WASHINGTONThe National Cancer Policy Board (NCPB) has a message
for states still deciding whether to devote some or all of their
tobacco settlement funds to lowering tobacco use: Aggressive, focused
control efforts work and save lives. As states contemplate
increasing their tobacco control efforts, many have asked if such
programs can make a difference. The evidence is clear: They can,
a new NCPB report says.
The NCPB, part of the National Academy of Sciences Institute of
Medicine, focuses on cancer policy issues. In State Programs
Can Reduce Tobacco Use, the board summarizes the evidence for
the effectiveness of state tobacco control programs and describes the
elements commonly employed by various states.
It is generally quite difficult to attribute a reduction in
tobacco use to any single factor; often many factors work in
parallel, the report said. The underlying message is
quite clear, however: Multifaceted state tobacco control programs are
effective in reducing tobacco use.
According to the NCPB, the best evidence for the effectiveness of
tobacco control programs comes from comparing smoking patterns in
states with varying degrees of aggressiveness and funding. Two
states, California and Massachusetts, have particularly aggressive
antitobacco programs. From 1989 to 1993, when the Massachusetts
program began, California had the largest and most aggressive tobacco
control program in the nation, and it showed a singular decline in
cigarette consumption that was over 50% faster than the national
average, the report said.
A recent evaluation of the Massachusetts program revealed a 15%
decline in adult smoking in the Bay State between 1993 and 1999, a
period when little change occurred in adult tobacco use nationally.
Moreover, as they aggressively pursued their control efforts,
California and Massachusetts had greater decreases in tobacco use
than states that participated in the less intense control efforts of
the American Stop Smoking Intervention Study (ASSIST), which received
funds from the National Cancer Institute.
ASSIST states showed a 7% drop in tobacco consumption per capita,
compared with all other states except California and Massachusetts,
between 1993 and 1996.
Such a dose response effect is strong evidence that
state programs have an impact, that more tobacco control correlates
with less tobacco use, and that the reduction coincides with the
intensification of tobacco control efforts, the report concluded.
Conclusions of the NCPB Report on Tobacco Control
Strong control programs result in reductions in tobacco use well
beyond what would be expected from increases in state tobacco taxes,
according to the NCPB analysis. For example, in the first 2 years
after Oregon instituted a tax hike and an aggressive control program,
cigarette consumption declined more than 11%, which is 5% more than
would be expected from the price increase alone.
And when cigarette companies dropped prices between 1992 and 1994,
consumption rose in states with weak control efforts, but not in 11
of the 14 ASSIST states, and usage remained constant in California
The NCPB explored the effectiveness of several antitobacco
approaches. Counteradvertising and education have become
standard elements of tobacco control, the report noted.
In California, evaluators found that counteradvertising was most
effective when it was well funded and emphasized deceptive practices
of the tobacco industry, and less effective when funding dropped and
advertisements began to focus on health risks rather than
tobacco industry practices.
School-based education programs are most effective when the
message is delivered repeatedly and is taken as seriously and
promoted as powerfully as are other forms of drug abuse
Smoke-free worksites and public places get people to quit or reduce
tobacco use, the report said. It cited estimates from a 1996 review
that smoke-free workplaces reduce the number of smokers by 5% on
average and reduce use among continuing smokers by 10%.
Smoking restrictions are key elements of many state tobacco control
plans and are the main thrust of many county and city efforts to
reduce tobacco use.
Raising the price of tobacco products, almost always by increasing
taxes, is one of the fastest and most effective ways to discourage
smoking by children and teens, the NCPB said. Although economists
long ago reached a consensus that a 10% price hike decreases total
cigarette consumption by 4%, most economists now believe the
response is larger (ie, about 8%) among youths, based on recent
studies. The report also calls for stricter enforcement of laws
that restrict the sale of tobacco to minors.