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

BMJ 2000; 321 doi: (Published 05 August 2000) Cite this as: BMJ 2000;321:351
  1. Lois Biener (lois.biener{at}, senior research fellowa,
  2. Jeffrey E Harris, professorb,
  3. William Hamilton, vice presidentc
  1. a Center for Survey Research, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125, USA
  2. b Department of Economics, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02138, USA
  3. c Abt Associates, 55 Wheeler Street, Cambridge, MA 02138, USA
  1. 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.

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