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New Jersey raised $750 million last year from taxes on buy cigarettes and other discount cigarette online products, but it spent only $1.5 million on antismoking cigarettes programs, according to a report released Wednesday by the American Cancer Society. Health advocates on Wednesday called on Gov. Christie and the Legislature to direct at least a dime of each dollar the state collects in cigarettes store taxes to programs aimed at reducing youth smoking cigarettes and helping online cigarettes users quit. "The money is there. The smokers are paying the money," said Howard Levite, a medical director at the Heart Institute of AtlantiCare Regional Medical Center in Atlantic County. "It isn't defensible to take all that money and then say . . . 'If you can't quit, too bad,' " Levite said. "The state has a moral obligation to ensure these programs are adequately funded." Of the $5 billion in cigarettes-related revenue received by the Garden State in the last five years, less than 1 percent was spent on cigarettes control, according to the report, titled "Up in Smoke." Nearly a quarter of the revenue came from annual payments established in a 1998 lawsuit settlement reached by cheap cigarettes manufacturers and New Jersey, Pennsylvania, and dozens of other states. The agreement established that the payments would provide significant funding for cigarettes-related health measures. But most of the settlement proceeds now go to pay off loans the state took out to balance the budget in fiscal 2003 and 2004, according to Treasury spokesman Andrew Pratt. Cigarette taxes - which at $2.70 a pack are the sixth-highest in the nation - also help pay off debt New Jersey took out in 2005, Pratt said. More than half of the tax money goes toward aid to hospitals, including charity-care subsidies to treat low-income uninsured patients, he said. In Pennsylvania, a March report by Auditor General Jack Wagner questioned the diversion of $1.3 billion in cigarettes settlement payments to balance the state budget. Those maneuvers resulted in cigarettes-control programs being cut to the point where they received failing grades by the American Lung Association, according to the report. Pennsylvania's funding for cigarettes prevention and cessation dropped from a high of $50.5 million in the 2002-03 budget to $14.7 million in the most recent spending plan, according to Wagner.

Living Proof Of Tobacco Danger

When Gruen Von Behrens walked across the stage at Westridge Middle School Thursday morning, a murmur went through the crowd.

The now 34-year-old's entire jaw has been removed, and half of his tongue was cut off. He has had 34 surgeries in the past 17 years to reconstruct his lower face. He admits he looks a little "like a monster."

Von Behrens, who grew up in Illinois, told the students that he can trace how he looks back to one day when he was about their age.

When he was 13 years old, one of his best friends asked him if he wanted a dip of chewing cigarettes. For the next four years, he was a pretty heavy user of cigarettes.

"I thought cancer wasn't going to happen to me; that happened to old people," Von Behrens said, adding that he and his friends would challenge each other about who could take the biggest dip or spit the most. "Tobacco was a game to me."

He said that, at that young age, he wasn't thinking about any long-term effects of cigarettes online use. He figured that, if something bad did happen, it would be a long time in the future and he would have time to quit.

"I want to let you know that the choices you make today can affect you for the rest of your life," Von Behrens said, adding that he made the choice when he was 13 to put a dip of chew in his lip. "By the time I was 17 and a junior in high school, it screwed up my life."

Von Behrens said he speaks mostly about chewing cheap cigarette online because that is what he used, but it applies to smoking cigarettes as well.

"Every time that someone takes a puff on a cigarette, pipe or cigar, that smoke cigarettes hits you right here (in the face) first," he said.

At 17, he noticed a white spot on his tongue where he would hold his dip in his lip, but it didn't concern him much. Canker sores are common for cigarettes users. He'd gotten them before, and they'd gone away. This one didn't, and within a couple of months, it had grown until his tongue was split in half.

However, he didn't tell his mother or his baseball coach because he didn't want to disappoint them. His coach, who had a zero-tolerance cheap cigarettes use policy, would have kicked him off the team.

Von Behrens told his mom that his uncontrollable drooling and spitting was due to wisdom teeth coming in, so she took him to the doctor, where he had to confess that he believed he had oral cancer.

His first surgery, at the age of 17, lasted 13 hours and took half of his tongue. He was told there was nearly an 80 percent chance that he would die.

