News: Tobacco education gets shorted

UCSF Report Says Program To Diminish Tobacco Use in California Is Fading
November 17, 2014
In a California Healthline report by Kenny Goldberg, experts discussed the funding conundrum of the California tobacco control program – because it has helped lower the number of smokers in the state, it gets about half the cigarette-tax funding it used to get. A new report from UC-San Francisco researchers said efforts to raise additional money have failed, in part because of increased willingness among state legislators to accept tobacco industry campaign donations.
The report includes comments from:
•Kimberly Amazeen, vice president of public policy for California’s chapter of the American Lung Association; Stanton Glantz, director of the UCSF Center for Tobacco Control Research and Education and co-author of the report; and
•Jim Knox, vice president of government relations for the American Cancer Society’s Cancer Action Network (Goldberg, California Healthline, 11/17).
You can download a PDF of this report.

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Government anti-smoking efforts not as effective as first thought
July 8, 2009
Cameron English – El Dorado County Conservative Examiner
In 2007, the Centers for Disease Control (CDC) claimed that “Research shows that the more states spend on comprehensive tobacco control programs, the greater the reductions in smoking—and the longer states invest in such programs, the greater and faster the impact.”
Despite such claims, new economic research indicates that increased funding for state tobacco control programs does not significantly reduce tobacco consumption, and calls into question the methodology of the research the CDC relies on to support their assertion. Michael L. Marlow, professor of economics at California Polytechnic State University, summarized a number of the flaws in the CDC’s research in the latest issue of the Cato Institute’s Regulation Magazine.
According to Marlow:
The CDC recommendations draw heavily on research from just two states: California and Massachusetts. Those two states are considered models of effective programs, in part, because they have the longest funding histories. Even if highly effective, their success may not be easily exported to other states.
The CDC ignores studies that show little to no impact from tobacco control programs.”
There is evidence, again ignored by the CDC, that little to no connection exists between state
spending on tobacco control and the degree to which residents smoke.
The CDC offers no empirical verification that implementing recommended spending targets causes significant reductions in tobacco use.
While some research does support the CDC policy recommendations, these studies typically ignore other factors that may influence tobacco consumption. A 2003 Journal of Health Economics paper by Matthew Farrelly et al., for example, explained “that most studies simply perform trend analysis on the introduction of new tobacco control programs,” according to Marlow. They don’t actually establish a causal relationship between tobacco control efforts and a reduction in smoking.
Several studies published as late as 2005, however, did control for other factors that influence tobacco consumption and still found that government programs can reduce smoking. Unfortunately, the value of the data these studies analyzed was severely limited. Most states didn’t begin funding their tobacco control programs until the Master Settlement Agreement was reached in 1998, and, as a result, the CDC only started releasing funding data in 2000. Therefore, the studied data only reflects the results in a handful of states that were funding their programs before 1998. It’s questionable whether such results can be counted as evidence that all states’ tobacco control efforts are successful.
Parenthetically, well-funded tobacco control programs may inversely urge teenagers and young adults to take up smoking as a form of rebellion. The reason being that, pushing a particular behavior beyond the bounds of social acceptability with foolish laws and poorly-produced media campaigns often results in more of that supposedly illicit behavior.
If given a hearing this evidence could seriously inconvenience the tobacco nannies and complicate their unrelenting attacks on personal freedom.
We can only hope.

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Tobacco education gets shorted

11/25/2007
by Carol Harrison
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For the past three fiscal years, Humboldt County has not spent a single dollar of the $1.3 million it receives from the 1998 tobacco settlement on tobacco education, prevention or cessation.

Instead, the entire sum goes to pay for half the county’s $2.6 million cost for jail medical expenses.

Jeanne Vidad, assistant director of the Humboldt County Department of Health and Human Services, said her department last received $215,000 in tobacco settlement money in fiscal year 2005.

Of that total, $75,000 supported DHHS Public Health Branch efforts for tobacco cessation and prevention services in the schools.

Another $140,000 went to the DHHS Mental Health Branch for alcohol and other drug dependency treatments for groups and individuals.

Since the elimination of the tobacco settlement allocation, the California Student Tobacco Survey identified a 2 percent increase in the number of youth smokers in the county to 17.4 percent in 2006.

Another concern: 7.1 percent of county youths use smokeless tobacco compared to 4.3 percent statewide.

