Restore Comprehensive Funding
| Read the full State of Tobacco Control report for Washington State by the American Lung Association |
Our Focus
Washington Breathes and its partners collaborate to ensure Washington State restores its support of sustainable, well-funded community programs that reduce commercial tobacco use and nicotine dependence. These programs should be effective, culturally-appropriate, and address inequities to adequately protect communities from tobacco industry tactics.
| Check out our Fact Sheet: Washington Invests Too Little in Preventing & Treating Nicotine Dependence |
Surgeon General's Report on Tobacco-Related Disparities
A November 2024 report "Eliminating Tobacco-Related Disease and Death: Addressing Disparities" explains the factors that drive tobacco-related health disparities and recommends strategies and programs to end them.
Data Snapshot
- In FY 2022 and FY 2023, Washington State ranked 45th and 33rd, respectively, for its state investment in commercial tobacco prevention and cessation treatment. In FY 2024, WA fell back to 39th because the level of state support decreased again. 1
- $847.6 million in state Medicaid program health expenditures are caused by commercial tobacco use.
- From 2012-2022, less than 1% of tobacco-related Washington state revenues were invested in nicotine prevention and cessation.
- $3.26 billion in annual health care expenditures are directly caused by commercial tobacco use.
Why A Comprehensive Program is Essential
We know that programs to prevent youth vaping, reduce smoking disparities, and equitably provide cessation services cannot be successful without sustained investment over time. A comprehensive and well-funded state program is essential for:
- Providing evidence-based and equity-focused treatment, prevention, and education services in all communities;
- Reducing known disparities in populations that are targeted by the tobacco industry and systemically disadvantaged; and
- Protecting our children, teens, and young adults from the industry’s pervasive e-cigarette marketing that fuels the vaping epidemic, especially among those who are Native American, Alaskan Native, people of color, and LGBTQ+.
Proven Success of a Comprehensive Approach
Washington was a national leader in reducing smoking and improving health in the early 2000s because of state investments that protected communities and helped people quit nicotine. From 2000 to 2009, about $23.6 million of state funds were invested each year in the Department of Health’s comprehensive prevention and cessation program that supported community-based programs, school-based programs, cessation services, retailer education and compliance to prevent youth access, and public awareness campaigns. As a result:
- Overall smoking rates fell 22.5% to 17.6% and youth smoking fell 12.5% to 7.8% from 2001-2005.2 These results exceeded national declines during the same time.
- Each $1 spent by the state on tobacco prevention and control saved more than $5 in tobacco-related health care costs from 2000-2009.3 Hospitalizations for heart disease, stroke, respiratory disease and cancer caused by tobacco use were reduced during this time.
Components of a Comprehensive State Strategy:
Community-based Programs
to provide resources to all communities and counties for locally-informed programs that support the most impacted communities and reduce health disparities
School-based Programs
for educational curricula, prevention support systems, effective intervention policies, referral systems for youth vaping cessation, and data gathering for assessments and evaluations
Cessation Support
for youth and adults with multiple access points to counseling and local programs. These programs should connect with underserved communities, fund free nicotine replacement therapy (NRT) to more Medicaid patients, and improve culturally appropriate outreach.
Retailer Education & Compliance
through well-supported retailer outreach programs at state and local levels and improved monitoring of Internet retailers
Public Awareness & Education
through social and mass media campaigns targeting youth grades 4-12 and adults interested in quitting to help counterbalance the tobacco industry's $87 million annual advertising budget in Washington State
Assessment & Evaluation
for more specific data collection and accurate assessments of most impacted subpopulations and program evaluation for ongoing improvements
This is a model strategy that Washington needs to reinvest in. The seven-year program plan was developed through an inclusive process and is described in A Tobacco Prevention and Control Plan For Washington State (September 2000).
Hard Consequences of Funding Cuts
Lack of sufficient investment has slowed the state’s progress towards reducing smoking and other nicotine use, especially in communities with the highest tobacco use rates.
State funding for commercial tobacco prevention and cessation was dramatically cut during the Great Recession in 2009, and has not been restored to support the proven comprehensive strategy outlined above. Program funding went from an average of $23.6 million per year (2000-2009) to an average of $2.3 million per year (2012-2022). Successful programs were scaled back or shut down, and many experienced staff could not be retained.
Washington received more than $500 million in tobacco tax revenues and Master Settlement Agreement payment in FY 2022.
None of these revenues are dedicated to helping people who want to stop using nicotine products, supporting nicotine-free youth, or countering the constant onslaught of enticing new products from the tobacco industry.
From 2012-2022, less than 1% of tobacco-related Washington state revenues were invested in nicotine prevention and cessation.
The pie chart above shows distribution of revenues for FY 2022.4
Since FY 2020, revenues from the vapor products tax have been allocated 50% to the Andy Hill Cancer Research Endowment and 50% to Foundational Public Health Services (FPHS). FPHS funding supports critical governmental public health infrastructure, but does not directly fund commercial tobacco prevention or cessation programs. In FY 2023, revenues linked to cigarettes sales decreased, resulting in total tobacco-related revenues to the state of $429 million. Use of some MSA funds to pay off bonds was completed in July 2024.