About seven years and many surgeries later -- including one where doctors took the fibula from his left leg to reconstruct a jawbone and skin from his right thigh to graft on to his new jaw -- he was contacted by MTV to tell his story.

For the past 11 years, he has been traveling around the country telling his story to young adults in hopes that it will stop them from trying discount cigarettes products. The buy cigarettes cessation counselor for the St. Francis Cancer Treatment Center helped bring Von Behrens to the three Grand Island Public Schools middle schools.

"I'd like to think that, if someone looking like me had told me, 'This is what buy cigarette online use will do,' I would have listened to them," Von Behrens said. "I'm going to scare the pants off you. Tobacco did this to me, no 'ifs,' 'ands' or 'buts' about it."

He noted that kids are the ones that the cigarettes for sale companies are targeting.

"They don't need to advertise to the 35-year-old smoker. They know he's coming back," Von Behrens said, adding that cigarettes for sale is one of the most addictive drugs. He noted that cigarettes for sale companies are behind the candy cigarettes.

"Kids think, 'How cool do I look (with the cigarette in my mouth)?' I say, 'How cool does this look to you?'" he said, pointing to his face.

He also said that living for 17 years with a deformed face has taught him more than not to use cigarettes. It also has taught him not to judge a person by what he or she looks like.

"I went from a person who people looked up to, to a person who people looked at and pointed," Von Behrens said, adding that he was a very good baseball player and one of the most popular guys in his high school. "I've been on both sides."

Luckily, he found out that his friends liked him for more than just being a good-looking guy who could help them win games.

His best friend, who gave him that first dip at 13, is still his good friend, as are the other guys that went over to his house the first day he was home from the hospital to take him to a ball game.

"Most important is to be yourself," he said, admitting that there were some people who were so insecure with themselves that they had to point out what he looked like to make them feel better. "But once you are comfortable with who you are on the inside and the out, that is when your inner beauty will shine out and people will love you and respect you for what is here (in your heart) than they ever would for what you look like (on the outside)."

