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Youth Smoking

Curbing teen smoking ‘must go beyond raising minimum age’

Teens below the age of 18 have been barred from smoking legally since 1993 – but the data two decades later tells a different story.

http://www.straitstimes.com/singapore/health/curbing-teen-smoking-must-go-beyond-raising-minimum-age

In 2013, the average age when smokers took their first puff was just 16, according to the National Health Surveillance Survey.

Said Mr Vincent Tng, 21, a non-smoker serving full-time national service: “I have friends who started smoking as young as 14 or 15 – they just got their friends to buy cigarettes for them. There are contraband cigarettes around, so you don’t even have to go to a proper shop.”

Experts said the discrepancy shows that efforts to curb teen smoking must go beyond raising the minimum legal age. Issues such as raising awareness and enforcement cannot be sidelined.

Said Sata CommHealth chief executive and anti-smoking advocate K. Thomas Abraham: “We should have a slew of measures that go concurrently with raising the minimum age. How are these young people able to get cigarettes? How do we plug the existing loopholes?”

Last week, the Ministry of Health (MOH) said it plans to raise the minimum legal smoking age from 18 to 21. In Singapore, these are the years when nearly half of smokers become regular smokers. The idea is to put cigarettes out of the reach of underage smokers, who tend to obtain them through their social circles.

A town in the United States known as Needham is often held up as a success story of how this measure can reduce smoking rates.

In 2005, it increased the legal smoking age from 18 to 21. Smoking rates among under-18s dropped by nearly half within five years – from 13 per cent in 2006 to 7 per cent in 2010. At least 215 other locales in the US have followed suit in recent years, including New York City, Boston and California.

Dr Chia Shi-Lu, who chairs the Government Parliamentary Committee for Health, said: “I don’t think that in itself will be enough… but raising the age would help interdict further access to cigarettes amongst the young.”

To complement the move, experts suggested increasing the size of graphic health warnings on cigarette packets, introducing plain packaging to make cigarettes look as nondescript as possible and even raising the tobacco tax.

According to the World Health Organisation, increasing tobacco prices in high-income countries by 10 per cent is estimated to reduce consumption by 4 per cent, said Professor Chia Kee Seng, dean of the Saw Swee Hock School of Public Health at the National University of Singapore.

Tobacco taxes were last raised in 2014, from $352 per kg to $388 per kg of tobacco, or 1,000 cigarettes. It was reported that out of the $12 for an average pack of cigarettes, $8.50 goes to the Government as tax.

Prof Chia said tobacco taxes should be raised further if smoking remains a serious issue, even after the age limit is raised.

At the same time, said Dr Abraham, even more work needs to be done to drive home the anti-smoking message among young people, as “the long-term effects of smoking are not always immediately apparent to a young smoker”.

Nee Soon MP Louis Ng, who used to smoke, said enforcement needs to be stepped up to ensure cigarettes are not sold to underage teens, and more has to be done to change the image of smoking.

“They think it’s cool to smoke and we need to tackle that mindset with a series of public awareness campaigns,” he said.

Management executive Catherine Ruth Jeyaseelan, 34, suggested involving parents too. “Sometimes parents smoke at home and kids will get curious, they might try it when their parents are out.”

When Public Health and Big Tobacco Align

Nobody trusts the tobacco industry, and it’s easy to understand why. For decades, industry executives knew that smoking caused cancer and heart disease yet publicly denied the dangers of cigarettes. It relentlessly attacked its critics. Documents that emerged in the 1990s showed that the industry targeted teenagers, knowing that the earlier someone became addicted to cigarettes, the more likely they would be lifelong smokers. And so on.

https://www.bloomberg.com/view/articles/2017-03-09/when-public-health-and-big-tobacco-align

In the 1980s and 1990s, the public health community went to war with the tobacco industry. Though the war largely ended in 1998 with Big Tobacco agreeing to a multi-billion-dollar settlement with the states, it remains a powerful memory for public health.

To this day, most tobacco-control advocates view the cigarette companies as being every bit as duplicitous and evil as they were in the bad old days. Some years ago, I asked Stanton Glantz, perhaps the leading anti-tobacco scientist in the U.S., what his ultimate goal was. He didn’t say it was to eliminate the scourge of smoking. He said: “To destroy the tobacco industry.”

What brings this to mind is an excellent cover story in the upcoming issue of Bloomberg Businessweek about the efforts of the tobacco industry to devise and market so-called reduced risk products like electronic cigarettes — products that give users their nicotine fix without most of the attendant carcinogens that come with combustible tobacco.

