Tobacco settlement seen as opportunity lost to curb cigarette use.

Tobacco settlement dollars are increasingly being used by states to shore up eroding budgets instead of for the purposes they were intended—to offset tobacco-related health care costs and institute tobacco control programs. Congress's investigative body, the General Accounting Office (GAO), reported in March that the 46 states party to the 1998 $206 billion Master Settlement Agreement (MSA) spent just 24% of fiscal 2003's earnings on health programs, and the states are expected to devote even less—17%—to such programs this year. Instead, states last year spent 36% of the $12.8 billion they collected to offset their budgets, and this year the GAO estimates that 54% of the $11.4 billion to be received will be used to address budget shortfalls. The federal report followed closely on the heels of the 40th anniversary of the U.S. Surgeon General's report that condemned smoking and launched a war against tobacco use, an event that has prompted soul searching among tobacco control " warriors, " as well as a little finger pointing. Whereas some see substantial progress in the war, saying smoking rates have been cut in half in the United States, others say much more should have been done by now. Grim Numbers The number of people who smoke, more than 46 million, is the same as in 1964 when the report was issued, critics say. They point out that between 1960 and 1990, deaths from lung cancer among women increased by more than 400% and by the mid-1980s began to exceed breast cancer deaths. Smoking still kills more than 440,000 Americans each year and is responsible for about 90% of lung cancer and up to one-third of all cancer deaths. More than 8.6 million Ameri-cans suffer from tobacco-induced illnesses and, in fact, one in every five deaths in America is smoking related, according to the Centers for Disease Control and Prevention (CDC). Cigarette smoking has long been known as the single most preventable cause of premature death in the United States. And even though public health researchers say they now know what works to curb tobacco use—compre-hensive programs that include combining school, health care, community, and media anti-tobacco marketing and such policy efforts as raising taxes on cigarettes and banning indoor smok-ing—most states do not engage in such approaches. The few that did have substantial tobacco control programs have mostly slashed them despite the influx of MSA monies. Many physicians and public health officials …