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recent years, however, many states have viewed tobacco excise tax increases as a tool for reducing demand for tobacco while providing funding for public health measures (Rabin and Sugarman 2001). Many studies have found that the overall consumption of cigarettes declines with increases in the price of cigarettes (DHHS 2000) (see Chapter 5). Although figures on the “price elasticity” of demand for cigarettes vary somewhat, the general rule is that a 10 percent increase in the real price reduces overall consumption by about 4 percent and the rate of smoking among youth by 7 percent.

In addition to tax revenues, in the 1990s states received funds from philanthropic organizations and the federal government to create comprehensive tobacco control programs. The National Cancer Institute’s American Stop Smoking Intervention Study (ASSIST) demonstration program, a partnership with the American Cancer Society, funded 17 state health departments from 1991 to 1999. The program’s goal was to “alter states’ social, cultural, economic, and environmental factors that promote smoking” (NCI 2005). The Centers for Disease Control and Prevention’s Initiatives to Mobilize for the Prevention and Control of Tobacco program (IMPACT) funded tobacco control initiatives in the other states (except California).

Also in the early 1990s, the Robert Wood Johnson Foundation (RWJF), under President Steven Schroeder, became the first philanthropy in the United States to make a major commitment to tobacco control. Over the next decade, the RWJF invested more than $400 million dollars in research, policy, and communications programs aimed at reducing the harm caused by tobacco (Bornemeier 2005). In 1994, RWJF created the SmokeLess States program, administered by the AMA, to support nongovernmental coalitions to educate the public and policy makers about the risks of tobacco use. The program was meant to augment the federal funding that was going to state governments and expand upon the innovations under way in California.

By the mid-1990s, every state had funds from one or more of these sources to build tobacco control programs. In 1999, the CDC replaced ASSIST and IMPACT with a nationwide program that provided funds to all 50 states and the District of Columbia. The Smokeless States program continued until 2004. Comprehensive state programs contained various initiatives, such as launching counter advertising and public education campaigns, establishing smoke-free workplaces and public spaces, increasing prices through taxation, supporting treatment programs for tobacco dependence, enforcing youth access restrictions, and monitoring performance and evaluating programs (IOM/NRC 2000). Some states, including California, Massachusetts, and Florida, pioneered innovative models that included edgy youth-oriented media campaigns that challenged youth not to let the tobacco industry manipulate them into smoking.

The state-based programs reflected a shift in tobacco control—from a reliance on efforts directed at individual behavioral change to community

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