Impact of the Massachusetts tobacco control programme: population based trend analysis

Objective To assess the impact of the Massachusetts tobacco control program me, which, since its start in January 1993, has spent ol er $200m-"the high est per capita expenditure for tobacco control in the world"-funded by an e xtra tax of 25 cents per pack of cigarettes. Design Population based trend analysis with comparison group. Subjects Adul t residents of Massachusetts and other US states excluding California. Main outcome measures Per capita consumption of cigarettes as measured by s tates' sales tax records; prevalence of smoking in adults as measured by se veral population-based telephone surveys. Results From 1988 to 1992, decline in per capita consumption of cigarettes in Massachusetts (15%) was similar to that in the comparison states (14%), corresponding to an annual decline of 3-4% for both groups. During 1992-3, consumption continued to decline by 4% in the comparison states but dropped 12% in Massachusetts in response to the tax increase. From 1993 onward, co nsumption in Massachusetts showed a consistent annual decline of more than 4%, whereas in the comparison states it levelled off, decreasing by less th an 1% a year. From 1992, the prevalence of adult smoking in Massachusetts h as declined annually by 0.43% (95% confidence interval 0.21% to 0.66%) comp ared with an increase of 0.03% (-0.06%, to 0.12%) in the comparison states (P < 0.001). Conclusions These findings show that a strongly implemented, comprehensive tobacco control programme can significantly reduce tobacco use.