Learning Objectives: Describe the pathway by which the California Tobacco Control Program affects health outcomes, and assess the relative contributions of program expenditures and the cigarette tax in reducing heart disease mortality.
Abstract: Objective: We test the hypothesis that the California Tobacco Control Program (the Program) has reduced per capita cigarette consumption and the age-adjusted death rate from heart disease. We use data from 1980 to 1997 and new methods not previously described in the literature. Our results are relevant to tobacco control advocates and policy makers everywhere.
METHODS: We employ a two stage statistical model to quantify the impact of the Program on mortality. The two stage model captures the pathway of policy induced changes in smoking by which the Program affects mortality, and leads to stronger causal interpretation. The first stage is a policy model which estimates the impact of the Program on smoking. The second stage is a disease model which links smoking and other risk factors to heart disease mortality. We use data on the cigarette excise tax and actual program expenditures to determine the independent effects of these two policy tools. We account for the time lag between Program expenditures, smoking reduction, and reduced mortality risk.
RESULTS: The Program achieved significant declines in cigarette consumption and heart disease mortality in California. Program expenditures alone averted 3,400 – 3,900 heart disease deaths between 1989 and 1997. Including the effects of the cigarette tax raises the number of averted deaths to 12,700 – 14,500.
Discussion: Our results demonstrate the Program has been successful in reducing smoking and heart disease mortality in California. Cigarette tax and program expenditures each contribute significantly, demonstrating the effectiveness of a coordinated approach to tobacco control.
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