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Synopsis. We propose to analyze the large state and national population surveys of tobacco-use behavior in order to inform California’s tobacco control policies. We propose to document population-level trends and influences on smoking cessation; to document uptake of new tobacco products and study their association with population-level cigarette smoking rates; and to document evidence that California’s comprehensive tobacco control program has reduced the health effects of smoking for recent California cohorts, especially lung cancer. We plan to publish our results in the scientific literature, and to present results, as invited, to policy making and advisory bodies.
Background. Since the mid-1980’s there has been a dramatic decline in the number of cigarettes smoked per capita in the US as a whole. An even larger decline was seen within California, and this was in part explained by the California Tobacco Control program. These historic declines in population level cigarette consumption were due to both reduced smoking initiation among young people, increased smoking cessation among adult smokers, and lower consumption levels among continuing smokers. However, it appears that in recent years smoking cessation rates have stalled both nationally and in California. During the most recent decade, there has been increased marketing and use of pharmaceutical cessation aids but this has not been associated with increased cessation success at the population level. High-intensity smoking has been especially reduced under comprehensive tobacco control programs, but lower intensity smoking has not. The prevalence of smoke-free homes and of workplace smoking restrictions has increased, but rates vary widely across the US, and these can be expected to impact non-smoker’s health as well as smokers’ consumption levels and quitting success.
Newer smokeless tobacco products are emerging into national markets, and concurrently the FDA has been given new regulatory authority over tobacco product manufacture and marketing. These products are being marketed as complements to and situational substitutes for cigarettes. Recent national estimates show high rates of concurrent use of cigarettes and smokeless products, especially among young adult men, raising concern about increased smoking initiation and reduced smoking cessation. These new products, and their possible accompanying FDA regulations, may impact behaviors and beliefs which mediate smoking cessation, such as maintenance of a smoke-free home, self-efficacy for cessation, and concern about the health of others from second-hand smoke. Each of these trends can be expected to impact future trends in population level smoking initiation as wells as cessation.
Specific Aims
Hypothesis 1: At the population level, Tobacco Control policies in California have effectively reduced the addictiveness of cigarettes.
We will assess population trends in smoking cessation and in predictors of cessation, and in regional tobacco control indicators such as smoking prevalence and exposure to indoor smoking. We will compare time trends across state jurisdictions and geographic areas, and between race/ethic groups, with an emphasis on African Americans and other disproportionately impacted groups.
Hypothesis 2: At the population level, new and emerging tobacco products are undermining smoking cessation rates and are promoting smoking initiation.
We will identify trends in the use of new and emerging tobacco products and how these relate to smoking behavior among current and former smokers, young adults and within demographic groups. We will include menthol and other flavored tobacco products, and traditional and new forms of smokeless tobacco in this aim.
Hypothesis 3: At the population level, Tobacco Control policies in California have effectively reduced the harm of cigarettes as measured by the health effects which accrue to smokers.
Using national population-based mortality linked files from the National Center for Health Statistics, we will assess differences in lung cancer rates by, gender and race/ethnicity, between California and the remaining United States. | 