For the fourth year running, Maine has ranked first in the nation for its use of tobacco settlement money to fund smoking prevention and cessation programs and can point to a dramatic drop in the rate of smoking in middle school and high school students as evidence that the funds are being well spent.

According to a national report released Wednesday, Maine now spends $14.2 million a year on direct anti-smoking initiatives, more per resident than any other state and more than the minimum amount recommended by the federal Centers for Disease Control and Prevention. Only three other states – Colorado, Delaware and Mississippi – spend even the minimum recommended.

States started getting money from the multistate settlement with the tobacco industry in 1998, and Maine has since reduced smoking rates among middle school students by 64 percent and among high school students by 59 percent.

“Maine has demonstrated to the rest of the country how to go about protecting people from tobacco use,” said William Corr, executive director of the Campaign for Tobacco-Free Kids, one of the national organizations behind the survey.

States are free to spend the tobacco settlement money as they choose, and many direct the funds toward highways, schools and other needs. But the CDC makes state-specific recommendations for spending the money to combat tobacco use based on the per capita cost of providing a comprehensive, six-point tobacco prevention and treatment campaign. The agency’s guidelines include community programs, school-based programs, public education, controlled access to tobacco products, support for established smokers who want to quit and ongoing evaluation of these efforts.

The CDC recommends Maine spend $11.2 million to $25.4 million of the approximately $46.5 million it receives each year from the settlement. It makes similar recommendations to all other states, but, according to the report released Wednesday by the Campaign for Tobacco-Free Kids, the American Heart Association, the American Lung Association and the American Cancer Society, only 11 other states are funding tobacco prevention and cessation programs at even half the recommended amount. Thirty states spend less than half, and five states – Michigan, Missouri, New Hampshire, South Carolina and Tennessee – and the District of Columbia allocate no significant funds at all to combat tobacco use.

With tobacco use the leading cause of preventable death in the United States, Corr said Wednesday that Maine should serve as a model for other states in the fight against tobacco use. Maine’s plummeting rate of tobacco use among teens “is a real tribute to the state’s visionary leadership in government, as well as individuals and community groups,” he said. “You won’t find a more consistently dedicated group of people anywhere in the country.”

The 1998 settlement agreement requires the tobacco industry to pay millions to states each year in perpetuity to compensate for health care costs associated with tobacco use. A total of about $246 billion will be distributed over the first 25 years.

Adding the settlement money to taxes generated by tobacco sales, states this year will receive a total of about $21.3 billion in tobacco-related revenues. In Maine, the combined amount is $185.4 million, not taking into account the most recent tax hike that raised the price of a pack of cigarettes over the $5 mark.