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Tracking the Media and Policy Impacts of State-Level Tobacco Control: SmokeLess States Evaluation

ImpacTeen Program Office
University of Illinois at Chicago
Institute for Health Research and Policy
1747 West Roosevelt Road
Room 558, M/C 275
Chicago, Illinois 60608

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.

  1. A new legislative bill tracking system.
  2. State level effort to track newspaper coverage of tobacco policy issues.
  3. The adaptation and conduct of the “strength of tobacco control” survey conducted by the National Cancer Institute (NCI) in 2000 for its ASSIST evaluation.