Hawaii's investment in tobacco prevention and control programs the past 10 years has paid off with significant reductions in adult and youth smoking and related health costs.

But funding for prevention activities also has been reduced—from about $10 million per year from 1999 through 2001 to $3.2 million this year—and health officials are concerned about backsliding.

Only about 6.5 percent of tobacco settlement money now is going into the Hawaii Tobacco Prevention and Control Trust Fund, managed by the Hawaii Community Foundation. The principal plunged as low as $32 million when the market slumped in 2008-09 but is back up to $52 million.

The Legislature distributes the fund to other purposes, including 28 percent to the University of Hawaii for costs of building the medical school in Kakaako; 25.5 percent annually for the state general fund through 2015; 15 percent for the rainy day fund; 15 percent for the state Health Department's Healthy Hawaii Initiative; and 10 percent for the Children's Health Insurance Program.

In a report titled “;A Decade of Saving Money, Saving Lives,”; the trust fund and state Health Department describe the fund's “;tremendous impact”; in preventing smoking and helping people quit.

While “;very pleased”; with results of the last 10 years of work, there is more to do, said Dr. Elizabeth Tam, professor and chairwoman of the Department of Medicine at the UH John A. Burns School of Medicine and chairwoman of the Trust Fund Advisory Board.

“;But even to sustain at the current level, we need to keep every dollar that we have in the tobacco trust fund or somehow dedicated to public health and prevention,”; she said. “;I know the budget is tight right now ... but every dollar we spend on prevention saves so much more in health care costs.”;

The trust fund “;is being well used and serving a public purpose,”; said Lola Irvin, tobacco settlement project manager for the Healthy Hawaii Initiative. “;With the policies, the interventions, the media campaigns and programs available for kids, we've seen a dramatic reduction in smoking rates for youths and adults.”;

Hawaii is the fifth lowest state in the country for adult smoking prevalence at 15.4 percent, compared with 21 percent or 22 percent in 2000. Smoking rates also dropped from more than 20 percent among high school youths in 2000 to about 9.6 percent in 2007.

“;In the last six years alone, the decrease in smoking prevalence has saved 14,000 lives,”; according to the report.

The “;consistent, well-funded effort over the last 10 years has really worked,”; said Trisha Nakamura, policy and advocacy director for the Coalition for a Tobacco Free Hawaii. “;We saved lives and saved state money. We saved over $400 million in direct health-related costs over eight years attributed to smoking.”;

But the decade of progress is in jeopardy, she said, pointing out smoking and tobacco consumption have increased in states where tobacco control funding has been cut.

Irvin said lawmakers “;were very progressive”; in 1999 and allocated 25 percent of Hawaii's tobacco settlement amount for the trust fund. That was cut to 12.5 percent in 2002 to help UH build the new medical school. The DOH portion of 25 percent for the Healthy Hawaii Initiative was cut last year to 15 percent as legislators tapped 25.5 percent of the tobacco fund for the state treasury.

The federally recommended level of tobacco control spending for Hawaii is $15.2 million annually.

Irvin said the trust was set up to operate like an endowment, using only the interest and new revenues. However, the law was amended in 2001 to allow money to be spent from the principal, she said, expressing concern about “;diminishing returns.”;

“;If it is raided and taken, the less it produces,”; Irvin said.