A bill that would more than triple what New Hampshire spends on smoking prevention and cessation faces “an uphill battle” in the Legislature, predicts the House Finance Committee chairman.

House Bill 1376 would distribute $10.8 million — about one-quarter of the $47 million in tobacco settlement funds the state expects to receive in the coming fiscal year — to the state’s tobacco use prevention fund. That proposed figure comes from national Centers for Disease Control estimates of what it would cost for New Hampshire to mount an effective anti-smoking campaign, based on per capita expenditures in several states that have successfully decreased their smoking rates. The bill’s prime sponsor, Rep. James Pilliod, R-Belmont, last week said the $10.8 million investment in smoking prevention is only a fraction of what New Hampshire spends on tobacco-related medical costs every year. Pilliod, who is a physician, said the legislative intent is “to make a very, very loud statement, I hope, to the world that the tobacco settlement was a very, very, very loud surrender by the tobacco companies.” The problem, Pilliod contends, was there was no “quid pro quo” for how states would use the annual windfall from the tobacco settlement. The New Hampshire Legislature last year temporarily solved the state’s budget shortfall by using all but $3 million of the settlement funds on education. The previous year, it spent just $1.5 million of the money on anti-smoking programs. Pilliod, himself a former smoker, said he resents the fact that the money coming in from tobacco companies has gone into the general fund. “I’d like to say, let’s pay at least a modest sum out of this . . . to do something that will save us billions in the future from a health standpoint,” he said. However, Rep. Neal Kurk, R-Weare, chairman of the finance committee, which will hear the measure, said asking for increased expenditures of any kind during the current economic downturn will be “a difficult case to make.” He noted state law now allocates $3 million a year for anti-smoking efforts. “They want to spend another $7.8 million on tobacco (prevention), and obviously that is $7.8 million that we would have to get from somewhere else,” Kurk said. “The real question is, how important is this program compared to other programs that might have to be reduced to pay for this? How important is this relative to the pain it would take to raise additional revenue?” A spokesman for Gov. Jeanne Shaheen voiced similar sentiments. Pamela Walsh said the governor supported the creation of the state’s $3 million tobacco prevention fund. “But the simple fact behind House Bill 1376 is we can’t afford it,” Walsh said. “Revenues were down in December, and the governor is instituting budget reductions because of the slowing economy.” Asked if that means the governor would veto the measure if it passed the Legislature, Walsh said, “It’s not something we can afford, and she’s going to have to look at that.” But state public health officials say smoking prevention is their top priority. And they say they can demonstrate how other states have decreased smoking rates — and medical costs as a result. Advocates say the state can rely on advertising and other proven activities that have been developed by other states — including California, Massachusetts, Arizona, Oregon and Florida — that have subsequently seen a drop in smoking rates. “There are certain benefits to not being the first person in line, and this is clearly one of them,” said Brook Dupee, assistant director of the state’s Office of Community and Public Health. He said California has even begun seeing decreases in lung cancer rates, about 10 years after the state embarked on an ambitious anti-smoking campaign. “They’ve been at this long enough to actually start hitting the holy grail.” Dr. Andrew Pelletier, chronic disease epidemiologist for the state health department, puts the blame squarely on the tobacco companies for recent increases in youth smoking rates, after years of declining rates. Pelletier said about one-third of New Hampshire high school students smoke, mirroring a national trend. And the habit is most prevalent among 18- to 24-year-olds; nearly four in 10 smoke. That compares to about 25 percent of the overall adult population who are smokers. “We attribute a lot of that to industry practices,” Pelletier said. He noted the tobacco industry now spends about $8 billion annually to advertise its products, a figure that increased “substantially” after the tobacco settlement. On a per capita basis, that amounts to about $37 million the industry will spend to advertise in New Hampshire this year, he said. Pelletier thinks legislators need to consider that when it comes to the request for $10.8 million for the anti-smoking campaign. “I think it’s helpful to keep in mind that the industry is spending about seven to 10 times that amount in promoting their product in the state. It’s sort of a David and Goliath situation.” A new approach So how do public health officials expect to counter those messages? Dupee — another former smoker — said public health departments now are taking a different approach than in past decades, when the focus was on educating the public about the dangers of smoking. “Everybody has figured out smoking is bad for you . . . so you have to point out the other factors,” he said. “The question is, can we give them the right tools so when the times comes for them to make the right decision, they can get there.” Pelletier said other states have found focusing on the short-term consequences of smoking — smoky-smelling clothing, bad breath, stained teeth — seems to be more effective with young people. “The fact that lung cancer is looming down the road is sort of a non-issue with them.” Pelletier said the state is ready to move forward with its anti-smoking efforts, even if the additional money is not approved by the legislature. In addition to the $3 million in state money for tobacco prevention, New Hampshire gets $1 million from the CDC and an additional $1 million from grants for the program. He said the state is following a CDC blueprint for anti-smoking campaigns, which includes school programs, enforcement to restrict minors’ access to tobacco, smoking cessation services, and disease prevention and detection efforts. “All the components are either in place or being put in place now,” he said. “It would be just a question of increasing the funding for each.” A key element of the effort is a $1.3 million “countermarketing” campaign, expected to kick off in March or April. The Executive Council recently approved a two-year contract with High Point Communications of Bow to coordinate the campaign, which will include paid advertising, public and school events, and coordinating the efforts of more than 15 anti-smoking coalitions that have grown up around the state in recent years. Kurk wasn’t optimistic that additional funds will be forthcoming. “It’s a complex problem, and I think any folks proposing increased spending at a time when state revenues are shrinking have a very uphill battle in persuading the legislature to reshift its priorities at the same time we’re cutting and the governor’s going to be proposing cuts,” he said. “The idea of spending additional money and therefore requiring still additional cuts for new programs or expanded programs is a tough argument. It’s a difficult case to make.” But Pelletier said the $10.8 million is a fraction of what the state already is spending every year on tobacco-related medical care, even in Medicaid funds alone. And he noted approximately 2,000 New Hampshire deaths a year are directly related to tobacco, making smoking-related illness the leading cause of preventable death in the state as well as the nation. “It’s not really a question of what we’re going to pay in the future, it’s what we’re paying now,” Pelletier said. “If we want to change what we pay in the future, we need to address smoking prevalence today.” “I think the greatest challenge is the political will to allocate the resources and to stay the course.” Krysten Godfrey of the American Lung Association of New Hampshire said her organization fully supports the pending legislation. “We do understand the challenges of the bill, but we hope when the facts are presented, the legislators and the public will understand the need to invest now — or pay later.”

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