When it comes to learning how to control tobacco use, Maryland is far from getting straight As. In fact, according to a new State of Tobacco Control Report Card release by the American Lung Association on Wednesday Maryland earns a grade of D in tobacco taxation, a D in access to smoking cessation services and an F in funding tobacco prevention programs.

The state's sole A grade was due to Maryland's curbing second hand smoke exposure with the passage of the 2008 smoke free law, which prohibited smoking in all enclosed work spaces.

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That's an A to be proud of, according to Deborah Brown, president and CEO of the American Lung Association of the Mid-Atlantic, but with tobacco killing an average of 7,500 Marylander's annually, according to the Centers for Disease Control and Prevention, Brown said the state needs to be doing more.

A good place to start, she said, would be to correct that F grade by properly funding anti-tobacco programs to the levels suggested by the CDC.

"Maryland takes in $480 million in tobacco generated revenue, but they only spend about $8.5 million on anti-smoking [programs]," Brown said. "While $8 million sounds like a lot of money, it's only small percentage of what CDC recommends for a comprehensive anti-tobacco program."

The CDC recommends Maryland spend $48 million of its tobacco revenue on anti-tobacco programs this year, and the $8,502,100 it did spend is only 17.7 percent of the CDC recommendations, according to the report card. It's a smaller fraction still of the $479,100,000 in tobacco revenue that Maryland generated through taxes on tobacco products and the annual payments from tobacco companies required by the 1998 Tobacco Master Settlement Agreement. Since 2000, the income from the settlement has been kept in the Cigarette Restitution Fund, and was meant to fund programs that would compensate for the harms caused by tobacco products.

"This money came in due to disability and death caused by tobacco use so it really is important that states start looking at spending the money on programs that help people quit smoking or that help ensure young people never start smoking," Brown said. "The policy makers really need to look at the reasons why they have that money."

No one in Governor Hogan's administration could be reached in time for a comment on this story, but the record of past governors has been one of shrinking spending of tobacco revenue on anti-tobacco programs.

According to Barbara White, director of the Cigarette Restitution Fund Program at the Carroll County Health Department, while early budgets for local anti-smoking campaigns were generous, funding had diminished by 75 percent in 2009, forcing the health department to suspend some smoking cessation grant programs in 2010, 2011 and 2012.

Funding has increased slightly since 2009, according to White: In FY13, Carroll County's share of Cigarette Restitution Fund money was $111,966 and in FY14 it was $153,571. In FY15, the present fiscal year, funding was $153,569, which goes toward anti-tobacco education in schools, smoking cessation clinics and testing vendors that sale tobacco to ensure they are not selling to minors, a function White said the health department has had to forgo for lack of funding in the past.

As a comparison, if Maryland were to meet the CDC recommendations for anti-tobacco spending, Carroll County could receive more than $1.4 million, money White said could be put to immediate good use.

"I would love to have more people in the schools to be able to talk to the students," she said. "We give out vouchers for nicotine gum and patch users and I always worry that am going to run out of the money for vouchers. I would also like to be able to give more vouchers for Chantix. It can cost $200 for a month's supply and some people's insurance won't cover it."

Access to smoking cessation tools like nicotine gum or prescription drugs like Chantix is another area where the American Lung Association gave Maryland low marks.

There are seven approved forms of smoking cessation treatment that need to be accessible without barriers if we are serious about stopping smoking, according to Brown, nicotine gums, the nicotine patch, lozenges, inhalers, nasal spray and the medications Zyban and Chantix. While Maryland makes these tools somewhat accessible in its public health plans, Brown said there are still significant hurdles for some individuals looking to quit tobacco.

"Under the state employee health plan, the medications they coverage are Zyban and Chantix, they do not cover the gum [or] the patch," Brown said. "The state Medicaid program covers all the medications, but there are barriers, like prior authorization, [which requires] you fail [to quit] with one method before you move on to another drug."

As for private insurers, Brown said that while state law requires they cover cessation products, it also permits them to add a tobacco surcharge to tobacco users premiums.

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"That means that people tend to either not tell the truth, or they may not be able to get smoking cessations services," she said. "Some states have indicated that the private insurers cannot charge surcharges on people that use tobacco products ... Maryland does not have that type of legislation."

Maryland also received a D on tobacco taxes. This is due in part, Brown said, to the current tax of $2 per pack of cigarettes being too low to discourage new users from picking up the habit, but also because other tobacco products are taxed at very different rates. Premium cigars, for instances, Brown said are taxed at 30 percent of wholesale, and these differences in tax rates reduces their deterrent power on consumers.

"One of the things the American Lung Association would like to see is that if the excise tax on a pack [of cigarettes] is $2, then we would be looking at the equivalent of that on other tobacco products as well," Brown said. "In many instances, if you have cigarettes taxed at one level, and other products at another level ... Young people start turning to those products because they are cheaper. It happens to older people too."

Maryland faces a lot of potentially difficult changes to bring up it's grades with the American Lung Association, but then do does any student with two Ds and an F on their report card. The clock is ticking, according to Brown: 2014 was the 50th anniversary of the 1964 Surgeon General's report that first warned Americans of the dangers of smoking tobacco, and yet smoking still kills nearly half a million Americans each year, thousands in Maryland, and costs the state more than $3.5 billion.

"We need to make sure there is a comprehensive tobacco control program in place," Brown said. "Polls show public support for this, so it's not something that is unpopular. It's something people think we need to do ... We cannot afford the consequences of failing to act."

Reach staff writer Jon Kelvey at 410857-3317 or jon.kelvey@carrollcountytimes.com.

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