Beginning in 2008, the 46 states, the District of Columbia and the U.S. territories that are part of the 1998 Master Settlement Agreement will receive “bonus settlement payments” totaling almost a billion dollars per year from the cigarette companies involved in the lawsuit.

The bonus payments are mandated by the terms of the settlement and will continue for at least 10 years.

Lin Glen, the retired director of Tobacco Free Humboldt, and other members of the Tobacco Education Network will ask the Humboldt County Board of Supervisors Dec. 4 to renew its commitment to tobacco cessation and prevention.

“It’s frustrating to look at the stats,” Glen said. “What are our biggest problems? Tobacco use is the No. 1 preventable cause of death; we have higher smoking rates than rest of the state and ever-shrinking resources.

“Data shows cessation programs are highly cost effective, along with mammograms and cancer screening. When you look at how dollars are used, they aren’t reflecting the data.”

“I do not want to criticize the decision makers; they have a lot of hard decisions to make,” said Mike Goldsby, program director of health education for DHHS. “It’s a national trend, not just a local trend, to put significantly more funds to enforcement than to treatment or prevention.”

But public health officials and activists see the move away from funding tobacco education, prevention and cessation as alarming. The 1998 settlement between cigarette companies and multiple states identified tobacco prevention and cessation as part of the spending plan for the estimated $240 billion that would come to states over the first 25 years of the agreement.

The settlement payments do not fully reimburse states for their smoking costs, which means prevention and cessation are key to reducing those costs.

Recent studies put the state’s annual expenses for direct medical care for treating tobacco-related illness at $3.6 billion annually, $1.7 billion of which comes out of the Medi-Cal program.

The state’s fiscal year 2007 revenue from the tobacco settlement: $745 million.

Citing those cost numbers, the American Lung Association advocated for a 15 percent commitment of settlement dollars to tobacco education, cessation and prevention programs.

Proposition 99, the state’s landmark 1988 ballot initiative that increased the state cigarette tax by 25 cents a pack, earmarked 20 percent of the revenue for health education programs for tobacco.

Jimmy Smith, the only Humboldt County supervisor to respond by 4 p.m. Friday to messages left Wednesday afternoon, expressed surprised at the uptick in youth smoking and bonus money.

“I need to see if the bonus money is going to happen and I need to talk to Lin Glen,” he said. “If there is extra money, we can sit down and see what it’s going to be used for. The $1.3 million is for jail medical expenses and a lot of those people are smokers.”

The 1998 multistate tobacco settlement agreement stipulates that in California, 50 percent of all payments go to the state and 40 percent to the 58 counties based on population. Ten percent is divided evenly among the cities of San Francisco, San Jose, San Diego and Los Angeles.

There are no restrictions on how states and counties may spend the tobacco settlement dollars.

“It’s easy to get complacent about the progress that’s been made with smoking,” Goldsby said. “It’s been a public health success related to a decline in smoking and reduced risk of secondhand or passive smoke.”

“We’ve had no funding to do what we wanted to do,” said Vidad. “We are working with some of the nonprofits to try and fill that hole, but until we raise the cigarette tax more or we get more smokers …”

California currently allocates $84 million a year for tobacco use prevention — 50.9 percent of the U.S. Centers for Disease Control and Preventions minimum recommendation of $165.1 million. That commitment ranks it 17th in the nation.

California’s spending on tobacco prevention amounts to 4.8 percent of the $1.7 billion in tobacco-generated revenue the state collects each year in tobacco settlement payments and tobacco taxes.

For the past 15 years, Vidad said the Humboldt County Public Health Branch received $150,000 per year of Proposition 99 revenues.

“Receiving the same amount of funding for over 15 years equals a significant decrease in the effectiveness of that money,” Goldsby said. “It is predictable that the impact of that would start to decrease effectiveness. Combine that with what’s happened to school funding and things compound.”

In a previous interview, Jon Sapper, assistant superintendent for the Humboldt County Office of Education, said county schools received approximately $450,000 from a variety of sources for drug, tobacco and alcohol education programs in 1990.

He said HCOE now receives only $25,000 from the state Department of Education for tobacco education only.

By 1990, the state had set in place its Tobacco Control Program to lead what is one of the nation’s oldest and most successful anti-tobacco efforts.

Since the passage of Proposition 99, cigarette consumption in California has declined by more than 62 percent, compared to 36 percent for the country as a whole.

From 1996 to 2004, smoking prevalence decreased by more than 60 percent among eighth-graders and by more than 50 percent among 10th-graders.

From 2000 to 2004, smoking prevalence decreased by more than 30 percent among 12th-graders.