Consequences of state cuts to commercial tobacco prevention and cessation:
- Reduced ability to address known inequities. Many communities were left behind in the state’s progress to reduce smoking, even as they are the most targeted by tobacco companies and disproportionately suffer from higher use rates, chronic diseases, and premature death. These disparities impact people who are American Indian/Alaska Native, Black/African-American, Hispanic, Latine, Asian, Pacific Islander, LGBTQ+, veterans, lower income, and people with behavioral health concerns.
- Reduced ability to pivot with the industry’s e-cigarette push. Resources and staffing for community-based prevention programs are too limited to effectively counter the influx of flavored e-cigarettes and the resulting dramatic increase in nicotine dependence among youth and young adults.
- Reduced capacity to sustain effective programs and experienced staffing. Funding limitations and uncertainties dismantled the successful statewide program built from 2000 to 2009. Across the state many committed professionals continue trying to do all they can with limited resources and need ongoing support to rebuild effective programs.
"People are doing the best they can to make things work...you can't get good at this job when you have no funding or limited resources"
WA State Commercial Tobacco Prevention Program Contractor, 2022
Funding History
- 2000-2008: Washington State invested in a comprehensive commercial tobacco program that was a successful model for the nation.
- 2009: In response to the 2008 recession, Washington eliminated all general fund support and all funding from the tobacco industry’s annual Master Settlement Agreement payments.
- 2012-2022: Program funding averaged only $2.3 million per year, compared to an average of $23.6 million per year from 2000-2009. The state's successful program was dismantled, just as e-cigarettes and the vaping epidemic began impacting communities.
- 2023-2024: Washington received another F grade for Tobacco Prevention and Cessation Funding in the American Lung Association’s annual State of Tobacco Control report. Washington has received an 'F' grade since at least 2017.
- FY 2024-2025: New state investment of $5.5 million is a promising sign, but still falls short of adequate support to meet community needs.
Meanwhile...the industry spends more than $80 million a year in Washington to market its addictive and deadly products.5
The Legislature's Recent Critical Investments in Public Health Have Not Funded Commercial Tobacco Prevention or Cessation
Washington State's Foundational Public Health Services funds critical, core services for public health and safety provided by Washington’s governmental public health system (state, local, and Tribal). However, none of the funds from the Foundational Public Health Services account are currently allocated to commercial tobacco education, prevention programs, or cessation services. Supporting the public health system indirectly benefits commercial tobacco prevention and cessation through health assessments, data systems, improving access to clinical care, and other services that support healthy communities.
Earlier reports to the legislature recognized commercial tobacco prevention and cessation as key parts of Foundational Public Health Services, but this goal has not yet been realized. The 2016 FPHS Report to the Legislature on Public Health Modernization and the 2014 FPHS Final Phase II Technical Workgroup Report, detail recommended models and funding plans to support commercial tobacco prevention & control.
Sources
- Campaign for Tobacco-Free Kids: States Ranked by Percent of CDC-Recommended Funding Levels.
FY 2022 State Rankings https://assets.tobaccofreekids.org/content/what_we_do/state_local_issues/settlement/FY2022/1_FY2022_Rankings.pdf
FY2023 State Rankings: https://assets.tobaccofreekids.org/content/what_we_do/state_local_issues/settlement/FY2023/1-FY2023-Rankings-of-Funding-for-State-Tobacco-Prevention-Programs.pdf
FY 2024 State Rankings: https://www.tobaccofreekids.org/what-we-do/us/statereport/washington, accessed January 2024. - Julia Dilley, et al. “Effective tobacco control in Washington State: a smart investment for healthy futures.” Prev Chronic Dis 2007 Jul;4(3):A65. https://pubmed.ncbi.nlm.nih.gov/17572969/
- Julia A. Dilley, et al. “Program, Policy, and Price Interventions for Tobacco Control: Quantifying the Return on Investment of a State Tobacco Control Program”, American Journal of Public Health 102, no. 2 (February 1, 2012): pp. e22-e28. https://doi.org/10.2105/AJPH.2011.300506
- Sources for tobacco-related revenues and distributions:
Annual Tax Revenues from WA Dept. of Revenue, see Tax Statistics report on https://dor.wa.gov/about/statistics-reports
MSA payments to states: National Associations of Attorneys. General MSA Payment Information https://www.naag.org/our-work/naag-center-for-tobacco-and-public-health/the-master-settlement-agreement/msa-payment-information/ see “Payments to the State since Inception through April 18, 2024”
Youth Tobacco and Vapor Products Prevention Account revenues are taken from enacted WA Operating Budgets. These revenues are from WA State tobacco license fees and fines. A portion of these revenues is allocated to the state’s Commercial Tobacco Prevention Program, see RCW 70.155.120.
State appropriations to WA Department of Health’s Commercial Tobacco Prevention Program are stated in enacted WA Operating Budgets, combining appropriations from the Youth Tobacco and Vapor Products Prevention Account and State General Fund dollars. - U.S. Federal Trade Commission (FTC), Cigarette Report for 2022, October 2023; FTC, Smokeless Tobacco Report for 2022, October 2023; FTC, E-Cigarette Report for 2021, April 2024. State total marketing is a prorated estimate based on cigarette pack sales in the state, as reported by the Campaign for Tobacco-Free Kids on their Toll of Tobacco in Washington webpage (last accessed September 3, 2024).