IOWA CITY, Iowa — Iowa is falling short when it comes to tobacco prevention funding, according to a recent American Cancer Society report.

To market its products in Iowa, every year the tobacco industry spends an estimated $103.5 million. At the same time, it pays Iowa about $65.8 million annually, as a result of the 1999 master settlement which ruled tobacco companies responsible to pay states for their tobacco-related healthcare costs.

One of the leading causes of preventable death in Iowa, about 5,100 adults die each year as a result of their own smoking.

To eliminate smoking deaths, the Center for Disease Control & Prevention recommends Iowa spend $30 million annually on tobacco prevention efforts.

It spends $4 million.

"It's incredible," said Eileen Fisher, president of the Johnson County organization doing tobacco prevention outreach.

The group, Clean Air For Everyone Iowa Citizen Action Network (CAFE), pushes for higher tobacco taxes, more prevention funding and more funding for programs aimed at smokers trying to quit.

Fisher added the American Cancer Society report also highlights Iowa's relatively low tobacco tax rate. The tobacco tax is currently at $1.36 per pack in Iowa, while the state average nationally is $1.81.

CAFE Iowa CAN fought to increase it by $1.50 this legislative session but it didn't advance, she said, adding it hasn't budged in about 12 years.

"The party in control doesn't want to raise taxes," she said.

Funding from increased cigarette taxes could help target the skyrocketing popularity of e-cigarettes. Over the past few years, companies marketing the products with candy-like flavors have attracted a rising number of teens, many of whom are ignorant of the adverse health effects of nicotine, according to health officials and advocates.

Three percent of youth in 11th grade in Johnson County reported smoking a cigarette in the last 30 days. The number was higher for e-cigarettes at 4.4%.

Johnson County Public Health Department health educator Susan Vileta said despite the rising numbers and low funding, there have been improvements in policy and initiatives.

Working with $77,000 in fiscal year 2019 to partner with schools, public spaces and workplaces on prevention, the department hopes to add a new school and community presentation to their awareness campaign.

Vileta visited a Solon school in May and hosted a vaping prevention awareness presentation. She made presentations for school staff, students and a community forum for parents and the general public.

They talked about what tobacco products look like and how to access resources. The biggest e-cigarette brand, JUUL, makes a small product that can be discretely used.

Resembling a USB flash drive, it can also be hidden easily. The e-cigarette holds one cartridge or "pod" and has about as much nicotine as a pack of 20 cigarettes.

Vileta is now working with other local schools to provide similar programs.

"Education is one thing," she said. "But it's also the policies that have a lasting impact.

This spring, the Johnson County Board of Supervisors passed an ordinance banning the use of e-cigarettes in the same places where traditional smoking is prohibited.

"It's a big step toward influencing social norms," she said, so youth see e-cigarettes regulated like conventional cigarettes.

Iowa has also seen improvements in access to medical care, according to the Iowa Government Relations Director at the American Cancer Society Cancer Action Network, Danielle Oswald-Thole.

In the last several years, she said the state expanded access to palliative care and Medicaid. Various treatment options, early detection screening and preventative care are now more available to cancer patients.

These advances are significant, she said, as annual health care costs related to smoking in Iowa total $1.28 billion. Medicaid costs in the state amount to $364.5 million.

Oswald-Thole said by raising the tobacco tax above a dollar, Iowa could see decreases in smoking rates, less kids starting to smoke and long-term health care costs savings.

"We know that tobacco still takes a major toll on Iowans, both in terms of human and healthcare costs," she said. "But luckily we do know what works."

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