States Do Poorly On Antismoking

States are doing a mostly poor job in setting policies to discourage cigarette smoking, a new American Lung Association (ALA) report concludes.

The annual report shows that most states have spent only a fraction of money available for tobacco-prevention programs and that most still don't have what the group considers adequate laws to prevent sales to minors.

At the same time, the report praises a growing number of states that have passed laws severely limiting smoking in public buildings, most notably restaurants and bars. But overall, it paints a picture of states that are far behind in curbing tobacco use, which remains the leading cause of preventable death in the United States.

Federal Goals

Smoking kills an estimated 440,000 Americans each year. Twenty-three percent of U.S. adults are smokers, while 22 percent of high school students report having smoked within the last month, according to the CDC.

Federal public health goals call for a reduction in the number of adult smokers to 12 percent by 2010; officials want the number of high school students who report smoking within the last month to drop to 16 percent by 2010. "We're not going to get there unless we see some dramatic shifts across the country," Paul G. Billings, the American Lung Association's vice president for national policy, tells WebMD.

The report shows that most states have used only a small portion of money they've received in the 1998 Master Settlement with tobacco companies to curb youth smoking. Fifteen states and Puerto Rico have used none of their share of the $246 billion settlement for antismoking programs, according to ALA.

"In reality, it's gone to many other things besides tobacco programs," Billings says. "Filling potholes, building roads, meeting budget shortfalls, whatever."

Straight A's for One State

Only one state -- Maine -- received consistently high marks for antismoking programs, laws, and high cigarette taxes. The state bans smoking in restaurants, bars, and public buildings and charges a $2 excise tax on cigarette packs. Maine also spent $4 million more on antismoking programs last year than was recommended by the CDC.

Many other states charge only around 35 cents in excise taxes and do not enforce youth antismoking laws, the group says.

California received an F from the group for so far spending none of its expected $25 billion settlement payout on antismoking programs. The state did spend $80 million in tax revenues on such programs, according to the report.

Four states -- Alabama, Louisiana, Kentucky, and South Carolina -- received straight F's for failing to take what the American Lung Association considers minimal steps to curb smoking.

The group praised 10 states -- including Maine, California, Washington, and New York -- for new laws restricting or banning smoking in public buildings, most bars, and restaurants. The New Jersey state legislature passed a smoking restriction bill on Monday, which the state's acting governor is expected to sign.

Last week, the Washington, D.C., City Council passed a similar bill barring smoking in bars and restaurants, and pressure is mounting on Mayor Anthony Williams to sign the measure.

Warnings on Youth Smoking

Overall youth smoking rates have dropped between one-third and one-half for U.S. teens since 1997, according to federal youth drug statistics released last month.

But smoking among eighth-graders has stayed flat at roughly percent since 2002, while their disapproval of cigarettes and the risk they see in smoking are both down, according to the federally funded report, known as the annual "Monitoring the Future Survey."

Lloyd Johnston, a University of Michigan researcher who leads the study, called the trend "worrisome" and cautioned that declines in smoking are likely to stop as today's eighth-graders move through high school.

"It appears to me they will end in the next couple of years in the upper grades," he says.

SOURCES: State of Tobacco Control: 2005, American Lung Association, Jan.10, 2005. National Center for Health Statistics. Paul G. Billings, vice president, American Lung Association. National Associations of Attorneys General, Master Tobacco Settlement Summary. 2005 Monitoring the Future Survey, University of Michigan, White House Office of National Drug Control Policy. Lloyd Johnston, University of Michigan.

By Todd Zwillich
Reviewed by Louise Chang, MD
© 2005, WebMD Inc. All rights reserved