New Study Shows State Tobacco Control Programs Cut Cigarette Sales

A landmark new study finds that cigarette sales dropped more than twice as much in states that spend more on comprehensive tobacco control programs than in the United States as a whole. Between 1990 and 2000, sales fell an average of 43 percent in four key states with large program expenditures – Arizona, California, Massachusetts, and Oregon – compared with 20 percent for all states. Program funding levels accounted for a substantial portion of this difference, with increasing expenditures producing bigger and faster declines in sales.

The study is the first analysis to include cigarette sales data from all states and to isolate the impact of tobacco control program expenditures by controlling for changes in cigarette excise taxes, cross-border cigarette sales, and other state-specific factors. It appears in the September 2003 Journal of Health Economics and was conducted by researchers at Research Triangle Institute (RTI), the Centers for Disease Control and Prevention (CDC), and the University of Illinois-Chicago.

“Although we’ve seen improvements in preventing and controlling tobacco use, smoking remains the leading cause of preventable death and disease in our nation, said CDC Director Dr. Julie Gerberding. “This study provides our clearest evidence to date that tobacco control programs are an excellent investment in public health.”

Tobacco-attributable disease accounts for 440,000 deaths per year in the United States and remains the leading cause of preventable death and disease. Tobacco use accounts for more than $150 billion annually in direct and indirect medical costs, and at least 8.6 million Americans are living with at least one serious illness caused by tobacco use.

Previous research has suggested that cigarette excise taxes lead to the largest and most immediate decline in cigarette sales, but that this effect erodes over time. While the new study confirms the strong effect of tax increases, it clearly shows that investments in tobacco control programs also have a strong effect that appears to grow as programs continue to dedicate resources to curbing tobacco use.

“It appears that sustained, well-funded programs become increasingly efficient over time,” said RTI’s Dr. Matthew Farrelly, lead author of the study. “As states build core capacity for tobacco control, they make better and better use of each additional dollar.”

As outlined in CDC’s Best Practices for Comprehensive Tobacco Control Programs, effective state-based programs generally include some or all of the following components: community and school programs and policies, counter-marketing campaigns, cessation programs including telephone quitlines, program monitoring and evaluation, and staffing and management. Currently, the overall average per capita funding for tobacco control is $1.22, far below CDC’s minimum recommended level of $5.98.

"States received unprecedented funds from the 1998 Master Settlement Agreement, but in many states these funds have been used for competing needs," said Dr. Terry Pechacek, CDC's lead scientist for the study. "These new data show that robust tobacco control programs prevent and reduce tobacco use and protect people from exposure to secondhand smoke."

For a copy of the article, “The Impact of Tobacco Control Program Expenditures on Aggregate Cigarette Sales: 1981-2000,” email tobaccoinfo@cdc.gov  or call CDC, Office on Smoking and Health, at 770-488-5493.

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