Study Shows Strong Tobacco Control Programs and Policies Can Lower Smoking Rates
A study published today in the Journal of the National Cancer Institute*
provides the latest evidence that investing in state tobacco control programs
can reduce smoking rates. In this evaluation of the American Stop Smoking
Intervention Study (ASSIST), the authors found that states that were part of
the ASSIST intervention program showed a greater reduction in smoking
prevalence (the number of people who smoke) than non-ASSIST states. The study
also found that states with stronger tobacco control policies and greater
ability to implement tobacco control programs experienced larger reductions in
smoking.
At the time of the study, ASSIST was the largest federally funded demonstration
project to help states develop effective strategies to reduce smoking. In 1991,
the National Cancer Institute (NCI), part of the National Institutes of Health,
provided funds to 17 state health departments** and forged a partnership with
the American Cancer Society to undertake the study. The ASSIST evaluation is
the most comprehensive evaluation ever conducted on a large, multi-state
tobacco control study.
The goal of ASSIST was to change the social, cultural, economic and
environmental factors that promote smoking by utilizing four policy strategies:
promoting smoke-free environments; countering tobacco advertising and
promotion; limiting youths' access to tobacco products; and raising excise
taxes to increase the price of tobacco products. The interventions were
developed and implemented by networks of state and local tobacco control
coalitions.
ASSIST was rolled out in two phases - a two-year planning phase from 1991 to
1993 and a six-year implementation phase from 1993 to 1999. NCI provided an
average of $1.14 million per state per year during the intervention years, for
a total of $128 million over the eight years of the program. Other additional
funding and support were available to the states through voluntary
organizations and other non-federal sources.
"These results are compelling," said Scott Leischow, Ph.D., chief of NCI's
Tobacco Control Research Branch. "ASSIST had a small but significant effect on
smoking prevalence. As the authors determined, this difference has a large
effect when viewed at the population level; if all 50 states and the District
of Columbia had implemented ASSIST, there would now be about 1,213,000 fewer
smokers nationwide."
"Our research emphasizes the importance of strong tobacco control programs and
effective policies," said Frances A. Stillman, Ph.D., of the Johns Hopkins
Bloomberg School of Public Health in Baltimore, Md., first author of the study
and director of the ASSIST evaluation. "States can reduce smoking prevalence
and the enormous health and economic burden of smoking if they put in place
proven programs and policies." According to the Centers for Disease Control and
Prevention (CDC), cigarette smoking is responsible for more than 440,000 deaths
in the United States each year.
The authors of the ASSIST evaluation note that several factors affected the
results. ASSIST was a demonstration project and did not restrict the flow of
tobacco control information between states. Therefore, non-ASSIST states
benefited from the intervention, as well. In addition, by 1994, the CDC and the
Robert Wood Johnson Foundation were supporting tobacco control programs in
ASSIST and non-ASSIST states, making it even more difficult to measure the
impact of the ASSIST intervention.
During this period, the tobacco industry opposed ASSIST and the policy
interventions it sought to implement, which likely reduced the potential impact
of the program. According to Federal Trade Commission reports, the tobacco
industry spent approximately $47 billion nationwide to market tobacco products
during the period of the ASSIST project.
"Even given these factors," said Stillman, "the results of this ASSIST
evaluation add to the body of research documenting that strong policy-focused
interventions can have a significant effect on smoking behavior."
# # #
To view Questions and Answers on the ASSIST evaluation, go to
http://www.cancer.gov/newscenter/pressreleases/ASSISTQandA
To visit NCI's central source for information related to tobacco research and
control, please go to http://cancer.gov/cancerinfo/tobacco.
To learn about NCI's Tobacco Control Research Branch, please visit
www.tobaccocontrol.cancer.gov.
For help with smoking cessation, please go to www.smokefree.gov
or call the NCI's Smoking Quitline at 1-877-44U-QUIT.
For information about cancer, please visit the NCI home page at
cancer.gov.
* Stillman FA, Hartman AM, Graubard BI, Gilpin EA, Murray DM, Gibson JT.
Evaluation of the American Stop Smoking Intervention Study (ASSIST): a report
of outcomes. Journal of the National Cancer Institute 2003 Nov 19;95
(22):1681-91.
** ASSIST states were: Colorado, Indiana, Maine, Massachusetts, Michigan,
Minnesota, Missouri, New Jersey, New Mexico, New York, North Carolina, Rhode
Island, South Carolina,Virginia, West Virginia, Washington, Wisconsin.
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