When it comes to getting Americans to put down their cigarettes, only a few states have made vigorous efforts - combining public-health awareness campaigns, services for smokers who want to quit, and enforcement of laws that restrict tobacco sales to youths.
Now, evidence is building that such multipronged plans really work. And it's coming at a crucial time, say antismoking activists, just as many states are deciding how to spend the bulge being added to their budgets by the huge tobacco-lawsuit settlement.
In Massachusetts, figures released this week show a dramatic decline in smoking since the state began its tobacco-control program six years ago. In contrast to the national trend, in which adult rates have held about steady and teen smoking has been on the rise, Massachusetts has seen a 15 percent drop among adults and a downward trend in adolescent smoking as well.
"While there's been a lot of attention paid to tobacco over the last [several] years,... if you look across the states, most are doing little or nothing in terms of tobacco prevention," says Danny McGoldrick, research director of the Campaign for Tobacco-Free Kids in Washington.
Now, more states can afford it
Massachusetts voters passed a 1992 ballot initiative to fund their program with a 25-cent-per-pack cigarette tax, but for states that haven't taken such a step, the argument that they lack the resources may be fading.
"The infusion of settlement money is an incredible opportunity," Mr. McGoldrick adds, referring to the $206 billion that 46 states won from tobacco companies last year.
Still, persuading more states to implement prevention programs is a difficult task, say antismoking forces. "The first thing lawmakers ask is, how do we know it works," says Seth Winick, who lobbies on behalf of the American Cancer Society.
Models like Massachusetts help, he says, but the arsenal of evidence to counter skepticism is still small.
Studies have shown that raising the price of cigarettes reduces consumption.
But besides Massachusetts, California, which started its tobacco-control initiative in 1990, offers the only other evidence that comprehensive programs can be effective. Newer antismoking efforts in about a half dozen states, including Oregon, Florida, and Arizona, are also showing promise.
Components of success
One key to any antismoking strategy is "countermarketing," experts say. A series of television spots featured a Massachusetts mother's unvarnished tale of her battle with emphysema after smoking since the age of 10. A round of billboards features statistics about the number of smokers and the health effects attributed to it, with the tagline "Get Outraged." The Boston company that created the state ads, Arnold Communications, was recently chosen to lead a four-year national campaign.
But raising awareness doesn't reduce smoking unless people who want to quit can be connected to helpful resources in their community. For Massachusetts participants of the American Cancer Society's national Great American Smokeout today, kicking the habit may be easier because of a long-established toll-free "quit line" and a variety of local assistance.
Other important components are school curricula and aggressive enforcement of restrictions on tobacco sales to minors. "They've reduced noncompliance among retailers dramatically," says McGoldrick.
Health officials and antismoking activists are encouraged by this week's study and say it is evidence that the Massachusetts model is worth copying. The number of smokers here has dropped by more than 150,000, says Public Health Commissioner Howard Koh, whose department released the study.
Compared with a national rate of about 25 percent, the adult smoking rate in the state is 19.1 percent. And although the sample of 14- to 17-year-olds was too small for the results to be statistically significant, the study showed a drop from 24.6 percent to 19.7 percent. Nationally, more than one-third of teenagers smoke.
"What the tobacco industry has done is weave smoking into every element of society ... and bill it as a rite of passage for kids. We have, I believe, changed that social norm in only six years ... and sent out the message that nonsmoking should be the social norm," says Dr. Koh.
Competition for the millions
As advocates take their message to states dividing up the tobacco-settlement millions, they find lawmakers are generally receptive. But "there are other competing interests ... for how they could use that money," says Mr. Winick. Many states have already designated the dollars to things such as education and general health-care spending.
Even in states that have antismoking programs, there is often a fight to continue funding. Massachusetts legislators who wanted to use part of the state's share of settlement money to bolster smoking-reduction efforts originally came up against resistance from Gov. Paul Cellucci, but the just-approved state budget includes a significant increase - $12.8 million.
(c) Copyright 1999. The Christian Science Publishing Society