This month marks the 20th anniversary of the Tobacco Master Settlement Agreement - the largest civil settlement in U.S. history. The 1998 court settlement was between 46 states and the District of Columbia and the four major tobacco companies at the time, and provided new protections against the marketing of tobacco products to kids and the opportunity for funding to address tobacco-related diseases in our nation. The American Lung Association (ALA) celebrates this public health accomplishment, and calls on more states to fully fund tobacco control efforts, prevent youth use of tobacco products and support the health of those living with tobacco-caused disease.

“Despite historically low smoking rates, tobacco use remains the leading cause of preventable death and disease in our nation,” said American Lung Association National President and CEO Harold P. Wimmer. “Today, 16 million people are living with a smoking-related disease. Many of these individuals were hooked on tobacco through marketing practices intentionally targeting children and youth. Reining in tobacco company marketing through the tobacco Master Settlement Agreement (MSA) was a critical step, but much more can be done to prevent youth use of all tobacco products, including e-cigarettes, and help smokers quit.”

Despite receiving huge annual sums from the settlement and collecting billions more in tobacco taxes, in the past 20 years, states have underfunded tobacco prevention and cessation programs that have been shown to save both lives and money. While at the time of the MSA, many states did establish programs to prevent and reduce tobacco use - often referred to as tobacco control programs - very few states have funded them at Centers for Disease Control and Prevention (CDC)-recommended levels over the last 20 years. And today, only one state funded these programs at CDC-recommended levels in fiscal year 2018, according to the Lung Association’s annual “State of Tobacco Control” report. In Fiscal Year 2018, the states will collect $27.5 billion from tobacco settlement payments and taxes. But they will spend less than 3 percent of it – $721.6 million – on programs to prevent kids from smoking and help smokers quit. 

In part the funds have supported many toll free tobacco quit lines, including the American Lung Association’s Lung HelpLine and Tobacco QuitLine, which offers free on-demand tobacco cessation support from registered nurses and tobacco treatment specialists.

“The benefits of investing in tobacco control efforts are clear – lower smoking rates and less smoking-related diseases such as lung cancer and chronic obstructive pulmonary disease,” said Wimmer. “This means not only healthier residents and lives saved, but also lower healthcare costs for the states.”

However, the vast majority of states have failed to use the funds for their intended purpose - some have used them to fill budget holes or pay off debts. A couple of states have even in the past used it to benefit the tobacco industry. For instance, South Carolina gave 15 percent of settlement funds to tobacco farmers affected by the drop in prices for their crop, while North Carolina used 75 percent of its settlement funds for tobacco production.

“The reality is that for decades the tobacco industry lied about their addictive and deadly products, hooking kids and adults alike for life,” Wimmer said. “The settlement funds have the potential to serve as a lifeline for the millions of Americans now living with a tobacco-related disease, and it’s really up to the will of our representatives to do the right thing and implement and fully fund proven tobacco control programs.”

Learn more about ongoing state tobacco control efforts in the annual “State of Tobacco Control” report at, and read more about the use of the MSA funds in the Broken Promises to Our Children report.