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Momentum Builds

Major advances in tobacco control occurred both in the courts and in legislatures during a short period of time, thereby reversing the political momentum that long seemed to favor the tobacco industry in Congress and state legislatures. Thus, by end of the 1990s, tobacco control advocates were energized and optimistic about further gains in the 50-year effort to end the tobacco problem. At about this time, the architects of Healthy People 2010 (DHHS 2002) set an ambitious goal of reducing the prevalence of smoking among adults (defined as smoking at least 100 cigarettes in their lifetimes and who now report smoking cigarettes every day or on some days) in half—from the 1998 baseline of 24 percent, to 12 percent in 2010. For high school students the target was a 54 percent drop from the 1999 smoking prevalence rate of 35 percent to a rate of 16 percent in 2010 (smokers in high school were defined as those having smoked one or more cigarettes in the previous 30 days).

Despite setbacks and persistent opposition, important milestones in tobacco control were attained in the 1990s and early 2000s. The MSA and the four-state settlement placed some controls on the industry and provided for large payments to the states. The American Legacy Foundation, established and funded pursuant to the MSA, sponsored a nationwide counter advertising campaign, the first in 30 years. The campaign, modeled on the “truth” campaign in Florida, was linked to 22 percent of the decline in the rate of smoking among youth between 1999 and 2002. The overall rate of smoking among students in grades 8, 10, and 12 dropped from 25.3 percent to 18 percent during that period. This translates into approximately 300,000 fewer young smokers (Farrelly et al. 2005) (see Chapter 5 and Slater, Appendix N).

Studies have also linked comprehensive tobacco control activities to decreases in smoking among youth. A recent study of state expenditures on tobacco control found, “clear evidence that tobacco control funding is inversely related to the percentage of youth who smoke and the average number of cigarettes smoked by young smokers” (DHHS 1994; Tauras et al. 2005). The smoking rates in states with the most aggressive programs declined more than the national average. Recently, in Maine, for example, the rates of smoking declined 59 percent among middle schools students and 48 percent among high school students between 1997, when the state began its campaign, and 2003 (Tobacco Free Kids 2004).

Aggressive state antismoking campaigns also contributed to the overall decrease in the prevalence of smoking among adults beginning in the late 1990s. Early evidence of the impact of these programs came from the California Tobacco Control Program, which was associated with nearly twice the rate of decline in smoking prevalence as that in the rest of the United



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