The Effect of Prices, Programs, and Smoke-free Homes on Smoking Behavior in the 1990s Evidence from Population Surveys John Pierce, UC San Diego Wael Al Delaimy, UC San Diego Karen Messer, UC San Diego Dennis Trinidad, UC San Diego Hao Tang, California Dept. of Health Services

Overall Goals of Tobacco Control Programs Reduce future health consequences  Encourage smokers to quit  For those who don’t quit, reduce their smoking level  Discourage nonsmokers from starting  Protect nonsmokers from secondhand smoke

CDC’s Recommended Best Practices for Effective Tobacco Control, Increase the excise tax on cigarettes to increase price 2. Statewide comprehensive programs (has central organization, technical assistance, demonstration projects) –Encouragement and support of local community initiatives $0.70/person/year –School programs $4-6/K-12 student/year –Enforcement programs (e.g. youth access restrictions $ per person/year) –Counter-marketing media campaign $1-3/person –Cessation programs (statewide quitline, clinic initiative)

Two Statewide Comprehensive Programs in the United States in the Early 1990s California: 1989-present Population: 36 million  Includes excise tax increases  Includes statewide smoke-free workplace law (1994) Massachusetts: Population: 5 million –Includes excise taxes –No statewide smoke-free workplace law

Tobacco Control Per Capita Expenditures: Massachusetts vs. California Massachusetts California Recommended

Only California Had Smoke-free Workplace Law Smoke-free workplaces are associated with voluntary smoke-free homes Smoke-free homes lead to:  Lower levels of cigarette consumption among current smokers  Less relapse following quit attempt  Lower levels of uptake by adolescents

Adults (18+ Years) with a Home Smoking Ban

Comparing Effects of California and Massachusetts Campaigns What State Groups Should Be Used?  Need to control for price of cigarettes and other social norms related to smoking Group 1: Tobacco-growing states – H o : lower price, lower excise tax, lower social norms Group 2: Two other large states with same price and excise tax as California and Massachusetts, but no program

Cigarette Price (2002 $s) CA NY NJ * = Tobacco-Growing States MA Highest price for tobacco-growing states California price

Top 6 Tobacco-Growing States Cash Receipts Excise Tax & in 1994 Rank in North Carolina $871m$0.05 (50 th ) 2.Kentucky $615m $0.03 (51 st ) 3.South Carolina $187m$0.07 (49th) 4.Tennessee $178m$0.20 (45 th ) 5.Virginia $147m$0.20 (45 th ) 6.Georgia $133m$0.37 (41 st ) Tobacco and the Economy

1993 (rank) 2005 (rank) New York$0.80 (3 rd ) $1.50 (8 th ) New Jersey$0.64 (12 th ) $2.40 (2 nd ) Tobacco control program states Massachusetts$0.75 (5 th ) $1.51 (6 th ) California$0.59 (17 th ) $0.87 (21 st ) Large Population States with High Excise Taxes on Cigarettes

Trends in Affordability (% Disposable Income) of a Pack of Cigarettes, MSA  No major difference between states on cigarette affordability  No change in affordability between 1992 and 1998  All state groups had a major decrease in affordability starting in 1999

California NY/NJ Tobacco States Per Capita Expenditure on Tobacco Control in Selected US States Recommended

Data Sources  Current Population Surveys (age 15+) –Ongoing State-specific surveys of 45,000 households/month conducted by Bureau of Census includes 4 month follow-back to estimate labor force participation –Tobacco Use Supplements in specific months in 1955, 1985, 1989, , , , –Since 1992, NCI coordinated additional telephone follow-up to increase % who self-report tobacco use  California Tobacco Surveys (age 12+) –Telephone surveys of 34,000 CA households in 1990, 1993, 1996, 1999, 2002.

Smoking Behaviors That We Considered  Among Non-Hispanic White Population  Consumption level among current smokers Wael Al-Delaimy  Quitting activity Karen Messer  Differences in smoking behavior in African Americans across these states Dennis Trinidad  California effect on smoking initiation Hao Tang