That she had been able to walk into my office at all was a miracle. She could just as easily have died in the waiting room, or at home in bed. The chest pain she was having was her heart gasping for air, starved as it was of oxygen-carrying blood by a near-total blockage in the main artery to the main chamber of the heart. In men that kind of blockage is often called “the widow-maker,” because it causes so many fatal heart attacks and creates so many widows.

At 46, her heart wasn’t any older than mine, but smoking made hers a high-mileage model. At the end of that day she was in the hospital and I was headed home. She was going to cost her health insurance about $10,000 in the next 48 hours, and if the rest of her day went badly she would be dead. Joe Camel would have been so proud.

We had both tried our first cigarettes at age 15; she got hooked and I got nauseated. (I also tried cigars, pipes and marijuana; if it had been cool to smoke cow manure wrapped in pages torn from some required summer reading book I would have tried that, too.)

Our children deserve a better chance at avoiding tobacco addiction than she and I had. The battle that really matters to them is not in Afghanistan, or over the length of their skirts; it is in their hearts and minds over whether they will become addicted to cigarettes. A million American teen-agers a year become regular smokers and of those, 350,000-plus will eventually die of tobacco-related illness. At current rates, five million American teens alive today will ultimately die of tobacco-related illness. Five MILLION. And it could get worse.

Pinched by dwindling tax revenues, state legislatures like Maine’s are looking again to state monies from the national tobacco settlement to solve some of their budgetary problems, monies that are supposed to go in part to programs aimed at keeping teens off cigarettes. In Maine this year the budget for state tobacco prevention and cessation programs was cut by $4.4 million, from more than $18 million to less than $14 million. Across the United States, only $430 million of the $8 billion states received in 2001 from the settlement was spent on tobacco cessation and control projects.

By comparison, the tobacco industry spends $430 million on advertising in just 20 days – David meets Goliath and gets smoked. That marketing works on teen-agers: smoking rates among teens reached a 19-year high in 1997, and the percentage of children under the age of 18 who smoke has increased by more than 70 percent in the last 10 years.

The puny spending on state tobacco cessation and prevention programs stands in sharp contrast to the success of such programs. In California, the state with the most comprehensive programs, tobacco consumption has gone down more than 50 percent in the last 12 years, and rates of heart disease and stroke are dropping with it. Programs to keep teens off cigarettes have been successful in every state they have been implemented in; Maine’s rate of smoking among high school students has gone from 27 percent to 17 percent in the last two years. Failure to keep those teens from smoking consigns many of them to the path of nicotine addiction that led the patient to my office with heart disease at age 46.

Any state that wants its children to live as long and healthy will fight tooth and nail to prevent them from becoming addicted to cigarettes as teen-agers, since more than 90 percent of smokers become addicted as teen-agers. Most start between the sixth and ninth grades, a time when no one should be free to make life and death decisions about smoking. Any state that does not want to pay for smokers’ heart attacks thirty years from now should be supporting programs to keep teens tobacco-free today. The only way to fight tooth and nail is to fund tobacco prevention and cessation programs.

The money to fund programs proven to keep teens off cigarettes, and to help smokers kick the habit, should be protected from state budget-cutters regardless of other hard fiscal realities. Per capita funding levels should be guaranteed for the duration of the settlement, along spending guidelines suggested by the Centers for Disease Control. A state not spending at least as much as the CDC recommends is consigning generations to smoking addiction and disease, and taxpayers to the bills that result.

In the battle with the tobacco industry for the hearts, minds and long-term health of our teen-agers, if we choose not to spend the tobacco settlement money on programs aimed at keeping our teen-agers off cigarettes it is our hearts, minds and consciences we should be worried about.

And by the way, our children will never understand why we made such a choice.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.