Maine was once a leader in the nation on smoking cessation and prevention programs, but it is slipping backward and the rates at which high school students are smoking and using electronic cigarettes have now moved above the national averages for the first time in 20 years.

In 2015 – the last year for which data were available – 11.5 percent of Maine high schoolers said they smoke, while another 17 percent said they regularly use electronic cigarettes, commonly known as vaping. For adults the numbers are worse, with nearly one of every five Mainers, or 19.8 percent of the state’s population, saying they smoke – the highest smoking rates for adults in New England, according to the federal Centers for Disease Control and Prevention.

Nationally, 8 percent of high school students smoke while 15.3 percent of adults do.

The habit is a costly one for Mainers, both in lives lost to smoking-related illness and disease and in taxpayer dollars spent on health care for the poor, who use tobacco in higher numbers.

About a third of all cancer deaths in Maine are connected to tobacco use and in all an estimated 2,400 people will die from tobacco-caused diseases in 2017 – more than six times the number who died from opioid drug overdoses in 2016 – while Medicaid costs for smoking-related illness and disease cost the state and federal governments $262 million in 2016, according to the CDC data.

It’s part of the reason why a coalition of health advocacy groups, including the American Lung Association and the American Cancer Society, are calling on Maine and all states to use the money they receive each year from a federal tobacco lawsuit settlement fund for its intended purposes – helping people quit smoking and preventing youth from ever starting the habit – instead of diverting much of the money to other priorities.

Maine received about $43 million from the settlement fund in 2016 but will spend only $5.3 million on tobacco prevention and cessation programs. Advocates worry it won’t be enough, and what’s been a long, steady march to a tobacco-free generation will be stopped in its tracks.

“There was a lot of work years ago to get into the communities and to get municipalities to promote nonsmoking facilities, nonsmoking fields and beaches and all of that and that money has started to be funneled out to other areas,” said Jeff Upton, the South Berwick Police Department’s school resource officer for Marshwood High School.

“We were kind of gangbusters there for awhile and doing really well and as years go by and budgets become tighter the money has become less and less to the point we are not even sure we are able to fund positions to continue to do the prevention work.”

Although the state receives millions from the tobacco industry lawsuit settlement, the Legislature and Gov. Paul LePage have steadily diverted more and more of those funds toward other health care priorities.

In 2010, the state spent about $10 million on prevention and cessation programs, down from the $15 million it spent on the programs in 2008. In 2018, the state will spend just $5.3 million on the programs. And Maine is not alone.

A new report by the health advocacy groups, “Broken Promises to our Children,” shows how all 50 states are now spending the funding, with most states using only a small fraction for the intended purpose. The report concludes that “nearly every state gets a failing grade and is spending a minuscule portion of tobacco revenues to fight tobacco use and the enormous public health problems it causes.”

That downward shift in prevention spending is slowly starting to show up in the numbers, and prevention advocates are bracing for even gloomier news when the next batch of data is released in early 2018.

That Maine is no longer keeping pace with the national average on smoking and is losing even more ground when it comes to the use of electronic cigarettes among its youth, as the data and the report show, is a cause for concern, according to Hilary Schneider, the government relations director for the American Cancer Society’s Cancer Action Network in Maine.

“When we have seen increases in tobacco use, especially among youth, in the past the increases can happen quickly,” Schneider wrote in an email message. “There is concerning data that suggests that if we do not take action, we could quickly see an increase in youth tobacco use. In fact, if you look at the data on use of any tobacco product in the last 30 days, that rate is higher than in the past (due to the tobacco industry’s introduction of new products like e-cigarettes). If nothing is done, 27,000 Maine kids alive today will die prematurely from smoking.”

Schneider and lawmakers who advocate for a robust public health system said easing up on prevention and cessation programs while the tobacco industry continues to pump $42 million each year into Maine on marketing and advertising spells trouble.

“This is a story of public health,”said Rep. Patricia Hymanson, D-York. “We are fighting a gigantic industry and the public health system in Maine has been pushing back against that – unfortunately we have taken our foot off the pedal.”

Others involved in addiction prevention and treatment also worry that a fraying of the infrastructure for public health outreach will have a compounding effect – especially as the state moves to make the sale of recreational marijuana legal.

Scott Gagnon, who led the opposition campaign against legalized marijuana in Maine, points to another recent study that shows tobacco users are seven times more likely to consume marijuana than nonsmokers.

“Now we are in this place where we are seeing the rise of vaping amongst our young people, as well as the introduction of the marijuana industry in Maine,” Gagnon said. “This is a time where robust funding for youth tobacco and substance use prevention is critical.”

He said it’s important to use the settlement fund money for prevention as it was intended, since the funds come directly from the tobacco industry.

“We’re not talking about taxpayer dollars; it doesn’t cost Mainers anything for us to be funding these programs we know that work,” Gagnon said. “The kicker is good prevention saves money for the state and taxpayers in the reduction of the costs of treating chronic diseases stemming from the use of tobacco products. This report should be an eye-opener for Maine and a call to recommit to a strong prevention response to youth and adult tobacco use.”