Study Finds Youth Smoking Would be Much Lower if States Followed CDC Guidelines for Tobacco Prevention and Cessation Spending

State investments fall far short of CDC-recommended levels; tobacco industry spent 14 times more marketing cigarettes than states did to prevent smoking and to help smokers quit in 2002

    • January 30, 2005

There would be far fewer teen smokers in America today if state spending on tobacco control followed levels recommended by the federal Centers for Disease Control and Prevention (CDC), according to a study published in the February 2005 issue of the American Journal of Public Health (AJPH).

Researchers from Bridging the Gap, a policy research program based at the University of Illinois at Chicago (UIC) and the University of Michigan and supported by the Robert Wood Johnson Foundation, found "clear evidence" of a direct relationship between what states invest in discouraging tobacco use and both the percentage of youth who smoke and the intensity of their smoking habits.

"If states had spent just the minimum amount recommended by CDC, youth smoking nationally would have been between 3 and 14 percent lower than was observed during the 10 year period that we examined," said John Tauras, a UIC economist and the study's lead author. "Furthermore, with so many states now making big cuts in tobacco control as a way of dealing with budget shortfalls, what our study predicts is that a substantial decrease in funding will lead to a significant increase in adolescent smoking."

The study focused on the fact that while state-level investments in programs to prevent tobacco use and help smokers quit—which draw on numerous funding sources public and private—had risen to $861.9 million in 2002, spending in almost all states remained well below the minimum amount CDC believes is needed to support a comprehensive and effective program.

By comparison, the Federal Trade Commission reports that in 2002 U.S. tobacco companies spent $12.47 billion to market cigarettes and promote smoking, more than 14 times the total of what states spent in that same year to try to discourage smoking.

Tauras and his colleagues looked at state-level spending on tobacco control, money that comes not just from cigarette taxes and general revenues earmarked for tobacco control, but also from the federal government, private foundations and other organizations. They noted that, overall, states are collecting a record amount of tobacco revenues, mainly in the form of cigarette excise taxes, and that most states are reaping millions annually from the 1998 landmark settlement between states and the tobacco industry.

But as of 2005, according to the Campaign for Tobacco Free Kids, only three states have budgeted to spend the minimum amount recommended by CDC for tobacco control. CDC has recommended a minimum [annual] investment of $1.6 billion for all states combined. All states combined are planning to spend $538 million in state funds in 2005 on tobacco control. States are expected to receive a collective $19.97 billion in tobacco revenues in 2005 from tobacco settlements and cigarette excise taxes.

The researchers matched state spending on tobacco control with data on smoking among 8th, 10th and 12th graders collected between 1991 and 2000 by the University of Michigan Monitoring the Future study, a study federally funded by the National Institute on Drug Abuse. The study includes information on the number of young people who smoke and the frequency of their smoking. What Tauras and his colleagues found is that higher per capita tobacco control expenditures were associated with fewer youths smoking and, for those who continued to smoke, lower daily cigarette consumption.

"State investments in tobacco control, even at current levels, are reducing youth smoking," Tauras said. "What our study is saying is that if states would move closer to the CDC recommended amounts, they could have a much greater impact. Conversely, when we see estimates that states may be actually cutting some $90 million from tobacco control efforts, then we need to understand that the cost will come in the form of more kids starting to smoke."

The study points out that evaluations of individual state programs are providing powerful evidence of what a comprehensive tobacco control campaign can accomplish. Comprehensive programs include public awareness media campaigns, school and community education, enforcement of laws regarding tobacco sales to minors, and programs to help smokers quit. For example, in California, which launched an initiative in 1988 with funds gained from a 25 cent-per-pack hike in the state cigarette tax, cigarette sales per capita have fallen almost 50 percent compared to 20 percent for the rest of the U.S. Particularly important: between 1995 and 1999, youth smoking in California fell by 43 percent. Impressive progress was also seen in Massachusetts, Oregon, Arizona and Florida in the wake of large-scale tobacco control efforts (however, Massachusetts, Oregon and Florida have significantly cut funding for their tobacco control programs in recent years).

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Bridging the Gap, which is funded by the Robert Wood Johnson Foundation, is a joint project of ImpacTeen, a program of the University of Illinois at Chicago's Institute for Health Research and Policy, and Youth Education and Society (YES!), a program of the University of Michigan's Institute for Social Research. Bridging the Gap improves understanding of the role of policy and environmental factors in youth alcohol, illicit drug, and tobacco use, as well as diet and physical activity to evaluate their effectiveness in reducing substance use and obesity among youth.

The Robert Wood Johnson Foundation, based in Princeton, NJ, is the nation's largest philanthropy devoted exclusively to health and health care. It concentrates its grantmaking in four goal areas: to assure that all Americans have access to quality health care at reasonable cost; to improve the quality of care and support for people with chronic health conditions; to promote healthy communities and lifestyles; and to reduce the personal, social and economic harm caused by substance abuse—tobacco, alcohol and illicit drugs.

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