Are anti-smoking efforts going up in smoke?

After years of decline, smoking rates in New Jersey are on the rise again.

In its recently released State of Tobacco Control report for 2010, the American Lung Association says the number of adults who smoke in New Jersey rose last year to 15.8 percent, up from 14.8 percent a year earlier.

The report also showed the smoking rate among New Jersey high school students increasing to 17 percent, up from 14.3 percent. The data was culled from federal surveys through the U.S. Centers of Disease Control and Prevention that were done in 2009.

Such numbers would seemingly provide reason for the state to expand its anti-smoking and smoking cessation programs. But, because of the $11 billion deficit in the state budget last year, New Jersey slashed its funding for such programs in July from $7.6 million to just $600,000.

The dramatic cuts came even though the state still brought in about $1 billion in 2010 from taxes on cigarettes and a 1998 legal settlement with the big U.S. tobacco companies, and despite the state having a near total ban on indoor workplace smoking.

Those who are working to combat smoking in the Garden State are wondering what will happen to smoking rates in New Jersey in the years to come, as the tobacco companies continue to spend more than $200 million a year to market an expanding line of products here.

They also are wondering if state funding for effective anti-tobacco programs will ever be restored or even wiped out entirely. And they are wondering if the number of deaths tied directly to smoking in New Jersey — 11,201 last year — and the economic cost to the state — nearly $5.6 billion in 2010 — will rise.

The state Department of Health and Senior Services says it will closely monitor new smoking figures to see if the increase was an anomaly or a new trend.

“The bottom line is that despite an extraordinarily difficult budget situation, the Department of Health and Senior Services remains committed to tobacco prevention as a key public health issue, and that is why we have merged tobacco prevention efforts as part of an overall chronic disease strategy,” said Donna Leusner, spokeswoman for the department.

Even through a recession in which other tax revenues have ebbed for the state, about $700 million or more each year continues to flow into the state Treasury from New Jersey’s $2.70-per-pack tax on cigarettes — the sixth-highest cigarette tax in the nation.

There is legislation on the books that called for millions to be spent on anti-smoking and smoking cessation programs from this pot, but there are no dictates about how money is spent in the state budgets that are passed each June.

“The budget overrides the law,” said Edward Kazimir, an ardent anti-smoking campaigner who helped start the Comprehensive Tobacco Control Program in the state Department of Health and Senior Services when he worked there for more than two decades. “A lot of people don’t understand that just because we have a law that calls for spending on these things, that doesn’t mean it happens.”

Then there’s the landmark settlement the big tobacco-makers agreed to with state attorneys general in 1998 to put an end to all the Medicaid reimbursement lawsuits the companies were facing. Since New Jersey started receiving payments from this settlement in 2000, it has received no less than $220 million a year and as much as $405 million.

However, the master settlement agreement with the tobacco companies doesn’t mandate how states must spend that money. In New Jersey’s case, then-Gov. Jim McGreevey, for his 2004 state budget, borrowed against the cash New Jersey was to receive over 25 years to help plug a $5 billion deficit that year. So those funds are gone, dedicated to paying off debt.

“That tobacco settlement money was for tobacco treatment and prevention,” lamented Connie Greene, vice president of the Institute for Prevention with the Saint Barnabus Health System. “It was never written into the agreement that it had to be spent that way.”

“They (the states) simply have not kept the promise of the tobacco settlement in how they’ve used the money,” said Danny McGoldrick, vice president of research for the Washington, D.C.-based Campaign for Tobacco-Free Kids, which, among other things, keeps track of how much money states spend on anti-tobacco initiatives.

While New Jersey never allocated funding for anti-tobacco programs at the level recommended by the federal Centers for Disease Control and Prevention — most states haven’t — New Jersey got close before McGreevey mortgaged away the settlement money.

As recently as the 2003 budget year, the state was spending $30 million annually on programs to teach youths about the dangers of smoking and to help adult smokers break their addiction — about two thirds of the $45 million in spending the CDC recommended then for New Jersey. At that time, New Jersey was among the leaders in funding anti-tobacco programs.

The programs funded by Trenton included a pioneering website — njquitnet — for smokers trying to quit and who wanted to communicate with each other for support. There were quit centers at more than a dozen New Jersey hospitals that offered medical services and group and one-on-one counseling for smokers.

And there was REBEL, a grassroots program that started with high schools and eventually went into middle schools and colleges in New Jersey that focused on dissuading youths from trying tobacco.

None of those initiatives was funded in the 2010-2011 state budget, in which the amount allocated for anti-tobacco programs fell from $7.6 million the previous fiscal year to $600,000. And the njquitnet website is defunct. The state now allocates just 0.5 percent of the $120 million recommended for New Jersey by the CDC since it revised its state spending recommendations in 2007.

Dr. Fred Jacobs, director of the Quality Institute for the Saint Barnabas Health Care System and former commissioner of the state Department of Health and Senior Services under former Govs. Richard Codey and Jon Corzine, said even in the face of budget cuts during each of his three years as commissioner, he always preserved the $11 million in funding he had for anti-tobacco programs. He did so even while watching other programs in his department lose money.

