WEDNESDAY, Nov. 19, 2003 (HealthDayNews) -- At a time when state governments are shrinking their investments in tobacco-control efforts, a new study says those policies are effective in persuading Americans to stop smoking.

The study examines the effects of the nation's first large-scale demonstration aimed at changing social, cultural, economic and environmental factors that affect people's decision to light up.

Seventeen states took part in the eight-year trial, known as the "American Stop Smoking Intervention Study (ASSIST). The states involved had a lower prevalence of adult smoking than non-participating states, the study found.

Results of the study, which appear in the Nov. 19 issue of the Journal of the National Cancer Institute, imply that promoting smoke-free environments, countering tobacco advertising, limiting access to tobacco products, and raising cigarette prices does help curb tobacco consumption.

Study author Frances A. Stillman, an associate research professor at Johns Hopkins Bloomberg School of Public Health, says states are "undermining" their success in reducing tobacco use by "taking away money" from effective policy initiatives.

"These types of programs in the long run really are saving money, but most importantly they're saving lives," she insists.

Thomas J. Glynn, the director of science and trends at the American Cancer Society, says in a prepared statement the results "are proof positive that comprehensive statewide tobacco control approaches can work nationwide."

If all 50 states and the District of Columbia had implemented ASSIST, there would be 278,000 fewer smokers nationally, the study authors estimate.

The study isn't the first to show that creating smoke-free workplaces, for example, or raising tobacco taxes has an effect on smoking behavior. But it is the largest and most comprehensive study to date, Stillman says.

Cassandra Welch, director of national advocacy for the American Lung Association, says the study "adds to other evidence that we've had that tobacco prevention is most successful when it's aimed at changing community norms and social norms."

Launched in 1991 by the National Cancer Institute, ASSIST provided funding to states to prevent and reduce tobacco use by implementing policies that would influence smoking behavior.

To assess the impact of ASSIST, Stillman and her colleagues compared changes in adult smoking prevalence, per capita cigarette consumption, and tobacco control policies between the 17 participating states and 33 non-ASSIST states and the District of Columbia.

ASSIST states -- in addition to a lower prevalence of smoking -- had lower per capita cigarette consumption. The difference, though, was not statistically significant. The study was not able to capture very small changes in per capita consumption rates, Stillman explains.

But a summary measure developed to capture states' tobacco control policy outcomes suggests a connection between policy-focused interventions and per capita cigarette consumption. States with larger increases in that score also had larger decreases in per capita cigarette consumption.

For example, adult smoking prevalence fell 3.02 percentage points in the 17 ASSIST states, compared to a decline of 2.11 percentage points in states not participating in the program.

This study, says Glynn, is "a clear mandate for states to put their tobacco settlement dollars back into tobacco control programs."

States signed an agreement settling litigation against the tobacco industry in 1998 that funnels millions of dollars in revenue to state coffers each year. Yet few states are devoting significant proportions of settlement funds to tobacco control and smoking cessation initiatives.

Welch says her group is calling on states to spend at least 10 percent of the money on tobacco prevention programs.

"Unfortunately, what we've seen lately is that they've been using this money to plug budget holes," she says.

A report last month from the National Conference of State Legislatures (NCSL) shows states appropriated just 3 percent of settlement revenue to tobacco prevention. The bulk of it -- 47 percent -- went to "other" non-health and non-tobacco related purposes.

"Three percent clearly isn't a majority of the funding and it's not what the CDC (Centers for Disease Control and Prevention) recommends," concedes Andrew McKinley, a research analyst with the NCSL.

Yet in this time of economic downturn, states are doing what their constituents want, McKinley adds. And what they want is no cuts to services, such as Medicaid, and no new taxes, he says.

Each year, more than 400,000 Americans die from cigarette smoking -- an estimated 276,000 men and 142,000 women. One in every five deaths in the United States is smoking-related, the CDC estimates.

More information

The American Lung Association has more on quitting smoking and on lung cancer.

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