US: Health Officials Fight for Share of Tobacco Funds

Source from:  West Hawaii Today 02/25/2015

Seeing a dwindling in tobacco settlement funds on the horizon and stiff competition from competing interests, the state Department of Health is stepping up an old fight for its share of the settlement dollars.

Hawaii receives $50 million annually as its share of a sweeping Tobacco Master Settlement Agreement reached between the states and the tobacco industry in 1998 to address some of the harm the product has done to public health. However only 15 percent, or $7.5 million, of that money goes to the DOH. Another 6.5 percent, or $3 million, goes into the Hawaii Tobacco Prevention and Control Fund. The bulk of the balance goes to the state rainy day fund, the general fund and the University of Hawaii John A. Burns School of Medicine.

The overall pie is expected to shrink to $41 million as certain "bonus payments" under the agreement come to an end in 2018. DOH officials are taking their case to the state's lawmakers to make sure their share isn't eroded further, pointing out that the law requires the 15 percent funding level to increase to 25 percent in the fiscal year 2016.

The money comprises the main funding source for the state's primary prevention and chronic disease management program.

"We're concerned about backsliding if funds for prevention programs are reduced," DOH spokeswoman Janice Okubo said. "It's a tight budgetary year. Many agencies will be vying for funding, so we want to make sure that this fund is maintained. It is important that we sustain these programs that have proven success and results."

Tobacco settlement dollars infuse the Hawaii Tobacco QuitLine, which state health officials say has helped some 22,000 residents kick the habit since 2005. The funds also helped establish school wellness guidelines and health education for students as well as the Start Living Healthy program, a multimedia initiative designed to give residents easy access to information on healthy living.

The states have historically been notorious for siphoning off Tobacco Settlement Special Funds to plug budgetary holes, anti-smoking advocates say. In 2002, the Campaign For Tobacco-Free Kids gave Hawaii a failing grade for using settlement money to finance $150 million in bonds to build the Kakaako campus of the John A. Burns School of Medicine.

However, only four other states were doing a better job than Hawaii in fiscal year 2015 of meeting the tobacco prevention funding levels recommended by the Centers for Disease Control and Prevention, according to data from Tobacco-Free Kids. But Hawaii could do better, health officials maintain.

"Hawaii only spends 62 percent of the recommended tobacco prevention and control spending level set by the CDC," state Director of Health Virginia Pressler said in a statement.

Lola Irvin, the state's tobacco settlement program manager, said Hawaii needs to keep trying to reach the groups at a disproportionately high risk for tobacco use, including the poor and those with mental health and substance abuse issues.

Adult tobacco use in Hawaii declined 13.3 percent in the past three years, and the state now holds the distinction of having the third lowest smoking rate in the U.S., at 13 percent of adults.

However, the latest Hawaii Youth Tobacco Survey pointed out weaknesses on the tobacco prevention front. E-cigarette use among high school students tripled from 5.1 percent in 2011 to 17.6 percent in 2013, and quadrupled from 1.8 to 7.9 percent among middle school students during the same period.

Combating e-cigarette use is high priority, Irvin said.

"We are concerned about e-cigarettes becoming a gateway to cigarette and other tobacco usage," Irvin said. "These products are currently not regulated, and we cannot assure their safety. These are also not approved cessation devices. E-cigarettes usually contain nicotine, which is highly addictive especially for developing brains. The solvents that are used to heat the nicotine and flavorings are not approved for inhalation into lung tissue. Several studies also show that these solvents when heated can become toxic and carcinogenic."