1. Missourians for Health and Education

2. Why a Tobacco Tax? Each year thousands of Missourians are diagnosed with tobacco-caused cancers, heart and lung diseases, and many will lose their lives. Missouri has the lowest cigarette tax (17¢ ) of all states in the nation, and very high smoking and other tobacco product use rates. National average tax is $1.49. Costs an estimated $581 per household in public expenditures, and claims 9,500 lives per year in Missouri from cancer and other smoking-related diseases. This ballot measure will mean increased longevity, improved quality of life, and fewer Missourians who will needlessly suffer and die from tobacco-caused diseases. This is a public health initiative that will impact the lives of Missourians for generations to come, through better health and education.

3. Why a Tobacco Tax? Revenue Win Provides CDC recommended levels of tobacco control funding Provides additional revenue for K-12 and Higher Education Health Win One of the most effective ways to reduce smoking rates and other tobacco product use, and helps prevent our youth from ever starting Increase is on cigarette and other tobacco products

4. State Tobacco Tax Excise Rates

5. Surrounding States

6. Health Impact in Missouri Smoking Prevalence Missouri adults 21.1%, Missouri is 11th highest in smoking prevalence now 19.5% high school students smoke 8,600 Missouri kids (under 18) become new daily smokers each year. Annual healthcare costs directly caused by smoking: $2.13 billion Annual cost of smoking to Medicaid: $532 million

7. $.73 Tax Increase Projected Benefits Kids in Missouri kept from becoming addicted adult smokers: 40,100 Current adult smokers in the state who would quit: 33,300 Smoking-affected births avoided over next five years: 8,200 Missouri residents saved from premature smoking-caused death: 22,200 5-year health savings from fewer smoking-affected pregnancies & births: $17.69 million 5-year health savings from fewer smoking-caused heart attacks & strokes: $11.80 million Long-term health savings in the state from adult & youth smoking declines: $1.37 billion

8. Allocation of Funding 50% Elementary and Secondary Education (emphasis in the classroom) 30% Universities and Colleges (emphasis on training healthcare providers) 20% Prevention and Quit Assistance

9. Elementary and Secondary Education Prevent staff reductions & increased class sizes. Ballot language includes safeguard to ensure additional revenue to K-12 education (supplement, not supplant) Distribution method DESE shall distribute Funds will be distributed based on average daily attendance Then funds will distributed on a per pupil basis At least 25% of the moneys shall be used in direct classroom expenditures Purposes, include, but not limited to: Teacher recruitment & retention, salaries or professional development; School construction, renovation, or leasing; Technology enhancements, textbooks, or instructional materials; School safety; or Supplying additional funding for required state & federal programs.

10. Higher Education Department of Higher Education distributes to public colleges and universities Based on proportion of basic operating appropriations for preceding FY – 25% shall be used for programs related to the education, training, and development of future caregivers including physicians, dentists, optometrists, pharmacists, nurses, and other healthcare providers

11. Tobacco Prevention and Quit Assistance Responsible for establishing initiatives to promote tobacco use quit assistance and prevention and public health for tobacco- related disease – including a comprehensive statewide tobacco control program – 15% may be used for public health, including loan forgiveness or scholarships for medical professionals who work in underserved areas

12. Questions?