Although the tobacco companies have done decades of R&D on smokeless products, the business was dominated early on by startups like NJOY, which is today the largest independent e-cigarette company in America. From the start NJOY has said that a big part of its mission was “to end smoking-related death and disease.” And from the start, messages like that have been scorned by the public health community.

Ingesting nicotine in some smokeless fashion is vastly safer than smoking a combustible cigarette. (In the words of the late South African tobacco scientist Michael Russell, “People smoke for the nicotine but die from the tar.”) Last year, the Royal College of Medicine issued a report saying that e-cigarettes were some 95 percent safer than cigarettes.

Even so, the public health community in the U.S., led by the Centers for Disease Control and Prevention, has done everything it can to demonize smokeless products. Some of this has been with good reason: to try to keep kids from picking up an addictive habit. But this effort has also helped to create the impression that smokeless products are as dangerous as cigarettes. One result, sadly, is that many long time smokers have refused to try them, even though they could save their lives.

My sense in talking to tobacco-control officials over the years is that too many of them simply don’t believe in a reduced-harm approach. We give heroin addicts methadone not because methadone is good but because it is better than heroin. With cigarettes, however, the public health mindset appears to be all or nothing — that the only “right” thing for smokers to do is to go cold turkey.

But the lingering distrust of the tobacco industry has also had a lot to do with public health’s unwillingness to acknowledge the potential benefits of alternative products. Matt Myers, the president of the Campaign for Tobacco Free Kids, has often complained, for instance, about the marketing of e-cigarettes, saying that companies are using the same tactics to hook teenagers that Big Tobacco once used.

With the e-cigarette market clearly established, the four big tobacco companies — BAT, Reynolds American, Altria (formerly Philip Morris) and Philip Morris International (spun off from Altria) — have proclaimed themselves all in.

Philip Morris International is an especially interesting case: Not only does it have an array of e-cigarettes and other smokeless products, but as the Bloomberg Businessweek story points out, it has publicly proclaimed that its goal is to lead the world into “a smoke-free future.” The home page of its website asks, “How long will the world’s leading cigarette company be in the cigarette business?”

As astonishing as it is that a company with $26 billion in tobacco revenue last year would be calling for the end of cigarettes, I believe Philip Morris is sincere. It has spent around $3 billion in research. Its new flagship product, called IQOS, heats tobacco but doesn’t burn it — which the company believes will be more satisfying to smokers than vaping. IQOS already has 7 percent of the tobacco market in Japan, and is being rolled out in other countries.

Philip Morris recently asked the British government that tobacco products “be taxed according to their risk profile.” In other words, it wants the government to impose higher taxes on cigarettes to encourage smokers to move to reduced-risk products. What tobacco company has ever done that before?

In the U.S., Philip Morris has done something extraordinary: It has made a submission to the Food and Drug Administration to get the right to market IQOS as a reduced risk product. The expensive submission consumed 2.3 million pages and is backed by a great deal of research, including several clinical trials. So far, none of the U.S. e-cigarette companies have attempted to get such a designation, and it is a big problem. How do you sell a reduced risk product when you can’t tell anybody it reduces risk?

The business case for diving into this market is that it’s a product category that’s growing, while the cigarette market is shrinking. Philip Morris doesn’t want to be left behind. But there is no particular need for the company to set out such a transformative agenda, at least not yet. The small smokeless companies are not much of a threat. NJOY filed for bankruptcy last fall. And under a 2009 law, every company in the e-cigarette industry will have to file something called a premarket tobacco application with the FDA by August 2018. The submissions will cost, on average, over $450,000, and the companies will have to show that their products have some public health benefit. There is a legitimate chance that some small companies won’t be able to clear the hurdle.

No, Philip Morris is pushing as hard as it is, I believe, because it wants to get on the right side of the issue, finally — to be viewed as a good corporate citizen. When I spoke to Glantz the other day about the company’s new anti-smoking agenda, he said, “I don’t believe them.” (He added, “If they were serious, they would stop marketing cigarettes right now.”)

No doubt many others in the tobacco-control community feel the same way. They still loathe Big Tobacco, and view Philip Morris’s new strategy as just another deception. But the truth is, if there is ever going to be a serious move from cigarettes to less dangerous products, it will have to come from Big Tobacco. They have the R&D resources, they have the marketing apparatus — and, it appears, they have the will.

