Background Despite controversy surrounding the use of fundsarising from settlement agreements with the tobacco industry,little is known about the role of these funds in expendituresfor state tobacco-control programs.
Methods We evaluated state expenditures for tobacco-controlprograms in fiscal year 2001 in the context of the amount oftobacco-settlement funds received and allocated to tobacco-controlprograms and in the context of other state-level economic andhealth data.
Results In 2001 the average state received $28.35 per capitafrom the tobacco settlement but allocated approximately 6 percentof these funds to tobacco-control programs. The average statededicated $3.49 per capita (range, $0.10 to $15.47) to tobacco-controlprograms. The proportion of settlement funds allocated to tobacco-controlprograms varied from 0 to 100 percent and was strongly relatedto levels of tobacco-control funding (P<0.001). States withhigher smoking rates tended to invest less per capita in tobacco-controlprograms (P=0.007), as did tobacco-producing states (the meanper capita expenditure was $1.20, as compared with $3.81 innon–tobacco-producing states; P<0.008). In a multivariateanalysis, the proportion of the settlement revenue allocatedto tobacco-control programs was the primary determinant of thelevel of total funding; the state tobacco-related health burdenwas unrelated to program funding.
Conclusions State health needs appear to have little effecton the funding of state tobacco-control programs. Because onlya very small proportion of the tobacco settlement is being usedfor tobacco-control programs, the settlement represents an unrealizedopportunity to reduce morbidity and mortality from smoking.
Source Information
From the Departments of Medicine (C.P.G., B.S., R.R.) and Radiology (H.P.F.), Yale University School of Medicine, New Haven, Conn.; and the Department of Epidemiology and Biostatistics and the Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York (P.B.B.). Dr. Gross is the recipient of a Cancer Prevention, Control and Population Sciences Career Development Award (1 K07 CA90402-01) from the National Cancer Institute. Dr. Forman is a Robert Wood Johnson Health Policy Fellow.
Address reprint requests to Dr. Gross at Yale University School of Medicine, Primary Care Center, 333 Cedar St., P.O. Box 208025, New Haven, CT 06520, or at cary.gross{at}yale.edu.
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