Anti-tobacco program saved lives in California

BOSTON, Massachusetts (Reuters) -- California's aggressive statewide campaign against tobacco prevented 33,300 deaths from heart disease between 1989 and 1997 and could have saved 8,300 more had officials not scaled back the program in 1992, according to a study.

The analysis, by Caroline Fichtenberg and Stanton Glantz of the University of California at San Francisco to be published in Thursday's New England Journal of Medicine, suggests that "a large and aggressive tobacco-control program" can reduce heart disease deaths in the short term.

Previous research has shown that aggressive, statewide anti-smoking programs cut cigarette consumption. The new study was designed to see if the combination of higher cigarette taxes and an aggressive public relations campaign against smoking and tobacco companies translated into a reduction in deaths from heart disease.

The researchers did not look at the campaign's effects on cancer and lung disease rates because those diseases take longer to appear in smokers.

The new findings, with their suggestion that programs to fight smoking yield substantial public health benefits, are likely to increase pressure on states to use billions of dollars from 1998 settlements between the tobacco industry and the attorneys general of U.S. states for tobacco control programs.

Many states have funneled some or all of their settlement money to other uses rather than allocate it for campaigns to reduce smoking. California has not used its settlement money to enhance its anti-tobacco program but pays for it from a cigarette tax passed in a 1988 ballot measure.

Using data from as far back as 1979, Fichtenberg and Glantz found that once the public relations effort was initiated in 1989, the number of packs of cigarettes sold per person and the death rate from heart disease dropped significantly faster than the national average.

"Mortality from heart disease decreased significantly more in California than in the rest of the United States after the introduction of the California Tobacco Control Program," they concluded.

But in 1992, Gov. Pete Wilson suspended the media campaign until a lawsuit forced him to reinstate it. Even then, Wilson softened the tone of the campaign and redesigned it to focus on teenage smoking. As a result, the researchers said, the decline in both smoking and deaths from heart disease was much less sharply.

In all, Fichtenberg and Glantz calculated that the program cost the tobacco companies $4 billion between 1989 and 1997 because 2.9 billion fewer cigarettes were bought. In addition, there were 33,300 fewer heart disease deaths.

They also found that if the steep decline seen from 1989 to 1992 had continued, it would have saved 8,300 extra lives than it ultimately did, and would have cost the tobacco industry an extra $1.4 billion.

Scaling the aggressive programs back by focusing on smoking in teens "is associated with an increase in deaths," they said.

In November 1998, 46 states and the tobacco industry reached a $206 billion settlement of the states' Medicaid lawsuits seeking recovery of their tobacco-related health care costs. Prior to that settlement, Texas, Mississippi, Minnesota and Florida reached their own deals for about $40 billion.

Based on experience in states with tobacco control programs like Massachusetts, Florida and California, the Centers for Disease Control and Prevention has recommended states use 20 to 25 percent of settlement money to set up similar programs, according to the Web site of Campaign for Tobacco Free Kids, an organization that tracks the use of the settlement money.

Copyright 2000 Reuters. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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Centers for Disease Control and Prevention
University of California San Francisco
UCSF Page on State Anti-Smoking Program

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