Steve Panetta smoked for 34 years, the last 10 at a three-pack-a-day clip. He watched his father die from lung cancer and his stepfather struggle with emphysema. He tried quitting six times before a state-funded cessation program helped him beat the habit in 2002.
Weekends now find him the guest speaker at anti-smoking programs, exhorting people to quit. He speaks for free and pulls no punches.
"I rub it right in their face," said Panetta, 55, of Troy. "I say, `If I could make you feel the way I felt back then for five minutes, then wipe it away and let you feel like I feel now for two minutes, you would throw the cigarettes away.'"
He credits a similar in-your-face attitude in the state's anti-smoking ads and programs for helping him quit.
Now, funding for those often chilling TV ads and other smoking cessation programs in New York and other recession-battered states is being slashed, sometimes more than other government programs, despite success and savings in health care costs.
A U.S. Surgeon General's report due to be released March 8 will come down hard on states that have cut anti-smoking funds in tough fiscal times, said Terry Pechacek, who oversees the report as director for Science in the Office on Smoking and Health at the Centers for Disease Control and Prevention.
The report can't result in sanctions, but it has proven to move public opinion in the past to force changes by tobacco companies in how they sell cigarettes, how states fund efforts and how the federal government regulates the trade.
"It is a hard-hitting report and it's going to say, `Why haven't we ended this epidemic? Why are we still feeding all these replacement smokers into a deadly industry?'" Pechacek said in an interview while opposing proposed budget cuts in Albany.
"We've been saying since 1964 that we are going to do something about it, and we are basically in a stall," he said.
There are increased federal efforts to cut into the smoking rate. The Food and Drug Administration is planning to spend about $600 million over five years to educate the public about the dangers of tobacco use.
The share of Americans who smoke has fallen dramatically since 1970, from nearly 40 percent to 20 percent down to about 46 million adult smokers now. But smoking levels haven't changed since about 2004. Multimedia campaigns are aimed at reducing death and disease caused by tobacco, which is responsible for about 443,000 deaths a year in the U.S. "It is a real tragedy and penny-wise, but pound foolish when states cut spending on tobacco control programs," said professor Kurt M. Ribisl of the Department of Health Behavior at the University of North Carolina. "There is zero doubt that well-run state tobacco control programs are very effective in reducing tobacco consumption and tobacco-related disease."
In New York, anti-smoking campaigns are credited with pushing the smoking rate to historic lows of 15.5 percent for adults and 12.6 percent for high schoolers. But Gov. Andrew Cuomo proposes to cut $5 million from the current $41.4 million for anti-smoking programs this year as he contends with a nearly $2 billion deficit. Funding was cut from $80.4 million in 2008-09 fiscal year, a nearly 50 percent reduction when the next-worst hit to any state agency was 30 percent.
Smoking programs have been an easier target politically in tough fiscal times when the alternative is to cut schools or hospitals, but many states also raided anti-smoking funds from a landmark $246 billion national court settlement funds from the tobacco industry for 15 years.
Ohio took $230 million set aside for tobacco prevention, used it elsewhere despite a court challenge, and liquidated the state's Tobacco Use Prevention and Control Foundation. New Hampshire depended mostly on the 1998 federal tobacco settlement for its cessation programs, but much of it was diverted for other budget needs in recent years. Iowa cut its anti-smoking programs nearly in half and eliminated the job of its tobacco use prevention and control director last year.
Meanwhile, some Californians are pinning their hopes on a June ballot initiative to raise cigarette taxes to fund cancer research, a move boosted by cycling champion Lance Armstrong's $1.5 million donation to stop kids and adults from smoking.
Colorado lawmakers have drained money intended for tobacco cessation for years _ even though voters amended the state constitution in 2004 to prevent it. Lawmakers have gotten around that by declaring the state in "fiscal emergency" every year since 2008.
This year, Colorado lawmakers say they won't declare a "fiscal emergency" and are restoring money for tobacco cessation programs.
"It's the right thing to do," said state Rep. Cheri Gerou, a Republican who leads Colorado's budget-writing committee.
Don't say that to Audrey Silk, a national spokeswoman for smoker's rights. Her website screams how anti-smoking funds would better be spent on schools, to keep firehouses open and reduce taxes. She's also pushing a boycott of businesses that ban smoking, the law in many states unless waivers are sought.
"With all of their efforts, the smoking rate has remained stagnant since at least 2004," said Silk, founder of NYC CLASH, a smoking advocate group that operates nationwide. "It's not that some adults who smoke still `haven't gotten the message.' They did and have answered, `Go away and leave me alone.'"
Philip Morris USA, among the tobacco companies paying into the national tobacco settlement, gave more than $55 billion to states _ money that should have been spent on cessation and prevention programs, said company spokesman David Sutton. In addition, New York raised the cigarette tax to the highest in the nation, at $4.35 per pack.
Philip Morris USA "continues to believe states should use (tobacco settlement) funding to fund youth smoking prevention and smoking- and health-related initiatives," Sutton said.
State Health Department spokesman Michael Moran says the program works, but fiscal constraints require more efficient use of tobacco funds. He said the state is trying innovative programs to keep youths from smoking.
Panetta, the ex-smoker, believes quitting cigarettes is tougher to kick than addiction to alcohol or drugs.
In 1985, two years after his father died of lung cancer and as his stepfather battled emphysema, Panetta was descending the stairs of St. Peter's Hospital. He had just been told the tumor in his back wasn't cancer. Relieved after seven weeks, smoke-free and scared, he spotted the drugstore across the street and bought a pack of Winston Lights.
If not for the state program, he might still be smoking.
"I'm behind it for everything they can say, every commercial," said Panetta, a butcher and grandfather who still gets into an occasional pickup basketball game. "The program works."
"We're going to lose people because they aren't seeing it, they aren't feeling it," he said. "They need more billboards up, more ads like the little girl breathing in smoke."
"I've seen all this tragedy."
Associated Press writers Kristen Wyatt in Denver; Norma Love in Concord, N.H.; Julie Carr Smyth in Columbus, Ohio; Ryan J. Foley in Iowa City, Iowa; Bill Kaczor in Tallahassee, Fla.; Scott Bauer in Madison, Wis.; Judy Lin in Sacramento, Calif.; David A. Lieb in Jefferson City, Mo.; and Bob Lewis in Richmond, Va., contributed to this report.