The Impact of Tobacco Control Programs on Adult Smoking
Matthew C. Farrelly, PhD,
Terry F. Pechacek, PhD,
Kristin Y. Thomas, MsPH and
David Nelson, MD, MPH
Matthew C. Farrelly is with the Division of Public Health and Environment, RTI International, and the RTI–UNC Center of Excellence in Health Promotion Economics, Research Triangle Park, NC. Terry F. Pechacek and David Nelson are with the Office of Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Ga. Kristin Y. Thomas is with the Division of Public Health and Environment, RTI International, Washington, DC.
Correspondence: Requests for reprints should be sent to Matthew C. Farrelly, PhD, RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC 27709 (e-mail: mcf{at}rti.org).
Objectives. We examined whether state tobacco control programsare effective in reducing the prevalence of adult smoking.
Methods. We used state survey data on smoking from 1985 to 2003in a quasi-experimental design to examine the association betweencumulative state antitobacco program expenditures and changesin adult smoking prevalence, after we controlled for confounding.
Results. From 1985 to 2003, national adult smoking prevalencedeclined from 29.5% to 18.6% (P<.001). Increases in stateper capita tobacco control program expenditures were independentlyassociated with declines in prevalence. Program expenditureswere more effective in reducing smoking prevalence among adultsaged 25 or older than for adults aged 18 to 24 years, whereascigarette prices had a stronger effect on adults aged 18 to24 years. If, starting in 1995, all states had funded theirtobacco control programs at the minimum or optimal levels recommendedby the Centers for Disease Control and Prevention, there wouldhave been 2.2 million to 7.1 million fewer smokers by 2003.
Conclusions. State tobacco control program expenditures areindependently associated with overall reductions in adult smokingprevalence.
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