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Sunday, March 24, 2013

Bottom of the pack: New Hampshire trailing all states in spending on tobacco prevention and cessation programs

Millions of dollars originally intended for smoking cessation programs in New England have been diverted to offset budget deficits, leaving some states struggling to fund quit-smoking hotlines, treatment programs and anti-tobacco advertising.

Nowhere is the trend more evident than New Hampshire, which collected more than $218 million in tobacco taxes and more than $40 million from the Tobacco Master Settlement Agreement, but spent less than 1 percent of that amount on tobacco prevention and cessation programs. ...

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Millions of dollars originally intended for smoking cessation programs in New England have been diverted to offset budget deficits, leaving some states struggling to fund quit-smoking hotlines, treatment programs and anti-tobacco advertising.

Nowhere is the trend more evident than New Hampshire, which collected more than $218 million in tobacco taxes and more than $40 million from the Tobacco Master Settlement Agreement, but spent less than 1 percent of that amount on tobacco prevention and cessation programs.

The state’s anti-tobacco program subsisted on just more than $1 million in federal grant money, one of the lowest budgets in the nation. Not one cent of that funding comes from the state. All tobacco taxes are sent back to the state’s general fund.

The $1 million in federal funding for New Hampshire helps pay for a quit-smoking hotline and smoking cessation programs in Nashua and Manchester, the state’s two largest cities, said Donna Fleming, who administers the state’s Tobacco Prevention and Control Program.

The money, however, isn’t even close to the $19.2 million that the federal Centers for Disease Control and Prevention said New Hampshire needs to adequately fund its anti-smoking efforts.

The same cutbacks in smoking cessation programs can be found throughout New England and come at a time when more than 20,000 New Englanders die annually from smoking-related diseases and as yearly health care costs to treat tobacco-related illnesses approach $7 billion in the six-state region, according to the Centers for Disease Control.

Nationally, those numbers are even more staggering, with smoking-related deaths topping 400,000 and annual health care expenditures reaching beyond $96 billion.

“More and more states are spending virtually nothing for tobacco control. It’s a huge concern,” said Ellen Vargyas, general counsel for the American Legacy Foundation, a Washington, D.C.-based nonprofit group formed after 46 states and four of the nation’s largest tobacco companies reached a Master Settlement Agreement in a lawsuit filed against the tobacco industry.

The 14-year-old settlement provides millions to states that filed suit against the tobacco industry in the 1990s under antitrust and consumer protection laws. The expectation was that the states would use that money to develop cessation and prevention programs that educate the public about the health effects of tobacco.

But, Vargyas said, “In terms of a moral obligation, the states have fallen short.”

Although smoking rates have declined by almost 50 percent in the United States in the last 50 years, 45 million people older than 18, or about 20 percent of all adults, still smoke, CDC studies found.

The percentage of smokers in New England is slightly less, ranging from a high of 18.2 percent of adults in Maine to a low of 16.1 percent in Massachusetts.

Among low-income individuals, some ethnic groups and male smokers younger than 18, the percentage of smoking is even higher.

“Clearly, we’re not making the investment we should be making if we want to tackle the problem,” said Stephen Shestakofsky, recently retired executive director of Tobacco Free Massachusetts, an anti-tobacco advocacy group.

“Roughly 99 percent of all the tobacco dollars that come into the state are used for something else,” he said, referring to the estimated $815 million in tobacco-related legal awards and taxes collected in Massachusetts last year.

Of that figure, only $4.2 million will be spent this year on smoking cessation and prevention programs in Massachusetts, state health officials said.

Shestakofsky added that cuts to anti-tobacco efforts in Massachusetts and other states have caused a drastic reduction in programs that target veterans, the poor and other groups where smoking is particularly high.

New Hampshire’s habit

Out of the New England states, none fully funds its tobacco control efforts at the individual state level recommended by the CDC, and New Hampshire spends no tobacco taxes at all on cessation or prevention programs.

Connecticut, which collects an estimated $520 million in tobacco-generated revenue annually from settlement payments and tobacco taxes, and New Hampshire, which takes in nearly $260 million, tied for 50th place in 2011 on a prevention and cessation spending list developed by the advocacy group Campaign for Tobacco Free Kids.

Despite that last-place finish, both states spend some federal dollars on those programs.

“When the Master Settlement Agreement was done, the hope was that the states would take a good chunk of what was needed to address smoking, but that wasn’t done,” said Kevin O’Flaherty, director of advocacy for New Hampshire’s Campaign For Tobacco-Free Kids.

“There’s only a handful of states that spend 50 percent of what they should spend, and many of them, like New Hampshire, spend nothing. It’s embarrassing and something the Legislature should be held accountable for.”

Failing to adequately fund tobacco cessation programs, he said, has created an undue burden on the nation’s health care system, which spends almost $100 billion to treat tobacco-related illnesses annually, according to the CDC.

The agency said smoking is also the leading cause of preventable death in the United States, accounting for 1 out of 5 deaths annually.

“Everybody talks about health care, but this is the single largest, wholly preventable health care cost out there,” O’Flaherty said. “It’s a huge driver in our health care system. If legislators will put a little money into prevention and cessation, these costs would largely disappear. Smoking will still be out there, but it won’t be the health crisis it is today. That’s what we should be addressing.”

In Vermont, which reaped more than $34 million from the tobacco settlement in 2012, officials know exactly how costly tobacco-related health care can be. The state spends almost all of that money on its health care insurance plan, leaving about $3.3 million from tobacco taxes to pay for smoking prevention and treatment programs, said Laura Bernard, coordinator for the Coalition for a Tobacco Free Vermont.

