The Scripps-Rady Ocean Plastic Pollution Challenge was a unique 6-month accelerator program focused on identifying effective, evidence-based approaches to curb the flow of plastic into the ocean, with a specific focus on marine conservation and marine cultural preservation areas along California’s coast. The inaugural program ran January - June, 2021, and participants engaged in a series of virtual short courses, team-based research, and a final two-day challenge to pitch solutions to an expert panel.

A key component of the Scripps-Rady Challenge was team-based research from March - May, 2021. Each team was assigned one of the following research topics: changing human behavior, evaluating policy solutions, and data mapping. Working closely with their dedicated mentors, teams researched various aspects of their respective topics such as a review of past efforts and programs, an identification of key stakeholders, and an analysis of major knowledge gaps.

This document includes: 1) a synthesis of all the findings of the white papers, including a table that divides them by stakeholder groups, and 2) a summary of each paper’s major findings and recommendations.

Executive Summary The California Tobacco Surveys (CTS), along with other data sources, have helped document the progress and success of over a decade of tobacco control efforts in California. Some of the most important findings are highlighted below, with reference to Selected Key Findings (KF) appearing on the following pages that provide more detail. Since young people are the focus of this report, findings pertaining to adolescents and young adults are presented first.

Executive Summary

PREFACE The California Department of Health Services contracted with the University of California, San Diego, to conduct a series of California Tobacco Surveys and to provide an independent and scientific assessment of the progress of the California Tobacco Control Program. Any interpretations of data or conclusions expressed in this report are those of the authors and may not represent the views of the State of California.

A primary goal of the Tobacco Control Program is to reduce smoking among California adults and adolescents. Assessment of Program progress in meeting this goal involves an examination of trends in per capita cigarette consumption and smoking prevalence. Program effects must be distinguished from differences resulting from changes in the demographic profile of the California population. Standardized prevalence estimates were computed to adjust for demographic changes. An effective program would lead to a more rapid decline in smoking than existed previously or that occurred in the rest of the United States. Moreover, the effect should persist over time.

The analysis considered two periods in the Tobacco Control Program, suggested by changes in per capita cigarette consumption trends, standardized adult smoking prevalence estimates from the California Tobacco Surveys, and the relative level of funding for the Program and what the tobacco industry spends to promote smoking. Before fiscal year 1992-1993, the ratio of spending was 5: 1 in favor of the tobacco industry and subsequently it was 10:1. The higher ratio resulted from reduced funding for the Tobacco Control Program and increased tobacco industry expenditures.

The first part of this executive summary presents a brief overview of the main evaluative outcomes relative to the California Tobacco Control Program: smoking behavior and exposure to secondhand tobacco smoke. Following this brief overview, trends in smoking behavior are discussed in more detail. Finally, other important findings, including those relating to secondhand smoke, are summarized under the five main tobacco control strategies identified by the Tobacco Education, Research, and Oversight Committee (TEROC).

OVERVIEW The trends in per capita cigarette consumption and adult smoking prevalence indicate that the introduction of the California Tobacco Control Program led to an acceleration of the rate of decline in smoking, but that this effect was not maintained between 1993 and 1996.

Over the course of the Program, there has been a continued major decline in the level of exposure to secondhand tobacco smoke among Californians.

BEHAVIOR In Period 1, from the start of the Program in January 1989 through June 1993, adult (18+years) smoking prevalence and per capita cigarette consumption declined over 50% faster than previously, and over 40% faster than in the rest of the United States.

In Period 2, July 1993 through December 1996, the rate of decline in per capita cigarette consumption and adult prevalence slowed, consumption to only 34% of the rate of decline in Period 1, and prevalence to only 15% of the Period 1 rate. In Period 2, California no longer showed a greater rate of decline in prevalence than the rest of the United States. However, per capita cigarette consumption was constant in the rest of the United States. The 1996 California Tobacco Survey estimated that adult smoking prevalence was 18.1 %.

Adolescent (12-17 years) smoking prevalence in California remained stable in Period 1, but it increased 26.3% during Period 2 to 12.0% in 1996? A detailed analysis of California data suggests that adolescent smoking prevalence will continue to increase through 1999.

