The cost of smoking-related diseases was the main reason state governments sued the nation's top cigarette companies in 1998, which led to the $206 billion, 25-year legal settlement.

In the past 10 years, states have used the settlement money to plug budget holes and pay for infrastructure and education programs. Many states have used the money for Medicaid programs or other health initiatives, but only a small percentage of the settlement money has gone where many public-health advocates hoped it would -- tobacco prevention.

According to research by the Campaign for Tobacco-Free kids, states are spending less than 3 percent of the settlement and revenue from cigarette taxes on tobacco-prevention programs.

So some of the optimism that public-health advocates expressed about the deal has waned.

"I think it has been a mixed bag," said Eric Lindblom, policy research director for the Campaign for TobaccoFree Kids. While the money has enabled many states -- Virginia included -- to start prevention programs, "the most enormous problem is that the states have not been allocating a decent amount of the money to tobacco prevention to reduce smoking-caused diseases and harm."

Public-health groups argue that states should fund tobacco-prevention programs as recommended by the U.S. Centers for Disease Control and Prevention. For example, the agency recommends that Virginia spend at least $39 million a year on tobacco-prevention programs.

Virginia's funding is about 37 percent of that. Only three states, Maine, Colorado and Delaware, are spending at or above the CDC's recommended minimum amounts.

In Virginia, the General Assembly committed 10 percent of the state's payments from the settlement to a youth tobacco-prevention campaign.

Since then, a foundation that oversees the money has spent about $88.7 million on prevention programs, but that money has not been free from legislative raids.

In 2003, the assembly drained $15.5 million to help fill a budget gap. The money has not been restored. Lawmakers made an unsuccessful attempt to shift money from the foundation in 2001.

"We were very slow and very methodical in how we wanted to structure this foundation and designing what our mission and goals were going to be," said Ricky Fulcher, a Stuart businessman who has led the foundation since 2003. "I think because of that we were penalized, because we were sitting on funds that we did not want to recklessly spend."

The foundation has spent about $39.6 million on an advertising and marketing campaign that includes television and radio ads targeted at adolescents. It has also spent $30.6 million on grants to community and school groups that offer tobacco-prevention and healthy-lifestyles programs to children, and $18.5 million in grants to state universities to conduct research on nicotine addiction and ways to prevent youth smoking.

Fulcher said he believes the campaign has been effective. "We have reached somewhere around 750,000 kids," he said. "And we have a recognition rate that is running from 74 [percent] to 79 percent of kids."

In a 2001 survey, almost 29 percent of high school students and 11 percent of middle school students indicated that they smoked in the previous 30 days. Both figures declined in 2003, with about 21 percent of high school students and 6 percent of middle school students saying they smoked. In 2005, however, the most recent a survey indicated that the decline had stalled.

New data on youth-smoking rates are due out this summer, and foundation officials say preliminary results indicate declines in smoking among middle and high schoolers.

Contact John Reid Blackwell at (804) 775-8123 or jblackwell@timesdispatch.com.