Smoking rate can be slashed in five years, UCSF study shows

By Wallace Ravven

The smoking rate could be cut dramatically across the U.S.
if political will is applied to do it. In California, the
rate could be cut to ten percent in just five years,
according to an analysis by University of California,
San Francisco researchers. Reducing smoking this quickly
would save 50,000 lives in the state from heart attacks
prevented during that period, says one of the study’s authors.

Their study appears as a “Perspective” article in the
December 5 issue of JAMA, the Journal of the American
Medical Association.

The U.S. Public Health Service has set a goal of reducing
adult smoking prevalence to 15 percent by 2010, a goal that
some find daunting since the current rate is between 23 and
26 percent, the authors state. But based on published data
from the effects of large and aggressive tobacco control
programs, this target is not only achievable in the state,
but “surpassable,” according to the study.

Using data from state and federal sources, the researchers
estimated the average rate of decline in smoking consumption
and prevalence for the first four states to create large
tobacco control programs—California, Massachusetts,
Arizona and Oregon. All these programs substantially
accelerated the decline in smoking prevalence and per
capita consumption above national rates, they note.

They show that a decline in California from 18 percent in
1999 down to 10 percent could be achieved if state and
local governments restore the magnitude and aggressiveness
of the California Tobacco Control Program to early 1990s
levels. Similar results are possible in other states, they
suggest. Achieving the ten percent goal might lead to a
collapse of “public acceptability and social support
networks for smoking,” the authors note.

Effective programs would include aggressive anti-tobacco
media campaigns that focus on exposing the tobacco industry’s
lies, the dangers of secondhand smoke and nicotine addiction,
according to the researchers. Programs must also involve
strong community-based efforts concentrating on clean indoor
air laws and countering pro-tobacco influences in the community.
Medically mediated smoking cessation programs, the authors
note, are too expensive to achieve results on such a mass basis.

A re-invigorated tobacco control program could be financed
with the billions of dollars available to the states from
the 1998 Master Settlement Agreement that ended state
litigation against the tobacco industry, the authors suggest.

“We know how to rapidly reduce smoking and immediately save
lives, particularly by reducing heart attacks, which respond
to smoking cessation very quickly,” said Stanton Glantz, PhD,
UCSF professor of medicine and senior author of the paper.
“But politicians around the country are using the current
budget difficulties as an excuse to gut these effective

Health advocates are fighting major cuts in tobacco control
programs in Florida, Ohio, Hawaii, Arizona, and elsewhere
according to Glantz, and they are waiting to see whether
California Governor Davis acts to reinvigorate California’s
program or cut it.

“It makes no sense to cut tobacco control programs even in
tight fiscal times because they save the state more money
in medical expenses than they cost—from immediate benefits
in terms of fewer heart attacks and fewer low birth-weight
infants,” Glantz added.

Lead author is Asaf Bitton, a UCSF medical student. Caroline
Fichtenberg, MS, a former UCSF researcher, now a PhD student
at Johns Hopkins University, collaborated in the study and
co-authored the paper.

The research was supported by the National Cancer Institute.