Public-health advocates don’t have to trust Philip Morris, or any other tobacco company. They don’t have to believe what I believe in order to arrive at the same conclusion: that the advocates should be rooting for the companies’ innovations — pushing them, double-checking their data, making sure regulations are in place to prevent their products from being marketed to kids. The advocates should also be spreading the word that there is an alternative to cigarettes. Who really cares whether it’s Big Tobacco or some other entity that reduces smoking deaths? What matters is that it happens.

The tobacco wars are long over. Continuing to fight the cigarette companies may bring a certain satisfaction to the veterans on the public-health side. But joining forces is the way to save lives.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

To contact the author of this story:
Joe Nocera at jnocera3@bloomberg.net

To contact the editor responsible for this story:
Philip Gray at philipgray@bloomberg.net

E-cigarettes attracting more youths towards world of tobacco

You might have thought e-cigarettes cut down tobacco consumption, but the reality is a bit different.

A study, by University of California- San Francisco,suggests that it actually attracts more youths towards tobacco consumption.

It has been published in Pediatrics.

Researchers from University Of California in the United States of America said they did not find any evidence of decline in the consumption of tobacco. In fact, the usage of e-cigarettes & cigarettes has gone higher among adolescents in 2014 compared to the numbers from 2009.

“We didn’t find any evidence that e-cigarettes are causing youth smoking to decline,” said lead author Lauren Dutra.

The analysis by the researchers also saw that section of youth who start smoking e-cigarettes are more likely to draw themselves in consuming traditional cigarettes in later part of their lives.

“While some of the kids using e-cigarettes were also smoking cigarettes, we found that kids who were at low risk of starting nicotine with cigarettes were using e-cigarettes,” Dutra said. “Recent declines in youth smoking are likely due to tobacco control efforts, not to e-cigarettes.”

In August 2016, the U.S. Food and Drug Administration, already restricted the purchase of e-cigarettes to adults aged 18 years and older. The FDA also directed to have a warning label on e-cigarettes which will start from August 2018.

The authors also said that there has been a decline in cigarette smoking youth but the decline has not been rapid after the advent of e-cigarettes in the U.S. between the years 2007 and 2009.

The authors performed an in-depth analysis of the psychological characteristics of the consumers of e-cigarettes. The research showed that the smokers tend to display some characteristics which non-smokers are less likely to show.

Characteristics like the tendency to live with a person who smokes or to wear clothing which displays tobacco product logo. The smokers in the national youth survey showed these characteristics, while the youth who were only using e-cigarettes displayed less of these qualities.

“E-cigarettes are encouraging – not discouraging – youth to smoke and to consume nicotine, and are expanding the tobacco market,” said senior author Stanton A. Glantz.

These new results are consistent with a similar study that took place in California last year by the researchers at the University of Southern California. The researchers also found that adolescents who consumed ecigarettes, but not traditional cigarettes have displayed less risk factors which were commonly found among cigarette smokers. (ANI)

Study finds high tobacco usage among students

A total of 775 students (336 boys and 439 girls) of two schools in Kannur were subjected to study by the medical college.

http://health.economictimes.indiatimes.com/news/diagnostics/study-finds-high-tobacco-usage-among-students/56731360

Thiruvananthapuram: In Kannur, over 70% of higher secondary school students begin tobacco consumption at a tender age of 15, while in rural Thiruvananthapuram tobacco sales near educational institutions is alarmingly high, finds a study, jointly carried out by Regional Cancer Centre (RCC) here and Kannur Medical College.

A total of 775 students (336 boys and 439 girls) of two schools in Kannur were subjected to study by the medical college. While 41% of the sample population got tobacco products from nearby shops, 27% of them got it from friends. According to 79% of students, it was “fairly easy” and “very easy” to obtain these products.

Dr Paul Sebastian and Dr R Jayakrishnan of RCC, who led the study in the rural parts of the state capital, presented a similarly bleak picture.

Nearly 19% of boys between 15 and 18 years use tobacco in any form. Of the 1,114 students of 10 random government schools surveyed, 7.4% were ‘ever users’, persons who have used tobacco at least once during the academic year.

The findings reflected the gravity of the issue and also underscored the expert opinion that called for measures to control the menace, said Shoba Koshy, chairperson of commission for protection of child rights.

Dr Elizabeth K E, president, Indian Academy of Pediatrics said, “The World Health Organisation has termed tobacco a global pediatric concern. Once initiated, it becomes very difficult to come off it; the key is to prevent it at a young age.”

