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Funding for tobacco prevention programs in Tennessee is also one of the lowest in the country, Henry said. "It makes it harder to counteract the marketing and advertising efforts that are being used in Tennessee by manufacturers of tobacco products," she said. Tobacco companies spend $227.2 million a year to advertise in Tennessee.
Funds received by each state from a multi-state lawsuit settlement against tobacco manufacturers have been put to use for tobacco prevention programs in most states, but Henry said Tennessee elected to place the settlement money into a general fund, allowing for a limited amount of state funds for her programs targeting tobacco. Tennessee receives in excess of $250 million a year in settlement funds, yet Henry said most funding for programs in Tennessee comes from the federal level by the CDC.
Changes on the horizon
But the tide is slowly beginning to turn in Tennessee and other states. Tobacco is not the cash crop it once was. "It used to be one of the top crops in Tennessee, but it's struggling to be in the top 10 now," Stamm said. Tennessee production of burley tobacco, which is chopped up and used to make cigarettes, has dropped by 111 million pounds since its peak in 1982, according to the state Department of Agriculture.
Income from tobacco totals less than what tobacco cost Tennessee in health care dollars. In 2002, an estimated 50 percent of smokers in Tennessee were Medicaid or TennCare recipients. The cost to the state for smoking-related Medicaid costs per capita was $142.6 million. The economic toll of tobacco use is staggering, with about $1.69 billion spent each year on smoking-related health costs in the Volunteer State.
With the cost, the new data from the Surgeon General's report and the consistent efforts of several state organizations in mind, Tennessee Gov. Phil Bredesen weighed in on the fight against the dangers of tobacco use. He proposed a ban on smoking in workplaces, as well as increasing tobacco taxes by 40 cents, bringing the total to 60 cents, which would still be well below the national average.
As the legislative session neared an end, the General Assembly approved, and sent to Bredesen for his signature, bills to ban smoking in enclosed businesses with more than three employees, effective Oct. 1, and a 42-cent hike in the cigarette tax, raising it on July 1 to 60 cents per pack, still below the national average of 80 cents. The smoking ban has exemptions, including bars that serve only patrons over age 21 and up to a quarter of the state's hotel rooms, but anti-tobacco advocates called it a break with Tennessee's tobacco ties and smokers railed against the perceived infringement on personal rights.
Nationally, the latest American Cancer Society figures show fewer Americans are dying from cancer for a second straight year, and this time by a greater number. Officials say this drop shows
prevention and treatment efforts, including anti-smoking efforts,
are paying off. However, lung cancer deaths, which dropped among men, increased among women. Health officials say that is due, in part, to the fact that women traditionally begin smoking at a later age than men.
The Speaker of the U.S. House of Representatives, Rep. Nancy Pelosi, made banning smoking a top priority after taking her seat as the first female house speaker by stamping out smoking near the house floor.
The advocacy group Americans for Non-smokers' Rights says for the first time in the nation's history more than half of Americans live in a city or state with laws mandating workplaces restaurants or bars be smoke-free, and they think all of Americans will live in smoke-free places in a few years. Seven states and 116 communities enacted tough smoke-free laws in 2006, bringing the numbers to 22 states and 577 municipalities across the country, and making last year the most successful year for anti-smoking advocates.
Until the last breath
It's all good news to Pam Collins, as she continues chemotherapy to try to keep her lung cancer from spreading. She has three tumors in her liver, one in her right kidney, and the one in her lung that can't be removed because it is too close to her heart.
So the Atlanta resident makes the three-hour trip each month to Vanderbilt-Ingram Cancer Center for treatment and tests. It's a routine she'll continue until she takes her last breath. She compares her situation with that of a recent high-profile lung cancer patient, Christopher Reeve's widow, Dana. "I've been alive for a year and a half with this diagnosis and I have the same lung cancer that Dana Reeve had and she lasted six months," said Collins.
She went to several other cancer centers and saw several other physicians, some much closer to her home, but Collins said Vanderbilt is the only place that offered her hope. "I came here to see Dr. [David] Johnson and felt very connected to him."
For now, her tumors aren't growing and doctors haven't discovered any new ones. So Collins tries to keep a positive attitude while she's in for, literally, the fight of her life. "I just want to have a good quality of life while I'm living. As long as I can stay the same or get better, I'll continue. I know I will know when enough is enough," she said. "I look at it this way, if it's not cancer it will be something else that will come to test you. I just decided that I couldn't dwell on it." 
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