Tobacco COntrol in California: Who's winning the war? An evaluation of the Tobacco Control Program, 1989-1996. Final Report. A report to the California Department of Health Services

Executive Summary PREFACE The California Department of Health Services contracted with the University of California, San Diego, to conduct a series of California Tobacco Surveys and to provide an independent and scientific assessment of the progress of the California Tobacco Control Program. Any interpretations of data or conclusions expressed in this report are those of the authors and may not represent the views of the State of California. A primary goal of the Tobacco Control Program is to reduce smoking among California adults and adolescents. Assessment of Program progress in meeting this goal involves an examination of trends in per capita cigarette consumption and smoking prevalence. Program effects must be distinguished from differences resulting from changes in the demographic profile of the California population. Standardized prevalence estimates were computed to adjust for demographic changes. An effective program would lead to a more rapid decline in smoking than existed previously or that occurred in the rest of the United States. Moreover, the effect should persist over time. The analysis considered two periods in the Tobacco Control Program, suggested by changes in per capita cigarette consumption trends, standardized adult smoking prevalence estimates from the California Tobacco Surveys, and the relative level of funding for the Program and what the tobacco industry spends to promote smoking. Before fiscal year 1992-1993, the ratio of spending was 5: 1 in favor of the tobacco industry and subsequently it was 10:1. The higher ratio resulted from reduced funding for the Tobacco Control Program and increased tobacco industry expenditures. The first part of this executive summary presents a brief overview of the main evaluative outcomes relative to the California Tobacco Control Program: smoking behavior and exposure to secondhand tobacco smoke. Following this brief overview, trends in smoking behavior are discussed in more detail. Finally, other important findings, including those relating to secondhand smoke, are summarized under the five main tobacco control strategies identified by the Tobacco Education, Research, and Oversight Committee (TEROC). OVERVIEW The trends in per capita cigarette consumption and adult smoking prevalence indicate that the introduction of the California Tobacco Control Program led to an acceleration of the rate of decline in smoking, but that this effect was not maintained between 1993 and 1996. Over the course of the Program, there has been a continued major decline in the level of exposure to secondhand tobacco smoke among Californians. BEHAVIOR In Period 1, from the start of the Program in January 1989 through June 1993, adult (18+years) smoking prevalence and per capita cigarette consumption declined over 50% faster than previously, and over 40% faster than in the rest of the United States. In Period 2, July 1993 through December 1996, the rate of decline in per capita cigarette consumption and adult prevalence slowed, consumption to only 34% of the rate of decline in Period 1, and prevalence to only 15% of the Period 1 rate. In Period 2, California no longer showed a greater rate of decline in prevalence than the rest of the United States. However, per capita cigarette consumption was constant in the rest of the United States. The 1996 California Tobacco Survey estimated that adult smoking prevalence was 18.1 %. Adolescent (12-17 years) smoking prevalence in California remained stable in Period 1, but it increased 26.3% during Period 2 to 12.0% in 1996? A detailed analysis of California data suggests that adolescent smoking prevalence will continue to increase through 1999. Between 1993 and 1996, California smokers made considerable progress towards future successful cessation by decreasing consumption levels and increasing their quitting activity. A strong motivational tobacco control program may produce another major reduction in smoking prevalence.