The Impact of Tobacco Control Program Expenditures on Aggregate Cigarette Sales: 1981-1998

Since the 1998 Master Settlement Agreement between states and the tobacco industry, states have unprecedented resources for programs to reduce tobacco use. Decisions concerning the use of these funds will, in part, be based on the experiences of states with existing programs. We review the experiences of several states that have adopted comprehensive tobacco control programs. We also report estimates from econometric analyses of the impact of tobacco control expenditures on aggregate tobacco use in all states and in selected states with comprehensive programs for the period from 1981 through 1998. Our analyses clearly show that increases in funding for state tobacco control programs reduce tobacco use.

Why Behavioral And Environmental Interventions Are Needed To Improve Health At Lower Cost

http://dx.doi.org/10.1377/hlthaff.2010.111

Medicaid Coverage for Tobacco Dependence Treatments in Massachusetts and Associated Decreases in Smoking Prevalence

Approximately 50% of smokers die prematurely from tobacco-related diseases. In July 2006, the Massachusetts health care reform law mandated tobacco cessation coverage for the Massachusetts Medicaid population. The new benefit included behavioral counseling and all medications approved for tobacco cessation treatment by the U.S. Food and Drug Administration (FDA). Between July 1, 2006 and December 31, 2008, a total of 70,140 unique Massachusetts Medicaid subscribers used the newly available benefit, which is approximately 37% of all Massachusetts Medicaid smokers. Given the high utilization rate, the objective of this study is to determine if smoking prevalence decreased significantly after the initiation of tobacco cessation coverage.Smoking prevalence was evaluated pre- to post-benefit using 1999 through 2008 data from the Massachusetts Behavioral Risk Factor Survey (BRFSS). The crude smoking rate decreased from 38.3% (95% C.I. 33.6%–42.9%) in the pre-benefit period compared to 28.3% (95% C.I.: 24.0%–32.7%) in the post-benefit period, representing a decline of 26 percent. A demographically adjusted smoking rate showed a similar decrease in the post-benefit period. Trend analyses reflected prevalence decreases that accrued over time. Specifically, a joinpoint analysis of smoking prevalence among Massachusetts Medicaid benefit-eligible members (age 18–64) from 1999 through 2008 found a decreasing trend that was coincident with the implementation of the benefit. Finally, a logistic regression that controlled for demographic factors also showed that the trend in smoking decreased significantly from July 1, 2006 to December 31, 2008.These findings suggest that a tobacco cessation benefit that includes coverage for medications and behavioral treatments, has few barriers to access, and involves broad promotion can significantly reduce smoking prevalence

Law as a Tool for Preventing Chronic Diseases: Expanding the Spectrum of Effective Public Health Strategies

Law, which is a fundamental element of effective public health policy and practice, played a crucial role in many of public health's greatest achievements of the 20th century. Still, conceptual legal frameworks for the systematic application of law to chronic disease prevention and control have not been fully recognized and used to address public health needs. Development and implementation of legal frameworks could broaden the range of effective public health strategies and provide valuable tools for the public health workforce, especially for state and local health department program managers and state and national policy makers. In an effort to expand the range of effective public health interventions, the Centers for Disease Control and Prevention will work with its partners to explore the development of systematic legal frameworks as a tool for preventing chronic diseases and addressing the growing epidemic of obesity, heart disease, stroke, and other chronic diseases and their risk factors

Racial and Ethnic Differences in Serum Cotinine Levels of Cigarette Smokers Third National Health and Nutrition Examination Survey, 1988-1991

