Alabama ranks high in number of smokers, low in money spent on prevention
by Eddie Burkhalter
Feb 09, 2014 | 3698 views |  0 comments | 53 53 recommendations | email to a friend | print
Grub Mart cashier Bernice Bragg stocks shelves with packs of cigarettes at the store in Jacksonville. (Anniston Star phot by Stephen Gross)
Grub Mart cashier Bernice Bragg stocks shelves with packs of cigarettes at the store in Jacksonville. (Anniston Star phot by Stephen Gross)
News last week that a national pharmacy chain will stop selling tobacco products was the sort of announcement health advocates would like to hear more often.

However, those advocates worry too many in Alabama still smoke, which costs the state millions each year in smoking-related health care expenses. The state also spends very little on smoking prevention programs, they say.

CVS Caremark announced Wednesday the chain will stop selling tobacco products at its 7,600 pharmacies by Oct. 1.

“I think it’s a great step in the right direction,” said Ginny Campbell, government relations director for the American Cancer Society Cancer Action Network in Alabama, speaking about the company’s decision.

Campbell explained that the pharmacy chain’s decision falls in line with the company’s desire to support customer health and well-being.

Campbell worries that Alabama isn’t doing enough to curb smoking, and she says the costs — both in money and in health outcomes — are too high.

Cost of tobacco

A 2011 study by the Institute for Social Science Research at the University of Alabama found that tobacco-related medical costs in the state that year were $1.6 billion. If that money was spent on education, it could provide more than 52,000 full-tuition, four-year college scholarships, according to the study.

A 2009 study by the Centers for Disease Control and Prevention found that in 2004, smoking-related Medicaid costs in Alabama were $285 million.

The study found 7,896 — or 18 percent — of all adult deaths in the state in 2009 were attributable to smoking.

The UA study also found that between 1996 and 2009 the percentage of adults who smoked in the state fell by only 3 percentage points, down to 25 percent.

Smoking among youth dropped drastically, however, in recent years. The study found that between 2000 and 2010 the number of high school-aged youth who smoked fell from 30.2 percent to 18.6 percent.

Alabama still scores poorly among other states when it comes to smoking. In 2011, Alabama ranked 42nd worst among states in terms of smoking prevalence, with about 23 percent of adults who smoked, according to the CDC. Alabama also ranked 42nd worst that year in the number of high school students who smoked, at about 22 percent.

Paying for prevention

In 1996, Alabama joined 45 states in a settlement with the nation’s major tobacco companies to recover some of the tobacco-related health care costs. Alabama is expected to get $87 million in tobacco settlement money this year, and an estimated $136 million in tobacco tax revenues during the 2014 fiscal year.

Campbell said that none of the money from the tobacco settlement is spent on tobacco use prevention and control, as required by the settlement agreement. “Which is a huge disappointment,” Campbell said.

The state will spend money from other sources on tobacco prevention, however, but at levels far below what health experts say is needed to reduce smoking.

A study released in December by a coalition of health organizations found that Alabama ranked 49th in recommended spending on tobacco prevention. The state will spend about $275,000 this year on such programs, which is less than one percent of the CDC’s recommended spending level of $56 million for Alabama.

Tobacco company advertising will outspend the state’s prevention programs this year 716-to-1, according to the study.

Where the money goes

Each year, Alabama spends the first $13 million of tobacco settlement money on bond payments for past economic development projects. The Children First Trust Fund — which spends the money on various programs that support Alabama children’s well-being — receives about 53 percent of the remaining settlement money, according to the fund’s website. About 31 percent is spent on the state’s Medicaid costs annually, which came to $29 million in 2012.

The state Department of Health receives about $4 million of the tobacco settlement money each year. “And all that money for the last couple of years has been spent on the Child Health Insurance Program,” said Dr. Jim McVay, director of the Bureau of Health Promotion and Chronic Disease at the state Health Department.

Spending on children’s well-being is worthwhile, Campbell said, but some of the money should also go to helping prevent them from smoking.

She believes it comes down to a lack of political will on the part of legislators to pay for smoking prevention, and budget shortfalls in programs the settlement money is spent on.

Reached by phone Friday, Brian Young, vice president of Young Oil, which operates 10 convenience stores in Alabama, said he couldn’t immediately say what percentage of his business’s profits come from tobacco sales, but profit margins in the category are low.

Tobacco pricing is largely set by the manufacturers, Young said, and it is a high-theft, high-inventory cost portion of his business.

“It’s a tough category, and I can understand CVS’s decision,” Young said.

With the increasing popularity of electronic cigarettes, Young said he could see a time when his stores stop selling tobacco products. But maybe not in his lifetime, he said.

Staff writer Eddie Burkhalter: 256-235-3563. On Twitter @Burkhalter_Star.

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