Source: San Jose Mercury News (CA) Contact: http://www.sjmercury.com/ Pubdate: Thu, 10 Sep 1998 Author: Jane F. Allen - Associated Press ANTI-SMOKING PROGRAM LOSING STEAM Study on cigarette use: Funding cuts, tobacco ads partly to blame for campaign's decreased effectiveness. LOS ANGELES -- A California anti-smoking program that initially made dramatic curbs in smoking is no longer as effective, partly because of funding cuts and increased tobacco-industry spending on advertising and promotion, a new study suggests. Even so, the California Tobacco Control Program started in 1989 ``has confirmed findings from earlier studies that large health promotion programs can have a major influence on smoking behavior.'' John P. Pierce and colleagues from the University of California-San Diego drew their conclusions after measuring declines in the rate of cigarette consumption and smoking prevalence among Californians. Their results appeared in Wednesday's issue of the Journal of the American Medical Association. The authors assessed the effectiveness of a voter initiative that led to a statewide program aimed at cutting the health costs of smoking-related illness. The program imposed a cigarette tax and mandated funding for anti-tobacco advertising, local government monitoring of anti-smoking laws and improved school-based smoking education programs. Local support for smoking bans and restrictions in public places and offices eventually led to a statewide ban. Using tobacco-industry sales figures, Pierce's study found that per capita cigarette consumption declined the fastest during the early years of the program: from January 1989 to December 1993, per capita cigarette consumption fell from 9.7 packs smoked per month to 6.5 packs. But from January 1994 through December 1996, the decline slowed as consumption went down to 6 packs. Nationwide, the decline halted at 10.5 packs, the study found. With the state program in place, the initial decline in smoking prevalence in California was nearly double that of the rest of the country, the authors found. Then from 1994 to 1996, smoking prevalence showed no identifiable decline statewide or nationwide. The study cited funding reductions and industry spending as possible explanations. ``Despite active industry opposition and political influences, it is urgent that the public health community determine how the California Tobacco Control Program can be modified to regain its original momentum,'' the authors wrote. In the early years, the program averaged about $96 million annually, but the amount fell to $53 million beginning in fiscal year 1994, according to the study and figures supplied by the state Department of Health Services in Sacramento. Dr. Donald Lyman, chief of the agency's Chronic Disease and Injury Control Division, disagreed with Pierce that funding cuts are the work of ``evil, wicked politicians.'' Lyman cited numerous factors that slowed down the program: The program's success hurt its finances because of its dependence on cigarette sales: ``As we cut the smoking rate 40 percent, we cut our own revenue,'' he said. Some tobacco proceeds were diverted to a child health services program until a court ordered the funds restored to the tobacco program two years ago. The tobacco industry is spending more than $1 million each day in California on advertising and promotions for what remains a legal product. Programs must be specially tailored to an influx of foreign-born people from countries where smoking is acceptable. Lyman said the drop in the percentage of adults who smoke -- from 26 percent when the program began to about 18 percent -- is ``a spectacular decline'' achieved by altering community attitudes toward smokers. ``What's happened here is a smoker who walks into the middle of a group and lights up risks his life,'' he said. ``In California, the community says you may not light up anyplace unless we give you our permission.'' Despite progress in deterring adult smoking, ``we have just not been as successful with kids,'' Lyman said. ``We have done better with kids than has happened nationally, but we have not done that much better.'' - --- Checked-by: Joel W. Johnson