State Cuts in Anti-Smoking Efforts Raise Teens' Risk

Minnesota survey finds negative impact almost immediately

THURSDAY, April 15, 2004 (HealthDayNews) -- State spending cuts on antismoking campaigns may be hitting where it hurts most: the lungs of America's youth.

A new report said the cutbacks have an almost immediate impact. Just a few months after Minnesota's youth-oriented tobacco prevention budget was slashed 80 percent, the number of adolescents who reported being susceptible to cigarette smoking, a predictor of tobacco use, rose precipitously, it said.

Smoking during adolescence is a critical issue, because most people who become regular puffers begin in their teen years. In Minnesota, state anti-tobacco programs, particularly those with strong advertising components, have been credited with a decline in teen smoking since 1997.

The latest unsettling findings echo data from Massachusetts, where a 92 percent cut in that tobacco control program was followed by a large increase in illegal tobacco sales to minors. The new research appears in the April 16 issue of Morbidity and Mortality Weekly Report, a publication of the U.S. Centers for Disease Control and Prevention.

"It's a major concern. We're worried about states' cutting back, and that this is a harbinger of what we might see," said Dr. David Nelson, one of the authors of the study and senior scientific advisor in the CDC's Office on Smoking and Health.

Cutting back funds "is penny-wise and pound-foolish," he added. "It may be an early smoking gun."

Nelson noted, "It's hard to find health problem bigger than this, and here we have programs that work."

Minnesota's Target Market, or TM, campaign was begun in 2000 and had three main components -- a youth organization, a Web site, and a paid advertising campaign, which used the lion's share of the funds, according to the new report. The initial budget of $23.7 million came from the 1998 Master Settlement Agreement (MSA) between the states and the tobacco industry.

In all, states received more than $200 billion over 25 years from the MSA. While some of the funds have been used for anti-tobacco programs, many states have used the monies to cover budget shortfalls.

And Minnesota was no exception. The TM campaign was reduced to $4.6 million in July 2003 in order to cover budget deficits, said Aggie Leitheiser, the state's assistant commissioner of health.

"The media campaign cost about $10 million, and that was part of what we were using the interest from the tobacco money for," she added.

The survey, conducted by the Minnesota Department of Health in collaboration with the University of Miami School of Medicine, involved four telephone polls of Minnesotans aged 12 to 17 years whose responses were then compared to responses that had been gathered while the TM campaign was still active.

Susceptibility to cigarette smoking, as reported by the adolescents themselves, rose from 43.3 percent in July-August 2003 to 52.9 percent in November-December 2003, after the drastic cuts took place. Individuals who responded anything other than "strongly disagree" to the statement, "You will smoke a cigarette in the next year," were considered susceptible.

This measure of susceptibility, said Nelson, is "a very valid measure. Those not firmly committed are two to three times more likely to take up smoking."

The percentage of respondents who were aware of the campaign had also changed, down from 84.5 percent in July-August 2003 to 56.5 percent in the later period.

The report stated that smoking among youths has declined most rapidly in states that have had the biggest media campaigns in combination with other activities. In Florida, for instance, smoking prevalence among middle-school students decreased 40 percent in two years after a program was initiated. Florida's budget for such activities has been cut by 99 percent.

Expenditures by cigarette companies, on the other hand, are up, the editors reported.

The tobacco industry spent $11.2 billion in 2001 -- or $39 per person in the U.S. -- on advertising and promotion, 17 percent more than the previous year, and almost twice what was spent in 1997, before the MSA.

But if states continue to use MSA funds to cover budget deficits, tobacco control programs are left in an awkward position, experts said.

"We'll be taking a look at the entire report and, as we think about next year's budget and budget challenges, how we can fit tobacco prevention in," Leitheiser said. "Are there certain things that adolescents reacted to? Are there ways to do that less expensively? We're still evaluating."

It's unlikely that Minnesota's previously successful program will be resurrected in its entirely. "There would have to be a new money source discovered, and we are still expecting budget challenges for the coming year so I don't know that it would return as before," Leitheiser admitted. "[Tobacco prevention activities] will be smaller, I think, no matter what."

More information

For more on tobacco prevention in youth, visit the CDC or the Campaign for Tobacco-Free Kids.

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