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tobacco control programs increased, beginning with California and then expanding to all states.

California launched the first statewide comprehensive tobacco control program in 1990, one and a half years after the passage of Proposition 99. This landmark referendum mandated an increase in state tobacco taxes and directed 20 percent of the revenues to tobacco control programs (Bal 1998; Glantz and Balbach 2000; Najera 1998). At that time, the National Cancer Institute (NCI) was already preparing to launch the seven-year national American Stop Smoking Intervention Study (ASSIST) program. In 1991, the ASSIST program funded community-level interventions to prevent tobacco use in 17 states (NCI 2005; Stillman et al. 2003).

By the mid-1990s, every state in the United States had some funding for comprehensive tobacco control, either from the ASSIST program or from the Initiatives to Mobilize for the Prevention and Control of Tobacco Use (IMPACT) program, funded by the Centers for Disease Control and Prevention (CDC). In addition, from 1994 through 2000, some states1 also received funding for tobacco control efforts from the Robert Wood Johnson Foundation’s (RWJF) SmokeLess States program (Gerlach and Larkin 2005; Tauras et al. 2005). In addition to educational and cessation programs, the funding supported statewide coalitions of individuals and organizations that pursued action strategies to strengthen tobacco control policies.

The ASSIST program promoted three types of interventions: program services, policy changes, and mass media. However, the ASSIST program guidelines stated that “efforts to achieve priority public policy objectives should take precedence over efforts to support service delivery” (NCI 2005, p.23). Mass media initiatives were intended to support those policy changes. The four ASSIST program priority policy areas were eliminating environmental tobacco smoke (ETS), increasing tobacco excise taxes, limiting tobacco advertising and promotion, and reducing youth access (NCI 2005).

Evaluation of Comprehensive State Programs

In 2005, the CDC’s Office on Smoking and Health (OSH) released a summary of the literature on evidence of the effectiveness of state tobacco control programs (Kuiper et al. 2005). Organized by major reviews and five outcome indicators (tobacco-related mortality, prevalence, consumption, cessation, and smoke-free legislation and policy), the results are generally organized by state. The evidence provided can be considered a guide to state health departments for measuring the success of their comprehensive


Smokeless States funded all states and the District of Columbia in its final round of grants in 2000.

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