The Campaign for Tobacco-Free Kids monitors state usage of the tobacco settlement fund. In its fiscal year 2007 report, it found that states had modestly increased total funding for tobacco prevention and cessation programs, but the “vast majority of states are still failing to keep the promise of the tobacco settlement and falling far short of funding such programs at even minimum levels recommended by the U.S. Centers for Disease Control and Prevention.”

Diverting funding out of education and prevention has been a public policy choice since the passage of Proposition 99. Researchers Thomas Novotny and Michael Siegel found the state health education account to be underfunded by 27 percent from 1988 to 1993 and 40 percent from 1993 to 1996.

A study by the University of California, San Francisco, called the health eduction account “under attack by both the Legislature, which consistently failed to allocate 20 percent of the revenues to the health education account, and by interest groups, particularly the California Medical Association and California Association of Hospitals and Health Care Systems, and the Western Center for Law and Poverty, which benefit from the diversion of funds from health education to pay for medical care expenses.”

Since 2000, state budget woes across the nation have led political officials to put their hands in the tobacco settlement cookie jar. The National Center for Policy Analysis raised the alarm in March 2003 when Wisconsin sold off 25 years of tobacco payments valued at $5.9 billion for a $1.3 billion lump sum payment to balance a single year’s budget.

Called “securitization,” California followed suit. The state issued bonds backed by future tobacco settlement payments to raise $2.5 billion in fiscal year 2003 and $3 billion in FY2004.

Counties have considered securitization of their tobacco settlement revenues, which are tied to the tobacco industry’s revenues. If tobacco revenues go down, so do the tobacco settlement funds.

For counties relying on tobacco settlement money to provide inmate health care, an uptick in youth smoking may be perceived in the short-term as a good thing for the budget.

Highlights of Tobacco Prevention Funding and Centers for Disease Control and Prevention recommendations

+ In fiscal year 2007, only three states — Maine, Delaware and Colorado — are funding tobacco prevention programs at CDC minimum levels.

+ Mississippi, long a national leader and one of the few states that met the CDC’s recommendation, has fallen to dead last from fourth place in FY 2006. Gov. Haley Barbour, a former tobacco lobbyist, is credited with eliminating the funding for the program.

+ Only 14 other states are funding tobacco prevention programs at even half the minimum level recommended by the CDC.

+ Twenty-eight states and the District of Columbia are spending less than half the CDC’s minimum amount. Another five states — Michigan, Mississippi, Missouri, New Hampshire and Tennessee — allocate no significant state funds for tobacco prevention.

+ The combined amount all the states have allocated for tobacco prevention this year — $597.5 million — is an increase of 8.4 percent from the $551 million allocated in FY 2006, but that is still just 37 percent of the $1.6 billion minimum the CDC recommends. One state, New York, accounts for nearly all the increase.

+ The combined total the states are spending on tobacco prevention amounts to just 2.8 percent of the record $21.7 billion in tobacco-generated revenue the states will collect this year from the tobacco settlement and tobacco taxes.

Source: Campaign for Tobacco-Free Kids

YOU BE THE JUDGE:

Does the Master Settlement Agreement language include an agreement to fund tobacco cessation and education programs?

Excerpts from the settlement agreement follow.

“WHEREAS, the Settling States that have commenced litigation have sought to obtain equitable relief and damages under state laws, including consumer protection and/or antitrust laws, in order to further the Settling States’ policies regarding public health, including policies adopted to achieve a significant reduction in smoking by Youth …

“WHEREAS, the Settling States and the Participating Manufacturers are committed to reducing underage tobacco use by discouraging such use and by preventing Youth access to Tobacco Products;

“WHEREAS, the undersigned Settling State officials believe that entry into this Agreement and uniform consent decrees with the tobacco industry is necessary in order to further the Settling States’ policies designed to reduce Youth smoking, to promote the public health and to secure monetary payments to the Settling States; and

“WHEREAS, the Settling States and the Participating Manufacturers … have agreed to settle their respective lawsuits and potential claims pursuant to terms which will achieve for the Settling States and their citizens significant funding for the advancement of public health, the implementation of important tobacco-related public health measures, including the enforcement of the mandates and restrictions related to such measures, as well as funding for a national Foundation dedicated to significantly reducing the use of Tobacco Products by Youth.”

Source: Master Settlement Agreement, Nov. 23, 1998, www.naag.org/tobaccopublic/library.cfm.?