Study Of California's Tobacco Control Program
Since the advent of the California Tobacco Control Program, in 1989, the state's young adult smokers are quitting the habit in record numbers and older smokers are consuming far fewer cigarettes, according to a new series of studies from the Moores C
These findings and others are detailed in a set of three companion papers from UCSD, published in the April 2007 issue of the bimonthly research journal Tobacco Control. The papers address the impact of the first 12 years of the California campaign on adult smokers, and focus on smoking cessation rates, daily cigarette consumption levels, and smoking trends among African Americans.
The researchers used national data from the U.S. Census Bureau (1) to compare California smoking trends before and after the advent of the campaign, and to compare the state's campaign-era trends with those of two comparison groups of states New York/New Jersey and the tobacco growing states (Kentucky, Tennessee, North Carolina, South Carolina, Virginia and Georgia).
The first paper compares smoking cessation rates of young, middle-age and older smokers in the decade before the California campaign started (1980s), with rates during the first decade of the campaign (1990s). While all age groups studied, from age 20 to 66, showed increased rates of smoking cessation during the '90s, the youngest group, smokers age 20 to 34, stood out.
"We were surprised to find that, since the advent of the California campaign, young people have increased their rate of quitting by 50 percent, far more than their older counterparts," said the paper's first author, Karen Messer, Ph.D.,"It used to be that smokers over age 50 were the ones quitting because they understood the health consequences of smoking."
Messer cited the changes in social norms wrought by the California campaign such as restrictions on smoking in the workplace and in the home as the likely reason for the upward trajectory in quitting rates among younger smokers.
"These young adults have grown up in a tobacco-controlled climate, where smoking isn't the norm and isn't socially supported," she said. "We may be seeing the first generation who believe it's not cool to smoke, which could pay huge dividends in their future health," she said.
In analyzing the national data, comparing California to the two other groups of states, the researchers found that cessation rates were much higher among young adults in California than in the New York/New Jersey group, which is a similar population size and has high prices on tobacco, but no focus on de-normalizing smoking. Cessation rates among young adults in the tobacco growing states (TGS), which has low tobacco prices and no comprehensive tobacco control program, were significantly lower than either California or NY/NJ.
"Here again, the data suggest that changes in social norms are driving the smoking-behavior change in young adults, who are, among the age groups studied, the most sensitive to social norms," said John P. Pierce, Ph.D., director of the Cancer Prevention and Control Program at the Cancer Center.
For older smokers, age 35 and older, cessation rates also went up during the '90s in California, but at about the same rate as in the New York/New Jersey group. This age group, the researchers say, may not be quitting at historic rates, but they are smoking fewer cigarettes, which is the focus of the second paper.
"We found that there is a national trend of declining cigarette consumption for all age groups, but the most significant by far was observed in California smokers over age 35," said the consumption paper's first author, Wael K. Al-Delaimy, M.D., Ph.D., "The data suggest that compared with states with no tobacco control initiatives (TGS) or states with an increased cigarette price as the principal tobacco control measure (NY/NJ) California's comprehensive tobacco control program is more effective in decreasing cigarette consumption for those over age 35."
These two findings high rates of cessation and low rates of consumption spell good news in terms of Californians' health. The most important predictors of lung cancer and other smoking-related diseases are known to be the number of years people smoke and daily cigarette consumption.
The consumption-paper authors write: "In conclusion, our study provides further evidence that there is a majorâ€¦trend for reduced smoking in the U.S. and that â€¦this is being led by the statewide tobacco control programs. These programs are reducing initiation in the young and promoting successful quitting in young adults, and are also associated with a decline in consumption in older continuing smokers. Taken as a whole, the benefits from the declines in smoking behavior will lead to a corresponding continued decline in the prevalence of adverse health consequences of smoking through the next 50 years."
The third paper in the series was designed to compare the effectiveness of California's comprehensive tobacco control program to price-centered programs (NY/NJ), with the tobacco growing states serving as a control group, in reducing adult African-American and white smoking prevalence rates over time.
The researchers found uniformly large annual rates of decline in African-American adult daily smoking across states during the '90s, regardless of the type of statewide tobacco control strategy.
"We found that, among whites, the smoking prevalence dropped dramatically in California, dropped modestly in the New York/New Jersey complex, and dropped very little in the tobacco growing states," said the study's first author, Dennis R. Trinidad, Ph.D., M.P.H., "Among African-Americans, however, there were uniformly large declines across states, regardless of the type of tobacco control strategy."
Trinidad added that there have been strong anti-smoking norms in the African-American community starting in the '70s that have translated into lower rates of smoking initiation nationally, and it appears that this has persisted over time, above and beyond tobacco control practices the states implemented.
The researchers state that further research is needed to better understand the factors associated with smoking declines among African-Americans.
Co-authors on the smoking cessation paper are Karen Messer, Ph.D., John P. Pierce, Ph.D.; Shu-Hong Zhu, Ph.D.; Wael Al-Delaimy, M.D., Ph.D.; Dennis R. Trinidad, Ph.D., MPH; and Elizabeth A. Gilpin, M.S. (all of the Cancer Prevention and Control Program at Moores UCSD Cancer Center, and Department of Family and Preventive Medicine at UCSD School of Medicine); and Anne M. Hartman, Ph.D., Division of Cancer Control and Population Sciences, National Cancer Institute. Co-authors on the cigarette consumption paper are Al-Delaimy, Pierce, Messer, Martha M. White, M.S. (also of the Cancer Prevention and Control Program at Moores UCSD Cancer Center, and Department of Family and Preventive Medicine), Trinidad and Gilpin. Co-authors on the African-American smoking trends paper are Trinidad, Messer, Gilpin, Al-Delaimy, White and Pierce.
The work was supported by a Tobacco-Related Disease Research Program grant from the University of California, which did not have any role in the research.
(1). Tobacco Use Supplements to the Current Population Survey: national household surveys conducted by the U.S. Census Bureau for the National Cancer Institute.
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