Amendment 35 Colorado
With economy’s climb, Amendment 35 again funds prevention programs

From 2004 to 2008, money from the Amendment 35 tobacco tax funded chronic disease prevention programs. Then the recession hit and the state redirected this money to other urgent needs.

Now, with the economy’s slow climb from the doldrums, millions of dollars from Colorado’s tobacco tax are once again flowing. Researchers in cancer prevention programs at the University of Colorado Cancer Center are hopeful the money will impact the state’s cancer rates—and save both lives and health care costs in the long run.

“The good news is programs to prevent cancer are being funded again,” says Tim Byers, MD, MPH, associate director of cancer prevention and control at CU Cancer Center and associate dean of public health practice at the Colorado School of Public Health.

For example, CU Cancer Center projects that screen uninsured individuals for colon cancer, help smokers quit, and identify patients at risk for hereditary breast and colorectal cancer are rediscovering their footing due to returned Amendment 35 funding.

“The competitive grants given because of Amendment 35 mean the best of the best evidence-based programs can once again compete for funding,” Byers says. “As a result, hundreds of people won’t get cancer and the health care system won’t have to bear those costs.”

Balancing the Smoking Burden

Smokers tend to tax the health care system, so the system should in turn tax smokers. That was the gist of the thinking in 2004, when 61 percent of Colorado voters approved Amendment 35 to increase taxes on cigarettes and other tobacco products.

The thinking was right: Annual health care costs in the United States directly related to smoking are more than $1 billion. Approximately $425 million in income and productivity is lost every year due to premature death caused by smoking. And tobacco-related illnesses are the leading cause of preventable death in Colorado.

Colorado Colorectal Screening ProgramTax revenue went to programs that sought to balance these numbers—to prevent these preventable deaths and save the health care system the money it would eventually spend taking care of these smokers.

For example, the statute requires 16 percent of tobacco tax revenues to be used for school funding of tobacco education programs aimed at keeping youth from smoking, smoking cessation programs and programs to reduce exposure to secondhand smoke. Another 16 percent goes to prevention, early detection and treatment of cancer, cardiovascular disease and chronic pulmonary disease.

CU Cancer Center got a slice of each of these funds—and came to depend on these monies to keep the lights on in many of the Center’s prevention and control programs.

When the economy went south, Colorado legislators declared a fiscal emergency. From 2009 to 2011 Amendment 35 funds were down in general—fewer people could afford to smoke. And these reduced funds were redirected to cover expanding Medicaid costs. Cancer prevention programs like CU Cancer Center’s Colorado Colorectal Screening Program saw their budgets slashed—free screenings were reduced and research projects went into maintenance mode.

At the same time, Byers and Cancer Center colleague Paul Bunn, MD, joined the American Cancer Society’s effort to encourage state legislatures to preserve Amendment 35 money. Their efforts worked.

Today, Colorado’s economy is recovering and Amendment 35 funding is being restored. In fiscal year 2012-2013, the state of Colorado predicts it will receive approximately $140 million in tax revenue from Amendment 35—about $46 million of which will be available to agencies working to prevent cancer—agencies like CU Cancer Center.

Out of Hibernation

The economy goes up, tax revenues go up, prevention and control programs go up. Hopefully speaking, smoking and cancer rates will go down. With the first now gaining traction, CU Cancer Center researchers are starting to see the other three fall in line.

Colorado Cancer Screening ResourcesArnold Levinson, PhD, MJ, a tobacco control expert at the CU Cancer Center, is the scientific director on a new three-year, $600,000 grant to design, implement and evaluate smoking cessation treatment programs for tobacco-using patients in the University of Colorado Health system.

The project—a collaboration between CU Cancer Center and University of Colorado Hospital (UCH)—brings together the academic expertise of Levinson’s research group with system-wide access to patients in three University of Colorado Health hospitals: UCH, Poudre Valley Hospital and Medical Center of the Rockies.

“We hope our initiative will serve as a model for other hospitals,” Levinson says.

Byers hopes the program will directly result in quitting. “About 17 percent of the population in Colorado smokes,” he says. “There is really no reason we can’t continue to drive down that number.”

Beyond Tobacco

In addition to funding tobacco cessation and education programs, Amendment 35 sets aside money for research and treatment grants.

Jan Lowery, PhD, MPH, CU Cancer Center investigator and assistant professor of epidemiology at the Colorado School of Public Health, is benefitting from one of these grants—and her work could soon benefit all Colorado residents. Lowery’s project, called “Colorado Generations” (for which she teamed up with Metro Community Provider Network and Plains Medical Center), is all about maximizing thin resources. Who should undergo costly advanced cancer screening? Well, the people who are at the greatest risk of developing the diseases.

“It’s critical that we identify people who are at risk for hereditary cancer because their risk for developing cancer may be as high as 80 percent,” Lowery says. “This project will help clinics identify their patients that, due to their family history, are at increased risk for cancer and in need of cancer screening.”

“Hopefully, by identifying high-risk patients, clinics can prioritize their already limited resources for subsidized screenings,” she explains.

Colorado Generations matches medically underserved Coloradans with genetic counselors who can help assess cancer risk, coordinate testing and make screening recommendations for those at especially high risk for hereditary cancers.

“The goal is to increase awareness about family history and hereditary cancer risk among patients and their providers,” Lowery says. “We want them to know what it is and whether it may affect them so that they can get appropriate care and make informed, pro-active decisions about their health.”

Colorado Generations refers patients to Women’s Wellness Connection for free breast cancer and cervical cancer screenings. It also refers patients to the Colorado Colorectal Screening Program (CCSP)—another Amendment 35-funded project at CU Cancer Center, which through June 2011 had screened more than 13,000 Coloradans at 65 community health clinics and detected 112 cancers.

“The program saves millions in medical costs by preventing colorectal cancer,” says Andrea Dwyer, CCSP Program Manager. “And you can’t put a price tag on the lives saved by those whose cancers were caught early or completely prevented.”

With the loss of Amendment 35 money, the CCSP had to cut way back. Now the money has returned.

“We were awarded nearly $3 million dollars this year in the state’s competitive grants program to rebuild the program infrastructure and screen several thousand people.”

Amendment 35 money goes up, cancer goes down. Byers, Bunn, Levinson, Lowery, Dwyer and their CU Cancer Center colleagues hope that 2012 and 2013 are only the start.