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disease in California. They found that between 1989 and 1992, both percapita cigarette consumption rates and the annual rate of mortality from heart disease declined significantly more in California than in the rest of the country. Reflecting the trends noted above, however, the rates of decline slowed noticeably after 1992. Consequently, Fichtenberg and Glantz concluded that the CTCP was initially effective in reducing deaths from heart disease but that cutbacks in the scale and funding of the program weakened further progress (Fichtenberg and Glantz 2000).

The last independent evaluation of the CTCP to be released by the Gallup Organization and its partners (Stanford and USC) assessed the program’s overall impact in relation to Californians’ exposure to its various elements and messages, as reported in surveys conducted in 1996–1997, 1998, and 2000. The evaluation concluded that the CTCP has had an impact on behavior, as counties with greater exposure to the program showed better outcomes than counties with less exposure, including a greater decline in adult smoking prevalence between 1996 and 2000, lower perceived access to cigarettes among 10th graders, and an increase from 1996 to 2000 in the proportion of adults with complete smoking bans in their homes (Independent Evaluation Consortium 2002).

The CTCP has also had success in reducing tobacco use among youth. A study released in 2005 associated the CTCP with reduced uptake and smoking rates among adolescents and young adults. The authors found that the rate of “ever puffing” declined by 70 percent among 12- to 13-year-olds from 1990 to 2002, by 53 percent among 14- to15-year-olds from 1992 to 2002, and by 34 percent among 16- to 17-year-olds from 1996 to 2002. The study identified similar patterns for smoking experimentation (smoking one or more cigarettes ever) and established smoking (smoking more than 100 cigarettes in a lifetime). Although the smoking prevalence among young adults (ages 18 to 24 years) remained constant in the rest of the country from 1992 to 2002, the prevalence among young adults in California decreased significantly (by 18 percent) from 1998–1999 to 2001–2002 (Pierce et al. 2005). Gilpin and colleagues found a similar behavioral trend when they compared the results of two 3-year longitudinal studies (1993–1996 and 1996–1999) that measured smoking initiation rates at the baseline among California adolescents who had never smoked. The authors identified a lower rate of initiation at follow-up in the cohort of the second study than in that of the first study (Gilpin et al. 2005).

Data published by CDHS indicate that California has continued to make progress in reducing tobacco use among youth. According to CDHS, from 2000 to 2004, the 30-day smoking prevalence rate among high school students in California decreased from 21.6 percent to 13.2 percent (CDHS 2005). Figure 5-2 shows that although the rate of decline in smoking prevalence among youth in California mirrored the rate of decline in the rest of



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