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