In Brief:
- A 1998 settlement with Big Tobacco obligates companies to make payments for damage caused by their products as long as tobacco is sold in the U.S.
- At the time of the settlement, Oklahoma voters approved a constitutional amendment ensuring these funds would be spent to improve health. No other state made such a move.
- Over the past 25 years, grants from the Tobacco Settlement Endowment Trust have had significant public health impacts. At a time when federal funding for public health is declining, the fund announced historic grant awards to mark its anniversary.
As a family physician practicing in Oklahoma in the 1990s, Steven Crawford saw the dark side of smoking on a daily basis: lung cancer, end-stage emphysema, limbs lost from damaged blood vessels. His state didn’t grow tobacco, but its large population of rural and low-income residents was a prime target for cigarette advertising.
In 1996, Oklahoma became the 14th state to file a lawsuit against Big Tobacco. In 1998, 46 states settled their lawsuits against the industry. At a meeting of family physicians following the settlement, Crawford heard a presentation by Mississippi Attorney General Mike Moore, who had led the litigation.
“He passionately recommended that we figure out a way in our states to protect the money from the vagaries of day-to-day politics, to put it into a fund and then only spend the earnings,” he says.
Crawford was convinced. A past president of the Oklahoma Academy of Family Physicians, he worked with academy leadership to get Moore to his state to talk to legislators. Moore addressed a group of lawmakers and senior government officials that year in a local hotel.
The visit helped convince state leaders to preserve the tobacco settlement funds for public health spending. Oklahoma is the only state in the nation that has done this.
Staying on Script
Drew Edmondson, Oklahoma attorney general at the time, had filed suit to recover Medicaid dollars spent treating illnesses caused by smoking. Some states were already receiving settlement payments by early 1999, and he didn’t like what he was seeing.
“Once their legislatures and governors started looking at the money that was coming in, they either cut taxes or aimed it towards a highway project, or something else that didn’t have anything to do with why the lawsuit was brought,” Edmondson says.
Edmondson worked with legislators to create a “constitutional” trust that would hold and use settlement funds for public benefit. The Legislature and governor would not have power to divert funds from such a trust.
This required voter consent. Almost 70 percent approved State Question 692 in a November 2000 election, and the Tobacco Settlement Endowment Trust was born. The trust's statutory obligation is to ensure that settlement funds are used “to improve the health and well-being of Oklahomans.” (Edmondson continued to serve as attorney general until 2010; he was the Democratic gubernatorial candidate in 2018, losing to Republican Kevin Stitt. He’s now in private practice in Oklahoma City.)
Casting a Wide Net
Tobacco cessation was an early priority for the trust. Because it could only spend interest earned from settlement money, it took a few years for investments to show results, Edmondson says. But by 2016, smoking rates were dropping ten times faster than in similar states. Since 2001, smoking prevalence has decreased by half, from 28.6 to 14.1 percent. (Smoking still causes 7,500 deaths in Oklahoma each year, and more than a third of all cancer deaths.)
The trust funded the Oklahoma Tobacco Helpline for 20 years; last year more than 27,000 smokers used it to register for services that could help them quit. In 2024, the trust received multiple awards from the American Advertising Federation for campaigns from its Tobacco Stops With Me program.
The work it has funded has been far-ranging, from research and rural health support to farmers markets, street improvement, community gardens and youth obesity prevention. A loan program provides up to $200,000 in medical debt relief to physicians who agree to practice in underserved rural areas.
The trust also funds three research centers in Oklahoma. In 2024, it reported that investments made since its creation had attracted more than $757 million in additional funding for medical research. Its support for the Stephenson Cancer Center at the University of Oklahoma has played a big role in helping it gain national accreditation, Edmondson says.
The trust’s principal assets have grown to more than $2 billion; earned interest gives it tens of millions each year for grantmaking.
Legacy Grants
At the beginning of 2026, its 25th anniversary, the trust announced $150 million in “Legacy Grants,” long-term investments in Oklahoma health infrastructure. Fourteen projects were chosen from a group of 167 applicants.
“They’re funding cancer clinical trials in Tulsa, nursing education in Ada, and food security for our students,” Gov. Stitt said when the grants were announced. “I am glad to see something's happening in every corner of the state."
The grants were envisioned as a one-time capacity-building investment. Oklahoma consistently ranks near the bottom of all states in health-care access, affordability and equity. “We have a lot of attributes that play into poor health outcomes,” says Julie Bisbee, executive director of the trust. “One of the things we saw that would be multigenerational and outlive us was adding capacity for doctor training.”
Oklahoma has one of the country’s largest populations of Native Americans, a demographic at heightened risk for tobacco-related illnesses. A grant to the Chickasaw Nation Department of Health will establish new residency and fellowship programs at its health services complex.
Rural East Central University received $13 million to expand training for nurses and health professionals; $30 million more will open up 100 new residency positions in the Oklahoma State University Academic Medical District. Grants will also fund nutritional science degree programs and mentorship programs for youth interested in medical careers.
Other awards will fund research, maternal health-care access, behavioral health integration in primary care, meals for low-income students and community health workers to assist hospitals throughout the state.
At a time when federal support for public health is declining, the trust will help Oklahoma fill the gap, Bisbee says. “We have a state-based solution for some of the things other states are trying to wrap their arms around,” she says.
At Risk
Edmondson says his father, who served in Congress for two decades, imparted to him the importance — and relative rarity — of policymakers taking a long view. Some countries think generationally, he says, but America is not one of them. Legislative trusts that other states created to safeguard tobacco settlement funds have not remained intact.
Tobacco companies are required to continue to make settlement payments as long as tobacco is sold in this country. Payments to Oklahoma in the last two years have been around $60 million. Three-fourths goes to the trust, and 25 percent to the Legislature. Some legislators want a bigger share.
The Oklahoma state Legislature passed a bill in 2025 that gave it the right to replace the trust’s board members at will. The state Supreme Court ruled the bill unconstitutional in an 8-1 decision.
“The Legislature thinks in terms of immediate needs, unfortunately, and not the long term,” Edmonson says. There’s now a bill in the state Legislature proposing a ballot question about a constitutional amendment that would earmark the trust’s earnings to expand the Oklahoma Higher Learning Access Program, also known as Oklahoma's Promise.
“We just fight that battle and knock on wood,” Edmonson says. “So far, they have been beat and beat badly every time, but they’re not giving up on it.”
