BOSTON -- Curbing teen tobacco use and publicizing the dangers of vaping get a lot of attention in Massachusetts, which has hiked age requirements to buy products, raised taxes and enacted some of the toughest regulations in the country.

But when it comes to overall spending on tobacco control, the state still gets failing grades.

That’s according to a new report by the American Lung Association, which raps the state for devoting too little from tobacco taxes and other sources of revenue to helping people quit.

Massachusetts collected more than $836 million in tobacco taxes in the budget year that ended June 30. That includes payments tied to a 1998 settlement with tobacco companies, according to the Department of Revenue.

But the state spent less that 1% of that money — about $4.6 million — on smoking cessation.

In recent years, Beacon Hill has put increasing amounts of the “sin tax” toward budget shortfalls and other programs, most of them unrelated to smoking.

“Unfortunately, the lack of funding leaves many adult smokers unable to get the cessation support and stymies our efforts to prevent kids from getting addicted to nicotine in the first place,” said Lance Boucher, the association’s senior director of state public policy. “The state has increased funding, but it’s still way short of what we need for a comprehensive and robust program.”

The state also gets federal funding for smoking cessation programs. It received $2.3 million in the previous fiscal year.

The U.S. Centers for Disease Control and Prevention recommends that Massachusetts spend at least 10.5% -- or about $67 million -- per year on anti-smoking programs.

The state also lost ground in other categories in the report, such as access to programs to help people quit. The lung association dropped its grade on access to smoking cessation programs from a “C” to a “D” from the previous year’s report. It dropped the state’s grade on the taxation of tobacco programs from a “B” to a “C” this year.

The lung association notes the state invests only $1.04 per smoker in its quit-line — a toll-free phone service to help smokers quit.

The average investment nationally is $2.14.

Granite State

Massachusetts isn’t alone in devoting a pittance to anti-smoking campaigns.

New Hampshire, where the cigarette tax is $1.78 per pack, collects nearly $246 million a year from tobacco sales and settlement funds. It spent about $360,000 on smoking cessation in fiscal year 2020, earning an “F” grade from the lung association.

The state also got $2.1 million in federal funding for smoking cessation programs.

The lung association also hit the Granite State with an “F” for not raising the minimum purchase age for tobacco and vaping products to 21, and a “D” for lacking access to smoking cessation programs.

“If this was a school report card, you’re probably hide it from your parents,” Boucher said. “These programs have been woefully underfunded in New Hampshire for years.”

In New England, Maine is the only state that funds tobacco control close to levels recommended by health officials. It collected $188 million from tobacco taxes and settlement money in fiscal 2020 and spent more than $11.8 million on anti-smoking efforts.

The lung association gave Maine four “A” grades for tobacco control, age restrictions, smoke-free air regulations and access to smoking cessation.

Despite its poor grades, Massachusetts is viewed as a “pioneer” by anti-smoking advocates for enacting some of the country’s toughest rules on tobacco and vaping products.

Last year, Gov. Charlie Baker signed a groundbreaking ban on the sale of flavored tobacco and vaping products, including menthol and mint cigarettes.

Prior to the bill’s passage, Baker declared a public health emergency and ordered a temporary ban on the sale of all vaping products, in part, as a response to injuries and deaths nationwide from a vaping-related illness.

The first-in-the-nation law also also sets a 75% excise tax on vaping products and requires insurers, including the state’s Medicaid program, to cover tobacco cessation counseling.

Tobacco control leader

Baker has raised the legal age to purchase e-cigarettes from 18 to 21, expanded a ban on workplace smoking to include e-cigarettes, and banned pharmacies from selling e-cigarettes.

“These are huge policy initiatives that have made Massachusetts a leader in tobacco control once again,” said Marc Hymovitz, Massachusetts government relations director for the American Cancer Society’s Cancer Action Network. “We’re not where we need to be on tobacco control funding, but we’ve definitely made progress in recent years.”

Hymovitz points out that Baker and legislative leaders have increased funding for tobacco control and cessation programs in the past several state budgets.

Recent data shows 41% of Massachusetts high school students have tried e-cigarettes at least once, according to the Campaign for Tobacco Free Kids.

About 20% of them reported using e-cigarettes in the past 30 days -- a rate six times higher than adults, the group says.

More than 9,000 Massachusetts residents die every year from smoking-related diseases, according to the CDC. Annual costs of tobacco-related illnesses have risen to $4 billion.

Nationally, smoking-related deaths top 400,000 a year, while health care expenditures are estimated at more than $170 billion.

Anti-smoking advocates say the federal government has done little to increase spending or enact policies aimed at curbing the death toll and mounting costs.

“Overall, the federal government is failing to protect kids,” Boucher said. “States need to be investing more in tobacco cessation and treatment to prevent the future costs to society.”

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites.

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