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

Objective To assess the impact of the Massachusetts tobacco control programme, which, since its start in January 1993, has spent ol er $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.