Sentinel Opinion: Tobacco action; New Hampshire lags in money- and health-saving efforts to prevent, stop tobacco use

The American Lung Association recently released its annual State of Tobacco Control Report that surveys state tobacco use policies and preventive measures, and New Hampshire landed at or near the bottom of the state rankings. Of the five policy areas the report grades, New Hampshire received “F”s for tobacco prevention and cessation program funding, tobacco taxes and restricting flavored tobacco products, and eked out “D”s for smoke-free-air policies and cessation services access. Only seven states — none in the Northeast — graded worse.

That’s especially dispiriting news because tobacco use is, the lung association reports, the leading cause of preventable death and disease in New Hampshire, as well as across the country. But if there’s any good news in the annual report, it’s that there are steps the Legislature can take to deter tobacco use more effectively and fund cessation initiatives without diverting funding for other legislative priorities.

The most obvious one is to raise tobacco taxes. The state’s current cigarette tax rate has not increased since 2013, and there’s room for a substantial increase that would still keep the state’s rate lagging behind its New England neighbors, an important consideration due to likely opposition from border-community merchants eager to lure out-of-state smokers.

Moreover, the benefits to the state are undeniable. It would generate desperately needed additional support for woefully underfunded prevention and cessation programs — currently the state’s funding is 10 percent of the level recommended by the Centers for Disease Control and Prevention, which is shockingly lower than the recommended levels for the state’s Northern New England neighbors, with Vermont at 45 percent and Maine at 100 percent. And, “increasing the price is one of the best strategies, if not the best strategy we have, to reduce tobacco use,” Lance Boucher, a lung association state public policy official, told The Sentinel’s Monadnock Region Health Reporting Lab.

Another no-brainer is to reauthorize the state’s expanded Medicaid program. This is important for so many reasons — not the least of which is making affordable health care accessible to more vulnerable families — but it would also assure the continued access to treatment and cessation programs that expanded Medicaid provides. Encouragingly, both Gov. Chris Sununu and Senate President Jeb Bradley have expressed support for reauthorization.

While some may bridle at efforts to legislate personal behavior, the state’s interest in reducing tobacco use has long been far broader. Put simply, the state, its health-care system and, by extension, all Granite Staters bear significant additional costs from smoking. And the shift away from cigarette use to vaping — particularly among youth — creates an additional imperative.

Although the lung association cites data showing New Hampshire’s adult smoking rate is 12.3 percent, the high school vaping rate is 34 percent, the state’s Department of Health and Human Services reports. Locally, Shawn LaFrance, Cheshire Medical Center’s vice president for population health, cites local youth risk behavioral survey data showing that over half of this area’s high school students have used an electronic vaping product. With youth vaping on the rise, the state’s at risk of fostering another generation hooked on tobacco products, a prospect both dangerous for the users and costly for the state. That makes especially critical increasing youth-targeted program funding, including using the recent e-cigarette company settlement proceeds.

Fortunately for this region, there are innovative local efforts underway to overcome the state’s shortcomings, including those of such groups as the Monadnock Youth Coalition and the Cheshire Coalition for Tobacco Free Communities. Among the youth coalition’s promising recent initiatives is a training program for teens to take on leadership anti-substance abuse advocacy roles with their peers. And the Cheshire coalition, which Cheshire Medical heads, has a new program aimed at challenging long-held assumptions that tobacco use is an inconsequential worry for those struggling with alcohol or drug addiction.

Promising though the work locally is, the state should do more. The lung association report cites the most recent estimate of New Hampshire’s annual health care costs due to smoking to be $729 million. For such a serious public-health concern and its economic toll on the state to be addressed, deterring tobacco use through increasing tobacco products taxes, reauthorizing Medicaid expansion and deploying more funding to prevention and treatment programs are essential.