The 1998 Master Settlement Agreement: a public health opportunity realized--or lost?

On November 23, 1998, a legal settlement of historic proportions took place. The five major U.S. tobacco manufacturers signed an agreement with 46 states, the District of Columbia, and five U.S. territories to settle pending lawsuits by compensating the states for Medicaid costs of treating smoking-related illness. This multistate Master Settlement Agreement (MSA) seemed to herald a new era in public health as it provided a potential source of funds for state-based tobacco-control programs (estimated at U.S.$206 billion for the first 25 years) and also banned an array of advertising and marketing efforts to attract young people to tobacco. Five years after the settlement, however, it appears that most states have not committed a significant portion of the funds for tobacco prevention efforts but rather have used the money to support other state needs. Moreover, tobacco companies have continued aggressive marketing efforts to reach youth.

Identifying and responding to technical assistance and training needs in tobacco prevention and control.

The Master Settlement Agreement generated expectations that significant, long-term funding would be available to the 46 participating states in reparation for the health costs incurred by tobacco use. Facing intense pressure to use anticipated funds for effective programming, states and national organizations considered how to supply the technical assistance and training at the state and local levels. This article reviews assessments by the American Legacy Foundation, the Tobacco Technical Assistance Consortium, and selected states of the current needs for support, technical assistance, and training in tobacco prevention and control. Key findings indicated the need for information, information exchange, mentoring, and training targeted to new staff, with advanced skill sets for experienced staff. As future funding is uncertain, all these organizations are exploring innovative ways to maintain infrastructure and programming at the state and local levels. Training and technical assistance can be the solution to sustaining impetus in the movement.

Building capacity for success: the Tobacco Technical Assistance Consortium.

The Master Settlement Agreement with the tobacco industry has infused resources into tobacco control and prevention, which has helped fund tobacco control programs at the national, state, and local levels. Many tobacco control programs face challenges in areas such as strategic planning, fiscal operations, advocacy, and personnel management. To provide technical assistance to these programs, the Robert Wood Johnson Foundation, the American Legacy Foundation, and the American Cancer Society combined resources to fund the Tobacco Technical Assistance Consortium (TTAC). TTAG, housed at the Rollins School of Public Health at Emory University, provides support for tobacco control programs and matches requests for technical assistance with consultants who have the appropriate expertise. TTAC is a valuable addition to tobacco control and prevention resources and is a viable component within a school of public health.