The impact of tobacco control programs on adult smoking

Abstract

Objectives: We examined whether state tobacco control programs are effective in reducing the prevalence of adult smoking.

Methods: 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.

Results: 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.

Conclusions: State tobacco control program expenditures are independently associated with overall reductions in adult smoking prevalence.

FIGURE 1—

Total expenditures on tobacco control programs: United States, fiscal years 1986 to 2004. Note. Expenditures are in 2006 inflation-adjusted dollars.

FIGURE 2—

The estimated effect that funding levels for tobacco control programs recommended by the Centers for Disease Control and Prevention would have had on smoking prevalence: United States, 1992–2003. Note. For these estimations, an annual 25% discount rate for expenditures on tobacco control programs was used. Source. RTI International State Tobacco Control Program Expenditure Database.