TSET/Tobacco Settlement Trust

Unfunding TSET Will Hurt Progress in Cancer Prevention, Treatment, and Research in Oklahoma


ACS CAN opposes the proposed cuts to the Tobacco Settlement Endowment Trust (TSET) in HJR 1017 which would decrease funding for vital TSET programs including those for cancer prevention and research. 

Proposes to end future funding for TSET from the annual tobacco Master Settlement Agreement payments received by the State of Oklahoma. The proposed discontinuation of new funding for TSET will result in the reduction or elimination of vital cancer prevention, research, and treatment grants and programs in Oklahoma that include:

Tobacco Prevention and Cessation

Tobacco use remains the largest preventable cause of disease and premature death in the United States.  Smoking is a known cause of cancer of the oropharynx, larynx, lung/trachea/bronchus, stomach, liver, pancreas, kidney, cervix, bladder, colon, and acute myeloid leukemia.[i] In fact, smoking is responsible for an estimated 31.1 percent of cancer deaths in Oklahoma.[ii]  Additionally, smokeless tobacco use can cause cancer of the mouth, esophagus, and pancreas.[iii]  If you add up the deaths from all diseases attributable to smoking, there are 7,500 lives lost each year in Oklahoma.[iv]

It should be noted that the damage tobacco inflicts upon our state is not limited to death and disease.  Annual health care costs from smoking are $1.62 billion in Oklahoma including $264 million that Oklahoma’s Medicaid program spends each year to treat smoking-related diseases.[v] Smoking-caused productivity losses cost the state an additional $2.1 billion annually.[vi]

To reduce the devastating health impact of cancer and other tobacco-related disease, we need to invest in programs that prevent kids from starting to use tobacco and help others who are already addicted to quit. 

TSET funds proven tobacco control programs:

  • The Oklahoma Tobacco Helpline is a free service available 24/7 that provides the tools and support needed to quit tobacco. To date, the Helpline has served over 360,000 Oklahomans.[vii] 
  • TSET’s support of grants and programs to prevent and reduce tobacco use has saved 42,000 lives and avoided $1.24 billion in direct medical costs.[viii]

Opposing HJR 1017 is vital for funding of lifesaving tobacco control programs in Oklahoma.

Obesity Prevention, Physical Activity, and Nutrition

ACS CAN supports evidence-based prevention policies to improve diet, increase physical activity, and manage weight in order to address the one in five cancer cases related to these factors.  Physical inactivity, along with poor diet, excess weight, and excess alcohol consumption are second only to tobacco use as major cancer risk factors.[ix] In fact, these risk factors are responsible for approximately 18 percent of annual U.S. cancer cases.[x]  Excess weight increases the risk for many cancers, including cancers of the female breast (postmenopausal), colon and rectum, uterus, kidney, adenocarcinoma of the esophagus, pancreas, ovary, liver, stomach, gallbladder, thyroid, brain and multiple myeloma.[xi]  The research is clear - maintaining a healthy weight and staying physically active throughout life are among the best ways to reduce the risk of developing and dying from cancer.[xii] 

Maintaining funding for TSET is an important step to support healthy eating and active living environments for Oklahomans.  Investments in making the healthy choice, the easy choice is money well spent toward cancer prevention.                                              


Access to Care in Rural and Underserved Areas

TSET funds are used to improve access to providers and health care services for low-income Oklahomans covered by the state’s Medicaid program:

  • $11 million in TSET funds have been invested in the Oklahoma Health Care Authority, Oklahoma Department of Mental Health and Substance Abuse Services, Physician Manpower Training Commission (PMTC), and Oklahoma State Medical Authority for efforts to improve health and health care outcomes since FY14.
  • 36 physicians are currently practicing in medically underserved areas of the state through the Oklahoma Medical Loan Repayment Program funded by TSET, administered by PMTC.
  • TSET funding supports the OSU Medical Authority’s efforts to recruit, train and retain more than 52

 osteopathic physician residents in rural communities across the state.[xiii]


