Unmet priority population needs in tobacco control: large disparities--little Master Settlement Agreement dollars.

Abstract

his section of the journal explores variousapproaches and the failure of the Master Settle-ment Agreement (MSA) to meet tobacco controlneeds of priority populations. Many factors make thesepopulations particularly vulnerable. Some groups haveexperienced an extraordinary growth in the past 10years, namely, Hispanic/Latino and Asian and PacificIslanders (U.S. Bureau of the Census, 2000), increasingtheirpurchasing powerandbecomingmoreattractivetothe tobacco industry. Others experience high preva-lence rates sometimes double that of the generalpopulation, such as American Indians, Vietnamese,gay/lesbian/bisexual/transgender (Joint Ethnic TobaccoEducation Networks [JETEN], 2003; Ryan, Wortley,Easton, Pederson, & Greenwood, 2001) and low socio-economic status (SES) communities (U.S. Departmentof Health and Human Services [USDHHS], 1998). Oth-ers suffer a disproportionate burden of tobacco-relateddiseases, such as African Americans, lesbian/gay/bisexual and transgender (LGBT) community, andAmerican Indians, experiencing premature death, lostproductivity (Max, Rice, Zhang, Sung, & Miller, 2002;USDHHS, 1998), higher rates of lung cancer mortality,cardiovascular disease, and asthma (JETEN, 2003).However, they benefit less because of lack of fundingfrom the MSA and other health care dollars going spe-cifically to these groups.The current financial crisis of many states has fueleda controversial debate on how to best spend MSA andother tobacco funds (Givel & Glantz, 2002; Schultz,2002). The public believes a significant proportion ofdollars should go toward tobacco control (Batra, Patkar,Weibel, Pincock, & Leone, 2002). However, at its best in2000, tobacco prevention allocations were limited toonly 9.2% of the revenues obtained from the settlement(Bergman, 2003). In most states, tobacco control needsof priority populations have been chronicallyneglected. Tightening of state budgets with the elimina-tion of tobacco control and other health programs sig-nals a potentially severe health crisis. The NCSLreported that only 3% of MSA moneys would be allo-cated in 2004 for tobacco prevention (Bergman, 2003).Thisisnotenoughtomeetoveralltobaccocontrolneedsin the future. Priority populations maywell be the hard-est hit. The cost of treating smoking-related diseasesand the lost productivity from smoking-related deathsis calculated at approximately U.S.$15.8 billion annu-ally, in California alone (Max et al., 2002), a state withhigh protection against smoking. The costs to the nationare anticipated at well over $100 billion dollars a year.At a time when foundations have also eliminated orlargely reduced their tobacco control funding and thestatesutilize themoneystodealwiththeirbudgetcrisis,who will protect the health of citizens in each state?In this section the article titled, “More Money MoreMotivation? Master Settlement Agreement and TobaccoControl Funding in Communities of Color” the authorsdocument historical factors, institutional barriers, andthe state of MSA funding for priority populations. Theypresent three model approaches to achieving fundingparity in tobacco control for priority populations. “AnAnalysis of Tobacco Industry Marketing to Lesbian,Gay, Bisexual, and Transgender (LGBT) Populations:Strategies for Mainstream Tobacco Control and Preven-tion” describes the “short but turbulent” targeting bythe tobacco industry of the LGBT populations, resulting