though there would be losses in the southeastern states that grow and process tobacco (Warner et al., 1996).

Indicators that might be considered include the following:

  1. Annual per capita retail cost of tobacco consumption for tobacco users.

    The per capita cost of tobacco use is a product of the numbers of tobacco users, the quantity of tobacco consumed, and the current pricing of tobacco products, including excise taxes. For some individuals or families, expressing use in economic terms may provide a better incentive to quit or reduce consumption so that the money can be used for other purposes. To employ this measure, communities would need an estimate of the number of tobacco users in the population. State excise tax records might serve as a source of information on consumption.

  2. Average annual value of retail sales of tobacco products per retail outlet.

    This measure would provide an indication of the contribution of tobacco sales to retail income in the community. Where tobacco sales are a major source of income, communities might expect less support for efforts to reduce tobacco use. Data on excise tax receipts might be a basis for estimating the value of retail sales.

Health Care

The health care system can contribute to preventing tobacco use, promoting cessation of use, and treating tobacco-related illnesses. Most health care resources are used in treating illness, and cure is generally not possible for more serious conditions such as lung cancer and emphysema. Many tobacco-related health risks can be reduced when people stop using tobacco products, and studies have demonstrated that tobacco cessation counseling by health care providers can increase cessation rates (see U.S. Preventive Services Task Force, 1996). In one study, 5 percent of smokers quit as a result of their doctor's spending less than one minute encouraging them to do so (Russell et al., 1979). Cessation rates have been shown to increase as the time devoted to counseling increases (Smoking Cessation Guideline Panel, 1996). On a national basis, even a 5 percent annual cessation rate among smokers who have a health care visit would translate



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