A handful of states that once led the nation in their tobacco prevention programs have taken an ax to those efforts in order to trim deficits and balance their budgets.

Maryland, Massachusetts and Minnesota were often praised for their use of tobacco settlement money. But thanks to deep cuts in tobacco control budgets, several anti-smoking groups claim they are now abandoning earlier commitments made when settlements with the tobacco industry were reached in 1998. A newly elected Republican governor leads each of those states, but even Democrat-controlled California has cut its tobacco prevention efforts to pay for a huge budget shortfall. In each case, the states are turning a blind eye to the promises they made to fund youth prevention programs, anti-smoking groups said. In the short-term, diverting money from tobacco control to the general fund might help governors and legislators balance budgets, which is required by law in some states. That approach, however, has long-term risks and a greater cost, said Carlos Alvarez, executive director of the Massachusetts American Lung Association. "We used to have a nationally recognized, highly successful program, and it has all gone down the toilet," Alvarez said. "As far as public health is concerned, I would say we have a serious crisis in the making by the cuts in tobacco prevention funding." Most of the cuts came during Republican Gov. Jane Swift's administration, but current Gov. Mitt Romney, also a Republican, recently proposed $10 million in cuts to the state's tobacco control efforts. "This is the fourth in the series of cuts made in the last 12 months, which will completely eliminate a program that has saved thousands of lives and millions of dollars, and been heralded by public health leaders and the Bush administration as one of the best in the nation," said William V. Corr, executive vice president of the Campaign for Tobacco-Free Kids. Massachusetts used to top the campaign's annual report on tobacco settlement spending. This year, however, it dropped to 38th because of the funding cuts. A state health commissioner did not return a call seeking comment, but the department had previously issued a list of accomplishments, including a 27 percent drop in teen smoking during the past six years. At the time the report was released in January, Minnesota (ranked second) and Maryland (ranked fourth) were still considered model examples of states that properly used the money they received from the settlement. But in the past few weeks, governors in both those states have said they need to slash their tobacco prevention programs to make up for budget deficits. In Maryland, Republican Gov. Robert Ehrlich is trying to close a $1.8 billion shortfall. The state currently meets recommendations set by the Centers for Disease Control and Prevention on tobacco prevention funding. Under Ehrlich's budget, the state would lose that designation, as funding would be cut in half to $15.2 million. Steve Peregoy, executive director of the American Lung Association of Maryland, said the figures are somewhat misleading since the state had usually budgeted for $30 million but never spent more than $20 million for tobacco control. Although Peregoy is concerned, he hopes the cuts will only be temporary. "I think some people tend to think that once they take money away from the pot, it's never going to be restored. I don't believe that's the case," he said. "If you can show that as a result of this investment, you are not only saving lives, but also reducing health-care costs, then anyone who manages a state budget is going to look at that and want to continue investing the money." Ehrlich could run into trouble with a Maryland law that requires the budget to include at least $21 million for tobacco prevention, according to an analysis by the Campaign for Tobacco-Free Kids. The group also criticized the state for hiking cigarette taxes but not using those funds for anti-smoking efforts. Last week, similar circumstances played out in Minnesota, where Republican Gov. Tim Pawlenty's budget would almost entirely eliminate the state's $430 million endowment that funds tobacco control programs on a yearly basis. The endowment was established after Minnesota settled a lawsuit with the tobacco industry separate from the Master Settlement Agreement, which was signed by 46 states. The endowment produces about $25 million per year for anti-smoking programs, said Holly Ziemer, spokeswoman for the Minnesota Smoke-Free Coalition. "When the settlement was drawn, Attorney General [Skip] Humphrey was calling for the money to be used to fund a comprehensive youth tobacco prevention effort," Ziemer said. "By eliminating that, I think it certainly is breaking the promise to kids that Minnesota had made, not only when they brought the lawsuit against the tobacco industry, but also when they settled and created this endowment." John Stieger, a spokesman for the Minnesota Department of Health, said Pawlenty was left with little choice but to move the money because he was facing a $4.2 billion deficit and had to balance the budget. Although anti-smoking groups in Massachusetts and Maryland said the cuts to tobacco prevention were not politically motivated, Ziemer blamed Pawlenty and the Republican-led House of Representatives. She said the House tried to move the endowment into the general fund during the last few years, but it was blocked by then-Gov. Jesse Ventura. Now that Pawlenty is in charge, she said the fight has intensified with the state's Democratic-Farmer-Labor Party. In general, Republicans do not slash tobacco prevention funding any more than Democrats, said Lee Dixon, director of the health policy tracking service at the National Conference of State Legislatures. Dixon said that in the cases of Maryland, Massachusetts and Minnesota, Republican governors inherited budget problems and were left little choice in their spending plans. Those three states also have received more attention, Dixon said, because they had leading tobacco control programs. "The actions that the state legislators and governors are taking across the board, including around tobacco prevention, reflect the electorate's position," he said. "They don't want to see their taxes increased, but they want services continued at some minimal level. So if you can't increase your revenues, you're going to have to cut back." California, for example, has a Democrat-controlled Legislature and governor, but it made this year's Campaign for Tobacco-Free Kids list as one of the "most disappointing states." Gov. Gray Davis proposed cutting the tobacco prevention budget by $46.2 million, about 34 percent. Department of Finance spokeswoman Anita Gore defended the move, noting Davis needed to fill a $34.6 billion budget gap. "California is in the forefront of smoking prevention," Gore said. "We have quite a successful campaign, and it will continue - just to a lesser degree. It could be that more funding will be available in the future, depending on the financial situation of the state." Most states are in the beginning stages of trying to solve their budget problems. Along the way, anti-smoking groups will lobby for better funding scenarios. But states have also come under fire from the tobacco industry, which will pay them $246 billion over 25 years as a result of the settlements. R.J. Reynolds Tobacco Co. has chosen to highlight some the ways states have chosen to spend their settlement money, which includes dump trucks and golf carts in New York, public television stations in Nevada and city parks in California. "An awful lot was said at news conferences and public functions how this was a great victory for the public health community because this money would now be available to stop youth smoking and deal with health-care issues related to smoking," R.J. Reynolds spokesman John Singleton said. "A fraction of these funds is actually being spent for anything that the state [attorneys general] said it was needed for or would be used for back in 1998."

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