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New Report: States Continue to Shortchange Tobacco Prevention Programs, But Several Show a Welcome Increase

January 13, 2023

WASHINGTON, D.C. – Even as tobacco use remains the number one cause of preventable death in the United States and youth e-cigarette use remains at high levels, a new report highlights how too many states continue to shortchange programs designed to prevent kids from using tobacco products and help tobacco users quit. A handful of states, though, have increased funding and set a positive example for other states to follow.

The report challenges states to do more to fight tobacco use, save lives and stop tobacco companies from addicting a new generation of kids.

This year (fiscal year 2023), the states will collect $26.7 billion from the 1998 tobacco settlement and tobacco taxes. But they will spend just 2.7% –$733.1 million – on tobacco prevention and cessation programs. This is a $14.5 million increase from last year, but still less than a quarter (22.2%) of the total funding recommended by the Centers for Disease Control and Prevention (CDC). 

The overall increase in spending can be attributed primarily to five states – Oregon, Maine, Connecticut, Maryland and Oklahoma.

Despite these increases, only two states – Oregon and Maine – currently fund their tobacco prevention and cessation programs at or above CDC-recommended levels, and only 7 other states provide even half the recommended amount. The low funding levels in most states are even more alarming when compared to the $9.1 billion the tobacco industry spends annually to market their deadly and addictive products in the United States.

The report – “Broken Promises to Our Children: A State-by-State Look at the 1998 Tobacco Settlement” – was released today by the Campaign for Tobacco-Free Kids, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights and Truth Initiative. These organizations have issued annual reports since the November 1998 landmark legal settlement between 46 states and the major tobacco companies, which – along with individual settlements with four other states – required the companies to pay more than $246 billion over time as compensation for tobacco-related health care costs. 

View the Report including state-by-state information and a ranking of the states.

The continuing need for well-funded tobacco prevention and cessation programs is clear. While the U.S. has made enormous progress in reducing cigarette smoking and other tobacco use, tobacco use still kills over 480,000 people and is responsible for over $241 billion in health care expenditures in the U.S. each year. 

The latest government survey results show that 3.08 million U.S. middle and high school students reported current (past 30-day) use of any tobacco product in 2022, including 2.55 million who used e-cigarettes. Youth e-cigarette use remains a serious public health problem, with 14.1% of high school students reporting current e-cigarette use and 46% of these high school e-cigarette users reporting frequent or daily use, a strong indication of addiction.

Among adults, the CDC has reported that 47.1 million U.S. adults (19%) were current tobacco users in 2020. The U.S. also faces large disparities in who still smokes. Adult smoking rates remain the highest among people with lower income and less education, residents of the Midwest and the South, American Indians/Alaska Natives, LGBTQ Americans, those who are uninsured or enrolled in Medicaid, and those with mental illness. In addition, Black Americans die at higher rates from smoking-caused diseases, in large part due to the tobacco industry’s predatory targeting of Black communities with menthol cigarettes.

“To continue driving down tobacco use, address health disparities and stop tobacco companies from addicting another generation of kids, states must step up their funding of tobacco prevention and cessation programs,” said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. “Our progress shows that we know how to win the fight against tobacco. But policymakers need to be as aggressive in implementing proven tobacco prevention measures as the tobacco industry continues to be in promoting its deadly and addictive products.”

To accelerate progress, policymakers at all levels should fully implement proven measures to reduce tobacco use. In addition to funding tobacco prevention and cessation programs, these strategies include ending the sale of all flavored tobacco products, significant tobacco tax increases, comprehensive smoke-free laws, hard-hitting mass media campaigns, and barrier-free insurance coverage for tobacco cessation treatment.  

Other key findings in the report: 

·       Oregon and Maine are the only states to fund tobacco prevention and cessation programs at or above the CDC-recommended levels.

·       Only 7 other states (Utah, Oklahoma, Delaware, Alaska, North Dakota, California and Hawaii) provide more than half of the CDC-recommended funding.

·       31 states and DC are providing less than 25% of what the CDC recommends; 17 states provide less than 10%; 11 states provide less than 5%.

·       Tobacco companies spend more than $12 to market tobacco products for every $1 the states invest to reduce tobacco use. According to the most recent data from the Federal Trade Commission (for 2020), the major cigarette, e-cigarette and smokeless tobacco companies spend $9.1 billion a year – over $1 million per hour – on marketing. 

For more information, visit: tfk.org/statereport.

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Emily Burr
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Senior Vice President, Advocacy Communications and Policy
Washington, D.C.