“They (anti-smoking programs) were that important to me,” Jacobs says. “If you increase the smoking rate just 1 percent, the cost is in the billions of dollars. So even just from a financial sense, it’s worth it to spend the money . . . But when you talk to the (state) Treasury, they don’t look at it that way.”

At Saint Barnabus, the hospital system decided last year to maintain its two quit centers at Newark Beth Israel and Lakewood medical centers and its smoking cessation programs at all six of its acute care hospitals in Central and North Jersey even after the state funding went away. Jacobs said Saint Barnabus is committed to continuing the fight against smoking whether the state is or not.

“We’re the only hospital in the state to pick up all the funding for these services,” said Greene. “There are no services now throughout the state. I don’t know how patients in some regions are going to get the help they need.”

Jacobs says the worth of these programs is clear. Smokers trying to quit stand just a 4 percent to 5 percent chance of kicking the habit for good on their own. With medical and counseling help, like what is available at Saint Barnabus through the quit centers, smokers have a 40 percent to 45 percent chance of permanently breaking their addiction.

New Jersey is not the only state to face budget crises in the last few years.

“States, overall, just about all of them, are failing miserably at funding these programs,” McGoldrick said. “They’ve never done a good job with this, but it’s gotten much worse in recent years. The spending on these programs peaked around 2002 and, because of so many bad budget cycles, has gone down ever since.”

Still, New Jersey stands out from the pack in how much things have changed. By cutting $7 million in funding in one year, New Jersey fell from the 37th best state at funding anti-tobacco programs to the 46th best.

“If you look at our rankings for funding, New Jersey is near the bottom. New Jersey may have fallen the farthest over time,” McGoldrick said. “We used to hold New Jersey up as a model to other states for its programs. We don’t hold it up as a model anymore.”

“It is really devastating to the residents of New Jersey, who have no programs or very limited programs to help them quit,” said Deborah Brown, CEO of the American Lung Association for the mid-Atlantic region. “People in New Jersey are going to be paying for (the funding cuts) down the road.”

The numbers back up Brown’s assertion. Smoking-related health care costs total $3.17 billion annually in New Jersey, nearly $1 billion of which is picked up by taxpayers through the state’s Medicaid program.

According to McGoldrick, for every $1 spent by government on anti-tobacco efforts, at least $2 to $3 is saved in health care costs: “These are evidence-based programs that have shown results,” he said. “Ultimately, these programs pay for themselves.”

Oddly, while Jacobs, Kazimir and others credit that law with protecting the public health in New Jersey by ensuring that fewer New Jerseyans are exposed to secondhand smoke and by taking away some of the allure of smoking, they also acknowledge that the law may have made it easier for legislators and the governor to dismiss the value of funding anti-smoking programs.

Smoking is banned in virtually every public indoor place in New Jersey, so why is there a need to spend millions on anti-smoking programs? “That’s exactly what I’ve heard some legislators say,” Jacobs said.

Yet somehow, new customers for Big Tobacco are still being developed. Why? The tobacco companies spend about $226 million a year marketing their products in New Jersey, according to a study from the Campaign for Tobacco-Free Kids. Much of this advertising is targeted at high-school and college-age students, while some is aimed at other specific populations such as the poor and minority groups.

“In other states where they’re cutting or eliminating altogether funding for anti-smoking and smoking cessation programs, they’re seeing smoking rates go up,” said Brown of the American Lung Association. “Florida and Massachusetts are good examples. When they started to cut their funding, their smoking rates went right up. We’re heading in that direction.”

It’s unknown yet whether the remaining $600,000 in the state budget for anti-tobacco programs will stay or be among the proposed cuts when the governor presents his state budget later this month.

Either way, with so few state resources dedicated to this cause, Kazimir worries that Big Tobacco will renew its push to get black Americans and poor people in the state addicted to a habit they can ill afford.

“This is a socioeconomic problem,” Kazimir says. “The poorer you are, the more you smoke. The tobacco companies know that.”

Jacobs wants the state to at least preserve in 2012 what little funding it now has for its curtailed anti-tobacco programs.

And if the state cannot allocate any money in the next budget, Jacobs would like Gov. Chris Christie and legislators to at least come out and say that even though they can’t fund anti-smoking efforts that have a track record of success, they value anti-smoking programs and see them as a necessary public health mission for the state to act upon.

Leusner, the Health and Senior Services spokeswoman, indicated that the administration may see things differently.

“The Department of Health and Senior Services remains committed to tobacco prevention. The Department has combined its cancer and tobacco prevention efforts as a part of a comprehensive chronic disease management strategy. The commissioner believes that smoking cessation is most successful when done in a physicians’ office as part of preventive care and counseling.”

As to whether or not the state will fund anti-smoking programs in the future, Leusner said it’s impossible to know today what money will be available in the future.

To Jacobs, a pulmonary doctor for 40 years, the need for such funding from the state is clear.

“I see the ravages of smoking, or saw them on a day-to-day basis,” Jacobs said. “Smoking is the No. 1 preventable cause of death in the U.S. This is not a trivial or peripheral issue. This is the most important public health issue facing the United States.”

By Mike Daniels: 856-486-2418; [email protected]

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