Fed effort cut smoke rates in 17 states

WASHINGTON — In 17 states where the federal government spent $128 million to discourage tobacco use, smoking dropped by about 3 percentage points over eight years, just over half a point more than in states without the program.

The program was responsible for reducing the number of smokers in the target states by about 104,000, estimated Frances A. Stillman, a researcher at the Johns Hopkins Bloomberg School of Public Health.

Translating the results to the entire nation, the program, called the American Stop Smoking Intervention Study, or ASSIST, would have cut the number of smokers by about 278,700, said Stillman, first author of a study appearing today in the Journal of the National Cancer Institute.

The program was funded by the institute.

Studies by the Centers for Disease Control and Prevention suggest that cigarette smoking is responsible for more that 440,000 deaths a year in the United States. Smoking has been linked to heart disease, emphysema and other respiratory system diseases, stroke and a number of different types of cancer.

The anti-smoking program trained local advocacy groups to lobby for passage of higher cigarette excise taxes and to promote regulations for smoke-free environments. The program also mounted a public relations effort to counter an estimated $47 billion spent by industry to market tobacco products during the study period and included efforts to limit underage access to tobacco.

States included in the study were Colorado, Indiana, Maine, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, New Mexico, New York, North Carolina, Rhode Island, South Carolina, Virginia, West Virginia, Washington and Wisconsin.

At $128 million, the program spent about $1,200 for each smoker who kicked the habit. Elizabeth A. Gilpin, a University of California, San Diego, researcher and a co-author of the study, called that cost "a real bargain."

"Most smoking cessation programs will spend that (for each smoker)," said Gilpin. "That's just for a few hours of a counselor's time. When you think about what you save in health care costs, $1,200 is a real bargain."

In the study, researchers used industry cigarette sales figures and tobacco use surveys to determine the impact of the ASSIST effort. The study found that smoking decreased nationally by about 2.41 percentage points. In the 17 states where the ASSIST program was in action, smoking declined by 3.02 percentage points, a difference of .61 point.