摘要：Changing political and economic forces in 1 tobacco-dependent state, North Carolina, demonstrate how the interplay between these forces and public health priorities has shaped current allocation of Master Settlement Agreement funds. Allocation patterns demonstrate lawmakers’ changing priorities in response to changes in the economic climate; some of the agreement’s funds targeted to tobacco farmers appear to reflect objectives favored by tobacco manufacturers. Funds earmarked for health have underfunded youth tobacco prevention and tobacco control initiatives, and spending for tobacco farmers in North Carolina has not lived up to the rhetoric that accompanied the original agreement. We discuss the implications of these findings for future partnerships between public health advocates and workers as well as tobacco control strategies. ALLOCATION OF MASTER Settlement Agreement (MSA) funds to tobacco control programs has fallen short of public health advocates’ expectations. There are several reasons for this failure, some structural and others the result of shifting political objectives and fiscal crises that recently confronted most states. We examined the evolution of these changing forces in 1 tobacco-dependent state, North Carolina, and discuss implications for future tobacco control efforts. North Carolina provides an excellent case study. It is a major tobacco-producing state with above-average tobacco use, 2 factors likely to diminish lawmakers’ and constituents’ interest in tobacco control. 1 , 2 State lawmakers face a complex array of competing interests and political issues: the tobacco lobby continues to exercise considerable political strength, tobacco-dependent communities face fragile economic futures, the substantial loss of manufacturing jobs in non–tobacco-dependent communities has introduced new pressures for economic development, 3 and shrinking tax revenues combined with rapidly rising Medicaid costs have created a constrained economic climate. Additionally, North Carolina tobacco farmers’ phase 2 settlement payments are being replaced by tobacco quota buyout payments. Although neither of the latter 2 funding sources is controlled by the state, their purposes and those of MSA funds are intertwined.
