State Tobacco Control Research Articles

Trends in Mortality from COPD in Selected U.S. States Differing in Tobacco Control Efforts

ABSTRACTU.S. state tobacco control programs have been associated with both temporal increases in smoking cessation rates in young adults and temporal declines in tobacco-related chronic diseases, but mortality from chronic obstructive pulmonary disease apparently has not been studied. Annual percent change (APC) (1990–2005) in age standardized mortality rate at ages 35–64 and 65++ years from this cause was analyzed for California (which started a comprehensive tobacco control program in 1989), the “U.S. exclusive of California,” New Jersey and New York (which had relatively high cigarette prices in the 1990s), and a group of six southern tobacco-growing states (which had limited tobacco control efforts and low cigarette prices in the 1990s). Declines in mortality rates from 1990–2005 for age 35–64 were larger and statistically significant in California (annual %% change –1.6%%) and New Jersey-New York (annual %% change –1.8%%), while declines the “U.S. exclusive of California” (annual %% change –0.5%%) and in six southern tobacco-growing states (annual %% change –0.3%%). Declines in mortality at age 65++ years were small or nonexistent. The geographic differences in mortality for age 35–64 years after 1990 were not a continuation of earlier trends (in 1980–89), and may be related to differences in tobacco control efforts. This suggests that states should increase their tobacco-control efforts, to reduce chronic obstructive pulmonary disease mortality in the entire U.S.

Lung cancer incidence trends by histologic type in areas of California vs. other areas in the Surveillance, Epidemiology and End Results Program

Background: This study compared temporal trends in incidence rates for the major histological types of lung cancer in areas of California (CA), which started a comprehensive state tobacco control program in 1989, and other selected geographic areas for which data on long-term trends were available. Methods: Age-standardized incidence rates (ASIRs) within age 25–64 years, most likely to have been affected by tobacco control programs, were compared for lung-bronchus adenocarcinoma, squamous cell carcinoma, and small cell carcinoma in 1992–2005 for non-Hispanic whites in three areas of CA in the Surveillance, Epidemiology and End Results (SEER) Program vs. 10 non-CA SEER areas. For 1985–2005, data were available for all whites in the San Francisco-Oakland CA SEER area and eight non-CA SEER areas. Results: ASIRs were roughly similar in CA and non-CA areas in 1992, but declines from 1992 to 2005 were larger in CA than non-CA areas for each histological type. In San Francisco-Oakland CA, declines were not clearly evident from 1985 to 1988 (before the tobacco control program started) but from 1992 to 2005 declines were larger than in the non-CA areas. Conclusions: These findings provide further support for expansion of statewide tobacco control programs, in order to reduce incidence rates for all histologic types of lung cancer.

Tobacco Control in the United States--Recent Progress And Opportunities

Effective tobacco control efforts have resulted in substantial declines in tobacco use and tobacco-related cancer deaths in the United States. Nearly 40% of reductions in male lung cancer deaths between 1991 and 2003 can be attributed to smoking declines in the last half century. Nevertheless, tobacco use still remains the single, largest preventable cause of disease and premature death in the United States. Each year, smoking and exposure to secondhand smoke result in nearly half a million premature deaths of which nearly one-third are due to cancer. In a previous report, we described youth and adult smoking prevalence and patterns and discussed policy measures that had proven effective in comprehensive tobacco control. In this report, we update trends in youth and adult smoking prevalence. We find that while adult smoking prevalence has declined overall, socioeconomic gradients in smoking still persist within race and ethnic subgroups. In addition, we describe the diffusion of tobacco-control strategies at the national, state, and community level. Although recent developments, such as the Food and Drug Administration's (FDA) regulation of tobacco products, hold promise for tobacco control, there continues to be a need for broader dissemination of sustainably funded comprehensive national and state tobacco-control programs.

Smoking Patterns in Oregon Youth: Effects of Funding and Defunding of a Comprehensive State Tobacco Control Program

Purpose Comprehensive tobacco control programs have included school-based prevention programs as a key strategy to reach adolescents. Unfortunately, these programs have undergone extensive budget reductions in recent years. In 2003, funding for the Oregon Tobacco Prevention and Education Program was reduced by about 70%, and the school component was entirely defunded. To assess the effects of program funding and subsequent defunding on smoking prevalence within targeted Oregon schools, we compared the change in 30-day smoking prevalence between grades 8 and 11 in school districts in two periods: namely, during funding and after funding was eliminated. Methods We used annual school-based survey data for grades 8 and 11 to describe district-level changes in smoking prevalence in five age cohorts: two during the funding period and three after defunding. Each cohort was comprised of districts whose 8th-graders completed the survey and participated again 3 years later. Using mixed models, we compared the change in 30-day adjusted smoking prevalence among cohorts in funded districts, defunded districts, and districts that never received funding. Results Smoking prevalence growth was significantly higher among cohorts from the defunded period than for cohorts from the funded period ( p = .04) and was not significantly different from schools that were never-funded ( p = .79). Conclusions In Oregon, funding a school component of a comprehensive tobacco control strategy was associated with depressed uptake of smoking. Gains were quickly lost upon program defunding. School programs are an important strategy if they are long term, comprehensive, and reinforced in the larger environment.

