State ranks 7th in funds for tobacco prevention
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By DANIEL BARLOW Vermont Press Bureau - Published: November 24, 2008
MONTPELIER — Vermont ranks seventh in the country for funding programs aimed at reducing cigarette smoking, but it is still spending millions of dollars less each year than the recommended federal level, according to a new study.
The state plans to spend $6.1 million this year in tobacco prevention efforts, according to a report released last week by a coalition of health organizations, but that number falls short of the $10.4 million recommended by the U.S. Centers for Disease Control and Prevention.
Vermont's tobacco prevention spending is closer to the recommended levels than 43 other states, but advocacy organizations and health professionals stressed this week that the state needs to begin placing more resources toward preventing smoking.
"One of our disappointments with Vermont is that the state is within striking distance of reaching that CDC number," said Kevin O'Flaherty, the Northeast director of advocacy for the Campaign for Tobacco-Free Kids, one of the groups that sponsored the new report. "Reaching that funding level would mean a huge difference over time and drive future smoking rates in the state down."
The report, labeled "A Decade of Broken Promises," tracks how states have funded tobacco prevention programs in the 10 years following the landmark civil settlement with the tobacco industry, which supplied the states with annual payments from the companies in perpetuity.
In the last decade, the states have received $203.5 billion in payments from the tobacco industry, a combination of $79.2 billion from the settlement and $124.3 billion from taxes on tobacco products, according to the study. In total, only $6.5 billion has been spent on tobacco prevention or cessation programs.
Vermont is expected to receive about $101 million this year from the settlement and tobacco taxes, with about 6 percent of that money going toward prevention and cessation programs. State funding for these programs remained level between 2008 and this year's state budget, although it will spend about $400,000 less due to a drop in federal funding for such programs, according to the report.
The Lawsuit
Attorney General William Sorrell was four weeks into his job in 1997 when he joined dozens of other states in suing the industry to recover costs from tobacco-related health costs. By November of that year, the industry decided to settle with the states in what still is the country's largest civil suit.
Sorrell said he joined the lawsuit because it was clear that tobacco-related health problems were costing Vermont. At the time, there were about $15 million in annual tobacco-related health problem costs via the state's Medicaid program, Sorrell said, although he knew that was a "lowball" number compared to the real costs.
"It was never about the money," Sorrell said, when asked about the settlement that resulted from the case. "Our goal was to hold these companies accountable for their products and try to change the culture of smoking in the country."
It's clear that cigarette smoking costs Vermont a lot: This week's report pegs annual health care costs in the state associated with tobacco to be $233 million, which translates to a tax burden of about $623 per Vermont family.
The settlement — its formal title is the Master Settlement Agreement — did far more than just set up payments from the tobacco industry to the states, it also led to the industry voluntarily changing the landscape in how it markets its products.
Bill Phelps, a spokesperson for Altria Group, the parent company of Philip Morris USA, the company that makes cigarettes such as Marlboro and Virginia Slim, said that after the settlement, the tobacco companies pulled away from their traditional venues of advertisements.
"You won't see us advertise anymore on billboards, buses, taxis, t-shirts, baseball caps or backpacks," said Phelps, citing a few of the places the companies no longer advertisement tobacco products. "And in 2004 we stopped advertising in major newspapers and magazines."
The target market for Philip Morris USA now is adults who already smoke cigarettes, Phelps explained, and the marketing now occurs mostly in stores where the company's products are sold (the company sometimes pays stores to display promotional items with their logo on it) and via direct mail to consumers.
He said the company goes to great lengths to ensure that its products are not marketed or sold to children.
"Our goal is to get the adult smoker to ask for our brand," Phelps said. "If they are smoking something else, we want them to switch to our products."
The decade-old settlement also resulted in states obtaining access to once-secret documents and studies held by the tobacco industry, according to Sorrell. These documents detailed a campaign to attract new, youthful smokers and to hide the true health consequences of the products, he said.
"We saw one study that showed nicotine was just as addictive as opiates," he said.
Ten years later
Vermont has seen great success in preventing smoking in the 10 years since the settlement, according to Sheri Lynn, the tobacco-control program chief for the Vermont Department of Health.
A 1999 study found that about 31 percent of Vermont students in grades 8-13 smoked cigarettes and that number has now dropped to 16 percent, Lynn said. The adult rate of smoking has dropped also, although a bit less, from 22 percent to 18 percent.
"We have about 9,000 fewer smokers today," she said.
Vermont has set an ambitious goal for 2010: To cut the youth and adult smoking rates in half from their pres-settlement numbers. Lynn said the state is almost there with the youth rates, but faces more of a steep hill when it comes to the adult numbers.
Any Vermonters interested in quitting smoking can turn to the state for help. Lynn said residents should visit www.VTQuitNetwork.org or call 1-800-QUITNOW for advice, counseling or even free nicotine patches or gum to fight the smoking urges.
"We are a doorway to services," she said. "And it's all free."
This week's tobacco prevention funding report was sponsored by the American Lung Association, American Heart Association, Cancer Action Network and the Robert Wood Johnson Foundation. The groups also issued recommendations to the state as well as its findings, including:
O'Flaherty said he and others are worried that states could become complacent in the battle to reduce cigarette smoking. He also worried that the economic downturn – and the revenue crunch that every state is experiencing now – will make the tobacco revenues an even more attractive option to fill budget holes.
"There are tremendous long-term cost savings by investing in tobacco prevention and cessation," he said. "For every dollar a state puts toward these programs, it pays back three to one when it comes to state money. When it comes to social implications, it pays back six to one."
The cookie jar
But for many states, the settlement money has been, as described by Sorrell, "used as a cookie jar." Earlier this year, Gov. James Douglas proposed dipping into some of the funds to pay for his scholarship program (lawmakers said no) and later both sides agreed to dip into the $30 million tobacco trust fund to cover other state costs.
Sen. Susan Bartlett, D-Lamoille, the chair of the Senate Appropriations Committee, said the tobacco settlement funds were always intended to be split up in three areas: building up a trust fund, offsetting health care costs and funding anti-smoking education programs.
She said Vermont has done a tremendous job in combating cigarette smoking over the last decade and the money put toward prevention and cessation efforts have paid off in the declines in smoking rates.
"Vermont still is lauded as one of the few states that has taken this money and really done it right," Bartlett said. "I think Vermont has done it right. I think we continue to do it right."
But even the tobacco companies believe that the states should use more of the money to educate people about the affects of smoking, especially children. Phelps, the spokesperson for the parent company of Philip Morris USA, said the company thinks the states should be funding these programs at the recommended CDC levels.
"A vast majority of the states have spent billions of dollars on things other than what this was intended for," he said, adding that the trend has continued despite that a scheduled increase in payments to the states recently took effect.
Sorrell issued a warning at his press conference 10 years ago announcing the settlement: Vermont could get addicted to the money from the tobacco companies just as easily as residents became addicted to their products.
The settlement agreement is set up in such a way that if tobacco consumption drops, so does the funds sent to the state, Sorrell said. In a perfect world, those funds would drop to zero as soon as possible, he added.
"If we reduce smoking by 50 percent and now get 50 percent less money, that's an accomplishment," he said.
Contact Daniel Barlow at Daniel.Barlow@timesargus.com.
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