Between 1993 and 1996, California smokers made considerable progress towards future successful cessation by decreasing consumption levels and increasing their quitting activity. A strong motivational tobacco control program may produce another major reduction in smoking prevalence.

Summary

This report presents data on a partial sample of a survey of cigarette smoking behaviors and attitudes among Californians conducted during the summer of 1990. The prevalence of current smoking among adults in California is 21.2% with males (23.8%) smoking more than females (18.8%). This represents a sharp decline in smoking following the increase in the tobacco excise tax and implementation of a comprehensive tobacco control program by the State of California, and is on track for reaching the goal of a 75% reduction in smoking prevalence by the year 1999.

Black Californians are more likely to be cigarette smokers than other racial or ethnic groups, and Hispanic and Asian/Pacific Islander women are less likely to be cigarette smokers. Smoking prevalence is also lower among those who have completed more years of formal education and among those who are over the age of 65 years.

Current smoking prevalence among adolescents aged 12-17 years is 10.4%; little difference in prevalence rates is found between boys and girls.

The prevalence of smoking prior to pregnancy among women who have been pregnant in the last 5 years was 15.7%, and 36% quit before the pregnancy reached term.

Among the counties and regions, there are only modest differences in the observed prevalence of smoking, but there is a somewhat greater observed difference in the fraction of those smokers who have quit in the last 5 years.

Approximately one-half of California’s smokers made an attempt to quit in the 12 months before the survey, in contrast to one-third of smokers nationally. The rate of quit attempts was highest among black smokers of both sexes and among Hispanic males. However, California smokers were unable to translate their high rate of cessation attempts into successful cessation. Only 11.7% of those who were smokers one year ago are currently nonsmokers. This high rate of failed cessation attempts is most evident for black males where 72% of those who were smoking one year ago attempted to quit but only 3.6% are currently nonsmokers.

The hazard of smoking is widely acknowledged; 84% of California smokers agree that smoking harms their own health. This acknowledgement is, if anything, somewhat stronger among black and Hispanic smokers, suggesting that informational campaigns have been successful but have not translated into successful cessation, particularly for black male smokers.

There is widespread support for taxation of tobacco products: 49.5% of Californian adults support a further increase in the current tax and only 15.9% want to reduce the tax. The support for increasing the tax is lower among smokers, but black and Hispanic smokers are substantially more supportive of increasing the tax than are California smokers as a whole. Black and Hispanic smokers are also more strongly supportive of efforts to ban the advertising and promotion of tobacco products as well as to restrict the access of children to tobacco products. This picture is consistent with a substantial level of concern in the black and Hispanic communities about the targeting of their communities by tobacco advertisers.

Executive Summary

The California Department of Health Services contracted with the University of California, San Diego, to conduct a series of California Tobacco Surveys and to provide an independent and scientific assessment of the progress of the California Tobacco Control Program. Any interpretations of data or conclusions expressed in this report are those of the authors and may not represent the views of the State of California.

A primary goal of the Tobacco Control Program is to reduce smoking among California adults and adolescents. Assessment of Program progress in meeting this goal involves an examination of trends in per capita cigarette consumption and smoking prevalence. Program effects must be distinguished from differences resulting from changes in the demographic profile of the California population. Standardized prevalence estimates were more rapid decline in smoking than existed previously or that occurred in the rest of the United States. Moreover, the effect should persist over time.

The analysis considered two periods in the Tobacco Control Program, suggested by changes in per capita cigarette consumption trends, standardized adult smoking prevalence estimates from the California Tobacco Surveys, and the relative level of funding for the Program and what the tobacco industry spends to promote smoking. Before fiscal year 1992-1993, the ratio of spending was 5:1 in favor of the tobacco industry and subsequently it was 10:1. The higher ratio resulted from funding for the Tobacco Control Program and increased tobacco industry expenditures.

The first part of this executive summary presents a brief overview of the main evaluative outcomes relative to the California Tobacco Control Program: smoking behavior and exposure to secondhand tobacco smoke. Following this brief overview, trends in smoking behavior are discussed in more detail. Finally, other important findings, including those relating to secondhand smoke, are summarized under the five main tobacco control strategies identified by the Tobacco Education, Research, and Oversight Committee (TEROC).