The Oklahoma Tobacco Settlement Endowment Trust Cancer Research Program (OTCRP)
The past two decades have seen significant improvements in the way we diagnose and treat cancer. Through scientific discovery, we have also learned how to more effectively reduce our cancer risk or prevent it altogether. But the work is far from over, and sustained investment in cancer control, research and surveillance is critical to ensuring the next breakthroughs reach those who need them. The OTCRP grant was renewed in 2015 for $20 million over five years.  The program awards research grants to both Oklahoma scientists and recruits scientists to Oklahoma, as well as supports a Phase 1 Clinical Trials Program at the Stephenson Cancer Center.[xiv]  ACS CAN strongly supports sustaining this research.

  • TSET is the largest funder for research and a key funder of treatment at the Stephenson Cancer Center, which is in the process of applying to become a National Cancer Institute designated cancer center. 
  • TSET funds a statewide clinical trials network:
    • OK Cancer Specialist and Research Institution (Tulsa, Bartlesville, McAlester)
    • Southwest Cancer Centers of Oklahoma (Altus, Lawton, Duncan)
    • St. Anthony’s Hospital (Oklahoma City)
    • Integris Hospital (Oklahoma City)


TSET is Oklahoma’s largest funder of prevention. Grants and programs funded by TSET focus on reducing tobacco use, poor diet and physical inactivity that lead to four chronic diseases – cardiovascular disease, cancer, diabetes and lung disease – which are responsible for 60 percent of deaths in Oklahoma.[xv] Tobacco use and obesity are leading cost drivers for health care costs in Oklahoma.  Cutting funding for TSET will have a devastating impact on the health of Oklahoma.  If we are serious about fighting the death, disease and preventable costs caused by tobacco, obesity, physical activity, and poor nutrition, as well as advancing cancer research in our state, opposing cuts to TSET is a critical step. 


[i] U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

[ii] American Cancer Society Cancer Action Network.  State-Specific Smoking-Related Cancer Deaths – 2014 Estimates.  https://www.acscan.org/policy-resources/just-facts-state-specific-smoking-related-cancer-deaths-2014-estimates

[iii] HHS, 2014.

[iv] CDC, Best Practices for Comprehensive Tobacco Control Programs, 2014.

[v] Campaign for Tobacco-Free Kids.  The Toll of Tobacco in Oklahoma.  Updated November 17,2017.  https://www.tobaccofreekids.org/facts_issues/toll_us/oklahoma

[vi] Campaign for Tobacco-Free Kids.  Toll of Tobacco in Oklahoma.  Updated November 15, 2018.

[vii] Tobacco Settlement Endowment Trust.  TSET Performance Dashboard.  Updated 2/2018.  Available at: http://tset.ok.gov/sites/g/files/gmc166/f/Dashboard_Feb18.pdf

[viii] Tobacco Settlement Endowment Trust.  TSET SJR45 Letter.  March 2018.

[ix]American Cancer Society. Cancer Facts & Figures 2019. Atlanta: American Cancer Society, 2019.

[x] Islami F, Goding Sauer A, Miller KD, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2018;68: 31-54

[xi] Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body Fatness and Cancer – Viewpoint of the IARC Working Group. N Engl J Med 2016; 375: 8.

[xii] American Cancer Society. Cancer Facts & Figures 2019. Atlanta: American Cancer Society, 2019

[xiii] Tobacco Settlement Endowment Trust.  Oklahoma State University Medical Authority Residency Program.  https://tset.ok.gov/content/oklahoma-state-university-medical-authority-residency-program

[xiv] Tobacco Settlement Endowment Trust.  Research.  Available at: https://tset.ok.gov/content/research

[xv] Tobacco Settlement Endowment Trust.  TSET SJR 45 Letter.  March 2018.