201644 Impacts of the Master Settlement Agreement (MSA) on state tobacco control policymaking and health outcomes

Tuesday, November 10, 2009

Walter Jones, PhD , Division of Health Administration and Policy, Medical University of South Carolina, Charleston, SC
Jayani Jayawardhana, PhD , Center for Health Economics and Policy Studies, Medical University of South Carolina, Charleston, SC
W. David Bradford, PhD , Department of Public Administration and Policy, University of Georgia, Athens, GA
Gerard Silvestri, MD , Department of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC
The landmark Master Settlement Agreement (MSA), enacted in 1999, involves a transfer of $206 billion from tobacco companies to 46 states spread out over 25 years. (The remaining 4 states receive comparable MSA payments resulting from separate legal proceedings.) These MSA payments are ostensibly to offset the burden of tobacco-related diseases on state Medicaid programs, and to reduce youth smoking rates. However, states are legally free to use their monies for any purpose. Most observers of MSA implementation have suggested that states have decidedly mixed records when it comes to using MSA funds for tobacco control and/or treatment of tobacco-related diseases. There are wide variations in state use of MSA funds for tobacco control/treatment, and there is little state comparative research on the impact of MSA spending on tobacco control outcomes. In this paper, using data from all states, we estimate two econometric models to find the impacts of MSA spending on tobacco control, youth smoking and overall cessation. We use data on MSA payments, MSA spending, state spending on tobacco prevention, the Strength of Tobacco Control Index of state policy activism, and individual health habits over the period of 2000-2008. The analysis relates the use of MSA funds to state tobacco education, regulation, taxation and treatment activities, as well as significant health outcomes. We also estimate the degree to which the MSA has in fact led to improvements in public health, and provide some suggestions as to how the policy effectiveness of MSA spending might be increased.

Learning Objectives:
1. Identify the impacts of Master Settlement Agreement funding on state tobacco control policymaking and health outcomes 2. Analyze the variations in state tobacco control policymaking activities 3. Discuss possible ways in which Master Settlement Agreement funding might be more effectively targeted for improved health education and outcomes

Keywords: Tobacco Policy, Tobacco Control

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an experienced and accomplished public health researcher in health policymaking, particularly tobacco control policymaking.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.