Executive Summary:

During the 1990s in California, smoking behavior and attiudes about smoking have changed, as measured from the California Tobacco Surveys (CTS) and other data sources. Some of the most important findings from the CTS are highlighted below. For a more complete summary, see the Key Findings from each chapter of this report, which appear both in this Executive Summary and at the end of each chapter. Throughout this report, results are given with the margin of error (±95% confidence limits)

Adult Smoking Behavior

Over the decade, per capita cigarette consumption fell by a factor of 57% in California compared to only 27% in the rest of the United States. By the end of 1999, Californians consumed only 4.1 packs of cigarettes per person per month, compared to 9.1 in the rest of the United States.

While adult (18+ years) smoking prevalence decreased in the first few years of the decade, after 1994 changes in the prevalence were not statistically significant. The most recent CTS indicated that adult smoking prevalence was 18.3±0.3% in 1999.

Despite relatively stable smoking prevalence since 1993, fewer California smokers are heavy daily smokers, and between 1990 and 1999, the prevalence of daily smoking declined by a factor of 18.6%. These findings explain the decline in per capita cigarettes consumption. In 1999, only 13.0±0.3% of Californians were daily smokers. Only 6.4±0.4% of California college graduates were daily smokers.

Over the decade, the percent of California smokers making a quit attempt lasting a day or longer in the last year increased by a factor of 25.9% to 60.1±1.5% in 1999. Quitters in 1999 appeared to be as successful as those earlier in the decade.

In California, the cigar fad appears to be dissipating, mostly among adults who have never smoked cigarettes. In 1999, most current California cigar smokers only a few cigars a month 83.2Executive Summary:

Durig the 1990s in California, smoking behavior and attiudes about smoking have changed, as measured form the California Tobacco Surveys (CTS) and other data sources. Some of the most important findings from the CTS are highlighted below. For a more complete summary, see the Key Findings from each chapter of this report, which appear both in this Executive Summary and at the end of each chapter. Throughout this report, results are given with the margin of error (±95% confidence limits)

Adult Smoking Behavior

Over the decade, per capita cigarette consumption fell by a factor of 57% in California compared to only 27% in the rest of the United States. By the end of 1999, Californians consumed only 4.1 packs of cigarettes per person per month, compared to 9.1 in the rest of the United States.

While adult (18+ years) smoking prevalence decreased in the first few years of the decade, after 1994 changes in the prevalence were not statistically significant. The most recent CTS indicated that adult smoking prevalence was 18.3±0.3% in 1999.

Despite relatively stable smoking prevalence since 1993, fewer California smokers are heavy daily smokers, and between 1990 and 1999, the prevalence of daily smoking declined by a factor of 18.6%. These findings explain the decline in per capita cigarettes consumption. In 1999, only 13.0±0.3% of Californians were daily smokers. Only 6.4±0.4% of California college graduates were daily smokers.

Over the decade, the percent of California smokers making a quit attempt lasting a day or longer in the last year increased by a factor of 25.9% to 60.1±1.5% in 1999. Quitters in 1999 appeared to be as successful as those earlier in the decade.

In California, the cigar fad appears to be dissipating, mostly among adults who have never smoked cigarettes. In 1999, most current California cigar smokers only a few cigars a month (83.2±3.7% smoked <5/month). Cigar smokers who were former cigarette smokers showed the highest level of monthly cigar consumption.

Adolescent Smoking Behavior

Although California adolescents showed an alarming increase in smoking prevalence (any smoking in the past 30 days) between 1993 and 1996, by 1999 current smoking prevalence had fallen to 7.7±0.8%, significantly lower than prevalence in 1990.

Among young adolescents 12-13 years of age, the percentage of committed never smokers rose by a factor of 17.7% between 1996 and 1999 to 65.7±1.9%.

In 1999, 79.8±6.4 of current adolescent established smokers reported they had tried to quit sometime in the past.

