As the nation faces dual health threats from an unprecedented respiratory pandemic that is disproportionately impacting Black and Latino communities and a youth e-cigarette epidemic that threatens millions of young people with a lifetime of addiction, a new report highlights how most states continue to shortchange programs designed to prevent kids from using tobacco products and help tobacco users quit. The report is a challenge to states to do more to fight tobacco use – still the nation’s No. 1 preventable cause of death – and prevent e-cigarettes from addicting a new generation of kids.
This year (fiscal year 2021), the states will collect $26.9 billion from the 1998 tobacco settlement and tobacco taxes. But they will spend a paltry 2.4% – just $656 million – on tobacco prevention and cessation programs. The total is an 11% decrease from last year and less than a fifth (19.8%) of the total funding recommended by the Centers for Disease Control and Prevention (CDC).

Not a single state currently funds its tobacco prevention and cessation programs at CDC-recommended levels, and only eight states provide even half the recommended amount. These low levels of funding are even more alarming when compared to the more than $9.1 billion the tobacco industry spends annually to market their deadly products.
The report – “Broken Promises to Our Children: A State-by-State Look at the 1998 Tobacco Settlement” – was released today by the Campaign for Tobacco-Free Kids, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights, Robert Wood Johnson Foundation and Truth Initiative. November 2020 marked the 22nd anniversary of the landmark legal settlement between 46 states and the major tobacco companies, which – along with individual settlements with four other states – required the companies to pay more than $246 billion over time as compensation for tobacco-related health care costs.
View the report, including state-by-state information and a ranking of the states.
The report comes as youth use of e-cigarettes remains at epidemic levels. With 3.6 million U.S. kids using e-cigarettes, including one in five high school students (19.6%), states should be devoting more of their tobacco dollars to help fight this epidemic.
The latest government surveys show that 20.8% of U.S. adults and 23.6% of high school students still use some form of tobacco, with cigarette smoking rates at 14% for adults and 4.6% for high school students. The U.S. is also facing large disparities in who still smokes. Adult smoking rates remain the highest among people with lower income and less education, residents of the Midwest and the South, American Indians/Alaska Natives, LGBTQ Americans, those who are uninsured or enrolled in Medicaid, and those with mental illness. In addition, Black Americans die at higher rates from smoking-caused diseases, in large part due to the tobacco industry’s predatory targeting of Black communities with menthol cigarettes.
“States cannot let up in their efforts to prevent kids from using tobacco and help tobacco users quit – not when the tobacco industry continues to addict our kids with flavored e-cigarettes and other products and tobacco still kills over 480,000 Americans every year,” said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. “As we fight COVID-19 and the stark health disparities it has exposed, preventing and reducing tobacco use is more critical than ever. Policymakers need to fund and implement the proven strategies that can end the youth e-cigarette epidemic and the grip Big Tobacco has had on this country for far too long.”
To accelerate progress, policymakers at all levels should fully implement proven measures to reduce tobacco use. In addition to funding tobacco prevention programs, these strategies include prohibiting all flavored tobacco products, significant tobacco tax increases, comprehensive smoke-free laws, hard-hitting mass media campaigns, and barrier-free insurance coverage for tobacco cessation programs.
To date, five states – Massachusetts, California, New York, New Jersey and Rhode Island – and hundreds of localities have prohibited the sale of flavored e-cigarettes, with Massachusetts and California passing laws that also end the sale of other flavored tobacco products, including menthol cigarettes and flavored cigars.
OTHER KEY FINDINGS IN THE REPORT:
Alaska (89.7%), Maine (87.4%) and Utah (79.4%) are the only states to provide even three-quarters of the CDC-recommended funding for tobacco prevention and cessation programs.
Only 8 states (Alaska, Maine, Utah, California, Hawaii, North Dakota, Delaware and Oklahoma) provide more than half of the CDC-recommended funding.
34 states and DC are providing less than 25% of what the CDC recommends; 21 states provide less than 10%.
Connecticut and Tennessee have allocated no state funds for tobacco prevention programs.
Tobacco companies spend more than $13 to market tobacco products for every $1 the states invest to reduce tobacco use. According to the most recent data from the Federal Trade Commission (for 2018), the major cigarette and smokeless tobacco companies spend $9.1 billion a year – over $1 million per hour – on marketing.