Effective tobacco control in Washington State: a smart investment for healthy futures

Abstract

Background: Tobacco use remains the leading cause of preventable death in the United States. Following the 1998 Master Settlement Agreement with the tobacco industry, Washington State dedicated substantial funding to the creation of a statewide, comprehensive tobacco control program. This report documents the history and observed effectiveness of that program.

Context: In 2000, the Washington legislature allocated $100 million out of the first Master Settlement payment of $320 million to tobacco control. The comprehensive tobacco control program was launched late that same year with an annual budget of $15 million.

Methods: We used existing data from state and national health behavior surveillance systems to describe smoking prevalence among adults and youth. For adult measures, we used data from the Washington State Behavioral Risk Factor Surveillance System and the National Health Interview Survey. For youth measures, we used data from the Washington State Healthy Youth Survey and the national Monitoring the Future survey. We used the National Cancer Institute's "Joinpoint" software to compare trends.

Consequences: Between 1990 and 2001, adult smoking prevalence in Washington was nearly unchanged, as it was in the United States as a whole. However, from 2001, one year after Washington instituted its comprehensive tobacco control program, to 2005, the prevalence of smoking among adults in Washington declined significantly from 22.5% to 17.6%, and by a significantly larger amount than it did nationally during the same period (22.7% to 20.9%). In addition, the prevalence of youth smoking also declined faster in Washington than it did nationally; for example, from 2000 to 2004, smoking prevalence among 8th graders declined from 12.5% in 2000 to 7.8% in 2004 in Washington but only from 12.2% in to 9.3% nationally.

Interpretation: Significant reductions in smoking prevalence among Washington residents following the implementation of a comprehensive tobacco control program funded at a level near that recommended by the Centers for Disease Control and Prevention indicate that tobacco control programs are an effective investment for states committed to improving public health.

Figure 1

Smoking prevalence rates among adults in Washington State and the United States and tobacco control funding per capita in Washington State, 1990 through 2005. Data for Washington State are from the Washington State Behavioral Risk Factor Surveillance System; data for the United States are from the National Health Interview Survey. The point of inflection is the point at which the slope of a line changes significantly.

Figure 2

Smoking prevalence rates among 8th-grade youths in Washington State and in the United States, 1990 through 2005. Data for Washington State are from the Washington State Healthy Youth Survey; data for the United States are from the national Monitoring the Future survey.

Figure 3

Smoking prevalence rates among demographic groups in Washington State that have prevalence rates higher than the state average. The category "Hispanic/Latino" includes English-speaking people of any race. Error bars represent 95% confidence intervals. Data are from the Washington State Behavioral Risk Factor Surveillance System, 2005.