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An earlier review (the results of which were published by the CDC in 1996) sought to determine the impact of the state’s excise tax and tobacco control program on per-capita cigarette consumption and adult smoking prevalence. In doing so, the authors compared the rates in Massachusetts with those in the rest of the United States during two time periods: the 3 years leading up to the passage of Question 1 on the state ballot initiative (1990 to 1992) and the years immediately following the implementation of the excise tax and establishment of the MTCP (1993 to 1996). Although they determined that smoking prevalence rates in Massachusetts required further study, they found that per capita cigarette consumption decreased significantly from the first period to the second. During the first period, consumption in Massachusetts declined by 6.4 percent, whereas that in the rest of the country declined by 5.8 percent (except for California, where consumption declined by 11.0 percent). From 1992 to 1996, however, per-capita consumption declined by 19.7 percent in Massachusetts, 15.8 percent in California, and just 6.1 percent in the remaining states and the District of Columbia. The authors reasoned that because real cigarette prices actually fell in 1993 (because of price reductions by the tobacco industry), the excise tax alone could not account for the decline in cigarette consumption that continued through 1996. Consequently, they concluded that Massachusetts’s tobacco control program played a role alongside tax increases in reducing the rate of tobacco use in the years immediately following the passage of Question 1 (CDC 1996).

Biener and colleagues (2000a) confirmed and added to the findings of the 1996 CDC study. They found that although Massachusetts and 48 comparison states experienced similar declines (15 percent and 14 percent respectively) in per-capita cigarette consumption from 1988 to 1992, Massachusetts experienced a greater annual decline (more than 4 percent) than the comparison states (less than 1 percent annually) following the establishment of excise tax and the establishment of the MTCP. As the authors of the CDC study had already observed, the decline in Massachusetts occurred even though price reductions for cigarettes effectively negated the potential effects of the excise tax increase. The authors also determined that after 1992 Massachusetts experienced a greater rate of decline in adult smoking prevalence than did the comparison states. The prevalence of smoking declined by 0.43 percent per year in Massachusetts but by only 0.03 percent in the comparison states. On the basis of these findings, the authors concluded that tobacco control programs such as the MTCP can reduce the rates of tobacco use and the related health risks (Biener et al. 2000a).

Massachusetts’s success in reducing the rates of tobacco use among youth has fluctuated over time, however. In its last review of the MTCP, Abt Associates reported that although the prevalence of smoking among youth in Massachusetts and the United States as a whole actually grew during



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