In 1998, an historic landmark legal settlement between 46 states and the major tobacco companies, – 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.

That money is still coming in. This year (fiscal year 2020), the states will collect $27.2 billion from the 1998 tobacco settlement and tobacco taxes. But they will spend less than 3% – just $739.7 million – on programs to prevent kids from using tobacco and help smokers quit - less than a quarter (22.4%) of the total funding recommended by the CDC.

In fact, no state currently funds its tobacco prevention and cessation programs at CDC-recommended levels and only six states provide even half the recommended amount.

Broken promises

A wide-ranging report on the issue – “Broken Promises to Our Children: A State-by-State Look at the 1998 Tobacco Settlement” – was released by the Campaign for Tobacco-Free Kids, American Cancer Society-Cancer Action Network, American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights, Robert Wood Johnson Foundation and Truth Initiative. It includes a ranking of the states.

Other key findings of the report include:

• California is the only state to come close (93.7%) to providing the CDC-recommended funding for tobacco prevention and cessation programs. The $326 million California is spending dwarfs what other states spend and amounts to almost half the total amount for all the states.
• At the other end of the scale, Connecticut did not spend any funding on these programs.
• 33 states and DC are providing less than 25% of what the CDC recommends.
• Tobacco companies spend more than $12 to market tobacco products for every $1 the states spend to reduce tobacco use. According to the most recent data from the Federal Trade Commission (for 2017), the major cigarette and smokeless tobacco companies spend $9.4 billion a year – over $1 million each hour – on marketing.

The report’s findings, set against the backdrop of an ever-worsening e-cigarette use epidemic among the nation’s youth, have raised the ire of health organizations.

An all-hands-on-deck strategy needed

“The e-cigarette epidemic is disrupting the lives of kids and families in every community, so it is critical that every state step up and do its part to end this crisis. That includes properly funding proven tobacco prevention programs, as well as prohibiting the flavored products that have fueled this epidemic,” said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. “We need a comprehensive, all-hands-on-deck strategy to prevent e-cigarettes from addicting a generation of children.”

Driven by skyrocketing youth use of e-cigarettes, the percentage of high school students who use tobacco products is at its highest level in 19 years. This year, 31.2% of high school students and 12.5% of middle school students – 6.2 million kids altogether – used some type of tobacco product, according to the 2019 National Youth Tobacco Survey. The number of kids who use e-cigarettes has skyrocketed to over 5.3 million, including more than one in four (27.5%) high school students, and recent trends indicate that nearly 5,000 more kids start using e-cigarettes each day.

Trump reverses ban plan

President Trump in September announced a plan to ban the sale of all flavored e-cigarettes, in response to an increasing number of lung injuries in the U.S. linked to vaping. However, Trump then decided against signing a decision memo on the ban, citing concern over potential job losses.

In the absence of federal action, some states and cities have taken action of their own. Massachusetts has prohibited the sale of all flavored tobacco products, including flavored e-cigarettes and menthol cigarettes, while Michigan has banned flavored e-cigarettes.

The findings of the “Broken Promises” report has angered the American Health Association (AHA), which accuses states of shortchanging programs designed to prevent kids from using tobacco products.

The AHA is calling for the federal government and states to fully implement proven strategies to reduce tobacco use and to prohibit flavored tobacco products, these strategies include significant tobacco tax increases, comprehensive smoke-free laws, hard-hitting mass media campaigns, and barrier-free insurance coverage for tobacco cessation treatments.

In addition, the AHA wants the FDA to:

• enforce a May 2020 deadline for e-cigarette manufacturers to apply to the FDA and submit their products for public health review in order to keep them on the market
• move forward with its proposals to prohibit menthol cigarettes and flavored cigars and to limit nicotine in cigarettes to minimally addictive or non-addictive levels, and
• meet a court-ordered deadline of March 15, 2020, for issuing a final rule requiring graphic cigarette warnings.