Hong Kong Department of Health Tobacco Control Zero Efforts

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Starting with e-cigs triples odds of starting cigarettes among college students; the evidence just keeps piling up

Tory Spindle and colleagues at VCU recently published a study, “Electronic cigarette use and uptake of cigarette smoking: A longitudinal examination of U.S. college students,” that followed 3757 students at Virginia Commonwealth University for a year to examine the relationship between e-cigarette use among never cigarette smokers at the beginning and whether they were smoking conventional cigarettes a year later. They found, controlling for a wide range of demographic and behavioral variables, that e-cigarette users at baseline were about 3.4 times as likely to be smoking cigarettes a year later as young adults who were not using e-cigarettes.

This effect is consistent with a similar study of young adult males in Switzerland as well as all the studies of adolescents.

Here are the highlights and the abstract:

HIGHLIGHTS

• E-cig and cigarette use has not been studied in college students longitudinally.
• Ever and current e-cig use increased non-smokers chances of trying cigarettes.
• Historically internalizing/externalizing factors predict cigarette uptake strongly.
• Most internalizing/externalizing factors examined did not predict e-cig uptake.
• Males and marijuana users were more likely to initiate e-cig use.

ABSTRACT

Introduction:

Electronic cigarette (e-cigarette) use prevalence is increasing among U.S. adolescents and adults but recent longitudinal data for college/university students are scarce.

Furthermore, the extent that e-cigarette use is associated with the onset of cigarette smoking and the factors that lead to the uptake of ecigarettes in college students has not been explored.

Methods:

3757 participants from a Mid-Atlantic university (women: 66%; White: 45%; Black: 21%; Asian: 19%; Hispanic/Latino: 6%) were surveyed in 2014 and again in 2015.

Results:

Among participants reporting never smoking at time 1, those who had ever tried e-cigarettes or were currently using e-cigarettes (at least one use in past 30 days) were more likely to have ever tried cigarettes by time 2 relative to individuals who had not used e-cigarettes. Ever use of e-cigarettes (but not current use) also increased participants’ likelihood of being current cigarette smokers at time 2. Among initial never users of e-cigarettes or cigarettes, males and ever marijuana users had an increased probability of trying e-cigarettes by time 2. Furthermore, less perseverance (an index of impulsivity) and ever use of other tobacco products increased initial never users’ chances of trying both cigarettes and e-cigarettes by time 2.

Conclusions:

Given that never-smoking participants who had tried e-cigarettes were more likely to initiate cigarette use later, limiting young adults’ access to these products may be beneficial. As the long-term health implications of e-cigarette use become clearer, predictors of e-cigarette use could help identify future populations likely to use and abuse these products.

Here is the full citation: Spindle, et al. Electronic cigarette use and uptake of cigarette smoking: A longitudinal examination of U.S. college students. Addictive Behaviors 2017; 67:66-72. http://dx.doi.org/10.1016/j.addbeh.2016.12.009

 

Nicotine’s Highly Addictive Impact on Youth Underestimated

http://www.medscape.com/viewarticle/873955

Although smoking trends among youth have shifted in recent years from tobacco cigarettes to e-cigarettes, the highly addictive culprit nicotine remains constant, a fact that should be underscored in discussion of risk with youth and their parents.

“I think most people realize nicotine is addictive, but I don’t know if there’s an understanding of just how addictive it is – particularly for youths,” said Lorena M. Siqueira, MD, MSPH, lead author of a new report on nicotine, addiction, and youth that was released by the American Academy of Pediatrics (AAP).

“People think, for instance, only having a few cigarettes a week may be fine and they can quit any time, but they don’t realize that they are already well on their way to dependency,” Dr Siqueira, a member of the AAP Committee on Substance Use and Prevention, told Medscape Medical News.

The report was published in the January issue of Pediatrics.

Evidence shows that the earlier in life a person is exposed to nicotine, the less likely they will be able to quit using tobacco and the more likely they will consume increasingly greater quantities.

The vast majority of tobacco-dependent adults – up to 90% – started smoking before age 18 years. The authors also point out that the earlier a child starts smoking, the greater the risk of continuing to smoke in adulthood.

Approximately two thirds of children who smoke in sixth grade, for example, become regular smokers as adults. In comparison, 46% of youth who begin smoking in the eleventh grade go on to become regular smokers as adults.

In addition, compared to adult smokers, youths require more attempts to quit smoking before being successful. In addition, only about 4% of smokers aged 12 to 19 years have been shown to successfully quit each year, the authors report.

Although e-cigarettes are marketed as a tool for smoking cessation, there is no strong evidence to support these claims, the authors note.

