The 1998 settlement between the District and leading cigarette manufacturers pulled the city out of financial peril and created a $250 million rainy-day fund. The settlement money was intended to mitigate health-care expenditures related to smoking.

But none of the settlement money has been spent on tobacco control to reduce costs to the Medicaid program. At the same time, the District's adult smoking rate has gone from 18.8 percent in 1998 to 21 percent in 2004. Among Washington's Medicaid recipients, the smoking rate is a whopping 35 percent. Smoking is the most preventable cause of premature death in the District. It is a major risk factor for cardiovascular disease, accounts for 30 percent of all cancer deaths and causes most cases of emphysema and chronic bronchitis.

Mayor Anthony A. Williams wants to issue bonds for the tobacco settlement payments from 2026 to 2040 to give the District a cash infusion of about $200 million for discretionary use. But before that money is locked into other projects, some of it should go to tobacco control.

A little more 13 percent of D.C. residents under the age of 18 smoke; that figures jumps to aforementioned 21 percent among adults. That increase can be attributed at least in part to a lack of prevention programs for young people.

According to the Centers for Disease Control and Prevention, more than 60 percent of smokers in the District attempted to quit in 2004. However, the high cost of nicotine replacement medications and of smoking-cessation counseling makes that especially difficult for low-income people. The same report found that smokers who live above the poverty line had greater success in quitting.

The 2000 Census reported that 20 percent of D.C. residents live below the poverty line. The national average is 12.4 percent. This helps to explain why the District has the 10th-worst success rate in smoking cessation in the nation when compared with the states.

Meanwhile, the District is experiencing the repercussions of all this tobacco use. It has a higher incidence of 11 types of cancers -- including lung cancer -- than any state. It pays $72 million each year in Medicaid costs for smoking-related illnesses and more than $224 million overall in smoking-related costs.

The District needs to invest in preventative measures instead of just continuing to pay the rising costs of treating sick smokers. The D.C. Council has an opportunity to allocate significant funds to support a sustainable tobacco control effort in the District in the budget for fiscal 2007. A comprehensive prevention program for youth and a cessation program would lead to fewer smokers and lower health-care costs for the city.

The D.C. Tobacco Coalition supports a $10 million investment in this effort to be spread over the next three years. That may seem like a lot of money, but it is a fraction of the smoking-related health-care costs the District pays each year. To alleviate the health and financial burdens of tobacco, the District must give its citizens the knowledge and means to overcome their addiction.

-- Aaron Tallent

chairs the nonprofit

D.C. Tobacco Coalition.