Annual report to the nation on the status of cancer, 1975-2005, featuring trends in lung cancer, tobacco use, and tobacco control.

BackgroundThe American Cancer Society, the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information on cancer occurrence and trends in the United States. This year’s report includes trends in lung cancer incidence and death rates, tobacco use, and tobacco control by state of residence.MethodsInformation on invasive cancers was obtained from the NCI, CDC, and NAACCR and information on mortality from the CDC's National Center for Health Statistics. Annual percentage changes in the age-standardized incidence and death rates (2000 US population standard) for all cancers combined and for the top 15 cancers were estimated by joinpoint analysis of long-term (1975–2005) trends and by least squares linear regression of short-term (1996–2005) trends. All statistical tests were two-sided.ResultsBoth incidence and death rates from all cancers combined decreased statistically significantly (P < .05) in men and women overall and in most racial and ethnic populations. These decreases were driven largely by declines in both incidence and death rates for the three most common cancers in men (lung, colorectum, and prostate) and for two of the three leading cancers in women (breast and colorectum), combined with a leveling off of lung cancer death rates in women. Although the national trend in female lung cancer death rates has stabilized since 2003, after increasing for several decades, there is prominent state and regional variation. Lung cancer incidence and/or death rates among women increased in 18 states, 16 of them in the South or Midwest, where, on average, the prevalence of smoking was higher and the annual percentage decrease in current smoking among adult women was lower than in the West and Northeast. California was the only state with decreasing lung cancer incidence and death rates in women.ConclusionsAlthough the decrease in overall cancer incidence and death rates is encouraging, large state and regional differences in lung cancer trends among women underscore the need to maintain and strengthen many state tobacco control programs.

Cigarette Smoking Among Adults in the United States

Cigarette Smoking Among Adults in the United States

Linking tobacco control policies and practices to early cancer endpoints: surveillance as an agent for change.

State tobacco control programs provide an important laboratory for the development, implementation, and evaluation of comprehensive tobacco control interventions. Studies have shown that states and municipalities with aggressive tobacco control programs have experienced more rapid decreases in per capita cigarette sales, smoking prevalence, lung cancer, and heart disease than entities without such programs. Despite strong evidence that population-level interventions are critical in achieving large and sustained reductions in tobacco use, states do not fund tobacco control efforts at levels recommended by the Centers for Disease Control and Prevention. Research on the effectiveness and cost effectiveness of these activities is essential to inform and strengthen tobacco control at the state level. A workshop, co-organized by the American Cancer Society, the National Cancer Institute, the American Association for Cancer Research, and the Centers for Disease Control and Prevention, was held in Philadelphia in December, 2007, to discuss the topic "Linking tobacco control policies and practices to early cancer endpoints: surveillance as an agent for change." Participants represented three different disciplines. Tobacco surveillance researchers described the data currently collected on state-level tobacco control policies, protobacco countermeasures by the industry, public attitudes toward tobacco use, and measures of smoking prevalence and consumption. Cancer registry experts described the geographic coverage of high quality, population-based cancer registries. Mathematical modeling experts discussed various modeling approaches that can be used to relate upstream tobacco promotion and control activities to downstream measures such as public attitudes, changes in tobacco use, and trends in tobacco-related diseases. The most important recommendation of the Workshop was a call for national leadership to enhance the collection and integration of data from multiple sources as a resource to further study and strengthen the scientific basis for tobacco control.

Seeing the forest and the trees: Using network analysis to develop an organizational blueprint of state tobacco control systems

In the United States, tobacco control activities are organized primarily in state tobacco control programs. These programs are comprised of public and private agencies working together to reduce tobacco use. The human, financial, and informational resources that go into state tobacco control programs are documented, and the outcomes of these programs have been studied in terms of health and health behavior. However, little is known about the organizational infrastructure that transforms the human, financial, and informational resources into positive health outcomes. This study examined the inter-organizational relationships among key partner agencies in eight state tobacco control programs. The state programs varied in terms of funding level, funding stability, and region of the country. Using a network analytic approach we asked an average of 14 agencies in each state program about their contacts and partnerships with the other key tobacco control agencies in their state program. Using network visualization and statistics we determined that the state networks shared some common features such as a highly central lead agency, but also had differences in network structure in terms of density and centralization. Using blockmodeling we found that, despite differences in state and program characteristics, there was a common organizational structure among the eight state programs. Understanding the inter-organizational relationships and the common organizational structures of state programs can aid researchers and practitioners in enhancing program capacity and in developing strategies for organizing effective public health systems.

