Telephone: 312.413.0475
Facsimile: 312.996.2703
The SmokeLess States: National Tobacco Policy Initiative has been
one of the largest and most visible philanthropic efforts to reduce
tobacco use. The program is a private sector effort that supports activities
of statewide coalitions working to improve the tobacco policy environment
with the goal of reducing tobacco use. The Initiative is a collaborative
effort among The Robert Wood Johnson Foundation (RWJF), the nation’s
largest philanthropy devoted exclusively to health and health care –
the American Medical Association (AMA), the nation’s largest physician
group – and statewide coalitions receiving initiative grants. Coalitions
are made up of major voluntary health organizations; tobacco control
organizations; state medical, dental, and hospital associations; state
government agencies; educational and civic groups; and businesses.
While anecdotal evidence of the program’s success is powerful, much
remains to be learned about the impact of the SmokeLess States program
on tobacco control efforts and tobacco use. This is particularly true
as the program is expanding in size and scope. In response, The Robert
Wood Johnson Foundation selected the UIC ImpacTeen research team to
conduct a comprehensive assessment of the program.
The primary objective of the ImpacTeen Tracking the Media and Policy
Impacts of State-level Tobacco Control: SmokeLess States Evaluation
is to identify to what extent the SmokeLess States program has impacted
a reduction in tobacco use through examination of media coverage of
tobacco policy and other tobacco related issues, tracking tobacco related
legislation, and conducting a survey to evaluate and measure the “strength
of tobacco control” efforts.
Project Background
Over the past decade, state and national initiatives have led to unprecedented
funding of state-level tobacco control programs. California led the
way with its comprehensive tobacco control program funded by revenues
generated from a 25-cent cigarette excise tax increase in 1989. Several
states, including Massachusetts, Arizona, Oregon, Maine and others followed
California’s lead by raising their state tobacco excise taxes and allocating
a substantial share of the new revenues to their own comprehensive tobacco
control programs. The National Cancer Institute (NCI) partnered with
the American Cancer Society on the American Stop Smoking Intervention
Study (ASSIST) for Cancer Prevention, funding coalitions in 17 states
from 1993 through 1999 (following an initial planning phase from 1991
through 1993). The Centers for Disease Control and Prevention (CDC)
followed by funding the remaining states (excluding California) and
the District of Columbia, albeit at lower levels, through its Initiatives
to Mobilize for the Prevention and Control of Tobacco Use (IMPACT) program.
In 1999, the CDC created the National Tobacco Control Program, which
currently provides about $1 million in federal funding to each state
health department. In 1994, The Robert Wood Johnson Foundation (RWJF)
initiated its SmokeLess States program, providing substantial additional
funding to state-level coalitions working to reduce tobacco use.
Over time, the SmokeLess States program expanded to fund at least
some activities in 31 states and two cities; 9 states (including two
states that had been funded for capacity building) were also funded
by the SmokeLess States National Program Office (NPO) (under a separate
grant) to assist in the development of plans for comprehensive tobacco
programs. Finally, individual state settlements with tobacco companies
and the 1998 Master Settlement Agreement (MSA) between the tobacco companies
and the remaining states have provided substantial new revenues to states.
Some states have committed a significant share of these new revenues
to funding comprehensive tobacco control programs, while others have
provided at least some funding for these efforts. These programs generally
have consistent goals for reducing tobacco use, including preventing
initiation among youth and young adults; promoting cessation among all
smokers; reducing exposure to environmental tobacco smoke (ETS); and
identifying and eliminating disparities among population subgroups (U.S.
Department of Health and Human Services (USDHHS), 2000).
The experiences of the states with comprehensive programs clearly
demonstrate that these programs are effective in reducing tobacco use,
although much remains to be learned about the channels through which
these programs work (Farrelly, Pechacek, and Chaloupka, 2001; Wakefield
and Chaloupka, 2000; USDHHS, 2000; CDC, 1999). In general, these programs
have one or more of four key components: state and community interventions,
countermarketing campaigns, policy and regulation, and surveillance
and evaluation (USDHHS, 2000). Different programs have placed differing
emphasis on these components, with substantial diversity among the types
of activities supported within each component. While greater funding
for these tobacco control efforts has significantly reduced tobacco
use (Farrelly, Pechacek and Chaloupka, 2001), little is known about
the relative impact of the various subcomponents of these programs.
SmokeLess States has focused much of its effort on reducing tobacco
use by strengthening tobacco control legislation and regulation. Thirty-one
states and two cities (Tucson AZ and Washington DC) have received funding
to educate the public and policy makers about the effects of stronger
tobacco control policies on tobacco use and its consequences. More recently,
as part of a separate grant, an additional nine states were funded through
the SmokeLess States NPO to improve awareness about the need to use
tobacco settlement funds to support comprehensive tobacco control programs.
Anecdotal information suggests that SmokeLess states funding has had
a major impact on state policies. For example, 13 of the 16 states that
raised their tobacco excise taxes since 1994 were SmokeLess States.
Similarly, a disproportionate share of new local clean indoor air ordinances
was adopted in SmokeLess States. Perhaps most importantly, of the 39
states that recently committed tobacco settlement funding to tobacco
control programs, 30 are SmokeLess States, and the average funding level
in the SmokeLess States is nearly five times that in the other nine
states.
ImpacTeen’s Tracking the Media and Policy Impacts of State-level Tobacco
Control: SmokeLess States Evaluation is expected to be particularly
valuable in providing the SmokeLess States with baseline information
and informing them of progress towards achieving their goals, as well
as in providing helpful information about the relative effectiveness
of alternative strategies for achieving the state goals. Data on policy
outcomes are of critical importance to ImpacTeen’s evaluation, given
the emphasis of the SmokeLess States coalitions on strengthening state
tobacco control policies. including data collection efforts. In addition
to employing the data from existing surveillance systems being compiled
as part of the ImpacTeen project, the SmokeLess States Evaluation includes
three, additional, key data collection efforts, not a part of any other
ongoing or planned surveillance systems. These three data collections
will provide information on the short term and medium term impact of
SmokeLess States on tobacco control efforts.
- A new legislative bill tracking system.
- State level effort to track newspaper coverage of tobacco policy
issues.
- The adaptation and conduct of the “strength of tobacco control”
survey conducted by the National Cancer Institute (NCI) in 2000 for
its ASSIST evaluation.
