State tobacco revenues compared with tobacco control appropriations--United States, 1998-2010.

In 1999, CDC published Best Practices for Comprehensive Tobacco Control, which outlined the elements of an evidence-based state tobacco control program and provided a recommended state funding range to substantially reduce tobacco-related disease, disability, and death. Best Practices recommended that states invest a combined $1.6-$4.2 billion annually in such programs and subsequently updated that recommendation to $3.7 billion annually in 2007. To analyze states' historical investments in tobacco control and calculate the amount of funding necessary to achieve Best Practices recommendations, CDC tracked data from 1998 to 2010. During this period, states collected $243.8 billion in total tobacco revenues from tobacco industry settlement payments and cigarette excise taxes. State and federal appropriations for tobacco control totaled $8.1 billion, whereas CDC's Best Practices recommended funding of at least $29.2 billion ($1.6 billion for 9 years plus $3.7 billion for 4 years). For the entire study period, the ratio of state tobacco revenues to state and federal tobacco control appropriations was approximately 30 to 1 ($243.8 billion to $8.1 billion); in 2010, the ratio was approximately 37 to 1 ($23.96 billion to $0.64 billion). If states allocated funding for tobacco control at Best Practices levels, they could achieve larger and more rapid reductions in smoking and associated morbidity and mortality.