Effect of the California Tobacco Control Program on Personal Health Care Expenditures

BackgroundLarge state tobacco control programs have been shown to reduce smoking and would be expected to affect health care costs. We investigate the effect of California's large-scale tobacco control program on aggregate personal health care expenditures in the state.Methods and FindingsCointegrating regressions were used to predict (1) the difference in per capita cigarette consumption between California and 38 control states as a function of the difference in cumulative expenditures of the California and control state tobacco control programs, and (2) the relationship between the difference in cigarette consumption and the difference in per capita personal health expenditures between the control states and California between 1980 and 2004. Between 1989 (when it started) and 2004, the California program was associated with $86 billion (2004 US dollars) (95% confidence interval [CI] $28 billion to $151 billion) lower health care expenditures than would have been expected without the program. This reduction grew over time, reaching 7.3% (95% CI 2.7%–12.1%) of total health care expenditures in 2004.ConclusionsA strong tobacco control program is not only associated with reduced smoking, but also with reductions in health care expenditures.

Effectiveness of tobacco control among Chinese Americans: A comparative analysis of policy approaches versus community-based programs

Objective To estimate the effectiveness of a tailored multicomponent community-based smoking cessation intervention among Chinese immigrants living in New York City, implemented within the context of state and city-wide tobacco control policy initiatives for the general population. Methods A pre–post-test quasi-experimental design with representative samples from Chinese populations living in two communities in New York City: Flushing, Queens, the intervention community and Sunset Park, Brooklyn, the comparison community. From November 2002 to August 2003 baseline interviews were conducted with 2537 adults aged 18–74. In early 2006, 1384 participants from the original cohort completed the follow-up interview. During the intervention period (October 2003 to September 2005), both communities were exposed to tobacco control public policy changes. However, only Flushing received additional linguistically and culturally-specific community-level tobacco control interventions. Results From 2002 to 2006 overall smoking prevalence among Chinese immigrants declined from 17.7% to 13.6%, a relative 23% decrease. After controlling for socio-demographic characteristics, there was an absolute 3.3% decrease in smoking prevalence attributed to policy changes with an additional absolute decline in prevalence of 2.8% in the intervention community relative to the control community. Conclusion City-wide tobacco control policies are effective among high-risk urban communities, such as Chinese immigrants. In addition, community-based tailored tobacco control interventions may increase the reduction in smoking prevalence rates beyond that achieved from public policies.

Consequences of dramatic reductions in state tobacco control funds: Florida, 1998–2000

Objective: This study assessed whether dramatic funding reductions to the Florida Tobacco Control Program (FTCP) influenced trends in recall of the Florida “truth” anti-smoking media campaign, anti-industry attitudes and non-smoking...

A comprehensive review of state laws governing Internet and other delivery sales of cigarettes in the United States.

All U.S. states regulate face-to-face tobacco sales at retail outlets. However, the recent growth of delivery sales of tobacco products by Internet and mail-order vendors has prompted new state regulations focused on preventing youth access and tax evasion. To date, there are no comprehensive and systematic analyses of these laws. The objectives of this study were to: (a) document the historical enactment of the laws; (b) assess the nature and extent of the laws; and (c) examine the relationship between the presence of laws and state tobacco control policy and other contextual variables. Between 1992 and 2006, 34 states (67%) enacted a relevant law, with 27 states' laws (45%) effective between 2003 and 2006. Five states banned direct-to-consumer shipment of cigarettes. The remaining 29 states' laws included a combination of requirements addressing minimum age/ID, payment issues, shipping, vendor licensure and related issues, tax collection/remittance, and penalties/enforcement. States with delivery sales laws have stronger youth tobacco access policies and state tobacco control environments, as well as higher state cigarette excise tax rates and revenue, past-month cigarette use rates, and perceptions of risk of use by adolescents. This paper provides the policy context for understanding Internet and other cigarette delivery sales laws in the U.S. It also provides a systematic framework for ongoing policy surveillance and will contribute to future analyses of the impact of these laws on successfully reducing youth access to cigarettes and preventing tax evasion.

Tobacco control indicators and lung cancer rates in young adults by state in the United States

Objective:To determine the association between a tobacco control index (TCI) for 1992–93 for each US state and lung and bronchus cancer mortality and incidence rates by state for younger adults,...