Anti-Tobacco Efforts Offer Smart Spending

Despite the rather significant "sin tax" they pay for each pack of cigarettes, the 23 percent of Tauntonians who smoke cigarettes better not expect to get much in return if and when they decide to kick the habit.
According to Department of Public Health statistics, Taunton has one of the highest smoking cigarettes rates in the state. Taunton is just behind New Bedford and Fall River when it comes to the number of smokers. Unfortunately, Massachusetts has taken another whack out of the dollars spent on anti-cigarettes efforts that keep people from smoking cigarettes or helping them stop.
In a decade, that money has been cut by 90 percent, from $50.5 million in 2001 to $4.1 million in the current state budget year. While a solid argument can be made that spending to keep people from smoking cigarettes is more than offset in savings on public spending on health care, in this case we have specific tax revenue that could be applied to making the stop-smoking cigarettes message stick.
The revenue from the state excise tax on cigarettes store is not specifically earmarked for anti-cigarettes initiatives, but that tax raises more than $500 million a year from smokers, and using it to help some of them kick the habit — and keep others from picking it up — seems a particularly appropriate use. Smokers are paying $8.50 a pack and more these days for brand-name cigarettes, and $2.51 of that is the state excise tax. Add $1.62 for the federal excise tax and about half of what you pay for a pack is what politicians like to call a sin tax.
In addition to the stop smoking cigarettes signs you see on buses and trains, the state Department of Public Health’s Tobacco Control Program helps pay for things like spot checks of local retailers to see if they will sell discount cigarette online to minors. The $2.3 million cut from the program’s budget this year means an end to free nicotine patches for populations with high smoking cigarettes rates, such as veterans, and the end of a program to help mothers and low-income people quit smoking cigarettes when they visit 19 community health centers across the state.
These programs work. In 1992, when the state anti-smoking cigarettes effort started, 23.5 percent of Massachusetts residents lit up. That was down to 14.1 percent last year, the fifth lowest smoking cigarettes rate in the country after Utah, California, Connecticut and Arizona.
There is a bill now in the Legislature that would guarantee that a set portion of the online cigarettes tax revenue be set aside for anti-smoking cigarettes programs. Whatever the humanitarian reasons — yes, there is a moral imperative to help people live healthier lives — there is a powerful economic argument when you consider the millions of state and federal dollars spent by Medicare and Medicaid each year on lung diseases, heart problems and other health issues directly related to smoking cigarettes. Our legislators need to reconsider the wisdom of cutting these successful anti-smoking cigarettes programs. We know money is tight, but this spending makes sense.
State leaders have gutted funding for anti-cigarettes initiatives more than 90 percent in the last 10 years, leading to fewer spot checks of retail stores for cigarette sales to minors, cuts to programs that help smokers quit and diminished prevention campaigns.
In fiscal 2001, state programs to combat smoking cigarettes were flush with cigarette tax revenue and funding from a 1998 multi-state settlement with the cheap cigarettes industry, with a budget of $50.5 million, according to the Mass. Budget and Policy Center.
Today, funding for anti-cigarettes initiatives has plunged to $4.1 million, with the new state budget dealing the programs another cut of $335,000 from fiscal 2011.
Anti-smoking cigarettes advocates say the cuts make little long-term financial sense given the toll that tobacco takes on state health care costs.
“Every dollar we spend on prevention is a few dollars saved on the treatment side,” said Tom Carbone, president of the Massachusetts Health Officers Association, which represents local health departments.
But the question that begs to be answered is: How big a problem is smoking cigarettes in Stoneham? While some would argue that the actual number of smokers in any one town is irrelevant compared to the need for higher anti-tobacco initiatives nationwide, looking at how certain communities compare to the state or national averages is still important.
According to 2010 statistics from the Massachusetts Department of Public Health, an estimated 2,410 smokers live in Stoneham (13.7 percent of adults, age 18-plus). The adult smoking cigarettes rate in town is 15 percent lower in Stoneham than statewide (compared to 16.1 percent statewide).
Since coverage of the tobacco cessation began in July 2006, 141 MassHealth smokers from Stoneham have used the benefit - an estimated 50.4 percent of MassHealth smokers living in town. Statewide, more than 75,000 MassHealth smokers (41 percent) have used the tobacco cessation benefit since July 2006.
Some tobacco opponents support legislation sponsored by state Rep. Jonathan Hecht, D-Watertown, and Sen. Harriet Chandler, D-Worcester, that would guarantee a portion of state tobacco revenue be set aside for smoking cigarettes cessation and prevention programs.
“Less than one half of 1 percent really gets spent on doing something about tobacco,” said Steve Shestakofsky, executive director of Framingham-based Tobacco Free Mass. “That, I think, really needs to be changed.”
State health officials said they have made progress lowering Massachusetts’ smoking cigarettes rate since beginning anti-smoking cigarettes programs in the early ‘90s and have maintained their core initiatives. But they acknowledged recent cuts have forced them to eliminate or scale back efforts they believe to be beneficial.
“I think we’re losing an opportunity,” said Lois Keithly, director of the Massachusetts Department of Public Health’s Tobacco Control Program. “We know what works. ... If we can get people to make quit attempts, we know that there will be cost savings downstream.”

Breaking down the cuts
The biggest cuts to anti-smoking cigarettes programs came in fiscal 2003 during a state budget crisis. Funding plummeted from $45.9 million to $5.8 million, and then dipped to the decade’s low point in fiscal 2004 with $2.5 million, according to figures provided by the Mass. Budget and Policy Center.
During this time, anti-smoking cigarettes advocates say lawmakers began tapping revenue from tobacco taxes and settlement funding to pay for other budget needs.
“Since then, things have been very different,” Keithly said.
The budget for tobacco programs inched back up to $12.8 million as of fiscal 2008, a result of additional support under the state’s health care reform law, Keithly said. But state leaders slashed nearly two-thirds of that money during the recent recession, leaving funding at $4.5 million in fiscal 2010 and 2011.
Among the cuts that resulted from the most recent rounds of budget reductions were:
· The elimination of about $2.3 million in media campaigns, including one that publicized counseling, patch treatment and other smoking cigarettes cessation benefits available to members of the Medicaid-funded MassHealth program. These services seemed to show early results - the smoking cigarettes rate fell from 38 percent to 27 percent among MassHealth clients in 2 1/2 years, Keithly said.
· About $1.7 million cut from smoking cigarettes prevention and cessation programs for town and city boards of health. This includes money for local spot checks of whether retailers are checking IDs before selling tobacco products.
· A cut of about $1 million for the state’s Smokers’ Helpline, 1-800-QUIT-NOW, which offers confidential referrals and counseling to smokers trying to quit. The cut reduced hours and staff, particularly on nights and weekends. The helpline also cannot serve as many clients as it used to, Keithly said.
· The end of contracts with 19 community health centers and three rural hospitals for staff to advise low-income people and mothers to quit smoking cigarettes and refer them to available help, totaling roughly $940,000.
· The elimination of nicotine patch giveaways for populations with high smoking cigarettes rates, including military veterans.
· Staff reductions for state anti-tobacco programs, largely through leaving open positions unfilled.

