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Effectiveness of Comprehensive Tobacco Control Programs in Reducing Teenage Smoking in the United States

Wakefield MA and Chaloupka FJ. Tobacco Control, 9: 177-186, 2000.

Objective: To describe the extent to which comprehensive statewide tobacco control programs in the USA have made progress toward reducing teenage smoking.

Data sources: Literature search of Medline for reviews of effectiveness of program and policy elements, plus journal articles and personal request for copies of publicly released reports and working papers from evaluation staff in each of the state programs of California, Massachusetts, Arizona, Oregon, and Florida.

Study selection: All studies, reports, and commentaries that provided information on aspects of program implementation and evaluation.

Data synthesis: Statewide comprehensive programs show high levels of advertising recall and generally positive improvement in smoking related beliefs and attitudes among teenagers. More fully funded programs lead to increased mass media campaign advertising and community initiatives; a greater capacity to implement school based smoking prevention programs; and an increase in the passage of local ordinances that create smoke free indoor environments and reduce cigarette sales to youth. The combination of program activity and increased tobacco tax reduce cigarette consumption more than expected as a result of price increases alone, and these effects seem to apply to adolescents as well as adults. Programs are associated with a decline in adult smoking prevalence, with these effects observed to date in California, Massachusetts, and Oregon. Arizona and Florida have yet to examine change in adult prevalence associated with program exposure. California and Massachusetts have demonstrated relative beneficial effects in teenage smoking prevalence, and Florida has reported promising indications of reduced prevalence. Arizona has yet to report follow up data, and Oregon has found no change in teenage smoking, but has only two years of follow up available. One of the most critical factors in program success is the extent of program funding, and consequent level of program implementation, and the degree to which this is undermined by the tobacco industry and other competitors for funding.

Conclusions: Despite the different strengths and combinations of program messages and strategies used in these comprehensive programs, there is evidence that they lead to change in factors that influence teenage smoking, and to reductions in teenage smoking.

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