“We used to have five people working for us. Today, we have one part-time worker,” Bernard said, recounting the days before budget cutbacks took their toll on tobacco funding.

According to the advocacy group Tobacco Free Kids, the top-ranking New England state, Maine, which came in ninth in the nation this year for spending on tobacco cessation and prevention programs, shelled out only about 41 percent of the $18.5 million the CDC suggests it should spend.

Vermont, which came in 10th out of the 50 states, spends 38.2 percent of the CDC’s $10.4 million recommendation.

Trailing Massachusetts, which ranked 36th, is Rhode Island, in 40th place, which earmarked just $376,665 for tobacco prevention and cessation programs in 2012, just 2.5 percent of the $15.2 million in expenditures recommended by the CDC.

Control the money

The Master Settlement Agreement was initially intended to fund tobacco prevention and mitigation programs, even though the agreement didn’t exactly specify how settlement money was to be used.

No one interviewed knew for certain why that was the case, but anti-tobacco advocates and state officials said they believe it was because state legislators wanted to control how the money would be spent.

Soon after that first 1998 windfall tobacco settlement, legislators would be spending that money freely. By the new decade, as municipal budgets became tighter, legislators throughout New England and the nation began placing the annual multimillion-dollar tobacco windfall into the general fund and using the money to bridge financial gaps in other budgets.

“The reality is we’ve had a series of fiscal crises, and since nobody wants to be raising taxes, they take that money from somewhere else,” said Massachusetts state Rep. Jonathan Hecht, D-Watertown, who has been working to craft legislation in his state that would close loopholes on smokeless tobacco products, among the fastest-growing sale segments in the tobacco industry.

While most states are diverting their windfall tobacco settlement dollars to other budgets, some states, such as Connecticut, are using that money in other related ways.

Of the $122 million the state received from the tobacco settlement in 2012, $26 million went into research programs focusing on tobacco-related and other illnesses, including Alzheimer’s disease and diabetes, said Brian Durand, spokesman for the Connecticut Office of Policy and Management.

Like many other states, however, the remaining funds – $96 million Connecticut collects in taxes and tobacco settlement money, or nearly 79 percent – went into the state’s general fund to offset budgetary shortfalls.

Maine has fared somewhat better. Although the state still spends 59 percent less on smoking cessation than recommended by the CDC, almost a quarter of the estimated $186 million in tobacco-generated revenue collected annually from settlement payments and tobacco taxes goes to tobacco mitigation and research programs.

“We’ve done pretty well in prioritizing tobacco,” said Debra Wigand, director of the Division of Population Health for the Maine Center for Disease Control, adding that the state also has been proactively implementing laws to protect children and teens from becoming smokers.

A prominent media campaign and a highly touted education and marketing program for retailers, known as “NO Butts,” has helped curb cigarette sales to minors dramatically, she said.

Those tactics seem to be working. From 1997-2005, Maine’s adult smoking rates dropped by 9 percent and the rate among high school students plunged nearly 60 percent, statistics provided by Partnership for A Tobacco Free Maine show.

Nationally during that same period, smoking rates dropped by 4.5 percent for adults and decreased by 45 percent for teens, statistics from the American Lung Association show.

New battle emerges

Still, battling the multimillion-dollar tobacco industry on a shoestring budget remains a challenge.

The tobacco industry spent $8.05 billion to market cigarettes and $444.2 million to promote smokeless tobacco products in 2010, primarily through price discounts that make cigarettes more affordable and promotional allowances that ensure prime product placement, a Federal Trade Commission report on tobacco found. Those marketing efforts account for nearly $1 million spent every hour.

Many of those smokeless tobacco marketing dollars are targeted at kids, anti-tobacco advocates claim. Although the tobacco settlement agreement prohibited tobacco companies from pitching cigarettes to minors, the agreement didn’t cover smokeless tobacco products.

So far, a separate smokeless tobacco settlement agreement has been signed by only one smokeless tobacco manufacturer.

With the tobacco industry now spending a chunk of marketing dollars to promote smokeless tobacco products, a new battlefront in the war against tobacco is forming.

Massachusetts state Rep. Hecht said the industry is subtly marketing to children younger than 18 with flavored cigars, chewing tobacco and other smokeless products with low price points and colorful packaging.

With little funding to offset the tobacco industry’s influence, Hecht worries that the next generation of tobacco addicts may not be far off.

“We’ve let down our guard at a time when they’re targeting that new generation,” he said.

But Brian May, spokesman for Philip Morris USA, one of the nation’s oldest cigarette manufacturers, said the states – not the cigarette companies – are failing the nation’s youth by improperly spending money meant to educate them about smoking and smokeless tobacco products.

Since the tobacco settlement agreement was signed in 1998, May said, Philip Morris alone has paid out more than $59 billion to the 46 states that were part of the settlement.

“The states have enough funds to spend $65 million every day on programs for underage tobacco use, but only spend about $8 million” daily, May said. “There’s more tobacco-generated revenue available to the states than ever before to prevent underage tobacco use.

“In fact, the CDC says states aren’t spending enough on youth and prevention programs, and we think they should.”

On that, anti-tobacco advocates agree.

“There’s definitely a lot more we need to be doing,” Hecht said. “Unfortunately, between our tax policies and the cuts we’ve made to public health spending, we’ve left the door open to an industry that has proven to be relentless.”

The New England Center for Investigative Reporting ( is a nonprofit investigative reporting newsroom housed at Boston University.