NCPB Urges States to Step Up Tobacco Control Programs

WASHINGTON—The 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

Tobacco control programs can reduce tobacco use, thus saving lives.

Tobacco control programs can incorporate many different elements modeled on existing state programs that have proved effective.

The effects of counteradvertising and education depend on their “intensity” and “dose.”

Smoke-free worksite policies reduce illness and death from involuntary smoking, increase smoking cessation, and reduce consumption among continuing smokers.

Raising excise taxes on tobacco products can reduce tobacco use while increasing state revenues.

Tobacco addiction is treatable, and treatment programs are cost-effective.

The enforcement of youth access laws will not achieve its full potential impact until merchant compliance rates are high.

To ensure accountability and enable future improvements in tobacco control programs, state tobacco control programs must be evaluated and have explicit goals coupled to performance measures.

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 and Massachusetts.

Effective Approaches

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 education.”

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.