Until recently, Arizonans could hardly turn on a television or radio without hearing a slightly self-righteous teen voice singling out smoking as a notably unattractive habit smelly and teeth-staining as well as an unhealthy one.
The riff was catchy, slightly disgusting, and highly effective: The American Lung Association credits the ads with helping to reduce teen tobacco use in Arizona by nearly 7 percent between 1997 and 2000. The US Centers for Disease Control and Prevention even touted the hard-hitting media spots as a national model.
But in the end, even widespread acclaim couldn't protect Arizona's Tobacco Education and Prevention Program from hard times. In these times of fiscal austerity, Arizona lawmakers who once touted the TEPP campaign found themselves raiding the program to fill a statewide $1 billion gap.
Across the country, states such as Arizona are tapping their antitobacco funds to make up budgetary shortfalls. Some of those funds come from the $246 billion settlement reached with tobacco companies in 1998. Others, such as in Arizona, are drawing from taxes on tobacco sales.
Either way, the controversial budget measures may muffle antitobacco programs, just as some of them are showing signs of success.
"In difficult times, lawmakers have to make difficult decisions about what and what not to fund," says Corina Eckl, fiscal program director of the National Conference of State Legislatures. "From the outset, there's been debate about how much of [the tobacco-settlement funds] should go towards antitobacco programs, and you won't find one single answer to that question."
Indeed, the choices aren't easy for lawmakers. In Arizona, state Rep. Robert Cannell (D), a pediatrician, says the tobacco funds were diverted to a struggling indigent healthcare program. It came down to tapping the antitobacco funds or denying certain crucial treatments to patients, he says. "I don't think it was an irresponsible decision."
The resulting antitobacco cuts soon rippled across Arizona, with local antismoking campaigns seeing their own share of state funding dwindle. In the northern Arizona city of Flagstaff, for example, schools will no longer receive popular "tobacco-free zone" signs, or the flashy "strong, fast, smart" antismoking posters that feature famous ballplayers.
Coconino County, which includes Flagstaff, will receive $100,000 less in antitobacco funds from the state. While officials tried to prepare for the expected shortfall by leaving staff vacancies unfilled, the reductions "mean that we've lost our ability to provide these necessary services to the community," says Barbara Worgess, director of the Coconino County Board of Health.
A similar controversy is swirling in Massachusetts, whose vigorous tobacco program is funded in part from voter-approved sales taxes on cigarettes. Hard-hitting ads that include testimonials from dying smokers are credited with helping reduce tobacco use by 5 percent in the 1990s. But now, Gov. Jane Swift is advocating large cuts in the program in order to address a $400 million budget gap. The American Cancer Society and other groups are suing, saying Ms. Swift has defied voters' intent.
And in California, Gov. Gray Davis has supported taking up to $60 million from the state's antismoking program to meet a $24 billion budget shortfall. The California program is credited with reducing youth smoking by more than 40 percent since 1996.
In some cases, these difficult budget decisions are at least partly determined by preexisting requirements. "We're seeing a lot more earmarked taxes: Money is being spent for specific purposes as a condition of raising the tax," says David Berman, professor of political science at Arizona State University in Tempe.
"The more we do that," he adds, "the more legislatures lose their discretion over funds. They don't have the revenue sources that they need."
That's led some states to tap funds awarded them under the tobacco industry settlements, despite pledges that the money would be dedicated to antismoking campaigns. A report by the National Conference of State Legislatures revealed that only 5 percent of settlement funds going to the states are being used to fight tobacco use.
Lyndon Haviland of the American Legacy Foundation, which was created out of the 1998 tobacco settlement, worries that the gutted programs may never recover. "There is a risk," she says. "It's hard to build an institution, a network of services. But it's even harder to rebuild it."
Whether experiments such as those in Arizona, California, and Massachusetts survive remains to be seen. While Arizona Gov. Jane Hull urged using antitobacco funds for other needs, "The governor's point is that when you're in tough economic times, core services health, safety, and education have to be maintained," says Hull spokeswoman Francie Noyes.
Still, the state's antitobacco funds "have been cut, but not eliminated," Ms. Noyes says.
Other measures may safeguard the programs, or at least save them from complete elimination. Many states including Arizona have proposed further raising tobacco taxes, with the proceeds earmarked for prevention efforts. In the Arizona Legislature, Representative Cannell is spearheading a ballot referendum to boost the state's tobacco tax by 60 percent. That measure goes before voters in November.