is going to the 19 public health districts, according to the report issued jointly Jan. 15 by the Campaign for Tobacco-Free Kids, the American Cancer Society, the American Heart Association and the American Lung Association. About $2.5 million is going to building community coalitions, $5.3 million to the ad campaign and $1.7 million to monitoring tobacco use and prevention efforts, according to the report. The additional settlement money went to support the One Georgia Fund, which attracts businesses for rural economic development, funding for school nurses, expansions of Medicaid services, expansions to the PeachCare for Kids program, expansions to the state's cancer registry and various health-care projects directed by the state's Department of Health Resources and Department of Community Health. Georgia was left off of the list of states misusing tobacco settlement funds to shore up tight budgets, and fared better than all but three Southern states. North Carolina has committed none of its settlement funds to tobacco prevention programs and wound up on the list of 10 most disappointing states. Florida also made the list after Gov. Jeb Bush slashed funding for one of the nation's most successful tobacco prevention programs by nearly a third. Tennessee has committed zero dollars to tobacco prevention. South Carolina, Alabama, Louisiana and Kentucky have committed only minimal funding, according to the report. Mississippi, however, stood out as one of five states that have met the CDC's recommended funding levels. Mississippi also settled up with tobacco companies independently and was not part of a large joint lawsuit, Lord said. Most states that settled independently received more money, he added. Other states also collect excise taxes on cigarettes, and have raised more money than states, such as Georgia, that do not have excise taxes, Lord said. The Georgia Alliance for Tobacco Prevention, as part of its refocused mission, will be supporting an effort to collect such taxes for tobacco prevention programs, Cohen said. There is overwhelming evidence that funding for tobacco prevention pays off and that smoking cessation and prevention programs work, said the AMA's Smoak. "In California, they are saving $3 in health-care costs for every $1 they spend on smoking prevention," Smoak said. "By not funding such programs, we are missing an opportunity to keep another generation from succumbing to tobacco products. We really are falling down on the job of rearing our young people when we don't properly use monies that could be beneficial to their future."

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