We're not surprised to learn that the State of Connecticut scored poorly yet again in the American Lung Association's State of Tobacco Control 2009 report.

For the third year in a row, the state received Fs in two categories: tobacco prevention and control spending and cessation coverage of Medicaid recipients.

However, the state did receive one A: for its high cigarette tax, which increased from $1 to $3 per pack last year. Connecticut is one of only four states that received an A in the category by imposing an excise tax of $2.68 or more.

It was our understanding that while smokers were spending $8.12 a pack, Connecticut was using the revenue for two initiatives: cessation programs and to prevent people from starting in the first place. Unfortunately, with record budget deficits, the state is using the revenue to help lessen its financial burden. It is lawmakers' hopes that the exorbitant taxes will prevent would-be smokers from picking up the habit, and with one of the highest tax rates in the nation, Connecticut is succeeding on that front.

Gov. M. Jodi Rell discussed anti-tobacco efforts in her 2009 budget proposal, and stated that Connecticut's economic disincentives were successful in reducing tobacco use, citing that cigarette sales declined by more than 28 percent since 2000.

In the same proposal, she stated that the statewide public smoking ban, in addition to targeting teens through school health guidelines resulted in the percentage of high school students who smoked dropping from 26 percent to 17 percent below the national rate of 22 percent.

Connecticut is making strides with tobacco prevention, but must put more of an effort into helping current smokers quit.

According to the Campaign for Tobacco-Free Kids, the U.S. Centers for Disease Control and Prevention (CDC) recommends that Connecticut spend $43.9 million a year to have an effective, comprehensive tobacco prevention program. Connecticut currently receives $7.2 million a year for tobacco prevention and cessation, which includes both state and federal funds. This is 16.4 percent of the CDC's recommendation and ranks Connecticut 28th among the states in the funding of tobacco prevention programs. Connecticut's spending on tobacco prevention amounts to 1.5 percent of the estimated $494 million in tobacco-generated revenue the state collects each year from settlement payments and tobacco taxes.

Combined with funds from the Centers for Disease Control and Prevention, total spending on tobacco prevention in FY2010 will be $7.2 million, slightly less than was spent in FY2009, but a substantial increase from what was spent on the program in previous years.

"Connecticut leaders are making progress when it comes to increasing the cigarette tax," said Dr. David Hill, pulmonologist and chairman of the American Lung Association Leadership Board in Connecticut, "but it is imperative that we hold them accountable for failing to implement the full range of policies proven to prevent death and disease caused by tobacco use. The American Lung Association fought hard in 2009 to ensure a portion of the tax revenue would provide Medicaid coverage to recipients for services to help them quit smoking, but this effort was defeated. It is embarrassing that Connecticut remains one of only five states that does not cover Medicaid recipients. We will continue fighting for vulnerable populations."

According to the report, tobacco-related illness costs the United States $193 billion annually; of this, Connecticut spends nearly $2.5 billion. The state also takes in about $500 million in excise taxes and tobacco settlement money each year but spends close to nothing on prevention and helping smokers quit.

Tobacco-related illness remains the No. 1 preventable cause of death in the U.S. and is responsible for an estimated 1,270 deaths per year in Connecticut.

"It is time for Connecticut elected officials to marshal efforts to reduce tobacco use, which is at the heart of a crisis plaguing America's health and economy," Hill. "It will require strong policies coming from both Hartford and Washington, D.C. to end the tobacco epidemic."

State of Tobacco Control 2009 grades states and the District of Columbia on smoke-free air laws; cigarette tax rates; tobacco prevention and control program funding; and coverage of cessation treatments and services, designed to help smokers quit. This annual report card is a vital measure of Connecticut's progress in combating death and disease caused by tobacco use.