By Matt Leingang
The Cincinnati Enquirer

Despite getting millions from a landmark settlement with the tobacco industry, most states are losing a golden opportunity to improve public health, a new report concludes.

The report, to be published this week in the New England Journal of Medicine, argues that states largely have done a poor job funding tobacco-prevention programs and protecting people from secondhand smoke.

In 1998, 46 states settled a lawsuit to recoup health-care costs from the tobacco industry. That settlement was worth more than $200 billion, to be paid over 25 years.

But many states have used that money to plug holes in budget deficits, a shortsighted strategy that leaves them open to rising Medicaid and Medicare payments resulting from smoking-related illnesses, said the report's author, Dr. Steven A. Schroeder.

Schroeder is director of the Smoking Cessation Leadership Center at the University of California - San Francisco.

"The country is going crazy over mad cow disease, yet there hasn't been a single case of it in humans. We lose 430,000 people a year because of smoking-related deaths, but no one wants to talk about it and money is being wasted," Schroeder said in an interview.

Ultimately, the tobacco industry could win out if nothing changes, Schroeder said.

Ohio's portion of the tobacco settlement was $10.1 billion. The state created seven trust funds to receive tobacco settlement dollars. Some of those funds went to programs to help farmers grow alternatives to tobacco; others were used for research on tobacco-related illnesses, and some even went to public school construction and renovation.

The big job of getting Ohioans to stop using tobacco products - or to not begin at all - was left to the Tobacco Use Prevention and Control Foundation.

The tobacco control foundation got two payments in 2000 and one payment in 2001, totaling a little over $330 million.

But legislators, citing the state's budget crisis, diverted $240 million in settlement payments away from the foundation in fiscal years 2002 and 2003 and another $112 million for 2004, according to Tobacco-Free Ohio, a Columbus-based advocacy group.

Gov. Bob Taft and other lawmakers said at the time that they were taking a fiscally responsible approach to a serious budget crisis. Taft said that Ohio is borrowing tobacco money, not taking it permanently. The money is supposed to be repaid in 2013 and 2014.

To survive these rounds of cuts, the tobacco control foundation has been dipping into money from its endowment. About $38 million is to be spent in 2003-004 for smoking-cessation programs, marketing campaigns against tobacco, surveillance and research.

Based on Ohio's smoking rate, which is among the highest in the nation, the state should be spending at least $61 million annually on tobacco control, according to recommendations by the U.S. Centers for Disease Control and Prevention.

"We're optimistic that the legislature will see the benefit of restoring our funding. But we'll have to wait and see," said Tim Ingram, Hamilton County health commissioner.

Ingram is one of 24 trustees on the foundation. "Lawmakers must realize that a dollar spent today saves thousands of dollars in health-care expenditures down the road," he said.

In analyzing state tobacco-control policies, Schroeder said taxes on tobacco have the strongest effect on reducing its use. Tax rates on cigarettes vary greatly between states, ranging from 3 cents per pack in Kentucky to a high of $2.05 per pack in New Jersey.

Not surprisingly, Schroeder said, taxes are generally lower in states that grow tobacco and in those that have more smokers.

Laws that ban smoking in public places, including bars and restaurants, are also effective, the report said. Five states - California, New York, Delaware, Connecticut and Maine - have banned smoking in essentially all public places.

E-mail mleingang@enquirer.com