Louisville Courier-Journal

March 11 , 2008

Kentucky's anti-smoking efforts inadequate, critics say
Activists favor raising state cigarette tax

By Deborah Yetter

A Glasgow family physician, Sherry Jones said she too often sees a traumatic and costly outcome for her pregnant patients who smoke.

Going into early labor -- a risk associated with smoking -- they are whisked by helicopter or ambulance to Louisville or Lexington for delivery. The premature baby usually winds up in an infant intensive care unit at an average cost of $35,000 per infant.

"The number of pregnant women we see who smoke is just incredible,'' Jones said.

Kentucky ranks second highest in the nation for smoking among pregnant women and has the highest overall smoking rate in the country. Yet the state ranks 44th in the amount of money it spends to try to help people stop smoking, according to a recent survey by the Campaign for Tobacco Free Kids.

"It's woefully inadequate," said Mike Kuntz, with the American Lung Association of Kentucky.

As lawmakers debate whether to raise the state cigarette tax -- at 30 cents a pack, one of the nation's lowest -- they should also consider how to pour far more public money into prevention and cessation programs, anti-smoking advocates said.

Kentucky gets about $100 million a year from the nation-wide settlement with tobacco companies and spends about $2.4 million of that on smoking prevention and cessation programs -- or about $2 per smoker.

That's well below the $57 million a year the state should be spending on such efforts, according to a 2007 report by the U.S. Centers for Disease Control and Prevention.

Smoking in Kentucky

Kentucky has some of the nation's highest rates of diseases associated with smoking, including lung cancer, cardiovascular disease and respiratory illnesses, causing nearly 8,000 deaths a year, according to the CDC. Smoking-related illnesses total $1.5 billion a year in health-care costs, including nearly $500 million in the state Medicaid program.

Rep. David Watkins, D-Henderson, a family physician, agrees state lawmakers should do more to discourage smoking.

"A lot of time we prance around and dance around and say what all we've done but we really don't do anything," said Watkins, the sponsor of House Bill 443, which would raise the cigarette tax from 30 cents to $1.

Advocates say Watkins' bill could produce more money to help Kentuckians quit smoking and would discourage smoking because of the higher costs of cigarettes.

Robert Walker, with the University of Kentucky Center on Drug and Alcohol Research, noted that nicotine in cigarettes is very addictive and said that the state's current effort is not sufficient, given the high rate of smoking.

Most experts recommend classes or counseling, nicotine replacement therapy such as patches or gums, or prescription drugs, such as Chantix, a new medication designed to block a person's craving for nicotine, he said.

All health departments provide the classes and some -- but not all -- offer nicotine replacement therapy. Anyone can call a toll-free line operated by the state Cabinet for Health and Family Services that offers counseling and advice on how to stop smoking.

Lawmakers last year approved a program to establish a stop-smoking effort for the state Medicaid program, which serves some of the state's 722,000 poorest citizens, who have an estimated smoking rate of 40 percent.

But they never funded it, so the Medicaid participants -- with the exception of those in the Passport Health Plan, a Medicaid managed-care plan for the Louisville region -- get nothing more than the toll-free quit line or local health department programs.

Helping smokers quit

Passport, which the state hired to manage Medicaid in Jefferson and 15 surrounding counties, has started a pilot program for its members who smoke. It offers support and counseling and pays for nicotine patches or drugs, including Chantix, which costs about $130 a month.

Although the state won't pay for the program, Passport is offering it because so many of its members smoke, said Sherry Rumbaugh, a nurse who oversees the program.

Of the first 220 participants who joined the pilot last year, 100 remain smoke free -- an extraordinarily high success rate for people trying to stop smoking, she said. Because of the results, Rumbaugh said Passport is expanding the pilot to 800.

"We are ecstatic," she said.

Many participants report success with Chantix, including Deborah Eddie, 39, a 10-year smoker who said she was able to stop recently.

"I tried patches and gum," she said. "Nothing worked like this. It stops the craving -- you don't feel like you need a cigarette."

But outside Passport, smokers have limited options through public health programs in Kentucky -- partly because of the way the state divvies up the tobacco settlement money.

Of the approximately $100 million, 50 percent goes to "agricultural diversification" -- funding projects to help Kentucky farmers switch to crops other than tobacco.

The funds have helped farmers develop new crops and expand into new lines of livestock, said Scott Smith, dean of the University of Kentucky agriculture school and a member of the board that oversees the project.

It has also helped fund creation of farmers markets across the state that bring fresh produce to neighborhoods and provide a new outlet for local farmers.

The rest of the tobacco settlement money goes for early childhood programs and health services -- including the $2.4 million the state directs to prevent or help people stop smoking.

Among the early childhood programs funded is the popular "HANDS" project -- Health Access Nurturing Development Services, which sends nurses and trained workers into homes to help pregnant women and new mothers. The program has been credited for improvements in maternal and infant health, higher educational attainment and reduced child abuse and neglect.

Anti-smoking groups say all those programs are worthwhile, and they do not recommend changing laws that direct where that money is spent.

"We are not for opening up that law," said Tonya Chang, director of advocacy for the American Heart Association in Kentucky. "The single most effective thing we support is raising the cigarette tax."

Reporter Deborah Yetter can be reached at (502) 582-4228.