Reflections on a Noteworthy Tobacco Control Anniversary

NOTE: This was originally published by the author as a LinkedIn article on March 3, 2025.

Today marks the 25^th anniversary of an important footnote in the story of tobacco control in the United States and a critical milestone in my career. On March 3, 2000, Ohio SB192 was enacted into law establishing the Ohio Tobacco Use Prevention and Cessation Trust Fund which, over a 15-year period, was to receive $1.5 Billion (yes, with a B) from Ohio’s share of the tobacco master settlement agreement. The Fund was established to support comprehensive tobacco control efforts through an entity eventually known as the Ohio Tobacco Prevention Foundation (OTPF) governed by a board of politically appointed trustees.

OTPF was staffed by an incredibly talented and passionate team that developed a youth-focused counter-marketing and engagement program (stand), a statewide network of local tobacco coalitions, initiatives designed to address disparities in tobacco use including a partnership with the Ohio Department of Mental Health, and a robust research and evaluation portfolio. I joined OTPF in 2005 as its Director of Evaluation and Research, and it was my job to help assess the impact of OTPF’s programming. I recently looked through my personal records from this time and was reminded that the scale and volume of programs managed by the small OTPF team was remarkable.

OTPF also had BIG ambitions to better support adults who wanted to quit. Those ambitions culminated in “Ohio Quits,” a multi-million-dollar initiative designed to help tobacco users choose the type of quit support they believed would be most effective. In addition to our quitline and community quit programs, we funded a network of “gold standard” treatment centers in major Ohio health systems. Essential to “Ohio Quits” was an intake process that helped match people to the type of cessation support they thought would be most successful for them. We strived to create a national model for tobacco cessation that would maximize both reach and impact to dramatically reduce cigarette smoking.

Sadly, Ohio became one of the many states that backtracked from using MSA and/or cigarette tax revenues for public health purposes. In 2008, Ohio passed legislation that abolished the OTPF and moved most of its remaining assets ($230 Million) into the general revenue fund. “Ohio Quits,” stand, and the entire statewide tobacco control infrastructure was dismantled. That legislation also effectively fired me and many of my colleagues. Among the many examples of “broken promises” from state governments who fail to invest cigarette-generated revenue to support people who want to quit smoking, the case of the OTPF is a deeply personal one to me.

On this anniversary, I want to thank my wonderful OTPF teammates. I learned so much from you about public health, collegiality and kindness. Mike Renner, thank you for hiring me and giving me a life changing opportunity. To our grantees, contractors and research partners, I wish we could have seen the long-term impact you would have made. To the OTPF board members who fought until the bitter end to save us, please know that your staff appreciated your courageous leadership.

Reflections on funding tobacco control in the United States

My involvement with OTPF was the most formative experience of my career. I saw the incredible potential of a very well-funded state tobacco control program as well as the heartbreak of having to shut down the entire enterprise in a matter of weeks. My experience in Ohio was a powerful lesson that while state policy makers are consistently attracted to tobacco-generated revenue, they are incredibly fickle when it comes to helping people quit smoking and improving public health.

In an earlier era of tobacco control, roughly a quarter century ago, several states dedicated substantial public funds to tobacco control. The experiences of those states informed the development of CDC’s Best Practices for Comprehensive Tobacco Control Programs which includes a “minimum” and “recommended” funding level for each state. The thought was a simple one. CDC could give each state a target funding level and then health advocates would convince state policymakers to increase program funding to approach or meet that target. To see how incredibly unsuccessful this approach has been over the last quarter century, you can refer to this handy report developed by the Campaign for Tobacco Free Kids.

In many ways, public in the United States has failed to move into a new era of tobacco control. Tobacco control’s MSA-funded golden era has clearly ended, and I don’t believe anyone today expects a major infusion of public funds for tobacco control. We certainly cannot rely on governments to devote cigarette tax revenues to public health. It is time for public health to recognize states are unlikely to ever reach the CDC’s recommended funding levels and embrace strategies that will accelerate declines in adult cigarette smoking in the absence of substantial public funding.

In the current era of tobacco control, we do not need major public investments like the Ohio Tobacco Prevention Foundation. Today, in the United States, millions of people no longer smoke cigarettes and, instead, are using noncombustible nicotine products. Public health needs to support and help unlock the power of federal tobacco product regulation to ensure that more people who smoke cigarettes can quit, even if that means their use of other, safer nicotine products. Organizations concerned about public health should support FDA authorization of more products that provide safer alternatives to adults, and actively encourage adults who smoke cigarettes and cannot or will not otherwise quit to instead use these safer products. Doing so will not require any additional public funding for tobacco control and will help us finally end the epidemic caused by cigarette smoking.