Are anti-tobacco programs working?
Despite cuts, Keithly said her staff has worked to preserve “key infrastructure,” including the smokers’ helpline, youth programs and working with health care professionals to ensure they identify tobacco users and refer them for help.
“When we have to take the cuts, we have a sense of what is important and what we absolutely need to protect,” Keithly said.
Federal sources have helped fill some gaps, largely helping to maintain the helpline, Keithly said, though some of that was temporary stimulus money.
State data suggests Massachusetts has had success in limiting tobacco’s harm. Julia Hurley, a Department of Public Health spokeswoman, said the statewide smoking cigarettes rate dropped from 23.5 percent in 1992, the year before state anti-tobacco programs began, to 14.1 percent in 2010.
Cigarette use among high school students also dipped from a high of 35.7 percent in 1994 to 16 percent in 2009, according to a statewide Youth Risk Behavior Survey.
But Keithly said her programs could make more progress without cuts.
“The decrease, we think, would be steeper,” she said. “We’re just trying to maintain the gains we’ve achieved and keep implementing those policies and systems we know are likely to drive down smoking cigarettes rates.”

Calls for action
Anti-smoking cigarettes advocates called the cuts counterproductive. In a report last year, the Campaign for Tobacco-Free Kids said Massachusetts ranked 37th in the U.S. in its spending on anti-tobacco programs - just 5 percent of the funding level recommended by the Centers for Disease Control.
“Obviously the state is facing serious financial challenges and health care costs are a big part of those,” said Katie King, director of health promotion and public policy for the American Lung Association of New England. “But tobacco is still the leading cause of death and disability in the state, and 10 percent of health care costs are tied to tobacco use.”
Carbone, president of the Health Officers Association and Andover’s health director, said local spot checks for retailers selling tobacco to minors have dropped in some areas from quarterly to once a year.
“When we don’t have that opportunity to interact with the retailers, they sometimes forget,” he said. “They get lax.”
At Tobacco Free Mass, Shestakovsky said cuts have hit programs proven to work and came as young people have begun to use less traditional forms of tobacco, such as small flavored cigars and smokeless products.
Pending legislation would set aside at least 3 percent of state tobacco revenues for anti-smoking cigarettes programs. Shestakovsky estimated the state now brings in nearly $850 million a year in tobacco taxes and settlement funds, which would mean about $35 million for anti-tobacco programs.
The legislation has not advanced since a committee hearing in May.
Keithly hopes to see at least some funding restored as Massachusetts recovers from the recession.
“I think we’re a very good investment,” she said. “I’m optimistic that when the commonwealth is not under such financial stress that funds will be available again for efforts that promote tobacco cessation and that are geared from stopping young people from starting (to smoke).”
Women’s health took center stage at Catawba College on Thursday, as Rowan Regional Medical Center presented Ladies’ Night Out.

The event drew an estimated 300 women to learn about how to stay healthy while enjoying life.

Free massages, food samples and exercise demonstrations were among the attractions.

Hospital spokeswoman Falon Nye said the goal was to help women relax, enjoy themselves and learn about healthy living options.

“They have the opportunity to have multiple health screenings,” Nye said.

More than 50 of the hospital’s clinical staff, including physicians, volunteered for the event, Nye said.

Hospital President Dari Caldwell said she hopes the women who attended the event see the hospital and participating vendors as partners in healthy living.

Tasty treats were among the attractions.

