Millions of dollars originally intended for smoking cessation programs in Massachusetts have been diverted to offset budget deficits, leaving the state struggling to fund quit-smoking hotlines, treatment programs and anti-tobacco advertising, the New England Center for Investigative Reporting has found. 

The cutback in smoking cessation programs comes at a time when more than 9,000 Massachusetts residents die annually from smoking-related diseases and yearly healthcare costs associated with treating tobacco-related illnesses in the state have risen to $3.9 billion, according to the Center for Disease Control. Nationally, those numbers are even more staggering with smoking-related deaths topping 400,000 and annual healthcare expenditures reaching beyond $96 billion.

“Roughly 99 percent of all the tobacco dollars that come into the state are used for something else,” said Stephen Shestakofsky, recently retired executive director of Tobacco Free Massachusetts, an anti-tobacco advocacy group, referring to the nearly $254 million in tobacco-related legal awards given to Massachusetts in 2012. More than $561 million in tobacco taxes was also collected, bringing the state's total tobacco tally to just over $815 million, the CDC reports.

Of that $815 million in tobacco money, only about $4.2 million will be spent in 2013 on smoking cessation and prevention programs in Massachusetts, state health officials said.  Since there is no requirement to spend either revenue from the state's tobacco taxes or the millions awarded annually as part of a 1998 Tobacco Master Settlement Agreement between 46 states and four of the nation's largest tobacco companies, the remaining funds will go into the state's general fund to pay for other cash-strapped programs, often unrelated to smoking.

Most of the other states involved in that tobacco settlement also use that annual windfall to fund programs unrelated to smoking, anti-tobacco groups said.

With Massachusetts spending just $4.2 million – or 4.6 percent of the $90 million the federal Center for Disease Control and Prevention says is needed to fully fund cessation and prevention efforts in Massachusetts – the state's anti-tobacco program is woefully cash-strapped..

“Major components of the program have gone unfunded,” said Dr. Lois Keithly, director of the Massachusetts Department of Public Health's Tobacco Cessation and Prevention Program, who has seen her budget slashed by $50 million from a peak of $54.3 million in 2000.

The cutbacks killed a major anti-smoking media campaign in 2001 that featured state residents talking about the effect smoking had on their lives, despite the campaign's much-touted success.  In conjunction with the Massachusetts Tobacco Control program, the media campaign was credited with reducing per capita cigarette consumption by more than 47 percent since 1997 and curtailing smoking by high school students by 27 percent, according to the Campaign for Tobacco Free Kids.

Also lost was $940,000 to fund contracts with 19 community health centers and three hospitals for a program that helped low-income individuals and mothers to quit smoking. Spot checks by state and local health officials at stores to ensure that cigarettes were not being sold to minors also have been reduced.

In releasing his proposed state budget this week, Governor Deval Patrick called for a $1 per pack increase in the state’s cigarette tax that is projected to raise $118.5 million annually.  An additional $18.54 million in revenue would come from raising taxes on other related products, such as snuff and chewing tobacco.  All of that money would end up in the state’s general fund. So far, none has been earmarked for the Bay State’s tobacco cessation and prevention program, Department of Public Health spokesman Omar Cabrera said.

In the four years since 2009 alone, when funding for smoking cessation programs in Massachusetts stood at $13.6 million, more than $9 million has been slashed from the state's anti-tobacco budget, leaving smokers with even fewer counseling options and support systems.

“It's become a very different kind of program,” Keithly said of the state's current anti-tobacco efforts that now focus primarily on providing technical assistance and training to other health-focused organizations to bring the stop smoking message to the public.  The state provides brochures and materials.     Enforcing anti-tobacco legislation, such as the statewide smoke-free workplace law, has also become part of the agenda along with maintaining a statewide telephone counseling service for smokers.

Still, the cutbacks have anti-tobacco advocates worried.

“More and more states are spending virtually nothing for tobacco control. It's a huge concern,” said Ellen Vargyas, General Counsel for the American Legacy Foundation, a Washington, DC- based non-profit group formed after the Master Settlement Agreement to develop cessation and prevention programs that educate the public about the health effects of tobacco. “In terms of a moral obligation, the states have fallen short.”

