Impact of the Massachusetts tobacco control programme: population based trend analysisBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7257.351 (Published 05 August 2000) Cite this as: BMJ 2000;321:351
- Lois Biener (), senior research fellowa,
- Jeffrey E Harris, professorb,
- William Hamilton, vice presidentc
- a Center for Survey Research, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125, USA
- b Department of Economics, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02138, USA
- c Abt Associates, 55 Wheeler Street, Cambridge, MA 02138, USA
- Correspondence to: L Biener
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.
Funding This research was supported with funds from the Health Protection Fund, established on passage of voter referendum Question 1 (Tobacco Excise Tax) in November 1992.
Competing interests LB and WH work for organisations that are contractors to the Massachusetts tobacco control programme. JEH has received compensation and research support through a public contract with the state of Massachusetts.