Cauble Creek Winery had wine, as well as muscadine grape juice which is promoted as rich in antioxidants.

Other vendors were more focused on mental health, rather than physical fitness.

For Pat “Mother Blues” Cohen, this means comfort food.

“Sometimes when you feel bad, you want something that feels like love,” Cohen said.

On the table in front of her were petite strawberry shortcakes, bread pudding and bon-bons.

Elsewhere, nurses and doctors stood by tables with information on reproductive health, cancer prevention and exercise.

David Bass, a respiratory therapist at Rowan Regional, had graphic displays of the effects of smoking cigarettes to encourage women to quit.

“This is the ‘Jar of Tar,’ ” Bass said. He held up a glass jar filled with roughly a quart of sickly-looking brown syrup.

Bass said the jar represented the tar inhaled by a person who smokes a pack of cigarettes online a day throughout the year.

Bass said many women are switching to “snus,” or spit-free smokeless cigarettes, which some believe is healthier.

Not so, Bass said.

And he provided a visual aid to show the dangers of smokeless cigarettes: a model of a human face with diseased gums and teeth.

The good news, he said, is it’s possible to quit. The hospital offers smoking cigarettes cessation programs.

“We’d like to start the conversation,” Bass said.

Not all of the displays relied on “shock and awe” to get conversations started.

At the RRMC Family Maternity Center booth, clinical educator Connie Hoffner handed out packets of information for expectant mothers.

The hospital offers classes for new moms on breathing, nursing and infant CPR and safety.

There’s even a class for soon-to-be big brothers and sisters.

“We talk about how to be a helper to mom and dad,” Hoffner said.

Sandi Surratt, also a clinical educator, said she hopes more women will learn about the support the hospital provides for new mothers and families.

Other tables offered free screenings for stroke risk, blood pressure, and body mass index.

Those might provide some wake-up calls for women who need to take better care of themselves.

But overall, the atmosphere was positive and uplifting, with a focus on women coming together to learn more about how to live healthier lives.

Lynn Treece of China Grove said she enjoyed the event.

“Maybe it’ll be the first step,” she said, encouraging women to seek medical advice and resources when they’re needed.

SALT LAKE CITY -- Utah's tax increase on cigarettes and tobacco takes effect this Thursday, July 1. The new $1.70 tax has some store owners concerned about business.

It's not just higher prices store owners are worried about. Some are scrambling to reduce inventory to avoid paying hefty taxes. Most of all, it's the customer that's going to feel the pinch.

"When I was in college in the '70s, all the guys in the dorms smoked, and we said when it gets to a dollar a pack we'll quit. Well, that was $2.50 cents ago," says Tobacco Store customer Thomas Sowell. Longtime customers Tobacco Store customers like Sowell are used to seeing price hikes every few years, but this time it's a big one. "I think it's an unfair tax," Sowell says.
Tobacco Store owner Jimmy Gibbs agrees.Duty free cigarettes
"It's a big jump. It's really too big of a jump. They shouldn't have done it that much," he says. Gibbs says he sees a lot of customers stocking up before cigarette prices jump on July 1. He says the tax will put a dent in business at first.

"A lot of people have bought tax free cigarettes for a reserve, and so those people won't be coming back for a month," Gibbs says.

Customers will pay, on average, $1.00 more for a pack of cigarettes. A $30 carton jumps to about $41.

Cigarettes Store owners will also have to shell out money for a floor tax -- a lump sum to be paid on their entire inventory. Fred and Joan Cvar, owners of the Tinder Box in Murray, have already sold a lot of cigars and pipe tobacco at sale price so they wouldn't have to pay so much on the floor tax. "We found out how fat we really were when we started looking at the situation -- seeing that there were some product we didn't sell a lot of, so there is no reason to be in the humidor," Fred Cvar says. He says the tax may push people out of state to find premium cigars at lower prices. "It's kind of a losing proposition for the state," he says. But Fred Cvar is optimistic about business and hopes his customers will stick around. "They're going to be paying more for a legal product that's sold legally, and it's a ludicrous thing," he says. "It's really silly, but we'll just go ahead and do the best we can." Customers will pay a tax of 86 percent -- the 17th highest tax in the nation.  

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