Washington -- States seem to be following a two-steps-forward, one-step- back pattern when it comes to smoking cessation efforts.

Although they are reaching more deeply into smokers' pockets for extra tax revenue, states are also trimming funds for programs to prevent or control tobacco use, according to a new survey by the American Lung Assn. The need to plug state budget gaps is running counter to public health needs in many states, and the result could be the growth in the horrendous health care costs associated with smoking. Still, increases in cigarette taxes are applauded by the lung association and others. "Higher cigarette taxes are a win-win decision for policy-makers," said American Lung Assn. president John L. Kirkwood. "The benefits are enormous. Higher taxes keep kids from smoking, motivate adults to stop [smoking], trim future smoking-related health care costs and raise new revenues to plug gaping budget holes." "The tobacco industry must recruit thousands of kids every year to make up for all the people who die because of tobacco," said Jack T. Evjy, MD, past president of the Massachusetts Medical Society. Studies show that increases in the cost of cigarettes reduce youth smoking and overall cigarette consumption, according to control advocates. Since Jan. 1, eight states have passed laws to increase their cigarette taxes. Three others passed laws last year that take effect on July 1. As of next week the average state tax will be 69.4 cents per pack of cigarettes, and 16 states will impose cigarette taxes of $1 or more. Connecticut and Massachusetts have the highest tax rate at $1.51 per pack while Virginia has the lowest rate at 2.5 cents per pack. Other states are either considering legislation or could, as in the case of Georgia, soon have an increase signed into law. Unfortunately those extra tax dollars aren't necessarily being spent on tobacco control efforts, said Kirkwood. "Only three states -- Arizona, California and Oregon -- commit tobacco tax dollars to such uses," he said. "As a result, public health will suffer in the future." The survey also found increases in the passage of smoke-free workplace legislation. For years California was the only state that prohibited smoking in indoor public sites, including bars and restaurants. In the past six months smoking bans were passed in New York City and New York state, Boston and Connecticut. Other states are poised to join them. The Smokeless States National Tobacco Policy Initiative, a collaborative effort of the American Medical Association and 42 state coalitions, points to successful efforts at passing smoking bans as important victories in its 10-year campaign. In addition to statewide smoking bans, about 1,500 communities have enacted their own bans in recent years, according to the initiative. Economic changes have also handed tobacco control advocates something of a curious victory. States are turning away from what had been a growing practice of selling the rights to all or part of their future payments from the 1998 tobacco settlement agreement to investors for a smaller up-front payment, a process called securitization. When states first looked at securitization, as a way to gain immediate access to cash, payments were between 30 cents and 40 cents on the dollar. That figure plummeted this year as the bond market was saturated with more than $18 billion in bonds backed by settlement funds. The low return rate has persuaded Virginia and California to postpone planned bond sales, and other states have put securitization on hold. The bonds are also less appealing to investors as the tobacco industry faces ongoing litigation that could result in the payment of huge penalties. One company, Philip Morris, claims that possible losses could force the company into bankruptcy and put an end to its future settlement payments to states.

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