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禁烟进展化为乌有

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应用1998年烟草和解协议补偿款来减少人们特别是年轻人中的吸烟率,成了两个州的谎言。10年前在全国有约最高的吸烟率的缅因州,在防止和禁止吸烟计划上,一直坚持花销和解协议补偿款的很大部分——去年,这项花销占了美国疾病防控中心建议的份额的62%。与之形成对比的是,马萨诸塞州花费了建议总额的15%,尽管在反吸烟运动方面,它是早的全国领军者。

可预见的结果是:缅因州目前拥有比马萨诸塞州更低的中学生吸烟率或无烟烟草制品使用率;实际上,在过去的十年里,缅因州的中学生吸烟率下降了64%。

当前的预算危机已给各州施加了将更多的烟草和解协议款用到别的地方的压力。然而,马萨诸塞州已成为特别落后的一个州,只花了当初打算使用的协议款的1.8%。

根据“无烟草青少年运动”机构的资料,马萨诸塞州今年坚持取得了3.018亿美元的烟草和解补偿款,包括一项在2月份到账的先前2180万美元的横财,已经都被普通资金侵吞了。只留下1250万美元与吸烟行为进行斗争了——远远少于联邦健康机构建议的9000万美元。州长帕特里克的预算将进一步消减预防计划,直至750万美元。州议会的预算只能算刚刚过得去。

马萨诸塞州还不象有些州搞的那么差,那些州已经开始用烟草款建监狱和博物馆了,甚至用来改善公用的高尔夫球场。现在这部分钱大部分转到了其它有价值的计划上,包括药物滥用和服务新措施。但在美国,吸烟仍然是导致可预防的死亡的第一位的原因,而且更少的吸烟者意味着可节省数亿美元的慢性病治疗费用。

反对者声称,经过10年后,马萨诸塞州的公民对反吸烟的的训诫已牢记于心了。但这忽略了新英格兰每年58,000名尝试吸烟的新成长起来的青年,他们中有17,000名成了烟民。不断强化反吸烟的训诫——结合高额的香烟税和让吸烟更加不方便的工作场所禁止吸烟的规定——是防止新一代变成疾病缠身的吸烟者的最好方式。

这个州的行政官员们常说,预防是减少保健费用和保持通过该州划时代的普遍适用的法律已取得的卫生保健成果最好的方法。没有什么好的借口可以允许将这么多已被证实的预防手段浪费掉。

译文:Progress goes up in smoke

THE USE OF billions in payments from the 1998 tobacco settlement to bring down the incidence of smoking, especially among young people, is a tale of two states. Maine, which had some of the highest rates of smoking in the country 10 years ago, has consistently spent a larger share of its settlement on smoking prevention and cessation programs - last year it was 62 percent of the recommendation of the federal Centers for Disease Control and Prevention. Massachusetts, by contrast, spent 15 percent of the recommended amount, despite being an early national leader in anti-smoking campaigns.

The predictable results: Maine now has a lower percentage of high school students who smoke or use smokeless tobacco products than Massachusetts; indeed, the incidence of high school smoking declined 64 percent in Maine over the past 10 years.

The current budget crisis has put pressure on all states to divert even more tobacco settlement money to other uses. But Massachusetts has been a particular laggard, spending just 1.8 percent of the settlement funds as originally intended.

According to the Campaign for Tobacco-Free Kids, Massachusetts stands to receive $301.8 million this year in tobacco settlement money, including a one-time windfall of $21.8 million that arrived in February and has already been raided by the general fund. Only $12.5 million is left to fight smoking - far less than the $90 million recommended by federal health officials. Governor Patrick's budget would slash the prevention program further, to $7.5 million. The House budget is only marginally better.

Massachusetts isn't as bad as some states, which have used tobacco money to build jails and museums, or even to improve a public golf course. Here the money mostly goes to other worthy programs, including substance abuse and other public health initiatives. But smoking is still the number one cause of preventable death in the United States, and fewer smokers means billions saved in chronic disease care.

Opponents argue that after 10 years Massachusetts residents are saturated with anti-smoking messages. But this ignores the 58,000 new teenagers in New England who try smoking every year, 17,000 of whom become regular smokers. Constant reinforcement of anti-smoking messages - combined with high cigarette taxes and smoke-free workplace rules that make it less convenient to smoke - is the best way to prevent new generations of sickly smokers.

The state's political leaders are forever saying that prevention is the best way to reduce healthcare costs and preserve the gains in access to care that have been made through the state's landmark universal coverage law. There's no good excuse for allowing quite so much in proven preventative measures to be squandered.

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