Greater investments in state tobacco control programs are independently and significantly associated with larger and more rapid declines in adult smoking prevalence, according to a study by researchers at Centers for Disease Control and Prevention (CDC) and RTI International, an independent nonprofit research institute based in Research Triangle Park, N.C. Researchers were able to quantify the link between comprehensive tobacco control programs and a decrease in adult smoking ? observing a decline in prevalence from 29.5 percent in 1985 to 18.6 percent in 2003.

The study, "The Impact of Tobacco Control Programs on Adult Smoking," is the first of its kind to use multi-state survey data on smoking to examine the association between cumulative state tobacco control program spending and changes in adult smoking prevalence. Combining educational, clinical, regulatory, economic, and social strategies, these comprehensive programs encompass coordinated efforts to establish smoke-free policies and social norms, to promote and assist tobacco users to quit, and to prevent initiation of tobacco use.

"It appears that sustained, well-funded programs become increasingly effective over time," said Matthew Farrelly, Ph.D., RTI International, who was lead author of the study. "As states build capacity for tobacco control, they make better and better use of each additional dollar."

The study, published in the February 2008 issue of the American Journal of Public Health, analyzed data from all 50 states and the District of Columbia and found that among individual states the declines in adult smoking prevalence were directly related to increases in state per person investments in tobacco control programs.

While increases in the cost of cigarettes have been shown previously to lead to declines in smoking rates, this new study finds that state program funding had an effect on adult smoking, independent of price.

According to the study, if all states had started in 1995 to fund their tobacco control programs at either the minimum or optimal levels recommended by the CDC in Best Practices for Comprehensive Tobacco Control Programs, there would have been 2.2 million to 7.1 million fewer smokers by 2003.

Yet despite extensive research demonstrating the effectiveness of tobacco control programs in reducing smoking prevalence and improving health, as of 2005, only four states funded their programs at the minimum levels recommended by CDC. Many states have substantially reduced funding for their tobacco control programs. Overall funding for state tobacco control programs declined by 28 percent between fiscal years 2002 and 2005. As of 2007, only three states were funding their programs at the CDC-recommended levels.

The study also found that increases in both tobacco control program expenditures and cigarette prices were effective in reducing smoking prevalence among adults, with tobacco control program expenditures somewhat more effective in reducing smoking prevalence among adults aged 25 or older, while increases in cigarette prices had a stronger effect on 18- to-24-year-old smokers.

"These results show that if states consistently fund programs at recommended levels?outlined in Best Practices for Comprehensive Tobacco Control Programs?they could substantially reduce adult smoking prevalence, and thus reduce smoking-related morbidity, mortality, and economic costs," said Terry Pechacek, Ph.D., associate director for science, Office on Smoking and Health, CDC, and one of the authors of the study.

This research supports the conclusion of not only the 2000 report of the U.S. Surgeon General but also 2007 reports from the Institute of Medicine, the National Institutes of Health, and the President's Cancer Panel that comprehensive state tobacco control programs are effective public health investments. The study also complements recent studies demonstrating that tobacco control program expenditures are associated with declines in smoking prevalence among youths and declines in per-person cigarette sales.

Tobacco-attributable disease accounts for an estimated 438,000 deaths per year in the United States, and remains the leading cause of preventable death and disease. Tobacco use accounts for more than $190 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.

The full study is available at http://www.ajph.org/. You may also contact CDC's Office on Smoking and Health at 770-488-5493 to obtain a copy of the study. For more information about CDC's Best Practices for Comprehensive Tobacco Control Programs-2007, please visit CDC's Web site at www.cdc.gov/tobacco.

State senators returned to the Legislature January 9 to a number of tobacco-related bills that carried over from last year, and the promise of other tobacco-related bill amendments and introductions to come.

Tobacco-related bills to be discussed this session include:
LB 395, the smoke-free worksite bill introduced by Sen. Joel Johnson of Kearney. This bill carried over from last year on Final Reading. This session, Sen. Johnson introduced amendment 1530 which would remove the provisions that would allow the governing body of any city, village or county, or the voters to "opt out" or weaken any aspects of the state law.
LB 966, introduced by Sen. John Synowiecki of Omaha. This bill would increase the amount of money allocated from the Tobacco Master Settlement Agreement for statewide comprehensive tobacco prevention and cessation from $2.5 million to $7 million.

New bills may be introduced until Jan 23. The 60-day session is tentatively scheduled to end April 17.

One new senator joined the Legislature this session. Sen. Scott Lautenbaugh of Omaha was appointed Nov. 2 to replace Blair Sen. Mick Mines, who resigned his seat.

The state's commitment to preventing tobacco use and exposure and helping tobacco users quit should be strengthened, according to testifiers before the Nebraska Health and Human Services Committee last month.

Nebraska currently funds tobacco prevention and control at $2.5 million annually, or about 18.8 percent of the minimum funding level recommended by the U.S. Centers for Disease Control and Prevention for Nebraska. Currently, Nebraska ranks 32nd of the 50 states in its per capita level of funding for tobacco control. Testifiers before the HHS Committee urged that the state do more to attack the state's primary cause of preventable death.

The CDC recommended in a 1999 report that Nebraska spend between $13 million and $31 million on tobacco prevention and control. Those recommendations were based on research conducted in California, Massachusetts and elsewhere that has documented strategies effective at reducing tobacco use and exposure.

Nebraska spending to combat tobacco use and exposure pales in comparison with the amount the tobacco industry spends to addict and retain tobacco users -- $75.8 million per year in marketing expenditures in Nebraska alone.

Master Settlement Agreement funds come from an agreement reached in 1998 between 46 states, including Nebraska, and the tobacco industry. The agreement specified that funds generated should be used for driving down tobacco use.

In fiscal year 2007, Nebraska received $104.7 million from tobacco generated revenue, which includes Master Settlement Agreement funds and tobacco excise tax.

Tobacco-Free Hospitals Guide Released
Moving Toward a Tobacco-Free Future, is a resource guide to assist hospitals and health systems in their efforts to implement tobacco-free campus policies. The Nebraska Hospital Association partnered with the
Nebraska Department of Health and Human Services Tobacco Free Nebraska and Nebraska CARES (Cancer Awareness, Research, Education and Service)programs to publish the resource guide, which is available here.

Nebraskans Support Smoke-Free Air

By a more than two-to-one margin, Nebraska voters favor a law that would prohibit smoking in most public places.

According to a poll conducted February 14 and 15, a full 69 percent of Nebraskans favor such a law.

An overwhelming majority of Nebraskans (84 percent) believe that all workers in the state should be protected from exposure to secondhand smoke in workplace. A full 88 percent of Nebraskans report that, "It would be really nice to go out and enjoy restaurants and bars in Nebraska without smelling like cigarette smoke when you get home." In fact, 89 percent of voters say that restaurants and bars would be healthier for customers and employees if they were smoke-free.

Nebraska voters believe that the rights of employees and customers to breathe clean air in restaurants and bars outweigh the rights of smokers to smoke and owners to allow smoking in those venues by a 73 percent to 23 percent margin.

According to the same poll, 83 percent of Nebraskans believe secondhand smoke is a moderate or serious health hazard.

The poll was conducted by Public Opinion Strategies.