As states rake in billions of dollars annually in tobacco settlement money, the Centers for Disease control would like to see states like Missouri use some of that money toward proven anti-smoking efforts to save lives and reduce millions of dollars in health care costs due to disease and illness.
“More than 20 times more is spent promoting tobacco use than preventing it,” said CDC Director Dr. Thomas Frieden. “Tobacco damages virtually every part of the body… And secondhand smoking also kills in both children and adults.”
Missouri is one of 46 states, D.C. and five territories that signed on to the tobacco industry settlement in 1998 and will receive an estimated 4.4 billion dollars through the year 2025 and more going forward from the four major tobacco manufacturers. The settlement was to compensate states into perpetuity for healthcare costs. However, nothing in the original attorneys general agreement mandated that the tobacco settlement money be used for programs to reduce smoking; improve the health of or pay for treatment of smokers and nonsmokers who contracted smoke-related illnesses.
Missouri’s share of the money has gone almost everywhere except toward tobacco control – K-12 and higher education; judiciary; corrections and public safety; human services and other departments.
Missouri does have a smoking Quit Line, 1-800-QUIT-NOW (1-800-784-8669) which is funded by the CDC, the Missouri Foundation for Health (MFH) and private sources. Frieden calls it a low-cost way of reaching lots of smokers and saving lots of lives and said the stimulus package provides additional funds to strengthen quit lines.
The CDC released a state-by-state assessment of tobacco use prevention and control efforts and showcased evidence-based strategies that are successful in reducing smoking rates. Twenty five percent of adult Missourians are cigarette smokers and nearly 12 percent of youth ages 12 to 17 light up, according to “Tobacco Control State Highlights 2010.” The CDC report ranks Missouri as one of the states lowest in tobacco settlement money spending to curb smoking and one of the states with highest rates of lung cancer. Missouri spent only 1.7 percent of the recommended amount for tobacco control, according to the CDC report, ranking 49th among the states.
“And smoke free laws save lives and they don’t hurt business,” Friedman said.
“People know that smoking causes lung cancer, but they may not know that it causes cancer of many, many parts of the body – leukemia, stomach cancer, pancreatic cancer, kidney, ureter, colon cancer, cervical cancer, bladder cancer and many chronic diseases; stroke, blindness, heart attack,” Frieden said. “About a third of all heart attacks and strokes are related to smoking –pneumonia, cardiovascular disease, COPD. About 90 percent of COPD is caused from smoking. It increases fractures – fertility affects.”
“With asthma, allergies, as well as diabetes, heart disease – many of those conditions are directly attributable to tobacco use. You’ll see almost a threefold increase in the likelihood of a child having asthma if they live in a house where their parents smoke,” said Matthew Kuhlenbeck, MFH tobacco program officer. “You’ll also see the leading cause of preventable death is heart disease associated with tobacco use, but tobacco use is also one of the main triggers for asthma as well.”
The CDC report said it would take Missouri approximately 30 percent of its total annual revenue from state excise taxes and tobacco settlement payments to fund a tobacco prevention program at CDC-recommended amounts.
Overall, states are sending less than three percent of tobacco settlement revenues on tobacco control, according to the report, and have cut the programs by $100 million last year.
In the February 2010 report, “Where Do We Stand?” prepared by the George Warren Brown School of Social Work for the MFH, Missouri, which is a minor tobacco-growing state, has a higher percentage of smokers than the national average.
“One in four Missourians use cigarettes in some form or fashion, and the national average is around 18 percent, so we have the second highest smoking rate in the country” Kuhlenbeck said. “In addition to that, the lower somebody’s income or their educational achievement is, the more likely they are to smoke –as well to say if they are on Medicaid or are uninsured, are more likely to smoke as well.”
MFH comprehensive asthma programs in the state focus on reducing children’s exposure to secondhand smoke by having their parents get information on cessation programs available in their community.
“In addition, we talk to parents about taking it outside rather than smoking indoors around their child because the smoke lingers and sticks to fabric; it sticks to the walls,” Kuhlenbeck added. “It does stick to the clothes when the go outside and come back in as well and so part of the ‘take it outside’ piece is staying outside for several minutes after you’ve finished smoking so some of that smoke dissipates off of your clothes.”
Frieden said sustained, counter-advertising to warn youth about the dangers of smoking, strong smoke-free workplace laws and higher taxation are proven ways to reduce the numbers of smokers and to protect those who do not smoke.
Local regulation of advertising, display and promotion of cigarettes and not requiring licensure for establishments to sell tobacco products over the counter and vendor machines in Missouri – is a problem for youth, who are bombarded with marketing that makes it look cool to smoke.
“We’ve actually seen numbers where two out of three kids have actually tried tobacco before they graduate from high school. The national average is about 50 percent,” Kuhlenbeck said.
Kuhlenbeck said it can be attributed to the lack of three main actions that really reduce smoking consumption.
“We have the second lowest tobacco tax in the country, so price is a major factor with youth as well as with adults,” he explained. “In addition, we do not have a comprehensive tobacco control program in our state, so there is no other message or persistent messages coming from the state or other individuals really talking about tobacco, its dangers as well as other resources about how to quit and where you can go to quit.”
Kuhlenbeck said the third effective measure lacking in Missouri are indoor tobacco smoke laws, which would create smoke free bars, restaurants, casinos and workplaces. The MFH is looking at communities who want to advocate in favor of policy change, and educate about to reduce exposure to indoor tobacco smoke. The Foundation is also very focused on increasing access to services at the local, community level.
“As well as to the state level to add nicotine replacement therapy as a benefit to the state tobacco quit line,” Kuhlenbeck said. “We have also been fortunate to partner with the American Legacy Foundation to offer a free, online service called BecomeAnEx.org. It actually ties into a lot of the social networking components of web culture where you can actually get linked in with groups who have common interests who are trying to quit.”
Nationally, the rates of people who have stopped smoking have been stagnant over the last five years, and the CDC wants states to help snuff out that trend. Frieden outlined several measures should be taken to reduce illness and health care costs due to effects of smoking and second-hand smoke, which align to those advocated by the MFH.
“Smoke-free laws, hard-hitting ads, and higher cigarette prices are among our strongest weapons in this fight against tobacco use,” Frieden said. “We must redouble efforts to bring down smoking rates, prevent suffering and premature death, and cut health care costs by reducing smoking.”
For more information, go to www.BecomeAnEx.org or call the Missouri Quit Line, 1-800-QUIT-NOW (1-800-784-8669).