Context.— Cotinine, a metabolite of nicotine, is a marker of exposure to tobacco smoke. Previous studies suggest that non-Hispanic blacks have higher levels of serum cotinine than non-Hispanic whites who report similar levels of cigarette smoking. Objective.— To investigate differences in levels of serum cotinine in black, white, and Mexican American cigarette smokers in the US adult population. Design.— Third National Health and Nutrition Examination Survey, 1988-1991. Participants.— A nationally representative sample of persons aged 17 years or older who participated in the survey. Outcome Measures.— Serum cotinine levels by reported number of cigarettes smoked per day and by race and ethnicity. Results.— A total of 7182 subjects were involved in the study; 2136 subjects reported smoking at least 1 cigarette in the last 5 days. Black smokers had cotinine concentrations substantially higher at all levels of cigarette smoking than did white or Mexican American smokers (P\u3c.001). Serum cotinine levels for blacks were 125 nmol/L (22 ng/mL) (95% confidence interval [CI], 79-176 nmol/L [14-31 ng/mL]) to 539 nmol/L (95 ng/mL) (95% CI, 289-630 nmol/L [51-111 ng/mL]) higher than for whites and 136 nmol/L (24 ng/mL) (95% CI, 85-182 nmol/L [15-32 ng/mL]) to 641 nmol/L (113 ng/mL) (95% CI, 386-897 nmol/L [68-158 ng/mL]) higher than for Mexican Americans. These differences do not appear to be attributable to differences in environmental tobacco smoke exposure or in number of cigarettes smoked. Conclusions.— To our knowledge, this study provides the first evidence from a national study that serum cotinine levels are higher among black smokers than among white or Mexican American smokers. If higher cotinine levels among blacks indicate higher nicotine intake or differential pharmacokinetics and possibly serve as a marker of higher exposure to cigarette carcinogenic components, they may help explain why blacks find it harder to quit and are more likely to experience higher rates of lung cancer than white smokers

A probabilistic model of intensive designs

Without internal validity, experimental data are uninterpretable. With intensive designs, most methods presented to quantify a design's internal validity have been subject to criticism. A probabilistic model of intensive designs is presented that demonstrates the high degree of internal validity of these designs without relying on adaptations from traditional inferential statistics. Where the experimenter is able to conform to the restrictions of the model, the equations provide an estimation of internal validity for either reversal or multiple-baseline designs. More importantly, the model provides mathematical bases for some of the common recommendations and design considerations in intensive research (such as the desirability of within-subject replications and of four or more multiple baselines)

Differences in African American and White mortality caused by cigarette smoking in the U.S

Background The objective of this study is to compare African American and White excess mortality caused by smoking cigarettes. Methods Estimates of relative risks and smoking attributable fractions were made using U.S. nationally representative data. We constructed a longitudinal cohort by linking respondents to the U.S. National Health Interview Surveys with death records. Smoking history was obtained on respondents to 11 annual waves from 1999-2009. Data from 200,000 respondents were linked to the National Death Index with follow-up through December 31, 2011. Relative risks comparing current and former smokers to lifetime nonsmokers were estimated. Estimates were adjusted for possible confounders including income, health insurance, access to health care, physical activity, obesity, hypertension, alcohol use, and birth country (U.S. or other). Attributable fractions showing the proportion of deaths caused by smoking were estimated. Results Among African American men, 82% of lung cancer, 78% of COPD, 26% of ischemic heart disease, 28% of other heart disease, and 18% of cerebrovascular disease deaths were caused by smoking. Patterns among African American women were similar but the attributable fractions were lower. The African American male attributable fraction for total cancer deaths was 22% higher than for white men. The attributable fraction for ischemic heart disease was 30% higher for African American men. The attributable fraction for all smoking-related causes was 6% higher for African American than White men. Attributable fractions for African American women were higher than those observed for White women for chronic obstructive pulmonary disease, ischemic heart disease, other heart disease, cerebrovascular disease, and all cancers. Conclusions Large mortality disparities exist for African Americans compared with Whites. The disparities cannot be explained by smoking rates alone. Other factors that may contribute include greater smoke intake per cigarette, obesity, hypertension, diabetes, exposure to environmental toxins, and a higher rate of menthol cigarette use