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N Engl J Med. 2002 Oct 3;347(14):1080-6.

State expenditures for tobacco-control programs and the tobacco settlement.

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Department of Medicine, Yale University School of Medicine, Primary Care Center, New Haven, Conn 06520, USA.



Despite controversy surrounding the use of funds arising from settlement agreements with the tobacco industry, little is known about the role of these funds in expenditures for state tobacco-control programs.


We evaluated state expenditures for tobacco-control programs in fiscal year 2001 in the context of the amount of tobacco-settlement funds received and allocated to tobacco-control programs and in the context of other state-level economic and health data.


In 2001 the average state received $28.35 per capita from the tobacco settlement but allocated approximately 6 percent of these funds to tobacco-control programs. The average state dedicated $3.49 per capita (range, $0.10 to $15.47) to tobacco-control programs. The proportion of settlement funds allocated to tobacco-control programs varied from 0 to 100 percent and was strongly related to levels of tobacco-control funding (P<0.001). States with higher smoking rates tended to invest less per capita in tobacco-control programs (P=0.007), as did tobacco-producing states (the mean per capita expenditure was $1.20, as compared with $3.81 in non-tobacco-producing states; P<0.008). In a multivariate analysis, the proportion of the settlement revenue allocated to tobacco-control programs was the primary determinant of the level of total funding; the state tobacco-related health burden was unrelated to program funding.


State health needs appear to have little effect on the funding of state tobacco-control programs. Because only a very small proportion of the tobacco settlement is being used for tobacco-control programs, the settlement represents an unrealized opportunity to reduce morbidity and mortality from smoking.

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