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. 2010 Apr;19 Suppl 1(Suppl_1):i3-15.
doi: 10.1136/tc.2009.030809.

The quarter that changed the world

April Roeseler  1 , David Burns
Affiliations

The quarter that changed the world

April Roeseler et al. Tob Control. 2010 Apr.

Abstract

Background: The California Department of Public Health (CDPH), California Tobacco Control Program (CTCP) is one of the longest-running comprehensive tobacco control programmes in the USA, resulting from a 1988 ballot initiative that added a 25-cent tax on each pack of cigarettes and a proportional tax increase on other tobacco products. This programme used a social norm change approach to reduce tobacco use.

Methods: The operation, structure, evolution, programme dissemination and results are reviewed.

Results: The sustained programme implementation has reduced adult per capita cigarette consumption by over 60% and adult smoking prevalence by 35%, from 22.7% in 1988 to 13.8% in 2007. From 1988 to 2004, lung and bronchus cancer rates in California declined at nearly four times the rate of decline seen in the rest of the USA and the programme is associated with an $86 billion savings in healthcare costs. Youth smoking rates among 12-17 years olds are the second lowest in the nation.

Conclusions: The social norm change approach is effective at reducing tobacco consumption, adult smoking and youth uptake. This approach resulted in declines in tobacco-related diseases and is associated with savings in healthcare expenditures. In considering CTCP's effectiveness, the takeaway message is that it should be viewed as a unified programme rather than a collection of independent interventions. The programme was designed and implemented as one where the parts complement and reinforce each other. Its effectiveness is dependent on its comprehensive strategy rather than any one part of the intervention.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Fiscal years 1989–1990 to 2008–2009 California Tobacco Control Program budget ($millions).
Figure 2
Figure 2
California Tobacco Control Program timeline of major events and accomplishments: 1988–2008.
Figure 3
Figure 3
Oroville Mercury Register, 24 March 1992: Butte County Health Officer, Chester Ward prohibited from involvement in tobacco regulation.
Figure 4
Figure 4
California Tobacco Control Program/Social Norm Change Paradigm as a logic model.
Figure 5
Figure 5
A Tobacco Institute memorandum dated 18 April 1990.
Figure 6
Figure 6
California and US adult per capita cigarette pack consumption, 1984–1985 to 2006–2007.
Figure 7
Figure 7
Lung and bronchus age-adjusted cancer incidence rates, 1988–2004.
Figure 8
Figure 8
30-day smoking prevalence for California and US high school (9th–12th grade) students, 2000–2006.
Figure 9
Figure 9
Proportion of California smokers thinking about quitting (1994–2007).
Figure 10
Figure 10
Proportion of smokers having first cigarettes within 30 minutes after waking up.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention Best practices for comprehensive tobacco control programs—2007. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2007
    1. Bal DG. Designing an effective statewide tobacco control program-California. Cancer 1998;83:217–21 - PubMed
    1. California Health and Safety Code Sections 104370 (d-f), 104385 (c) (5), 104420 (4) (F), and 104425 (c) (3).
    1. Kizer KW. Testimony regarding California's anti-smoking media campaign presented to subcommittee on transportation on hazardous materials, committee on energy and commerce, US house of representatives, 1990April30 http://legacy.library.ucsf.edu/tid/ton92d00 (accessed 2 Jun 2009).
    1. Glantz SA, Balbach ED. Tobacco war: inside the California battles. Berkeley and Los Angeles, CA: University of California Press, 2000

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