Smoking rate sources:
2001-2018: CDC, via United Health Foundation*New survey ethodology implemented in 2011 could affect the jump in smoking rates seen in 2012
Funding for the Tobacco Prevention and Cessation Commission comes from a settlement between the attorneys general of 46 states, five U.S. territories and the District of Colombia. The agreement requires manufacturers to allot a portion of their U.S. cigarette sales to a fund that is then split up among the involved states and territories each year in reparations for costs of tobacco use.
State House Rep. Todd Huston, R-37, said funding has to be balanced among many programs, and appropriated as needed based on administrative recommendations.
"We take a look at the best use of all the dollars and obviously, their constraints," Huston said. "There are special interest groups that have come forward with those types of requests (for tobacco control funding) but again, there are a lot of groups that come forward with requests for dollars and you just have to prioritize.”
Huston has served six years on the Ways and Means Committee, which decides where settlement funds should be distributed.
After leading in tobacco prevention funding in the early 2000's, Indiana is "backsliding," activists say.
In the 1990s, Indiana did not allocate any funding for tobacco control, according to a report for the Richard M. Fairbanks Foundation. But in 2001 and for three years afterward, the state's tobacco control funding met or nearly met the CDC-recommended amount.
When the state budget was passed in 2003, that funding was cut more than 60% and has been decreasing since.
A 2003 IndyStar article reported the tobacco prevention money was diverted after legislators chose to lessen the state's deficit and support economic development initiatives instead. The money was allocated to programs that hadn't previously received the funding, including the 21st Century Research and Development Fund and health services, the Star reported.
“We were making really great strides,” said Nick Torres, advocacy director for Indiana’s branch of the American Lung Association. “We just never have been able to recapture the same level of funding. Meanwhile… our rankings on health across the board are going down."
Huston said addressing tobacco control in different ways in the future is not off the table.
"Obviously, we all want a healthier population here in Indiana and we’d like to reduce tobacco usage," Huston said. "I know there’s a variety of ways that could be improved and we will continue to consider those ways.”
The CDC currently recommends Indiana should spend $73.5 million yearly in tobacco prevention and cessation programs. The suggested funding levels are determined by population and other state-specific factors, including the prevalence of smoking among adults and the number of local governmental health units in the state.
But today, Indiana only spends $7.5 million on tobacco control, despite raking in more than $550 million in revenue from cigarette manufacturers in the form of tobacco taxes and master settlement funds.
Total spending on tobacco control is Indiana, which Includes $2.2 million in federal funding, according to the American Lung Association, mounted to about $9.7 million in 2019.
By comparison, tobacco companies are spending about 30 times that on marketing, Campaign for Tobacco-Free Kids reports show.
"When you have an industry spending nearly $300 million and the state spending $7.5 million, it’s hard to compete with that message from the industry," said John Schachter, spokesperson for the Campaign for Tobacco-Free Kids. "It's amazing how irresponsible it is for policy makers not to spend more on tobacco prevention."
Currently, Indiana ranks 29th in the nation in tobacco spending. That said, the state still ranks higher than neighboring states Kentucky, Illinois, Michigan and Ohio.
Where the funding is going
More than half of tobacco taxes were distributed to the Indiana general fund in 2018. An additional 27% were distributed to the Healthy Indiana Plan Trust Fund, and the rest was split up among the Cigarette Tax Fund and funds for medicaid reimbursements, mental health centers, affordable housing and state retiree health benefits.
More than 75% of settlement funds are dispersed among health programs within the Indiana State Department of Health and the Family and Social Services Administration, including the $7.5 million for the Tobacco Prevention and Cessation Commission. The rest is allocated to hospitals, scholarships and the attorney general's office.
Master Settlement funding recipients in 2019
These funding recipients share $136 million given to the state by tobacco manufacturers in 2019 as part of the terms of a settlement agreement.
MSF FundingIndiana State Department of Health 46.86%
Family and Social Services Administration 34.92%
Capital Appropriations 9.14%
Other Appropriations 5.64%
Fund Reserves 3.44%
The Tobacco Prevention and Cessation Commission spent almost half of its $7.5 million budget on local community- and minority-based partnership grants in 2018. Another $1.4 million supported the Indiana Tobacco Quitline, a phone-based counseling service for smokers.
The rest of the funding was apportioned for public education campaigns and materials, other partnership grants, surveillance, administration and training.
The costs of spending less
In 2014, tobacco-related health issues cost the state more than 11,000 lives and $2.9 billion in medical expenses. More than 150,000 current Hoosier youth are expected to die from tobacco use in their lifetime, the CDC estimates.
Torres said to decrease healthcare costs all around and lead to better quality of life for Hoosiers, he said, the state must invest more money in tobacco control.
“Tobacco is the leading cause of preventable death and disease in the state,” Torres said. “Everyone in the state is bearing the cost of tobacco use. We all are supplementing insurance rates, healthcare costs, for tobacco related illnesses.”
The Campaign for Tobacco-Free Kids estimates tobacco use costs each household about $920 each year.
Keeping people off of tobacco products could stop common diseases before they start, Schachter said, saving lives and millions of dollars in healthcare costs.
"It's a lot harder to treat the symptoms than it is to prevent them in the first place," Schachter said. "When states choose not to spend anything close to what the CDC recommends, they're being penny-wise and pound-foolish. ... The issue is, states need to do what’s right for both the short term and the long term, and that’s invest in tobacco prevention.”