Although smoking rates have declined by almost 50 percent in the United States in the last 50 years, 19.3 percent of adults over the age of 18-- or 45.3 million people - still smoke, according to the CDC. Among low-income individuals, certain ethnic groups and male smokers under the age of 18, the percentage of smoking is even higher. 

“Clearly, we're not making the investment we should be making if we want to tackle the (smoking) problem,” noted Shestakofsky, adding that cuts to the Bay State's tobacco funding have cost the state a loss in programs that target veterans, the poor and other groups where smoking is particularly high.

Although not specifically designated for tobacco cessation, the Master Settlement Agreement was initially intended to fund tobacco prevention and mitigation programs, even though the agreement didn't exactly specify how settlement money was to be used. No one interviewed knew for certain why that was the case but anti-tobacco advocates and state officials said they believe it was because state legislators wanted to control how the money would be spent. Soon after that first 1998 windfall tobacco settlement, legislators would be spending that money freely.  By the new decade, as municipal budgets became tighter, legislators throughout New England and the nation began placing the annual multi-million dollar tobacco windfall into the general fund and using the money to bridge financial gaps in other budgets.

“The reality is we've had a series of fiscal crises and since nobody wants to be raising taxes, they take that money from somewhere else,” said Massachusetts State Rep. Jonathan Hecht, D-Watertown, who has been working to craft legislation that would close loopholes on smokeless tobacco products, among the fastest growing segments of overall tobacco sales.

Today, smoking rates for adults in all six New England states are slightly below the 19.3 percent of adults who smoke nationally. But battling the multi-million dollar tobacco industry on a shoestring budget remains a challenge.

“Obviously, we have nowhere near the money that the tobacco industry has. They spend scads of money advertising in the Commonwealth,” said Knightly, adding that the state spends only a small fraction to combat smoking compared to the estimated $164.5 million spent on tobacco ads in the Bay State.

In 2010, the tobacco industry spent $8.05 billion to market cigarettes and $444.2 million to promote smokeless tobacco products in the United States alone, according to a report compiled by the Federal Trade Commission.   Together, those marketing efforts account for nearly $1 million spent every hour.

Much of those smokeless tobacco marketing dollars are targeted at kids, anti-tobacco advocates claim. Although the tobacco settlement agreement prohibited tobacco companies from pitching cigarettes to minors, the agreement did not cover smokeless tobacco products.  A separate smokeless tobacco settlement agreement so far has been signed by only one smokeless tobacco manufacturer. 

With the tobacco industry now spending a chunk of marketing dollars to promote smokeless tobacco products, a new battlefront in the war against tobacco is forming.

One thing that is apparent is how the tobacco industry is targeting kids, said Hecht, noting that flavored cigars, chewing tobacco and other smokeless products with low price points and colorful packaging are being subtly marketed to children under the age of 18 as an alternative to cigarettes. With little funding to offset the tobacco industry's influence, Hecht worries that the next generation of tobacco addicts may not be far off. “We've let down our guard at a time when they're targeting that new generation,” he said.

But Brian May, spokesman for Philip Morris USA, one of the nation's oldest cigarette manufacturers, said the states --- not the cigarette companies--- are failing the nation's youth by improperly spending money meant to educate them about smoking and smokeless tobacco products.

Since the tobacco settlement agreement was signed in 1998, May said, Philip Morris alone has paid out more than $59 billion dollars to the 46 states that were part of the settlement.

The states have enough funds to spend $65 million every day on programs for underage tobacco use but only spend about $8 million daily, he noted.

"There's more tobacco-generated revenue available to the states than ever before to prevent underage tobacco use. In fact, the CDC says states aren't spending enough on youth and prevention programs and we think they should,” May said.

That's something the tobacco industry and anti-tobacco advocates can agree on.

“We've accomplished a lot,” noted Shestakofsky, “ but there's still a long way to go.”


The New England Center for Investigative Reporting is a nonprofit investigative reporting newsroom based at Boston University.