Tobacco is the leading cause of preventable death in the United States. Over 420,000 people die each year from tobacco use, and 53,000 die each year from exposure to environmental tobacco smoke (ETS). In response and because of the lack of legislative action, public health professionals in Massachusetts used the initiative process as a way to fund tobacco education and prevention programs.

In 1992, a coalition of over 200 organizations called the Massachusetts Coalition for a Healthy Future, led by the American Cancer Society, successfully qualified and passed Question 1, a state ballot initiative which raised the state tobacco tax by 2.5 cents per pack of cigarettes and on smokeless tobacco products to 25% of its wholesale price to provide funds for tobacco education and prevention programs.

In the campaign to pass Question 1, the Coalition promised voters that the new tobacco tax revenues would be used to reduce tobacco use in the state. However, the initiative was not constitutionally allowed to appropriate the new revenues the power to appropriate funds resided with the state legislature.

Since the 1993-1994 fiscal year, the state has spent a total of 27.5% of Question 1 funds or $116.4 million for tobacco education and prevention programs and 72.5% of Question 1 funds $306.7 million for non-tobacco education programs.

The available pool of Question 1 tobacco tax revenues has declined over time because fewer people are smoking.

Tobacco education and prevention programs have had their funding reduced each fiscal year. In fact, between the 1993-1994 and the 1995-1996 fiscal years, Question 1 funding for tobacco education has declined by 19%.

In contrast, since the 1993-1994 fiscal year, the Legislature has chosen to appropriate state general funds to non-tobacco education programs to more than compensate for the decline in Question 1 revenues. As a result, state general funds appropriated to non-tobacco education programs which receive Question 1 funds has grown from $34.7 million in the 1993-1994 fiscal year to $76.6 million in the 1995-1996 budget and total funding (i.e., Question 1 funds and state general funds) for these programs has increased by 9.3%, or $14.5 million.

The legislature has established a trend that has produced real reductions in Question 1 funding for tobacco education which appears contrary to the mandate of the voters when they enacted Question 1 in 1992. In addition, because the Legislature has appropriated state general funds for non-tobacco education programs, total funding for these programs have increased at the expense of tobacco education.

The failure of the ACS and Coalition to continue to mobilize public support for tobacco control programs in Massachusetts suggests that the public health promise of Question 1 will not be realized and the tobacco industry will again dominate public health policy making in Massachusetts at the expense of public health.