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Thomas R. Frieden, MD, MPH, Farzad Mostashari, MD, MSPH, Bonnie D. Kerker, PhD, Nancy Miller, PhD, Anjum Hajat, MPH and Martin Frankel, PhD

Thomas R. Frieden, Farzad Mostashari, Bonnie D. Kerker, Nancy Miller, and Anjum Hajat are with the New York City Department of Health and Mental Hygiene. Martin Frankel is with the Department of Computer Information Systems, Baruch College Zicklin School of Business, City University of New York.

Correspondence: Requests for reprints should be sent to Thomas R. Frieden, MD, MPH, New York City Department of Health and Mental Hygiene, 125 Worth St, Room 331, CN #28, New York, NY 10013 (e-mail: tfrieden{at}health.nyc.gov).

Objectives. We sought to determine the impact of comprehensive tobacco control measures in New York City.

Methods. In 2002, New York City implemented a tobacco control strategy of (1) increased cigarette excise taxes; (2) legal action that made virtually all work-places, including bars and restaurants, smoke free; (3) increased cessation services, including a large-scale free nicotine-patch program; (4) education; and (5) evaluation. The health department also began annual surveys on a broad array of health measures, including smoking.

Results. From 2002 to 2003, smoking prevalence among New York City adults decreased by 11% (from 21.6% to 19.2%, approximately 140000 fewer smokers). Smoking declined among all age groups, race/ethnicities, and education levels; in both genders; among both US-born and foreign-born persons; and in all 5 boroughs. Increased taxation appeared to account for the largest proportion of the decrease; however, between 2002 and 2003 the proportion of cigarettes purchased outside New York City doubled, reducing the effective price increase by a third.

Conclusions. Concerted local action can sharply reduce smoking prevalence. However, further progress will require national action, particularly to increase cigarette taxes, reduce cigarette tax evasion, expand education and cessation services, and limit tobacco marketing.

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