Impact of the Massachusetts tobacco control programme: population based trend analysis

OBJECTIVE: To assess the impact of the Massachusetts tobacco control programme, which, since its start in January 1993, has spent over $200m—“the highest per capita expenditure for tobacco control in the world”—funded by an extra tax of 25 cents per pack of cigarettes. DESIGN: Population based trend analysis with comparison group. SUBJECTS: Adult residents of Massachusetts and other US states excluding California. MAIN OUTCOME MEASURES: Per capita consumption of cigarettes as measured by states' sales tax records; prevalence of smoking in adults as measured by several population-based telephone surveys. RESULTS: From 1988 to 1992, decline in per capita consumption of cigarettes in Massachusetts (15%) was similar to that in the comparison states (14%), corresponding to an annual decline of 3-4% for both groups. During 1992-3, consumption continued to decline by 4% in the comparison states but dropped 12% in Massachusetts in response to the tax increase. From 1993 onward, consumption in Massachusetts showed a consistent annual decline of more than 4%, whereas in the comparison states it levelled off, decreasing by less than 1% a year. From 1992, the prevalence of adult smoking in Massachusetts has declined annually by 0.43% (95% confidence interval 0.21% to 0.66%) compared with an increase of 0.03% (-0.06% to 0.12%) in the comparison states (P<0.001). CONCLUSIONS: These findings show that a strongly implemented, comprehensive tobacco control programme can significantly reduce tobacco use.