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States use little of the income they receive from tobacco taxes or legal settlements with cigarette manufacturers to pay for smoking prevention or cessation programs, the American Lung Association concludes in a new report.

Although states receive a total of $25.7 billion in tobacco settlement payments and tobacco taxes annually, more than 40 states do not invest even half of what is recommended by the Centers for Disease Control and Prevention (CDC) in proven tobacco prevention programs, according to the report. Some states receive money from tobacco companies under a 1998 anti-smoking agreement with tobacco companies, Reuters reports.

States spent a total of $462.5 million on smoking prevention and cessation programs this fiscal year, about 12.5 percent of the CDC recommendation. North Dakota and Alaska were the only states that spent amounts close to the recommendation. Some states put most of their tobacco-related income toward their general budgets.

The report notes that states and the federal government have not raised taxes on tobacco products other than cigarettes, which has led to a surge in the use of certain cheaper tobacco products, including flavored cigars popular among youth.

“By not having a level playing field with tobacco taxes, we’re seeing market shifts from cigarettes to lesser taxed and subsequently more affordable tobacco products. This means candy flavored cigars and a new wave of smokeless products are enticing new, young customers to become addicted to nicotine,” Paul G. Billings, American Lung Association Senior Vice President for Advocacy and Education, said in a news release.

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