Impact of the Massachusetts tobacco control programme: population based trend analysis

• Published in: BMJ Vol. 321; no. 7257; pp. 351 - 354
• Main Authors: Biener, Lois, Harris, Jeffrey E, Hamilton, William
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 05.08.2000; British Medical Association; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; BMJ Publishing Group; British Medical Journal
• Edition: International edition
• Subjects: Adult; Anti smoking movements; Behavioral Risk Factor Surveillance System; Biological and medical sciences; Cigarette smoking; Cigarettes; Consumption taxes; General Practice; Government Programs; Government regulation; Health Promotion - legislation & jurisprudence; Health Surveys; Humans; Laws, regulations and rules; Massachusetts - epidemiology; Medical sciences; Population control; Population estimates; Prevalence; Prognosis; Program Evaluation; Risk-Taking; Secondhand smoke; Smoking; Smoking - epidemiology; Smoking - legislation & jurisprudence; Smoking - trends; Smoking Cessation - legislation & jurisprudence; Statistics; Taxation; Taxes; Taxes - legislation & jurisprudence; Tobacco; Tobacco taxes; Tobacco use; Tobacco, tobacco smoking; Toxicology; United States; North America; America; Massachusetts; Human; Prevention; Sanitary program; Prevalence; Toxicity; Analysis; Tobacco smoking; Trend; Adult; Operation; Epidemiology; Public health
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.321.7257.351

Abstract Objective: To assess the impact of the Massachusetts tobacco control programme, which, since its start in January 1993, has spent over $200m—“the highest per capita expenditure for tobacco control in the world”—funded by an extra tax of 25 cents per pack of cigarettes. Design: Population based trend analysis with comparison group. Subjects: Adult residents of Massachusetts and other US states excluding California. Main outcome measures: Per capita consumption of cigarettes as measured by states' sales tax records; prevalence of smoking in adults as measured by several population-based telephone surveys. Results: From 1988 to 1992, decline in per capita consumption of cigarettes in Massachusetts (15%) was similar to that in the comparison states (14%), corresponding to an annual decline of 3-4% for both groups. During 1992-3, consumption continued to decline by 4% in the comparison states but dropped 12% in Massachusetts in response to the tax increase. From 1993 onward, consumption in Massachusetts showed a consistent annual decline of more than 4%, whereas in the comparison states it levelled off, decreasing by less than 1% a year. From 1992, the prevalence of adult smoking in Massachusetts has declined annually by 0.43% (95% confidence interval 0.21% to 0.66%) compared with an increase of 0.03% (−0.06% to 0.12%) in the comparison states (P<0.001). Conclusions: These findings show that a strongly implemented, comprehensive tobacco control programme can significantly reduce tobacco use.