The quarter that changed the world

• Published in: Tobacco control Vol. 19; no. Suppl 1; pp. i3 - i15
• Main Authors: Roeseler, April, Burns, David
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.04.2010; BMJ Publishing Group; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adolescent; Adult; Advertising; Advertising campaigns; advocacy; Anti smoking movements; Budget deficits; California; California - epidemiology; Campaign contributions; Child; Cigarette smoking; Cigarettes; comprehensive tobacco control programme; Culture; Departments; Funding; Health care; Health Care Costs; Health Promotion - economics; Health Promotion - methods; Health Promotion - organization & administration; Health surveillance; Humans; Infrastructure; Litigation; Lung Neoplasms - epidemiology; Lung Neoplasms - prevention & control; Marketing; Nicotiana; Political campaigns; Prevalence; Program Evaluation - economics; Public health; Public Health Practice; public policy; Research Paper; Secondhand smoke; Smoking; Smoking - economics; Smoking - epidemiology; Smoking - legislation & jurisprudence; Smoking - trends; Smoking cessation; Social Environment; Social norms; State budgets; Surveillance; Tax increases; Tobacco; Tobacco control; Tobacco industry; Tobacco Industry - legislation & jurisprudence; Tobacco smoke; Tobacco use; Tobacco Use Cessation - economics; Tobacco Use Cessation - statistics & numerical data; Tobacco Use Disorder - economics; Tobacco Use Disorder - prevention & control; California
• ISSN: 0964-4563; 1468-3318
• DOI: 10.1136/tc.2009.030809

BackgroundThe California Department of Public Health (CDPH), California Tobacco Control Program (CTCP) is one of the longest-running comprehensive tobacco control programmes in the USA, resulting from a 1988 ballot initiative that added a 25-cent tax on each pack of cigarettes and a proportional tax increase on other tobacco products. This programme used a social norm change approach to reduce tobacco use.MethodsThe operation, structure, evolution, programme dissemination and results are reviewed.ResultsThe sustained programme implementation has reduced adult per capita cigarette consumption by over 60% and adult smoking prevalence by 35%, from 22.7% in 1988 to 13.8% in 2007. From 1988 to 2004, lung and bronchus cancer rates in California declined at nearly four times the rate of decline seen in the rest of the USA and the programme is associated with an $86 billion savings in healthcare costs. Youth smoking rates among 12–17 years olds are the second lowest in the nation.ConclusionsThe social norm change approach is effective at reducing tobacco consumption, adult smoking and youth uptake. This approach resulted in declines in tobacco-related diseases and is associated with savings in healthcare expenditures. In considering CTCP's effectiveness, the takeaway message is that it should be viewed as a unified programme rather than a collection of independent interventions. The programme was designed and implemented as one where the parts complement and reinforce each other. Its effectiveness is dependent on its comprehensive strategy rather than any one part of the intervention.