Nov. 18 2003
Washington, DC — A new study published today in the Journal of the National Cancer Institute (NCI) finds yet again that investing in tobacco prevention and cessation programs and adopting public policies like tobacco taxes and smoke-free workplace laws reduce smoking. This study adds to the considerable and ever-growing evidence that tobacco prevention works. The study, “Evaluation of the American Stop Smoking Intervention Study (ASSIST): A Report of Outcomes,” demonstrates that the National Cancer Institute’s ASSIST program was successful in reducing smoking in the 17 states in which it was implemented. These reductions were relatively small due to ASSIST’s limited investment, particularly when contrasted with the billions of dollars spent by the tobacco industry during the same time period. However, subsequent larger expenditures by states have produced dramatic declines in both youth and adult smoking.
This study shows once again that we know what to do to reduce tobacco use; we simply have to exercise the political will to do it. We have the resources from the tobacco settlement and tobacco taxes to invest in proven solutions to tobacco use. Unfortunately, too many governors and state legislators are ignoring the tremendous evidence and failing to fund comprehensive tobacco prevention and cessation programs.
When launched, ASSIST was the largest federally funded demonstration project to help states develop effective strategies to reduce smoking, and the evaluation is the most comprehensive ever conducted. The authors of the new study compared changes in tobacco use in 17 ASSIST states during the period of the intervention (1993-1999) with changes in the remaining states. In addition, they examined how differences in state tobacco policies and tobacco control infrastructure affected tobacco use during this time period. Despite a number of confounding factors such as dissemination of ASSIST strategies and other programs in non-ASSIST states and the powerful opposition of the tobacco industry, the study found small but significant reductions in smoking among adults in the ASSIST states compared to others. The authors also found that states with strong tobacco policies like increased excise taxes and clean indoor air laws and those with the strongest tobacco control infrastructure had lower rates of tobacco use.
In addition to outspending ASSIST by billions, the tobacco companies clearly understood the value of the ASSIST program’s investment in tobacco control at the community level and attacked the program at every chance. Referring to the ASSIST program, their own documents best describe their understanding of the value of the program: “In California our biggest challenge has not been the anti-smoking advertising created with cigarette excise tax dollars. Rather, it has been the creation of an anti-smoking infrastructure, right down to the local level. It is an infrastructure that for the first time has the resources to tap into the anti-smoking network at the national level.” (1992 Internal Philip Morris Memo, Bates Number: 2021253353)
While the tobacco companies have increased their marketing expenditures to a record $11.5 billion since the 1998 Master Settlement Agreement (MSA), state tobacco prevention and cessation programs have been CUT by 28 percent in the last two years. As a result, the tobacco companies are spending more than $20 for every dollar that states are spending on tobacco prevention. This is despite the fact that the states will receive roughly $19.5 billion in fiscal year 2004 from the tobacco settlement and tobacco excise taxes. It would take about eight percent of this amount to fund tobacco prevention programs in every state at the level recommended by the Centers for Disease Control and Prevention (CDC). Currently, however, only four states are funding programs at the level recommended by the CDC, and only eight more are funding at even half the CDC recommendation.
The ASSIST program was a seminal intervention in tobacco control at the time. It taught us much of what we know about tobacco prevention, especially the need to invest in programs at the state and community levels, and it helped train a group of tobacco control professionals who have been the vanguard of progress in reducing tobacco use. It is disgraceful that our public leaders are ignoring the lessons of this work.
Tobacco use kills more than 400,000 people in the U.S. ever year, and more than 8.6 million people in the U.S. are living with at least one serious illness caused by tobacco use, according to the CDC. Tobacco use costs our nation more than $75 billion a year in health care costs. Nearly 90 percent of smokers start as teens or younger. Every day, another 2,000 kids become regular, daily smokers, one-third of whom will die prematurely as a result. The new study shows we know how to reduce tobacco’s terrible toll. What’s missing is the political will to do so.
More information about NCI’s Tobacco Control Research Branch can be found at www.tobaccocontrol.cancer.gov or by calling Nicole Gottlieb at the NCI Press Office at (301) 496-6641.