The 1998 Master Settlement Agreement: a public health opportunity realized--or lost?

On November 23, 1998, a legal settlement of historic proportions took place. The five major U.S. tobacco manufacturers signed an agreement with 46 states, the District of Columbia, and five U.S. territories to settle pending lawsuits by compensating the states for Medicaid costs of treating smoking-related illness. This multistate Master Settlement Agreement (MSA) seemed to herald a new era in public health as it provided a potential source of funds for state-based tobacco-control programs (estimated at U.S.$206 billion for the first 25 years) and also banned an array of advertising and marketing efforts to attract young people to tobacco. Five years after the settlement, however, it appears that most states have not committed a significant portion of the funds for tobacco prevention efforts but rather have used the money to support other state needs. Moreover, tobacco companies have continued aggressive marketing efforts to reach youth.