Unwise to cut tobacco control funding in tough times
Friday, May 09, 2008
Jonathan Foulds, MA, MAppSci, PhD
Using my home state as an example, I’d like to summarize some of the reasons why cutting tobacco control funding is not a wise policy, even in tough financial times.
Here in New Jersey, our Comprehensive Tobacco Control Program (CTCP) started in 2000, with funding of $32.5 million via the Master Settlement Agreement. At that time the Centers for Disease Control (CDC) recommended a minimum of $45 million annual expenditure on tobacco control. The program was set up to follow CDC guidelines to have components for media, evaluation, community activities, youth prevention, and smoking cessation. With the post 9/11 recession causing severe budget problems for the state, funding was drastically cut by 66% to $11 million in 2004 and has remained at that level. The state brings in approximately $1 billion per year from tobacco sources (MSA plus tobacco taxes) and so is currently spending around 1% of tobacco revenues on tobacco control. In 2007 the CDC updated its funding recommendations for New Jersey to $120 million ($13.75 per person per year, and 12% of total tobacco-related revenue to the state).
Despite being drastically underfunded, the New Jersey CTCP has had many noteable achievements. Just a few of these are:
- Over the years 2000 to 2007, cigarette taxes were increased from 80 cents per pack to $2.575 per pack (highest state tax in the country).
- Legislation was passed to ban smoking in all workplaces and indoor public places, and implemented in 2006, adding casinos in 2008.
- The number of cigarettes being smoked by New Jersey youth was cut by 50% from 1999 to 2006.
- Adults cigarette smoking fell from 21% during the mid 1990s to 17.1% in 2007, the lowest level recorded.
Some may ask for early signs of a health impact. One early response to reduced smoking is a reduced rate of heart attacks. The number of acute myocardial infarctions causing reported inpatient hospitalizations in New Jersey was above 22,000 every year from 1995 to 2003 (24278 in 2000), but dipped below 22,000 in 2004 and has continued to fall to below 20,000 in 2006. This reduction from the year 2000 to 2006 was evident for every age group over age 15. Clearly all of this reduction cannot be entirely attributed to the CTCP, but it is highly likely that many heart attacks were prevented by the reduced smoking in the state. In tough financial times, one has to consider the cost savings to the healthcare system from reduced hospital admissions for MIs, lung cancer, premature babies, respiratory disease and all the other diseases caused by smoking.
Some point to the successes in reducing smoking and seem to be under the misguided impression that smoking is so rare nowadays that there is no longer a need for robust tobacco control programs. The reality is that according to our latest data (2006), New Jersey’s 7th through 12th graders smoke 90 million cigarettes a year. This does not include the significant proportions smoking cigars and bidis, or chewing tobacco.
Per capita cigarette consumption is currently 43 packs per year (down from 69 packs in 1999), and lower than the average for the country (69 packs).
To put New Jersey’s investment in tobacco control into perspective, on an annual basis it is less than the amount of revenue the state receives in excise taxes from illegal cigarette sales to kids ($11.5 million)!
Yet in that scenario of incredible success despite serious underfunding, New Jersey’s Comprehensive Tobacco Control Program is currently threatened with further cuts. I don’t think we can really say that with New Jersey’s youth smoking 90 million cigarettes per year, and with 43 packs being consumed annually for every person in the state, that the work for tobacco control is done. We are only beginning to see the return on investment in terms of reduced health effects from tobacco. To cut the program now would result in a reversal of the progress, and directly cause more heart attacks, more cases of lung cancer and emphysema, and more premature babies.
Tobacco control spending provides an excellent return on investment, and it is for this reason that CDC recommends that New Jersey should spend $120 million, rather than be considering cutting from $11m. Even in tough financial times, a dollar spent on tobacco control is a dollar well spent on improving health and reducing healthcare costs.
So when times are tough, and money is needed for other important causes (like healthcare for uninsured smokers), a far better way to fund these is to increase the excise tax on cigarettes. http://www.tobaccofreekids.org/reports/prices/
Full details and evaluation of New Jersey’s Comprehensive Tobacco Control Program can be found at: http://www.nj.gov/health/as/ctcp/research.htm
For more details on the toll of tobacco in New Jersey, click on:
http://www.tobaccofreekids.org/reports/settlements/toll.php?StateID=NJ
For the CDC’s best practices for Comprehensive Tobacco Control (2007), click on:
http://www.cdc.gov/tobacco/tobacco_control_programs/stateandcommunity/best_practices/
Labels: cigarette tax, comprehensive tobacco control, funding, jonathan foulds, New Jersey
8 Comments:
At Sat May 10, 10:04:00 AM 2008,
Anonymous said…
Dr. Foulds,
Thanks for saying what needs to be said!
While it sometimes seems crystal clear, it seems that most political systems cannot muster the wisdom in tough times to avoid cutting prevention efforts.
Perhaps that is human nature, but it's critical that there are voices like yours to point out why certain effots must not be cut - even in hard times.
Thanks again.
At Mon May 12, 09:26:00 AM 2008,
Caroline W said…
Unwise, unappreciated, unlawful.
These words describe what a mistake it is to cut tobacco control funding. I am speaking from first-hand experience.
I am a Health Educator, (Certified Health Education Specialist, CHES), who has been facilitating smoking cessation programs for 23 years. From 1985 until 2001, I facilitated cessation programs that were offered through my community hospital's health education department, of which I was a trainer. As the years passed, and all the community hospitals faced financial hardships, the various health education/community wellness programs/departments were either downsized or eliminated. And as such, so were the cessation program offerings.
