State and Community Tobacco-Control Programs and Smoking-Cessation Rates among Adult Smokers: What Can we Learn from the COMMIT Intervention Cohort?

Abstract

To assess the long-term effect of a randomized community-based trial of smoking cessation and to examine the effect of exposure to large state-based tobacco-control programs on smoking cessation. Longitudinal tobacco-use telephone surveys conducted in 1988, 1993, and 2001. Baseline smokers (6603) from 20 communities in 9 states completed a survey in 2001 (35% of the original sample). The Community Intervention Trial for Smoking Cessation (COMMIT) intervention was a randomized community-based smoking-cessation intervention between 1988 and 1993. In addition, cohort data were used to evaluate quasi-experimental differences in the strength of state-level tobacco control programs and policies. Multivariate logistic regression was used to compare quit rates among those who were exposed to community- or state-level tobacco-control programming and those who were not between 1988 and 2001. Quit rates were higher in the COMMIT intervention communities during the period when the trial was funded (Relative Risk [RR] = 1.19) but were no different than comparison communities 8 years later after funding stopped. Quit rates were highest in those communities in states with both strong tobacco-control policies and aggressive tobacco-control programs, such as California and Massachusetts (RR = 1.44) compared with those communities in states that had little tobacco-control activity, such as Iowa, New Mexico, and North Carolina. The findings suggest that well-funded tobacco-control programming coupled with tobacco-control policies may be associated with increases in cessation rates.