After years of success, California's pioneering efforts to reduce smoking have faltered, according to controversial new research that fixes some of the blame on diversions of money from anti-tobacco programs.
The research, published today in the Journal of the American Medical Assn., shows that the prevalence of adult smokers fell sharply in the early years of the state's tobacco control program, from 23% before it began in 1989 to 18% by 1993. But no further decline occurred by 1996, and some headway was lost, with smoking prevalence among teenagers jumping from 9% to 11%.
Although there are several possible reasons for that lack of progress, the researchers emphasize the cuts in the program's funding, which dropped from $3.35 per resident in the earlier years to $2.08 after 1993. "Taking the money out of the budget crippled the program," said the study's lead author, John Pierce, associate director of the cancer prevention and control program at UC San Diego.
Pierce said that after he submitted his complete report last fall to the state health department, which paid $1.8 million to UC San Diego for the research, department officials pressured him to revise the findings in a way that would make the tobacco control efforts look more successful. He said he refused to do so, and after a heated dispute his contract to continue the research was not renewed.
"I can only conclude that the decision to terminate our contract was politically motivated," he wrote in a letter to tobacco program officials in June.
A health department official, Dr. Donald Lyman, who is chief of chronic disease and injury prevention, disputed charges that the decision was political. He said the disagreement was not over the data in Pierce's report but the "conjecture" that the program lost effectiveness chiefly because of funding cuts. Pierce's research contract was not renewed partly because he was "difficult to work with," Lyman said.
The new research touches off another round of controversy over the state's tobacco control program, funded by proceeds from a 25-cent-a-pack cigarette tax mandated by voters in 1988.
The program--the most comprehensive anti-smoking campaign in any state--supports anti-tobacco TV ads and billboards as well as community and school anti-smoking efforts. Researchers laud it as a prime reason that the state has the nation's second-lowest smoking rate, after Utah. About 24% of American adults smoke, according to the Centers for Disease Control.
But Pierce and other researchers say that the program's success has been imperiled by elected officials' repeated attempts to cut its funding. In 1992, Gov. Pete Wilson vetoed the program's budget for mass media ads. Some of it was restored after a court challenge. Still, the program's $42-million budget for 1995-1996 was less than half that for 1992-1993.
Several anti-smoking groups have filed lawsuits against the state to recover funds diverted from the tobacco program to other areas, such as medical services to the poor. Attorney A. Lee Sanders of Oakland, founder of a group called Just Say No to Tobacco Dough, has sued the state to recover $140 million that he charges was diverted from the program over the years.
The significance of the Pierce report, he said, was that it shows how the diversion of anti-tobacco funds "has increased the nicotine addiction of young people and will therefore increase the death toll."
Some researchers and anti-smoking advocates say that attempts to reduce the program's effectiveness coincide with increased lobbying and campaign contributions by tobacco companies.
A recently unearthed 1990 memo from the Tobacco Institute, an industry-funded research group, outlined several tactics specifically for "eliminating" money set aside for anti-smoking ads. Among the suggested "strategies" were to "encourage the Legislature to intervene" and "encourage the governor to intercede against the campaign."
Tobacco industry campaign donations to California Assembly candidates, political parties and party committees rose 70% between 1994 and 1996, to $1.5 million, Pierce and coauthors write. "The slowing of the decline in smoking in recent years may well be a result of these political counter-strategies," they write.
Pierce and his critics agree that other factors contributed to the leveling off of smoking rates after an initial decline. Tobacco companies cut the price of cigarettes in 1993, and boosted advertising and promotion. In addition, the 25-cent excise tax reduced cigarette consumption slightly.
The most disturbing trend, health experts agree, is the recent upturn in teenage smoking, although Pierce and his coauthors have different estimates from the health department. Last week, the health department reported that teenage smoking dropped slightly in 1997, to 10.9% from 11.2% the year before, but a health department official said the change was not statistically significant.
Pierce and co-authors say in their complete report, from which the journal article is excerpted, that if present trends continue, the prevalence of teenage smoking will rise to 14.2% by 1999.
However, funds appropriated to the tobacco control program since the low point of 1996 have increased substantially, which may offset the recent upturn and restore some of the program's early momentum, state health officials say.