Massachusetts' share of the 1998 nationwide tobacco settlement runs at about $700 million annually, and the state rakes in millions more as the result of three cigarette tax hikes since 1992. One of those -- a 25-cent-per-pack increase -- was supposed to be dedicated to an antismoking campaign.

But since 2002 the budget for the youth prevention campaign has been dramatically cut, shrinking a program once cited as a national model by the Centers for Disease Control and Prevention. In 2004, the American Lung Association gave the state an "F" for its smoking-prevention efforts.

"It's almost like we had developed a vaccine to prevent a leading cause of death in Massachusetts and left it on a shelf," said Diane Pickles of Tobacco Free Mass. "We know how to solve the problem but we're not doing it."

State lawmakers have shown few signs of changing their approach to the tobacco-settlement money: a new proposal calls for spending about $225 million from the fund on insurance coverage for state residents.

Tobacco prevention groups say they would be satisfied if Massachusetts would dedicate even the $35 million recommended by CDC to prevention. "We're thrilled with the House's health reform plan because it increases access for cancer patients, but we are also mindful that the funds were meant for antismoking programs," said Jennifer Cruickshank, a spokesperson for the American Cancer Society in New England.

Others say that using the settlement money to provide healthcare for victims of smoking-related illnesses is in line with the 1998 agreement.