AUGUSTA — Health advocates say that if lawmakers aren’t careful, they could undo decades of successful anti-tobacco policy.

Elements of Gov. Paul LePage’s budget and several bills in the Legislature could each push Maine toward a backslide, they said during a news conference Thursday.

“For over 25 years, we have systematically worked to reverse the upward trend of smoking. … We are perilously close to seeing that progress disappear” said Karen O’Rourke, an assistant professor of public health at the University of New England and long-time anti-tobacco advocate.

O’Rourke was joined by representatives from the American Lung Association, American Medical Association, American Cancer Society and MaineHealth in urging legislators not to de-escalate what one speaker called the “war against tobacco.”

LePage’s budget would cut state spending on anti-tobacco programs at the Healthy Maine Partnerships, a network of community health organizations throughout the state. The roughly $6 million annually in state appropriations would be used, instead, to fund increased primary care reimbursements rates for Medicaid patients.

The group’s opposition to that budget provision is well-known. But it’s not just the budget that has them ringing alarms. They’re are also carefully watching three other bills. They support a bill by House Majority Leader Jeff McCabe, D-Skowhegan, to ban the use of nicotine vaporizers or e-cigarettes in all the places that smoking is currently prohibited.

And they oppose a bill by Sen. Jim Hamper, R-Oxford, to allow certain tobacco shops to operate cigar lounges that can serve alcoholic beverages to cigar smokers.

The problem with public vaping and cigar bars is that both could “normalize” tobacco use for a new generation who have come up in a society that otherwise discourages smoking.

“Policymakers cannot let big tobacco convince us there is a new reality, where electronic cigarette aerosol is safe and acceptable, or the creation of a cigar bar, which unfairly competes with other bars [where smoking would still be illegal] won’t make a difference,” O’Rourke said.

In the late 1990s, the U.S. Centers for Disease Control and Prevention released a survey of smoking in the United States, which indicated that Maine had the highest smoking rates in the country, with roughly four out of 10 young adults reporting they smoked.

Policymakers quickly adopted measures to combat tobacco use, including doubling the cigarette excise tax from 37 cents to 74 cents. As the years went on, Maine banned smoking in public places, and a giant annual cash settlement from Big Tobacco was diverted to the new Healthy Maine Partnerships.

Today, the cigarette excise tax is $2 per pack — tied for 12th highest in the nation. The youth smoking rate is just 13 percent and the overall rate is 20 percent, roughly mirroring the rate nationally, according to the MaineHealth Index.

For DHHS Commissioner Mary Mayhew, that’s evidence that tobacco cessation and prevention efforts at the Healthy Maine Partnerships aren’t working. Because low-income Mainers are more likely to smoke than more affluent ones, diverting funding to Medicaid reimbursements just makes sense, she said.

“Despite ranking seventh in the country for tobacco cessation spending, Maine’s smoking rate for years has mirrored the national average,” Mayhew said in a written statement. “The [Healthy Maine Partnerships] approach simply hasn’t worked and it’s time for a change.”

But an epidemiologist with MaineHealth, Tim Cowan, said the overall smoking rate is not the only indicator worth examining to analyze Maine’s progress in kicking the tobacco habit.

The state has a higher-than-average percentage of people who are more dependent on tobacco, he said. And certain demographics smoke more than others: Adults aged 25 to 34 smoke at a rate of higher than 30 percent. Those who make less than $15,000 per year have a smoking rate of almost 40 percent.

There are also geographic factors, Cowan said: In Aroostook, Somerset and Oxford counties, one in four adults smoke.

“The war on tobacco is not over yet,” said Hillary Schneider, director of government relations for the Maine chapter of the American Cancer Society’s Cancer Action Network. “While progress has been made in the battle against addiction, we cannot rest on past success.”

For now, public health advocates — the warriors in Schneider’s war — are in lobbying mode.

McCabe’s and Hamper’s bills are both awaiting votes in the Legislature. Budget negotiators in the Appropriations Committee are working long hours on LePage’s budget, and will vote soon on whether to go along with his plan to cut funding to the Healthy Maine Partnerships.

Ed Miller, northeast senior vice president for policy for the American Lung Association, said he’s hoping the committee’s Republicans will continue funding the Healthy Maine Partnerships in exchange for an independent audit of the group’s activities. He said the groups could use a “reset,” given the radically different look tobacco has today than it did 20 years ago.

“If you were developing these entities today, what would their tobacco agenda look like?” he said in an interview.

“We don’t want to restore the money just for the status quo. We want this program to be changed, to be looked at. I’m hoping that in the budget process there are enough people who see that the infrastructure [of the Healthy Maine Partnerships] has great benefit to a rural state like Maine. This really is our public health infrastructure,” he said.