Arkansas will spend more money than most neighboring states this fiscal year to curb smoking rates and steer kids away from taking up the addictive, cancer-causing habit, according to a report released Friday.
But dogged by some of the nation's highest smoking rates, Arkansas still spends far less than suggested to reduce tobacco use, according to the national review by the Campaign for Tobacco-Free Kids and other groups.
Titled "Broken Promises to Our Children," the report provides a state-by-state look at tobacco-prevention and -cessation spending 20 years after the major 1998 settlement of a lawsuit that 46 states filed against the largest cigarette manufacturers.
The report gauges public spending, smoking rates and tobacco companies' marketing budgets -- taking stock of an advertising battleground that has transformed from decades ago, when ubiquitous ads portrayed cigarettes as hip while downplaying health risks.
Cigarette and smokeless tobacco companies still spend in excess of $9 billion a year to market their products in the U.S, mostly through price discounts paid to retailers, direct marketing to consumers and "point of sale" tactics, according to the federal Centers for Disease Control and Prevention.
States will collect three times that amount -- $27.3 billion -- from the 1998 settlement and from tobacco taxes this fiscal year, according to the report. The current fiscal year, fiscal 2019, began July 1 and will end June 30.
States have budgeted a combined $655 million for programs to stop and prevent tobacco use, about one-fifth of the $3.3 billion recommended by the CDC.
Arkansas will take nearly $283 million from the settlement and tobacco taxes this fiscal year and spend $12 million on anti-tobacco programs, the report says.
The $12 million Arkansas will spend on prevention and cessation is close to one-third of the $36.7 million the CDC recommends, according to the national report.
No state meets its recommended spending level on tobacco prevention, and only four spend at least 50 percent of their CDC guidance amounts. Alaska, which budgeted for 89 percent of the suggested total, is tops in the U.S., followed by California, North Dakota, Oklahoma and Delaware.
Arkansas ranks 14th nationally in how much it spends as compared with its recommended amount, better than all of its neighbors except Oklahoma.
The reason Arkansas spends more than most neighbors is in part because of the voter-approved Tobacco Settlement Act of 2000, said Joy Gray, chief of the Arkansas Department of Health's tobacco and cessation branch.
The legislation requires that tobacco settlement money be spent on health-related matters, including anti-tobacco programs, targeted public health programs, Medicaid and research.
Gray said she believes Arkansas is the only state that dedicates all of its settlement money to health-related issues. Other states, particularly in the South, spend the funds on a wider array of government services, Gray said.
"One of the reasons why the other states don't have that money to spend is because they've used their [settlement] funds on roads, bridges, infrastructure and things like that," Gray said.
Arkansas this year began an overhaul to its stop-smoking efforts, under the new slogan "Be Well Arkansas," Gray said.
State-employed counselors last month began helping people who call the stop-smoking hotline or sign up online, replacing staff from an outside vendor, Gray said.
"Instead of going to an outside vendor, it goes into the building," Gray said, adding that Arkansas is the only state in the country to take this in-house approach. "They provide a really personalized level of service to these folks."
The new arrangement also allows the counselors to provide referrals to callers suffering from ailments caused or worsened by tobacco use, such as diabetes or hypertension, Gray said.
Gray's goal is to staff each of the state's 94 local health units with at least one nurse focused on smoking cessation, she said.
Stop-smoking plans are unique to each person and can include counseling sessions and may include nicotine patches or lozenges, she said.
Arkansas is also shifting its smoking-cessation messaging, focusing on "good things that can come from being well as opposed to all the dire things that happen if you continue smoking," Gray said.
"People report being kind of fatigued at some of the extreme messaging," she said.
Since 2001, Arkansas has received more than $1 billion from the tobacco settlement, according to Attorney General Leslie Rutledge's office.
This fiscal year's settlement-only take is $57 million, according to figures provided by Matt Gilmore, director of the Arkansas Tobacco Settlement Commission. That sum is split among health-related initiatives, with the largest chunk, $17.8 million, going to Medicaid.
Taxes on cigarettes, cigars and other tobacco products in Arkansas are mostly collected as state general revenue.
Dr. Alan Blum, a family physician and director of the Center for the Study of Tobacco and Society at the University of Alabama, critiqued the national approach to stopping tobacco use.
Blum lamented that public health officials and anti-tobacco crusaders, including himself, have spent decades describing the problem -- the harmful effects of smoking -- rather than solving it.
"It's almost like somebody has a gun pointed at them, and the public health [officials] go up to them and beg them to 'duck' or 'look out' as opposed to taking away the gun," Blum said.
Blum also noted that through tobacco taxes and settlement funds, states are finding themselves more and more dependent on revenue generated by tobacco sales.
Tobacco companies will spend an estimated $116 million in Arkansas this fiscal year on marketing, according to the Campaign for Tobacco-Free Kids report.
Barred from television or billboard advertising, the companies spend most of their marketing dollars on price discounts paid to retailers and wholesalers, according to the CDC. They also pay for prime shelf space and signs behind the counters at retail shops, such as convenience stores.
Companies also appeal directly to consumers, soliciting personal information such as mailing addresses in exchange for coupons.
Such targeted approaches spare companies the "grief or pushback" that accompanied broader campaigns of decades ago, Blum said. Examples include companies placing "Marlboro Man" or "Joe Camel" on billboards, sponsoring kids television programs or buying up ad space inside sports arenas.
"They're still targeting people, but it's much more sophisticated," Blum said. "It's even, in many ways, better for them. They aren't violating any ethical [norms or] law. There's nothing preventing them from doing anything they're now doing."
About 22 percent of adults and 14 percent of high-school students smoke in Arkansas, according to the report. Nationally, those rates have hit record lows of 14 percent and 7.6 percent, respectively.
About 5,800 Arkansas residents die each year from causes attributed to smoking, according to the "Broken Promises" report, and the state spends $1.2 billion a year on health care costs related to smoking.
Metro on 12/15/2018