Then, as a result of the Tobacco Master Settlement Agreement, funds were to be focused on the arenas mentioned in Dr. Foulds article. Cessation efforts being one.
I became employed within the Pennsylvania Tobacco Control Program (specifically the Bucks County Tobacco Control Project), and one of my charges was to revitalize hospital-based cessation programs for the community.
We had extreme success. Our community members were attending the programs, achieving various levels of success, and through the funding, we were able to reach lower-socio economic populations. We were making a difference.
However, as was the scenario with all the programs, our funding was cut. My position was cut. I became unemployed, and the cessation program offerings diminished.
Although they are now continuing, and I am still facilitating many of the programs, it is disheartening to know that all the work that we all have accomplished in the tobacco control world, seems to go unappreciated by legislators.
Indeed, when times are tough, budget revisions need to be made. However, when the entire picture is in focus of how much of a difference, both statistically and
behaviorally, has been made through tobacco control...it almost seems unlawful to break the rules of success.
Dr. Foulds mentioned the many areas of success the NJ CTCP has achieved. Likewise for the Pennsylvania CTCP. And...likewise for many other states.
In addition, I have completed by training as a Certified Tobacco Treatment Specialist (CTTS), as a result of the Tobacco Program at UMDNJ. I value this certification made possible through the program.
The members of the Tobacco Dependence Program at UMDNJ are making a difference. Members of each state's Tobacco Control Program are making a difference.
I am making a difference.
We now need our legislators to make a difference and stand firm on all the funding allotments.
Please no more cuts!
Make the difference.
Caroline Williams, BA, CHES, CTTS
At Mon May 12, 10:10:00 AM 2008,
Ronald F. Day said…
As a Tobacco Helpline Coordinator that works with a population that has exceedingly high rates of tobacco use (the NYS prison system), I have gained invaluable information and strategies from the Tobacco Dependence Program in NJ on how to help the incarcerated people lower their tobacco consumption. I think that it would be unwise to cut funding to a program that is making serious advancements in the area of tobacco control. The tobacco industry has been relentless in its pursuit of new smokers and particularly shrewd in search of American dollars. Hence, why should the funding be cut for a program that is gradually and methodically working to improve the overall health and well-being of a society that has seen, and often been apathetic to, millions of its citizens dying from tobacco-related deaths? The mission is not complete! To strip the Tobacco Dependence Program of essential funding sends a wrong message. It sends a message that we want thousands of people to continue becoming new smokers each day, that we want millions of people to need time off from work because of conditions caused by tobacco use, that we are willing to "save" now and cringe later because of the staggering health costs associated with diseases caused from tobacco use, and it concedes that although we have won battles against big tobacco, we are all but resigned to a gloomy fate: we cannot win the war against the tobacco industry. Yes we can! Yes we will! But it takes hard work, perseverance, and one thing that big tobacco has plenty of: MONEY.
At Mon May 12, 10:53:00 AM 2008,
Anonymous said…
I'm so glad that we now have smoke-free air to breath, and that my kids attend NJ schools that have active REBEL chapters (youth led anti tobacco program). We here in New Jersey are lucky to be getting the antismoking TV ads paid for by New York. If we are only spending 1% of tobacco revenue on tobacco control they should increasing the funding, not cutting it. What are they thinking of?
At Tue May 13, 10:08:00 AM 2008,
Ivy P. said…
As a Tobacco Dependence Treatment Specialist and Nurse Practitioner who works with Adolescents at HiTOPS in Princeton I am seeing a new trend in tobacco use emerging- that of hookah or water pipe use. Young people are perceiving this method of smoking tobacco as less dangerous and even "natural" when if fact it is just the opposite. I agree with Dr. Foulds that our work is not done and younger generations are particularly vulnerable to all forms of enticements from the tobacco industry.
At Wed May 14, 08:13:00 AM 2008,
Anonymous said…
As a C.T.T.S. who got her credentials at Dr. Foulds classes I truly hope the people with the power will reconsider what they are about to do.
IN New Mexico we have just now started to really make inroads with the low SES people. THis is like anything the people who are higher educated and the people who have more connections always learn of and keep up with the latest health news and programs, it takes a long time for it to trickle down to the custodian, waitress, and other people who are of the working class, just as we are reaching them now all of a sudden there is a push to cut these programs all over the U.S.
At Wed May 14, 04:34:00 PM 2008,
Nuria Lanzagorta said…
New Jersey and other U.S. states have been helped by the New Jersey's CTCP, but it also has been an important and succesful program outside the States. In every meeting and scientific journal where any member of the staff share their outcomes, it is sure that less experienced people is going to be benefit.
There are CTTS (Certified Tobacco Treatment Specialists) in Mexico City and Spain that have been trained in NJ. Thanks to what I've learned in the training, I'm able to help smokers to quit, and to encourage health specialists to treat and advice their patients about tobacco use.
NJ's CTCP has been an example of what we all MUST do to control tobacco in our facilities and states.
It is not logic to cut the budget to a program that has been saving a lot directly and indirectly to both the state and the people.
At Mon May 19, 07:52:00 AM 2008,
Jonathan Foulds, MA, MAppSci, PhD said…
Thanks for the comments..and keep them coming. I just want to point out that the risk of cuts is to the whole New Jersey Comprehensive Tobacco Control Program, of which the Tobacco Dependence Program at UMDNJ-SPH is just a part. But all the components of tobacco control are important and work synergistically together, as explained in my post of May 18.
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