In fact, research, including a study published in JAMA Pediatrics in 2014, indicates that e-cigarettes, which contain nicotine, encourage, rather than discourage, tobacco use in youth.

Since that study’s publication, a number of other studies have shown similar harms, the study’s coauthor, Stanton A. Glantz, PhD, of the Center for Tobacco Research and Education at the University of California, San Francisco, told Medscape Medical News.

“There are now seven published longitudinal studies showing that youths who initiate smoking with e-cigarettes are about three times more likely to be smoking conventional cigarettes a year later,” he said.

“So clearly, e-cigarettes are acting as a gateway to conventional cigarette smoking.”

Instead of making quitting easier, e-cigarettes make it harder, Dr Glantz added.

“What the evidence shows is youths who use e-cigarettes are much less likely to stop smoking than youths who don’t use e-cigarettes, so not only are they not beneficial, as promoted, or even useless, they actually [work against] cessation.”

Among key attractions to e-cigarettes – and arguments that adolescents are likely to raise with parents ― is the idea that at least they are not as harmful as tobacco, Dr Siqueira said.

“It’s not unlike the prescription drug epidemic – adolescents think, ‘If my grandmother takes it, then it must be safe,’ so this is sort of the same thing,” she said.

The report also notes that e-cigarettes are not without toxic hazards of their own. Accidental poisonings associated with e-cigarette use have increased from one per month in 2010 to 215 per month in 2014, including one death.

“The take-home message is that there’s no arguing that nicotine is highly addictive, and it’s not just in cigarettes but it’s in all of these other products that are being cleverly marketed to youths to include ingredients and flavors to increase the palatability,” she said.

A new report from the University of Michigan’s Monitoring the Future study shows some encouraging trends regarding e-cigarettes. According to the study, after gaining popularity earlier in the decade, the percentage of US teens who use e-cigarettes declined for the first time from 2015 to 2016. The percentage of adolescents who used e-cigarettes in the past 30 days declined from 16% to 13% for 12th graders, from 14% to 11% for 10th graders, and from 8% to 6% among 8th graders; each change was statistically significant.

The report had even more encouraging news for cigarette smoking. The levels of smoking among 8th-, 10th-, and 12th-grade teens are the lowest they have been since annual tracking began 42 years ago.

“Since the peak year in 1997, the proportion of students currently smoking has dropped by more than three quarters — an extremely important development for the health and longevity of this generation of Americans,” principal investigator Lloyd Johnston, PhD, University of Michigan, Ann Arbor, said in a release.

The authors have disclosed no relevant financial relationshps. Dr Glantz has received research funding from the National Institutes of Health and from the Truth Initiative, a tobacco use prevention nonprofit organization.

Hiking tobacco excise alone won’t reduce smoking: Finance Ministry

The Finance Ministry doubts that the increase in tobacco excise can reduce the prevalence of smoking in the country, arguing that the regulation needs to be combined with non-fiscal policy to make it more effective.

http://www.thejakartapost.com/news/2016/12/20/hiking-tobacco-excise-alone-wont-reduce-smoking-finance-ministry.html

Suahasil Nazara, the ministry’s fiscal policy office (BKF) head, said besides gradually increasing excise tax, educating people about the negative impact of smoking and preventing youths from purchasing tobacco products also were equally important.

“I don’t believe that increasing excise tax will reduce the prevalence of smoking. We need to use a combination of fiscal and non-fiscal policies,” he said in a discussion on cigarettes at Hotel Borobudur in Central Jakarta.

In eight years, the number of tobacco factories had gone down from 4,669 in 2007 to 714 in 2015, which reflected the recent decline in cigarette production. The fact implied that production had decreased in line with market forces, he said.

The government’s argument was slammed by Hasbullah Thabrany, a professor of public health at the University of Indonesia’s School of Public Health, who said the reason behind the declining number of tobacco companies was because many small companies—mostly hand-rolled cigarettes—were unable to compete with big firms.

The Finance Ministry announced in October that it had issued a regulation to increase excise taxes by an average of 10.54 percent next year for several types of cigarettes. The price increase was lower than the target set by the government this year of 11.33 percent. (win/evi)

EDITORIAL: NJ giving up on smokers

Let’s just say New Jersey officials don’t care a whole lot whether kids in this state start smoking, or whether the ones who have ever stop.

http://www.dailyrecord.com/story/opinion/editorials/2016/12/17/nj-spends-zilch-anti-smoking/95538342/

That may sound a little harsh, but there seems little other way to interpret the fact that the state once again ranks dead last in the nation in spending on tobacco prevention.

