State’s Anti-Smoking Plan Needs More Time : Health: Halfway through the landmark campaign, supporters say early results are encouraging, but that it will be years before its true success or failure can be measured.

Jacquie Duerr, head of the state’s tobacco control office, apologizes over the phone. The surgeon general of the United States is on the other line wanting--like everyone, it seems--to talk about California’s ambitious plan to turn the state into a smoke-free mecca by the turn of the century.

“We do feel that California is a petri dish for the nation,” Duerr says with a sigh after the brief interruption to speak with Surgeon General Antonia Novello. “We have a lot of eyes on us. We receive calls throughout the country, pretty much on a daily basis. And international calls are not unusual.”

Faced with all that attention, one question has been on the minds of health officials, legislators and anti-smoking leaders:

Is the plan working?

The question is of growing importance as the four-year, $271-million program hits the halfway point.

Money is one reason. Some anti-smoking officials are concerned that part of the funds earmarked for the campaign may be funneled to other state health programs. Anti-smoking advocates hope to see program funding extended--for as long as it takes to meet the state’s goal of cutting the number of smokers 75% by 1999.

Also, the stakes are high: The potential exists for saving billions of dollars in health-care costs by reducing smoking-related illnesses. And health organizations worldwide are watching to see if--given ample money and creativity--disease prevention strategies can make a difference in such a large population base.

The questions are clear. The answers are not. Many say it will be years before the state can measure the success or failure of the campaign.

For one thing, anti-smoking officials say, the scope and nature of the campaign--and its goals--make it difficult to judge the results. It’s hard to evaluate large-scale attempts to change social behavior, especially in so short a time span.

The campaign started in 1988 when voters approved Prop. 99, which raised the cigarette sales tax from 10 cents to 35 cents a pack. Tax money goes to an anti-smoking campaign that combines school education, massive media advertising and community-based programs. The program emphasizes both prevention and cessation, and it targets the state’s 4 million smokers, many of whom are youths and minorities.

The campaign has gained widespread attention because of its use of bold advertising and its willingness to face the tobacco industry in a head-on war of words, experts say. The tobacco companies, after their failed attempt to defeat Prop. 99, have been relatively silent.

The program’s advocates, though, are speaking up, especially because they worry the lack of short-term answers may mean the campaign won’t get the time or money it needs to reach its goals.

A recent flurry of activity in Sacramento signaled that anti-smoking planners are concerned about protecting program funds long enough to give the campaign a chance to work.

The Tobacco Education Oversight Committee, which reports on the campaign to the Legislature, last month called for more funds and more time to reach the program’s goals. Legislation appropriating funds for the anti-smoking campaign is due to expire in June, although several projects will be funded through 1992.

The committee also protested Gov. Pete Wilson’s new budget plan to divert to prenatal care $72 million in money earmarked for anti-tobacco programs.

Health and anti-smoking officials also released preliminary information indicating apparent gains in the anti-smoking fight.

Last week, State Health Director Kenneth Kizer released a report that showed that 87% of school-age youths and 78% of adult smokers questioned were aware of the campaign.

Very preliminary health department studies show there are 750,000 fewer smokers now than when the campaign began.

Officials also say studies show a decrease in the number of youths taking up smoking and an increase in the number of Californians who say they are trying to quit.

“This is the most innovative, most extensive public-health project that I know of,” says Carolyn B. Martin, chairwoman of the tobacco oversight committee. “But the legislators are looking at dollars and cents and are asking us which parts are working and which aren’t.”

The problem in making judgments now, Martin says, is that funds were only recently issued to many of the schools, community-based organizations and health departments sponsoring projects.

She says that early information indicates “there have been some positive results already, more than we expected.” However, she says, it will take about two years for detailed studies to show how the campaign is faring.

Evaluating behavioral changes takes time. For instance, one major goal of the campaign is preventing young people from starting to smoke.

“Our goal is prevention and cessation. And in order to reach that vulnerable age group, 9 to 18, it’s going to take awhile to see (if) they can successfully resist the advertising of the tobacco industry,” Martin says. “People can say ‘I’m never going to smoke.’ But will they stick with that, and for how long? You can’t tell that in six months.”

Local anti-smoking advocates agree that it is unrealistic to expect immediate results from the campaign.

“I think what is going on right now is people are saying we want to see results or we won’t go on funding this campaign,” says Ray Durazo, a partner in the Los Angeles-based public relations firm Moya, Villanueva and Durazo. The firm is helping to plan the anti-smoking media campaign aimed at Latinos.

“There isn’t a campaign in the world . . . that is going to bear overnight results. One of the basic premises of advertising and public relations is: If you’re starting out with a new product, a new concept, if you’re not willing to put a couple years into it, you’re not going to see any appreciable results.”

Despite such caveats, some anti-smoking advocates around the state say early signs--such as the estimated 750,000 drop in smokers--indicate the campaign is working the kind of magic that has eluded the federal government and other states aiming for smoke-free societies.

“The main battle being waged in the United States in the war against smoking is being fought in California,” says Ahron Leichtman, president of Smokefree Business Services in San Francisco, a private consulting and public relations business. “It’s damned difficult to do something like this at the federal level. It’s like knocking your head against the wall (because) the tobacco industry is so powerful.”

But, he says: “The (federal) Office of Smoking and Health is looking very carefully at what goes on in California and what can be done with money from tobacco-tax money.”

Leichtman goes a step further than some in interpreting the early results. “You can debate whether or not it’s the result of this campaign, but the fact is there has been an extraordinary drop in smoking in the state of California since this campaign began,” he says. “I don’t think it’s too early to read the indicators. (The statistics show) they must be doing something right in the state. I don’t attribute that to a quirk of fate.”

State health officials are more cautious.

“I think everyone has said it would take an awful lot of hard working to reach our goal,” says Duerr of the state tobacco control office. “We are really still learning a lot. There has never been an attempt where a whole state and whole set of disparate people have been involved in something like this.”

In addition, Duerr says, public behavior is a tricky thing to predict.

Planners kept that in mind. The campaign, unlike others, used preliminary research, including focus groups, to evaluate what strategies have the best chance of working.

The resulting strategy is specific and well-honed:

The campaign uses paid media advertising, school education, community-based organizations, health departments, private physicians and other sources to carry its message.

The materials are developed to reach a few key groups most vulnerable to smoking: youths, blacks, Latinos and young pregnant women.

The campaign is heavy on prevention while also supporting cessation programs, which have been shown to be only marginally effective.

Martin of the tobacco oversight committee says the state modeled the campaign on a study by the National Cancer Institute that suggested that changing health behavior is most successful when it is carried out at several levels: through schools, doctors’ offices and the media, for example.

“If you just have the media, you won’t be effective,” Martin says. By doing this “we are creeping into every little crevice of California.”