effective strategy for reducing tobacco use. The small but statistically significant differences in the reduction of adult smoking prevalence in ASSIST states, when applied on a population basis, could be expected to have a large effect on the public. If all 50 states and the District of Columbia had implemented ASSIST, there would be about 1,213,000 fewer smokers in the country (NCI, 1991, 2005, 2006).

The finding that states with a greater change in tobacco-control policies during ASSIST had larger decreases in per-capita cigarette consumption shows that interventions that result in policy change can have a strong and sustained effect on the amount of cigarette smoking. That conclusion adds to the body of similar research and expert reports that document the importance of a comprehensive approach to tobacco control. Although policy efforts take time, they can bring about major changes in social norms, including smoking behavior.

The finding that states with stronger infrastructure or capacity (ability to implement tobacco-control activities) had lower per capita cigarette consumption is additional evidence that when tobacco-control programs are strong and well supported, a decrease in the amount of smoking can be achieved. ASSIST was the first study to provide a method for measuring states’ capacity to implement tobacco-control programs.

A 2006 study published in the American Journal of Health Promotion provided further evidence of the effectiveness of comprehensive tobacco-control programs and policies (Hyland et al., 2006). The study’s findings suggest that well-funded tobacco-control programs combined with strong tobacco-control policies increase cessation rates. Quit rates in communities that experienced both policy and programmatic interventions were higher than quit rates in communities that had experienced only policy interventions (excise-tax increases or secondhand-smoke regulations). The finding supports the claim that comprehensive tobacco-control programs can increase adult cessation rates in the population and have an effect beyond that predicted by tobacco-control policies alone.

Other Tobacco-Control Programs

The Agency for Healthcare Research and Quality published Tobacco Use: Prevention, Cessation, and Control in June 2006. The document, prepared by RTI International, involved a systematic literature review of human studies conducted in developed countries. The included studies were limited to those with participants at least 13 years old, with a duration of at least 6 months, and with sample sizes of at least 30 for randomized controlled studies and 100 for experimental or observational studies (HHS, 2006).

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