Cigarette smoking is a major threat to the health of the American population. In 2002, 30% of Americans over the age of 12 reported using tobacco within the past month. Smoking is the most popular form of nicotine use, and is a major cause of
and the third leading cause of preventable death in the United States.
Many major institutions, including the National Cancer Institute (NCI), the American Cancer Society (ACS), and the Centers for Disease Control and Prevention (CDC), have funded anti-smoking campaigns.
In 1991, the National Cancer Institute (NCI) awarded funding for the American Stop Smoking Intervention Study (ASSIST) to 17 states: 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. ASSIST’s goal was to prevent and reduce tobacco use by initiating policy changes that discourage smoking. The program lasted eight years—a two-year planning phase and a six-year implementation phase.
A new study in the November 19, 2003 issue of the
Journal of the National Cancer Institute
found that, compared with states that did not participate in the ASSIST program, ASSIST states had a greater decrease in smoking prevalence. The researchers estimated that if all 50 states and the District of Columbia adopted the ASSIST program, 278,700 smokers in the U.S. would stop smoking.
About the Study
Seventeen states were selected to receive ASSIST funding. On average, the implementation cost each state $1.14 million. The program included interventions in four policy areas:
Promoting smoke-free environments
Countering tobacco advertising and promotion
Limiting tobacco access and availability
Increasing tobacco prices through new excise taxes
To measure the success of ASSIST, the researchers performed four measures on all 50 states:
Adult smoking prevalence
Adult per capita cigarette consumption
Degree of smoking-related policy change
Amount of resources dedicated to tobacco control
The researchers compared these measures between the 17 ASSIST states and the 33 non-ASSIST states and the District of Columbia.
Both ASSIST and non-ASSIST states saw decreases in smoking prevalence, but ASSIST states had a significantly larger decrease. On average, ASSIST states saw a 3.0% decrease in smoking prevalence, while non-assist states saw a 2.1% decrease.
Overall, ASSIST was not associated with a decrease in per capita cigarette consumption or smoking-related policy changes over time. States with more resources dedicated to tobacco control, however, had lower per capita cigarette consumptions. And, during the first two years of the study, ASSIST was associated with an increase in smoking-related policy changes. When the researchers analyzed the data further, they found that the only policy change that significantly reduced cigarette consumption was cigarette price.
How Does This Affect You?
These findings indicate that the ASSIST program produced moderate but important decreases in smoking prevalence. The authors suggest that if ASSIST were applied to all 50 states and the District of Columbia, it “could be expected to have a large impact on the public,” resulting in approximately 278,700 fewer smokers.
But do the benefits of ASSIST outweigh the high cost? After all, in 2001, 46.2 million adults in the United States were current smokers. Reducing that number by 278,700 would be a relatively minor improvement. And it would be expensive. Assuming the ASSIST implementation would cost each state $1.14 million, the total cost of disseminating the program nationwide would total $57 million, or over $200 per smoker who quits. On the other hand, since smoking-related illnesses cost the nation more than $150 billion each year, the ASSIST program may be well worth its costs.
ASSIST focused on policy change. Future anti-smoking campaigns may want to follow suit. As the authors conclude, “Although policy efforts take time, they bring about major changes in social norms, affect smoking behavior, save lives, and ultimately, improve public health.”
Cigarettes and other nicotine products. National Institute on Drug Abuse website. Available at:
. Accessed November 19, 2003.
MMWR Highlights—Cigarette smoking among adults—United States, 2001. Centers for Disease Control and Prevention website. Available at:
. Accessed November 20, 2003.
Stillman FA, Hartman AM, Graubard BI, Gilpin EA, Murray DM, Gibson JT. Evaluation of the American Stop Smoking Intervention Study (ASSIST): a report of outcomes.
Journal of the National Cancer Institute
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