The amount of money New Jersey devotes to the task? Zero. This is the fifth consecutive year the state has spent absolutely nothing to discourage smoking or encourage active smokers to quit.

New Jersey just seems to have a knack for ranking first or last in all the wrong categories.

For those thinking New Jersey just doesn’t have the money to spend, consider the state will take in more than $900 million in estimated tobacco revenue as part of the national 1998 settlement with Big Tobacco. The Centers for Disease Control and Protection annually recommend an amount that each state should devote to tobacco prevention programs. The recommendation for New Jersey in 2016 was $103 million. But not a dollar of that money has been set aside for tobacco prevention in the 2016 budget. Only Connecticut is similarly apathetic.

It’s also worth noting that Gov. Chris Christie has vetoed a proposal to raise the legal smoking age to 21.

To be fair, we can’t say lawmakers have completely dropped the ball in combating smoking. New Jersey continues to make inroads in curbing public smoking, this year pushing through enhanced restrictions on beaches and state parks. While that legislation didn’t go as far as anti-smoking advocates would have preferred, the new restraints represent another step in the right direction. Federally funded anti-smoking programs are also available in New Jersey.

Through it all, something seems to be working, even if more or less by accident. Smoking rates are declining across the country, and New Jersey is no exception, despite the absence of investment in prevention. Both youth (8.2 percent) and adult (15.1 percent) smoking rates in the state are well below the national average.

But advocates warn that the lowering rates are insufficient reason to ignore continued and aggressive prevention efforts. The Tobacco Free Kids Campaign estimates that nearly 12,000 deaths each year in New Jersey can be directly attributable to smoking — deaths that are essentially being treated as irrelevant from a policy perspective by scrapping all prevention spending.

That said, New Jersey shouldn’t feel obliged to simply pour money into random smoking cessation programs to create the impression of renewed interest in the issue.

Some programs have more value than others, and officials should at the very least identify one or two areas to which some funding can be effectively deployed. While we don’t see a need for the state to suddenly ratchet up its spending to the levels recommended by the CDC, it is more than reasonable to expect some funding to be directed to saving lives.

Despite nearly $1B in tobacco funds, NJ will spend zero on prevention programs

New Jersey ranks dead last for the money it devotes to tobacco prevention and cessation programs.

http://nj1015.com/despite-nearly-1b-in-tobacco-funds-nj-will-spend-zero-on-prevention-programs/

According to a new report from several anti-smoking and health advocacy groups, the Garden State is spending nothing on these programs out of the $944.5 million it will receive this fiscal year from taxes on tobacco products and the 1998 tobacco settlement. Connecticut is the only other state that spends absolutely no tobacco-related revenue on anti-smoking causes.

The report finds 13.5 percent of New Jersey adults smoke, and 8.2 percent of high school students. Smoking causes 11,800 deaths per year in the state, the report said.

“Failure to fund tobacco prevention programs is not only bad health policy, it’s bad fiscal policy,” said Vince Willmore with the Campaign for Tobacco-Free Kids, one of the organizations that issued the report. “Because tobacco use costs New Jersey over $4 billion a year in health care bills.”

The Centers for Disease Control and Prevention recommends that New Jersey spend more than $103 million a year on tobacco prevention.

“That leaves plenty for other purposes,” Willmore said.

The state does use more than $2.2 million in federal funds on services related to prevention and quitting programs, such as NJ Quitline (1-866-657-8677).

According to the New Jersey Department of Health, the state’s adult smoking rate has declined significantly since 1990, and both the adult and youth smoking rates are below national averages.

“The Department of Health strongly encourages everyone to quit smoking and there are many ways to do that including medication, patches, gum and counseling available through employer-sponsored health benefits – including Medicaid, the State Health Benefits Plan and NJ FamilyCare,” a department spokeswoman said.

Approved by the full New Jersey Assembly in November, and referred to a Senate committee, is a measure that would dedicate 1 percent of tobacco tax revenues to anti-smoking initiatives. The proposal originally called for a 5 percent share but was scaled back.

In January, Gov. Chris Christie vetoed a measure that would have banned the sale of tobacco and vaping products to anyone under the age of 21. Willmore said he hopes to see the bill advance again with a different outcome.

It was passed by the Senate in May but hasn’t seen action in the Assembly.

Nationwide, the report said, states will collect $26.6 billion in tobacco-related revenue. Less than 2 percent of it will be spent on programs to prevent kids from smoking and help smokers quit.