Patton has proposed spending $5.5 million over the next two years on smoking-prevention and cessation programs aimed at youths. The money would come from the $360 million Kentucky is expected to get from the national tobacco settlement during that period. The U.S. Centers for Disease Control and Prevention says Kentucky should spend at least $25 million a year if it wants an effective campaign to cut use of tobacco among youths. The state has the nation's highest percentage of teen-agers and adults who smoke. Leaders of anti-smoking groups credit Patton with taking a step in the right direction -- they just say it's a baby step. "This is the first time in history that tobacco and health are on a Kentucky governor's radar screen, and that's very, very important," said Carol Birgmann, executive director of Kentucky ACTION, a coalition of anti-smoking groups. But "we think we need more money" to mount an effective campaign. Patton proposes spending $2.5 million in the 2001 budget year, which starts in July, and $3 million in 2002 on the cessation effort. Under Patton's plan, the bulk of Kentucky's share of the national settlement money, paid by tobacco companies to avoid state lawsuits, would be used for such programs as assistance to tobacco farmers and early childhood development. Birgmann said all those concerns are worthy, but she also contended that Kentucky's rank among the 50 states makes it clear why a better-funded effort against smoking is needed. The CDC figures show 30.8 percent of Kentucky adults smoke, just ahead of Nevada's 30.4 percent, and that 47 percent of high school students said they had smoked at least one cigarette in the previous month. Birgmann said Kentucky must do more to help thousands of young people such as Tara Stinson and Josh Mills, 15-year-old freshmen at Allen County High School in Southern Kentucky who have been smoking for five years. Both Tara and Josh are taking part in a school program for students who want to stop using tobacco. "I smoke a pack and a half a day," said Tara, adding that she no longer plays softball and basketball because smoking leaves her winded. "I hope I can quit." Dr. Rice Leach, Kentucky's public health commissioner and a defender of Patton's plan, said the governor's proposal "is plenty of money to jump-start" a concerted anti-smoking campaign, adding that Patton is the first Kentucky governor to authorize state public health officials to move against youth smoking. Birgmann acknowledged that the governor's commitment is significant. But she said she doesn't think Patton is backing up his concern about tobacco's health consequences with enough money to reduce the numbers of young smokers in Kentucky. "We think Dr. Leach wants to do the right thing, but it's just not enough money," she said. The CDC has urged states to use their tobacco settlement dollars to pay for anti-smoking programs, and Kentucky ACTION had proposed spending $21 million a year for two years on campaigns aimed at teen-agers and pregnant women. The CDC says Kentucky should consider a comprehensive campaign, including school programs to help students avoid tobacco or stop smoking and ads to counter tobacco marketing. Birgmann said that Kentucky ACTION's plan would base most efforts in coalitions of community groups working with local health departments. Kentucky ACTION's statewide program would have a director and a board that would issue grants for community anti-smoking efforts. Those might include support groups and other efforts in the schools to help young people quit tobacco and ads on billboards, in movie theaters and on radio and television focusing on smoking's dangers. Patton's plan would build on existing programs and launch new ones using the state's medical structure, Leach said. For example, workers in family-planning programs could put more stress on the importance of stopping smoking before pregnancy, he said. The governor also would ask groups, such as doctors and hospitals, to devote more time to discouraging smoking, through such things as their own advertising. Dr. Michael Eriksen, director of the CDC's Office on Smoking and Health, said, "Kentucky probably has the worst problem in the country with respect to tobacco use." A comprehensive program is needed to cut smoking rates, he added. Asked about the adequacy of Patton's plan, Eriksen said, "I would say that a multimillion dollar commitment to tobacco prevention is a good first step," but "this is a fraction of what we estimate is needed" to bring down rates. Dr. Melinda Rowe, president of the Kentucky Public Health Association and director of the Jefferson County Health Department, made a related point. "The disappointing part," she said, is that the settlement presented "a once-in-a-lifetime opportunity to do something about smoking in Kentucky. . . . Maybe we in public health failed to inform the executive how important this is, and how effective some programs can be." According to the CDC, the few states that have succeeded in reducing smoking spend significantly more money than Patton has suggested. For example, Dr. Greg Connolly, director of the Massachusetts Tobacco Control Program, said last week that his state spends $58 million a year on tobacco programs and has been able to reduce teen smoking by 15 percent, adult smoking by 24 percent, and cigarette consumption by 35 percent. Asked about Patton's proposals, Connolly said, "I don't want to get in a fight with the governor." But he added: "Kentucky has a very serious problem. The health of its citizens shouldn't play second fiddle to other issues, in my opinion." California has spent more than $500 million to reduce use of tobacco since it increased the tax on cigarettes by 25 cents a pack in 1988 and earmarked 20 percent of the money for tobacco programs, including statewide media campaigns. The tobacco control section of California's health department says that in eight years the efforts have led to a 33 percent decline in smokers, to 18 percent from 27 percent, and a 42 percent drop in the number of cigarettes the typical smoker puffs. Among Californians ages 12 to 17, smoking rates increased from 8.7 percent in 1992 to 12 percent in 1995, but then started declining, dipping to 10.7 percent in 1998. Cigarette excise taxes by themselves have been credited with cutting smoking by making it more expensive. Kentucky's tax on cigarettes is 3 cents a pack. Only Virginia's, at 21/2 cents, is lower. Studies indicate broad-based, well-funded efforts, including advertising, can reduce smoking. A 1998 report by researchers from the University of California in the Journal of the American Medical Association concluded, "A strong media campaign is a key element of any tobacco control effort," and can influence people to quit. The same study said cigarette consumption in California, which had been declining before programs there began, dropped about 500 million packs more than had been predicted from past trends after anti-smoking advertising campaigns began. States have been anything but uniform in their use of the tobacco settlement, however, and there are no restrictions on what they can do with the money. The Campaign for Tobacco-Free Kids, which favors use of the settlement money on anti-smoking programs, reports 30 states have decided how to spend their settlement share. Eight committed a substantial part of the money to prevention. New Jersey, for example, has decided to spend 20 percent of its money on reducing tobacco use. Eleven committed small amounts to prevention. Five others put their funds in trust for a range of purposes, including prevention in some cases. The final six decided to use all the money for efforts unrelated to smoking. Dr. Harry Carloss, a Paducah oncologist and president of the 5,000-member Kentucky Medical Association, said the governor's proposal has some good points, even if it falls short of the $21 million-a-year campaign the KMA called for. "But I don't think it's a disaster," Carloss said, adding that Leach had told him that Patton was committed to reducing smoking. "To me, (that) the governor's saying it's time to stop teen smoking in Kentucky is more important than a dollar amount." Josh Mills, one of Allen County students in the American Lung Association Not On Tobacco program, said he wants to quit "for the health reasons and stuff like that." "There are heart problems in my family," he said. But he thinks the state should hit against smoking early, so elementary school students will know about tobacco's dangers. "We need to tell them what it can do to you," Josh said.

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