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ND anti-smoking agency could be snuffed out over budget concerns

Kimberly Cobb of Moorhead exhales cigarette smoke while waiting for a bus Friday, Jan. 6, 2017, in Fargo on her way to work.Michael Vosburg / Forum Photo Editor

FARGO—The North Dakota Center for Tobacco Prevention and Control Policy may find itself fighting for air in the coming weeks, as state lawmakers hope to tap the agency's trust fund as a way to shore up the North Dakota's sagging budget.

Best known as BreatheND, the agency is holding news conferences here and in Bismarck on Tuesday, Jan. 10, to make a case for continued funding for its anti-tobacco work.

Dr. Eric Johnson, a family physician from Grand Forks who's on the agency's executive committee, is concerned about a loss of momentum in North Dakota's declining smoking rates if the agency is reformed or eliminated.

"It doesn't make a lot of sense to change something that's working," Johnson said.

In his final budget address in early December, former Gov. Jack Dalrymple called for eliminating the agency and directing all tobacco prevention efforts back to the state Department of Health.

Gov. Doug Burgum, who took office Dec. 15, said in a statement that BreatheND is part of ongoing budget considerations in which "everything is on the table."

The agency was created after North Dakota voters approved a measure in 2008 to spend part of the state's share of national tobacco settlement funds on comprehensive tobacco prevention.

While the state will continue getting tobacco settlement dollars for water projects and schools, BreatheND will receive its last such payment this year.

The balance of its trust fund is projected to be near $56 million at the end of the biennium June 30.

BreatheND Executive Director Jeanne Prom said that money would keep them operating another seven years as they aim to reduce youth smoking rates to a single-digit percentage.

In 2015, approximately 11.5 percent of youths in North Dakota smoked, down from about 22.5 percent in 2009.

"In order to get outcomes, you need funding," Prom said. "You need a single unwavering focus."

This is the first chance legislators have to make any changes to BreatheND because enough time has passed since voters approved the measure that created it. The $56 million trust fund makes an appealing target for lawmakers who have to close a budget gap of more than $1 billion caused by slumping tax revenue from the oil and agricultural industries.

Dalrymple recommended using the money to help pay for additional needs in behavioral health, Medicaid costs associated with tobacco use and costs associated with other smoking-related illnesses, such as lung cancer and heart disease.

Burgum supports tobacco prevention and cessation efforts but is also looking for cost savings in many areas, including "programs that may be duplicative," he said in his statement.

BreatheND has eight full-time employees who have focused since 2009 on establishing smoke-free laws and getting e-cigarettes also covered under those laws.

The way it spends tobacco settlement dollars is based on "best practices" outlined by the Centers for Disease Control and Prevention.

Prom said 36 percent of the agency's trust fund goes to state and local public health units in the way of grants and about 33 percent goes to smoking cessation—an area the state health department also focuses on, with its ND Quits program.

About 13 percent is spent on public education through advertising campaigns, 9 percent on evaluation of the agency's objectives and 5 percent on general administration.

Johnson said the agency's work is saving the state $69 million annually in smoking-related costs, with its smoking rate below the national average.

"There are very few agencies that could show return on investment like we have," he said.

Prom and Johnson both acknowledge the state's difficult economic situation and the growing calls to spend more money on mental health and addiction treatment in light of the state's growing opioid problem.

But Johnson said of all the addictive substances around, nothing trumps tobacco.

"Tobacco kills a thousand people in North Dakota every year," he said. "It's by far the biggest killer."

The agency will get to make its case at a legislative budget committee hearing on Wednesday, Jan. 11.

House Majority Leader Al Carlson, R- Fargo, said in the coming weeks, lawmakers will take a good look at tobacco settlement dollars and how tobacco prevention programs will be run.

"We're still committed to the cause, it's just a matter of how we distribute the money," Carlson said.