EVALUATING THE IMPACT OF STATEWIDE ANTITOBACCO CAMPAIGNS - THE MASSACHUSETTS AND CALIFORNIA TOBACCO CONTROL PROGRAMS

Despite more than 30 years of public health programs to reduce tobacco use, smoking is still the leading preventable cause of death in the U nited States. In response to this continuing epidemic, voters in Calif ornia (1988), Massachusetts (1992), Arizona (1994), and Oregon (1996) approved ballot initiatives that established statewide tobacco control programs funded by cigarette excise tax revenues. Evaluating these in novative public health interventions is important, both to improve exi sting programs and to guide other states in developing and implementin g similar interventions. In this paper we describe the methods being u sed to evaluate the statewide anti-tobacco campaigns in California and Massachusetts, and review the findings of process and outcome evaluat ions of both programs. Our review suggests that both programs have had a substantial impact on the public's health by reducing cigarette con sumption and stimulating the development of policies to reduce environ mental tobacco smoke exposure. However it does not appear that either program has reduced smoking initiation among adolescents. Our evaluati on suggests three problems in program implementation that future anti- tobacco campaigns must avoid in order to produce long-term, sustained effects: (1) the gradual erosion of program funding by the state legis latures and governors; (2) the lack of a consistent, supportive consti tuency within state government; and (3) inconsistency in campaign them es, messages, and programs. We conclude by offering recommendations to correct these problems so that statewide cigarette-tax-funded anti-to bacco campaigns can realize their potential to become one of the most effective public health interventions available.