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John P. Pierce, PhD; Elizabeth A. Gilpin, MS; Sherry L. Emery, PhD; Martha M. White, MS; Brad Rosbrook, MS; Charles C. Berry, PhD

JAMA. 1998;280:893-899.

Context.— Comprehensive community-wide tobacco control programs are considered appropriate public health approaches to reduce population smoking prevalence.

Objective.— To examine trends in smoking behavior before, during, and after the California Tobacco Control Program.

Design.— Per capita cigarette consumption data (1983-1997) were derived from tobacco industry sales figures. Adult (18 years) smoking prevalence data were obtained from the National Health Interview Surveys (1978-1994), the California Tobacco Surveys (1990-1996), the Current Population Surveys (1992-1996), and the California Behavioral Risk Factor Survey and its supplement (1991-1997). Trends were compared before and after introduction of the program, with the period after the program being divided into 2 parts (early, 1989-1993; late, 1994-1996).

Main Outcome Measures.— Change in cigarette consumption and smoking prevalence in California compared with the rest of the United States.

Results.— Per capita cigarette consumption declined 52% faster in California in the early period than previously (from 9.7 packs per person per month at the beginning of the program to 6.5 packs per person per month in 1993), and the decline was significantly greater in California than in the rest of the United States (P<.001). In the late period, the decline in California slowed to 28% of the early program so that in 1996 an average of 6.0 packs per person per month were consumed. No decline occurred in the rest of the United States, and in 1996, 10.5 packs per person per month were consumed. Smoking prevalence showed a similar pattern, but in the late period, there was no significant decline in prevalence in either California or the rest of the United States. In 1996, smoking prevalence was 18.0% in California and 22.4% in the rest of the United States.

Conclusions.— The initial effect of the program to reduce smoking in California did not persist. Possible reasons include reduced program funding, increased tobacco industry expenditures for advertising and promotion, and industry pricing and political activities. The question remains how the public health community can modify the program to regain its original momentum.

From the Cancer Prevention and Control Program, Cancer Center (Drs Pierce and Emery, Mss Gilpin and White, and Mr Rosbrook), and Department of Family and Preventive Medicine, Division of Health Care Sciences (Dr Berry), University of California, San Diego.

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