A report issued by a coalition of public-health organizations said that states continue to underfund smoking prevention a decade after receiving billions from tobacco companies under a landmark 1998 settlement agreement.

The report, titled A Decade of Broken Promises: The 1998 State Tobacco Settlement Ten Years Later, said that states have spent only 3.2 percent of the $203.5 billion generated from the settlement and tobacco taxes over the past 10 years.

Released by the Campaign for Tobacco-Free Kids, the American Heart Association, the American Cancer Society Cancer Action Network, the American Lung Association and the Robert Wood Johnson Foundation (RWJF), the study said that no state is funding tobacco-prevention programs at levels recommended by the U.S. Centers for Disease Control and Prevention (CDC), although North Dakota will be doing so next year thanks to a voter-approved ballot initiative.

Researchers found that just nine states funded tobacco prevention at even half the level recommended by CDC, while 27 provided less than 25 percent of the CDC-recommended funding. Meanwhile, tobacco companies increased their annual marketing expenditures from $6.9 billion in 1998 to $13.4 billion in 2005 -- effectively outspending states 19-to-1 in the battle over youth smoking.

States should fund tobacco prevention programs at CDC-recommended levels, increase tobacco taxes and enact smoke-free workplace laws, the report said. Moreover, Congress should enact legislation allowing the U.S. Food and Drug Administration to regulate the manufacturing, marketing and sale of tobacco products, the authors said. Revenue from these efforts could be used to fund national public education and smoking-cessation campaigns, according to the report.

"The nation’s challenge today is to resist complacency and stay focused on reducing tobacco use," said Risa Lavizzo-Mourey, president and CEO of RWJF. Mourey said that enacting the recommendations of the report "will help get us to the goal that the Institute of Medicine has set for us -- to eliminate tobacco use as one of the most pressing public-health problems in the United States."

Surveys show significant progress in reducing smoking in the past decade, but 20 percent of high-school students and 19.8 percent of adults in the U.S. continue to smoke. More than 400,000 people die from tobacco-related causes each year, costing nearly $100 billion in healthcare expenditures.