A small legislative funding commitment toward tobacco-prevention initiatives was the catalyst for a small improvement in North Carolina’s ranking in an annual report.
North Carolina improved from 47th to 43rd among the states in terms of how much it funds annually toward tobacco-prevention programs such as quit lines and public health marketing initiatives.
The ranking is the main focus of the 19th annual national follow-up on an initial study by a coalition of anti-tobacco advocacy groups titled “Broken promises to our children.”
About 17.9 percent of North Carolina adults consume a tobacco product, as well as 13.1 percent of youths.
The report was released this week by the Campaign for Tobacco-Free Kids, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, the Robert Wood Johnson Foundation, Americans for Nonsmokers’ Rights and Truth Initiative.
The coalition has for several years taken North Carolina’s elected leaders to task for cutting funding toward tobacco-prevention programs.
The state collected $450.5 million in tobacco-related monies in fiscal 2017, which represents excise taxes and North Carolina’s share of the annual Master Settlement Agreement funds.
Tobacco companies, including R.J. Reynolds Tobacco Co., agreed in 1998 to settle lawsuits that 46 state attorneys general brought over smoking-related health-care costs by paying those states about $206 billion over 20 years. Some payments will remain in place beyond 2018.
Economists say most states have become dependent on MSA money and tobacco excise taxes to fill general-fund gaps.
For example, in 2011, the Republican-controlled General Assembly abolished the N.C. Health and Wellness Fund — funded by MSA monies — after 10 years of existence as part of an attempt at resolving the state’s budget gap at that time.
North Carolina now has a rainy-day fund of $1.8 billion, the largest in state history.
The average annual spending on the state programs had been $17 million at that time.
With the funding cuts, direct state spending on tobacco-prevention initiatives was $1.1 million in fiscal 2016-17 for QuitlineNC.
The 2017-18 and 2018-19 state budgets include $500,000 to be used “to develop strategies to prevent the use of new and emerging tobacco products, including electronic cigarettes, by youth and people of childbearing age.”
That raises state spending on the programs to $2.1 million annually, according to the coalition.
By contrast, the federal Centers for Disease Control and Prevention recommends that North Carolina spend $99.3 million.
According to 2015 Federal Trade Commission data, tobacco companies spend more than $12 to market tobacco products for every $1 the states spend to reduce tobacco use. The amount spent by the major cigarette and smokeless tobacco companies was $8.9 billion in 2015.
Nationally, the participating 46 master settlement agreement states will collect $27.5 billion in fiscal 2016-17. They are projected to spend less than 3 percent, or $721.6 million, on tobacco prevention and cessation programs.
“It is unacceptable that states continue to withhold the necessary funding for these vital prevention and cessation programs, despite having billions of dollars from tobacco settlement payments and tobacco taxes to fund them,” Harold Wimmer, president and chief executive of the American Lung Association, said in a statement.
“These prevention programs are particularly important in making sure we continue to reduce tobacco use for all Americans, including populations that have high tobacco use rates.”
Meanwhile, anti-smoking advocates are urging state health officials to embrace e-cigs and vaporizers as a reduced-risk option to traditional cigarettes. Some studies, most prominently one by the Royal College of Physicians in London, have found that e-cigs and vaporizers are up to 95 percent safer to consume than traditional cigarettes.
The CDC said in May that traditional cigarette smoking among adult Americans dropped to a historic low of 15.1 percent, or about 37.4 million adults, in 2015.
By comparison, the rate was 24.7 percent in 1997.
The youth smoking rate was 8 percent among high schoolers in 2016.
The coalition repeated its long list of recommendations for Congress and state legislatures to reduce tobacco consumption.
They include: increasing funding for quit lines; reducing nicotine levels in traditional cigarettes to very low levels to decrease the possibility of smokers getting addicted; requiring graphic warnings covering at least half of cigarette packs (which has been bogged down by legal challenges); and prohibiting the use of menthol in cigarettes and flavors in other tobacco products.
The Republican-controlled Congress has been averse to adding tobacco regulations and is unlikely to consider prohibiting the use of menthol flavoring, according to analysts.
State legislatures are being urged to significantly raise their excise tax on tobacco products, increase the legal sales age for tobacco products to 21, and take their own steps to limit or prohibit menthol and other tobacco flavorings.
“A commitment from our elected leaders to invest more on tobacco prevention, combined with tough smoking policies, will keep up the momentum until we reach our goal of becoming a nation that is 100 percent tobacco-free,” said Nancy Brown, chief executive of the American Heart Association.