California as a model

One of every three persons who starts smoking falls ill and dies prematurel y because he or she smoked. Smoking has been causally linked to heart disea se, cancer, and respiratory diseases and continues to be the number one pre ventable cause of death in this country. To prevent these deaths and the in cidence of these diseases, California's Tobacco Control Program was establi shed in 1989 specifically to reduce tobacco use in the state. The strategy of the program is to "denormalize" tobacco. This strategy emphasizes three areas of programmatic activity: to counter pro-tobacco influences, to reduc e exposure to environmental tobacco smoke, and to reduce access to tobacco products, with a focus on both social and commercial sources. A fourth prio rity area, cessation, is considered more of an outcome. California's Tobacc o Control Program has touched the life of every Californian. Adult smoking prevalence in the state has gone from approximately 11% lower than the rest of the notion in 1988 to 20% lower in 1996. There are now approximately on e million fewer smokers in California than would have been expected. Overal l, per capita cigarette consumption has fallen by more than 50%. Seventy pe rcent of adult smokers reported that they tried to quit in the last year. E xposure to secondhand smoke has plummeted. California's lung and bronchus c ancer incidence is already declining at a significantly higher rate than th at seen elsewhere in the nation. Youth smoking rates have also declined sig nificantly. However, contrary to the message of its massive public relation s campaign, the tobacco industry has not changed its stripes after the nati onal tobacco settlement. They are still aggressively marketing their produc ts to teenagers, ethnic minority groups, and young adults. They need to be combated with renewed vigor by a vigilant health community. (C) 2001 by Ame rican Society of Clinical Oncology.