South Dakota's Medicaid spending on smoking-related health problems has more than doubled in recent years as medical expenses soar and tobacco use remains prevalent, a new study finds.

Smoking-caused Medicaid costs in South Dakota spiked from $7 million in 1993 to $17 million last year, according to a report by the Washington-based American Legacy Foundation. Nationally, costs jumped from $12.9 billion in 1993 to $27.2 billion in 2001. Some $12 billion of that total is paid directly by state governments as their portion of the federal-state Medicaid health insurance for low-income people. During the same period, state Medicaid costs in Iowa more than tripled to $98 million. They doubled in Minnesota to $204 million. "This report is a wake-up call for states," said Cheryl Healton, president of Legacy, a nonprofit public health foundation. Healton said states such as California have proven that comprehensive tobacco prevention programs cut smoking rates and, by extension, the associated health problems and costs. With advertising campaigns and public counseling programs, California has saved $3 for every one dollar it has spent, she said. The result: While smoking-related Medicaid costs still rose in California during the period of the Legacy study, they climbed only at a 50 percent rate. That compares to 144 percent in South Dakota, 119 percent in Minnesota and 233 percent in Iowa. "We hope that states will realize that investing in tobacco control is not only good public health policy but sound fiscal policy," said Mitch Zeller, a government affairs analyst with Legacy. South Dakota officials said they have taken note of such reports, and they point to the launching of new efforts this year. The centerpiece of the state's tobacco-control program is a toll-free telephone line that provides tobacco users counseling and discounted cessation products. Staffed and co-promoted by the American Cancer Society, it has a budget of $2.6 million. The state also introduced community programs in Lower Brule, Parkston, Spearfish and Watertown. Officials in those towns are developing prevention programs with schools and businesses. The aim is to determine effective methods in helping people refrain from tobacco use. With future funding, officials hope to duplicate statewide any successes in those communities. In total, the state has a $4.8 million tobacco-control budget, which secretary of health Doneen Hollingsworth called "a major investment" for a state the size of South Dakota. The hope is that tobacco-control programs can curb some of the highest smoking rates in the nation. An estimated 32.6 percent of high school students smoke in South Dakota, compared to 28 percent nationally, according to the Campaign for Tobacco-Free Kids. Nearly a fourth of all adults and 50 percent of Native Americans in the state smoke. Health problems attributed to smoking cost South Dakota $173 million a year. Anti-tobacco advocates hope to trim smoking statistics by 25 percent this decade. Doing so, the Legacy report said, would save states a collective $550 million in Medicaid costs alone. Tobacco use is still the leading cause of preventable death, claiming the lives of 400,000 Americans every year. And, as smoking rates remain high, overall health costs continue to climb. Demand for hospital services and prescription drugs drove national health care spending up 6.9 percent in 2000, the highest increase in seven years, according to a federal report. South Dakota and its neighboring states had increases around the national average. Private studies have estimated that costs last year jumped by 10 percent or more. All of which, the Legacy report said, makes tobacco-control essential public policy. "It's a case where an ounce of prevention truly is worth a pound of cure," Zeller said.

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