RALEIGH, N.C. (AP) -- Edgy ads dramatizing the addictive and health-destroying power of cigarettes are credited with helping states including California, Massachusetts and Florida cut their smoking rates sharply.

One of the in-your-face television commercials rated as highly effective by teenagers shows a puffy-faced, 26-year-old woman who said she started smoking because she wanted to look older. She said her smoking led to emphysema and removal of one of her lungs at age 24, and how her medication left her with "this fat face and a hump on my neck." "It's clear these kind of programs get adult smokers to quit and convince kids and teenagers not to start," said Deborah Bryan of the North Carolina chapter of the American Lung Association. "The evidence is overwhelming." But don't expect to see such ads fighting for attention anytime soon in the country's largest tobacco-growing state. A quarter of the $4.6 billion North Carolina expects to receive over the next 25 years from the 1998 national settlement with cigarette-makers has been earmarked by the General Assembly for health programs -- including smoking-control programs. But for the foreseeable future nearly all of that money is expected to go for a prescription-drug plan for the elderly proposed by Gov. Mike Easley. An 18-member board of political appointees is in charge of distributing $1.15 billion that the General Assembly has designated for health programs. The Health and Wellness Trust Fund Commission has about $73 million in settlement money in the bank now and expects to receive $41 million annually through 2025. Its first job is putting together the prescription plan for seniors, said Lt. Gov. Beverly Perdue, the commission's chairwoman. The group also will be working on three other initiatives it hopes to launch next year. Perdue said she expects one to focus on teenage smoking. "We're probably not talking about a whole lot of money for those three programs at first, maybe $5 million or so," Perdue said. "For now most of the money will go to get the prescription plan for seniors up and running." Two other trust funds have also been formed to distribute money from the settlement. The Golden L.E.A.F. Foundation, which is designed to benefit tobacco-dependent communities, is expected to receive $2.3 billion over 25 years. The other, called the Tobacco Trust Fund, is to help growers and government quota owners. It is expected to receive $1.15 billion. Neither group is expected to fund any anti-smoking efforts. Health advocates said they are disappointed that tobacco control efforts appear to be such a low priority. But most also acknowledge that any tobacco-control initiative faces an uphill battle in North Carolina, the headquarters for three of the country's five largest cigarette companies. "This is such a rare opportunity to really do something historic to address the leading preventable cause of death in the world," said Meg Molloy, a professor at the School of Public Health at the University of North Carolina at Chapel Hill and executive director of North Carolina Prevention Partners, a health advocacy group. "It is absolutely tragic to waste this once-in-a-lifetime chance to improve the future health of this whole state," she said. North Carolina's low taxes -- at 5 cents a pack the third-lowest in the nation -- also contribute to the high smoking rates among adults and young people, tobacco-control advocates said. Fifteen percent of North Carolina children in grades 6 through 8 smoke cigarettes, compared with 9.2 percent nationwide. Even some tobacco industry representatives say they think it is a mistake for the state not to spend more of the settlement money on smoking-control efforts. "The money is being given away, but the people who should be getting it -- including the health groups -- aren't getting it," said Phil Carlton, a former state Supreme Court justice who was lead negotiator for the tobacco industry during the settlement talks. One teenage smoker said anti-tobacco campaigns would have a hard time succeeding, no matter how aggressive or comprehensive they might be. Kari Coghlan, 18, of Raleigh, who started smoking at 14. She said she wants to quit but can't. Most of her friends also smoke, she said. They, too, want to quit but can't. "We all know it is bad for us, but we just can't seem to kick it," Coghlan said. "It is really, really hard." Coghlan said her mother tried to get her to quit once, even buying her packs of nicotine gum. She sold the gum to classmates -- and used the money to buy cigarettes. "I just wasn't ready to quit," she said. "You have to want to do it yourself."

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