Efforts to Curb Tobacco Use in Arkansas Have Paid Dividends, but More Effort Needed

A decade of unprecedented efforts to curb tobacco use in Arkansas has paid dividends by cutting cigarette use by nearly one-third and reducing incidence of tobacco-related illnesses such as heart attacks and stroke, according to a new RAND Corporation study.

Despite the meaningful gains, the state still could take further actions to become a national leader in tobacco control by raising taxes to meet or exceed national averages and broadening smoke-free laws to more public spaces, according to the report.

The findings are from the final report in a 10-year effort to document the impact of money spent by Arkansas on tobacco control and public health programs with funds provided under a legal settlement states made with tobacco manufacturers.

Arkansas was unique among states in committing its portion of the tobacco settlement funds to a comprehensive program that invests in the health of the state's residents. RAND has worked with state leaders since 2002 to provide an outside evaluation of the program.

"The Arkansas Tobacco Settlement Program has made real and meaningful improvements to the health of the state's residents across tobacco and many others areas," said John Engberg, leader of the project and a senior economist at RAND, a nonprofit research organization. "But we found that more effort still is needed to improve the health of Arkansas residents, particularly in areas such as improving diet and exercise."

The Arkansas tobacco settlement program has four broad goals: to reduce tobacco use and related health and economic impacts; expand access to health care for state residents; develop new research initiatives to improve the health of state residents; and to improve the Arkansas health care system.

RAND researchers found that Arkansas' smoking rate declined faster since 2001 than the decline seen in six neighboring states. One of the largest decreases occurred among high school students, with only half as many smoking today as compared with a decade ago.

Evidence suggests the drop in smoking rates has resulted in fewer people in the state being hospitalized for heart attacks and strokes, and may have helped slow the incidence of asthma, pneumonia and other smoking-related illnesses, according to the report.

"However, funds have been diverted over the past two years from tobacco prevention and control activities to other uses, which is likely to slow the downward trend in tobacco use," said Deborah M. Scharf, a co-author of the report and behavioral scientist at RAND whose research focuses on tobacco control programs and policies.

More than two-thirds of the tobacco settlement money—nearly $500 million over the past decade—has been devoted to nontobacco programs, with the goal of improving the health of Arkansans. Overall, the efforts appears to have had modest success, with the state moving up one spot in a composite score of all health outcomes, from 45 out of 50 states to 44 out of 50 states.

The state experienced greater improvement in certain individual categories such as infant mortality and geographic disparity of health. Researchers say these improvements are a sign that efforts are helping to address racial and ethnic health disparities, since both measures are considered a proxy for the health of minority groups.

Some of the tobacco settlement program expanded Medicaid and created other programs to improve access to health care for low-income Arkansas residents. Despite the efforts, the state did not rise in any national rankings of access to health care. The major success in this area appears to have occurred in the state's Delta region, where access to medical care increased.

Results were unremarkable in a portion of the tobacco settlement program aimed at educating portions of the Arkansas community to replace risky behaviors with healthy ones. The RAND analysis found that the state's ranking related to diet and exercise grew significantly worse over the past decade, which could cause future troubles.

"While Arkansas made progress across many health outcomes, that progress may be tenuous because the state's residents lag behind in preventive health behaviors that could trigger more disability and disease in the future," Engberg said.

In order to maintain the gains the state has made and improve where performance is lacking, Arkansas should continue its financial commitment of devoting the tobacco settlement funds to the public health programs, Engberg said.

Support for the study was provided by the Arkansas Tobacco Settlement Commission. Other authors of the study are Deborah M. Scharf, Susan L. Lovejoy, Hao Yu and Shannah Tharp-Taylor.

RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.