SUPPORT TOBACCO PREVENTION
 
1.      What does this measure do?
This initiated measure will give North Dakota’s public health community the tools necessary to save lives and diminish the toll of tobacco in our state. This measure places new tobacco settlement payments called strategic contribution funds into a tobacco prevention and control trust fund. In April 2008, North Dakota received the first of ten annual strategic contribution fund payments. The 2008 payment was about $14 million, and each additional payment is projected to be near this amount, with the final payment in 2017. The tobacco trust fund will be used to provide a U.S. Centers for Disease Control and Prevention (CDC) comprehensive tobacco use prevention program to benefit all North Dakota citizens. This measure does not change the allocation of the annual tobacco settlement funds from the N.D. Legislature’s allocation of 45% for the school lands trust fund, 45% for the water development trust fund, and 10% for the community health trust fund.
 
2. What is a Centers for Disease Control and Prevention (CDC) comprehensive tobacco prevention program?
The CDC comprehensive program is a short list of five strategies (state and local programs, public information campaigns, cessation services, evaluation, and management) that when all used together are proven to cut tobacco use dramatically. When tobacco use drops significantly, the sickness and death caused by tobacco also is reduced. To illustrate this need to be comprehensive, imagine if an immunization program only administered one out of a series of three doses of vaccine needed to protect a child from a contagious disease.  Because only one third of the recommended dose was given, the child would not be protected and would remain at risk. The same is true for preventing and reducing tobacco use.  Delivering less than one-third of a comprehensive plan doesn't work! 
 
3. If this measure passes, how much will North Dakota invest in a comprehensive program?
If this measure passes, North Dakota will invest the CDC-recommended $9.3 million annually for a comprehensive program.   Currently, North Dakota uses tobacco settlement money to fund about one-third of this recommendation on a tobacco prevention program that is not comprehensive. While the current program provides some important services, it will not cut tobacco use rates significantly. 
 
 
 
4. How would the current tobacco prevention and cessation program improve if it was comprehensive?
If North Dakota invested $9.3 million annually in a comprehensive program, it would fill gaps in the current efforts without duplication. For the first time, North Dakota could fund ongoing statewide campaigns to encourage tobacco users to quit and stay quit, to keep kids from ever starting, and to promote no tobacco use
as the norm. North Dakota could offer more free services and medications through cessation programs and the North Dakota Tobacco Quitline, including interactive web-based services and services tailored to youth. North Dakota could provide new statewide services specifically for groups most affected by tobacco use, including Native Americans, and pregnant women. Finally, the state would be able to evaluate the comprehensive program to prove that it was cutting tobacco use rates significantly.
 
5. Do comprehensive tobacco prevention and cessation programs work?
Yes. CDC research shows that the more states spend on comprehensive programs, the greater the reduction in smoking, and the longer states fund these programs, the greater and faster the improvements in health. California, home to the longest-running comprehensive program, has seen adult smoking rates drop to 13.3% in 2006, compared to 19.5% in North Dakota. The number of new cases of lung cancer in California has been declining four times faster than in the rest of the country, but in North Dakota, lung cancer cases actually are increasing. 
 
6. Is tobacco use a big problem in North Dakota?
Yes. Each year 900 N.D. residents die from smoking, and 800 youth become new daily smokers. Of youth now smoking, one in three will eventually die from their smoking. One in 5 adults in North Dakota smoke, a rate basically unchanged for a more than a decade. While North Dakota’s youth smoking rate recently dropped from its peak as one of the highest rates in the nation, this reduction has leveled off, leaving more than 1 in 5 kids (21%) still smoking, and 1 in 5 high school males (20%) using spit tobacco. An estimated 42,000 kids are exposed to secondhand smoke at home. Currently, no indicators point to either N.D. adult or youth tobacco use rates dropping significantly.
 
7. What is the strategic contribution fund and how is it different from earlier state tobacco payments?
The strategic contribution fund is not payment for the fraud perpetrated on smokers or compensation for health costs related to past tobacco usage. Instead, the strategic contribution fund compensates North Dakota for the work done by the North Dakota Attorney General’s Office in finalizing the national tobacco settlement agreement. North Dakota will receive a dramatic increase in the amount of tobacco settlement payments because the Attorney General played a major role in finalizing the tobacco agreement. The legislature and the governor have justified spending tobacco settlement dollars for purposes other than tobacco control arguing that past state government tobacco related health expenditures delayed work on other state projects, like water development. That argument remains nonsense, but it is particularly ridiculous when applied to strategic contribution fund payments.
 
 
8. Why doesn't the initiated measure dedicate all of the tobacco money for public health?
The first priority for the use of the tobacco settlement dollars must be tobacco prevention and control. This measure modifies current law by allocating only the amount of tobacco settlement dollars necessary to run an effective CDC tobacco prevention and control plan. While more tobacco settlement dollars should be dedicated to public health in general, this measure only addresses tobacco control and prevention. 
 
9. Why does the measure create a new committee instead of allocating this money to the
North Dakota health department?
This measure assures that health care professionals will design and manage North Dakota’s tobacco prevention and control plan. Under this measure doctors, nurses, respiratory therapists and public health professionals will be in charge. Politicians, in both the governor’s office and the legislature, are more susceptible to the strong tobacco lobby in North Dakota and consequently the best choices for public health are not always their top priority. Since the signing of the tobacco settlement agreement in 1998, the major tobacco companies have doubled their marketing expenditures. Quite simply, the state’s tobacco control plan can not be subject to the lobbing of the tobacco interests if the state is to run an effective tobacco prevent and control program.
 
10. Isn't the North Dakota legislature better able to determine how this money should be spent?
Past surveys inform us that, unlike the legislature, the North Dakota’s citizens believe that preventing deaths from tobacco usage is the most important use for tobacco settlement dollars. A 2008 Winkelman Report showed that 82% of North Dakotans support using new tobacco settlement dollars to fund tobacco prevention and cessation programs. The citizens of our state have waited 10 years since the signing of the agreement for the state legislature to adequately fund tobacco prevention and control. After ten years we must conclude that the legislature simply does not see saving lives from the death and disease caused by tobacco usage in our state as a priority. 
 
11. What impact will this change have on effectively funding education and water projects?
Using the strategic contribution fund for tobacco prevention andcontrol does not create a funding shortage for either water development or education. North Dakotan’s believe that money from the tobacco settlement should first fund tobacco prevention and control. Instead the Legislature allocated 90% of the money to non-tobacco and non-health related programs. During the first ten years of tobacco payments, water projects and the school fund have or will receive over $120 million each from the tobacco settlement. In addition, high oil prices and increased production have dramatically increased the amount of oil extraction tax dollars to education and water development. (Under North Dakotalaw, 20% of the oil extraction tax revenue is allocated for water development and energyconservation and 20% is allocated to education--10% common schools trust fund and 10%to the foundation aid stabilization fund.) It is estimated that, because of high oil prices water projects and education will receive an additional $25 milliondollars each this biennium alone. Under this measure the tobacco settlement will continue to fund education and water projects in the amount equal to the level of past annual payments.
 
12. Why, when there is not adequate funds for a CDC program,
is the money taken from water development trust fund
and not also from the school trust fund?
Public education plays an important role in the health of our children. The allocation of tobacco settlement dollars to education is a higher public health priority than the allocation of tobacco settlement dollars to public works projects, such as water development. The measure reflects that fact.
 
13. When will this measure be on the ballot?
Provided adequate signatures are collected, this measure will be on the November 4, 2008 general election ballot