A study published in the "Journal of the National Cancer Institute" provides the latest evidence that investing in state tobacco control programs can reduce smoking rates. In this evaluation of the American Stop Smoking Intervention Study (ASSIST), the authors found that states that were part of the ASSIST intervention program showed a greater reduction in smoking prevalence (the number of people who smoke) than non-ASSIST states. The study also found that states with stronger tobacco control policies and greater ability to implement tobacco control programs experienced larger reductions in smoking.
At the time of the study, ASSIST was the largest federally funded demonstration project to help states develop effective strategies to reduce smoking. In 1991, the National Cancer Institute (NCI), part of the National Institutes of Health, provided funds to 17 state health departments and forged a partnership with the American Cancer Society to undertake the study. The ASSIST evaluation is the most comprehensive evaluation ever conducted on a large, multi-state tobacco control study.
The goal of ASSIST was to change the social, cultural, economic and environmental factors that promote smoking by utilizing four policy strategies: promoting smoke-free environments; countering tobacco advertising and promotion; limiting youths' access to tobacco products; and raising excise taxes to increase the price of tobacco products. The interventions were developed and implemented by networks of state and local tobacco control coalitions.
ASSIST was rolled out in two phases -- a two-year planning phase from 1991 to 1993 and a six-year implementation phase from 1993 to 1999. NCI provided an average of $1.14 million per state per year during the intervention years, for a total of $128 million over the eight years of the program. Other additional funding and support were available to the states through voluntary organizations and other non- federal sources.
"These results are compelling," said Scott Leischow, PhD, chief of NCI's Tobacco Control Research branch. "ASSIST had a small but significant effect on smoking prevalence. As the authors determined, this difference has a large effect when viewed at the population level; if all 50 states and the district of Columbia had implemented ASSIST, there would now be about 280,000 fewer smokers nationwide."
"Our research emphasizes the importance of strong tobacco control programs and effective policies," said Frances A Stillman, PhD, of the John Hopkins Bloomberg School of Public Health in Baltimore, MD, first author of the study and director of the ASSIST evaluation. "States can reduce smoking prevalence and the enormous health and economic burden of smoking if they put in place proven programs and policies." According to the Centers for Disease Control and Prevention (CDC), cigarette smoking is responsible for more than 440,000 deaths in the United States each year.
The authors of the ASSIST evaluation note that several factors affected the results. ASSIST was a demonstration project and did not restrict the flow of tobacco control information between states. Therefore, non-ASSIST states benefited from the intervention, as well. In addition, by 1994, the CDC and the Robert Wood Johnson Foundation were supporting tobacco control programs in ASSIST and non- ASSIST states, making it even more difficult to measure the impact of the ASSIST intervention.
During this period, the tobacco industry opposed ASSIST and the policy interventions it sought to implement, which likely reduced the potential impact of the program. According to Federal Trade Commission reports, the tobacco industry spent approximately $47 billion nationwide to market tobacco products during the period of the ASSIST project.
"Even given these factors," said Stillman, "the results of this ASSIST evaluation add to the body of research documenting that strong policy-focused interventions can have a significant effect on smoking behaviour."