The Impact of Tobacco Control Programs on Adult Smoking

We examined whether state tobacco control programs are effective in reducing the prevalence of adult smoking. We used state survey data on smoking from 1985 to 2003 in a quasi-experimental design to examine the association between cumulative state antitobacco program expenditures and changes in adult smoking prevalence, after we controlled for confounding. From 1985 to 2003, national adult smoking prevalence declined from 29.5% to 18.6% (P<.001). Increases in state per capita tobacco control program expenditures were independently associated with declines in prevalence. Program expenditures were more effective in reducing smoking prevalence among adults aged 25 or older than for adults aged 18 to 24 years, whereas cigarette prices had a stronger effect on adults aged 18 to 24 years. If, starting in 1995, all states had funded their tobacco control programs at the minimum or optimal levels recommended by the Centers for Disease Control and Prevention, there would have been 2.2 million to 7.1 million fewer smokers by 2003. State tobacco control program expenditures are independently associated with overall reductions in adult smoking prevalence.

Do state characteristics matter? State level factors related to tobacco cessation quitlines

Background:Quitline services are an effective population-wide tobacco cessation strategy adopted widely in the United States as part of state comprehensive tobacco control efforts. Despite widespread evidence supporting quitlines’ effectiveness, many...

Community guide recommendations and state level tobacco control programmes: 1999–2004

Objective: To identify the level of effort state tobacco control programmes and partners have expended on interventions recommended by the community guide and how those efforts have changed over time...

Differential impact of state tobacco control policies among race and ethnic groups

This paper describes patterns of racial and ethnic cigarette use in the United States and discusses changes in state-level tobacco control policies. Moreover, this paper reviews the existing econometric literature on racial and ethnic smoking and discusses the limitations of that research. Finally, this paper outlines an agenda for future research. Patterns of racial and ethnic smoking and changes in state-level tobacco control policies in the United States were obtained from a variety of sources, including surveys and government and private documents and databases. After an extensive literature search was completed, the existing research was scrutinized and recommendations for much-needed future research were put forth. Despite the fact that certain racial and ethnic minorities bear a disproportionate share of the overall health burden of tobacco, less than a handful of econometric studies have examined the effects of state-level public policies on racial and ethnic smoking. The existing literature finds Hispanics and African Americans to be more responsive to changes in cigarette prices than whites. Only one study examined other state-level tobacco policies. The findings from that study implied that adolescent white male smoking was responsive to changes in smoke-free air laws, while adolescent black smoking was responsive to changes in youth access laws. While much has been learned from prior econometric studies on racial and ethnic smoking in the United States, the existing literature suffers from numerous limitations that should be addressed in future research. Additional research that focuses on races and ethnicities other than white, black and Hispanic is warranted. Furthermore, future studies should use more recent data, hold sentiment toward tobacco constant and control for a comprehensive set of tobacco policies that take into account not only the presence of the laws, but also the level of restrictiveness of each policy.

The association of retail promotions for cigarettes with the Master Settlement Agreement, tobacco control programmes and cigarette excise taxes

Background: Retail stores are the primary medium for marketing cigarettes to smokers in the US. The prevalence and characteristics of cigarette retail advertising and promotions have been described by several...

The Best Practices: Use of the Guidelines by Ten State Tobacco Control Programs

The Best Practices for Comprehensive Tobacco Control Programs by the Centers of Disease Control and Prevention was the first national resource to define the nine required components of a comprehensive state tobacco control program. This evaluation examined how states used the guidelines in their program planning, and identifies strengths and weaknesses of the guidelines. During 2002-2003, data were collected and analyzed from ten state tobacco control programs on familiarity, funding, and use of the guidelines. Data were collected via written surveys and qualitative interviews with key tobacco control partners in the states. The typical number of participants interviewed was 17, representing an average of 15 agencies per state. Lead agencies and advisory agencies were the most familiar with the guidelines, while other state agencies were less aware of the guidelines. Participants' prioritization of the nine components was closely related to the lead agencies' estimated category expenditures. Three states modified the guidelines to develop more-tailored frameworks. Major strengths of the guidelines included providing a basic program framework and state-specific funding recommendations. The guidelines did not address implementation strategies or tobacco-related disparities, and had not been updated with current evidence-based research. The guidelines are important recommendations for state tobacco control programs. To continue to be useful to states, the guidelines need to be updated to address implementation and tobacco disparities, and include additional evidence-based examples. Active dissemination of updated guidelines needs to be increased beyond typical consumers to other tobacco control partners such as coalitions and other state agencies.

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

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.