[25] [26] Despite these statistics, tobacco companies have not been held responsible for the health costs associated with tobacco use for many years. This changed in 1998 when the four largest tobacco companies in the United States, when the original participating manufacturers (Brown & Williamson, Lorillard, Philip Morris and R.J. Reynolds) reached a settlement agreement with the attorneys general of 46 states and the District of Columbia to offset the excessive burden of tobacco-related diseases on the state`s Medicaid programs. This settlement, known as the Tobacco Master Settlement Agreement (MSA), involved a significant financial transfer from cigarette manufacturers, both original participating manufacturers and subsequent manufacturers, to the states. To examine the magnitude of tobacco control „leaks,“ we looked at whether there are significant relationships between per capita MSA payments and state SoTC scores and sub-components. The most recent available data on ESA expenditure of all States (2006) broadly confirm the above trends. As shown in Table 1, tobacco control expenditures in most states are only a small fraction of total MSA expenditures. .

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