Adolescent use of other tobacco products is highly related to cigarette smoking. In 1999, rates of adolescent ever experimentation with cigars (15.0±1.2%) and bidis (7.0±0.8) were much higher than for chewing tobacco or snuff (3.1±0.5%).

Protection of Nonsmokers form Secondhand Tobacco Smoke

In 1999, 93.4±0.8% of California indoor workers reported that smoking was not allowed in their workplace, up from 35.0±1.3% in 1990.

In 1999, the percentage of nonsmokers exposed to someone smoking in their work area in the past two weeks increased significantly from 11.8±1.5% in 1996 to 15.6±1.4% in 1999. Over the decade, however, exposure to secondhand smoke in the workplace decreased by a factor of 46.2%

In 1999, 73.3±1.1% of Californians lived in smokefree homes, up by a factor of 30% since 1993. Further, nearly half (47.2±1.8%) of current California smokers live in smokefree homes, a factor increase of 135% since 1993.

Accordingly, the percentage of California children and adolescents protected from secondhand smoke at home increased by a factor of 15.1% since 1993, to 88.6±1.1% in 1999.

Other Important Findings

While adult California smokers were more concerned about the price of cigarettes after the $0.50/pack excise tax increase in January 1999, about 70% buy their cigarettes at the most expensive outlets, only a few (5.47±0.8%) bothered to seek out untaxed sources, and 58.2±1.139% supported a further tax increase of $0.50 or more.

In 1999, less than half (48.0±1.5%) of California’s adolescent never smokers believed that it is easy to get cigarettes, down by a factor of 16% since 1996.

Perceived compliance with smokefree school policies increased by a factor of 64% from 1996 to 1999, when 66.6±1.5% of adolescents reported that most of the students who smoke obey the no-smoking rule on school property.

In 1999, 9.0±0.9% of adolescents had a tobacco promotional item, a factor decrease of 34.5% since 1996. However, 14.9±1.1% of adolescents said they would be willing to use a promotional item. Few adults (1.2±0.2%) reported ever giving such an item to a child or adolescent, but 7.6±0.6% said they were willing to do so.

Executive Summary and Key Findings EXECUTIVE SUMMARY During the 1990s in California, smoking behavior and attitudes about smoking have changed, as measured from the California Tobacco Surveys (CTS) and other data sources. Some of the most important findings from the CTS are highlighted below. For a more complete summary, see the Key Findings from each chapter of this report, which appear both in this Executive Summary and at the end of each chapter. Throughout this report, results are given with the margin of error (±95% confidence limits).

Adult Smoking Behavior • Over the decade, per capita cigarette consumption fell by a factor of 57% in California compared to only 27% in the rest of the United States. By the end of 1999, Californians consumed only 4.1 packs of cigarettes per person per month, compared to 9.1 in the rest of the United States. • While adult (18+ years) smoking prevalence decreased in the first few years of the decade, after 1994 changes in prevalence were not statistically significant. The most recent CTS indicated that adult smoking prevalence was 18.3±0.3% in 1999. • Despite relatively stable smoking prevalence since 1993, fewer California smokers are heavy daily smokers, and between 1990 and 1999, the prevalence of daily smoking declined by a factor of 18.6%. These findings explain the decline in per capita cigarette consumption. In 1999, only 13.0±0.3% of Californians were daily smokers. Only 6.4±0.4% of California college graduates were daily smokers. • Over the decade, the percent of California smokers making a quit attempt lasting a day or longer in the last year increased by a factor of 25.9% to 60.1±1.5% in 1999. Quitters in 1999 appeared to be as successful as those earlier in the decade. • In California, the cigar fad appears to be dissipating, mostly among adults who have never smoked cigarettes. In 1999, most current California cigar smokers smoke only a few cigars a month (83.2±3.7% smoked <5/month). Cigar smokers who were former cigarette smokers showed the highest level of monthly cigar consumption.

Adolescent Smoking Behavior • Although California adolescents showed an alarming increase in smoking prevalence (any smoking in the past 30 days) between 1993 and 1996, by 1999 current smoking prevalence had fallen to 7. 7±0.8%, significantly lower than prevalence in 1990. • Among young adolescents 12-13 years of age, the percentage of committed never smokers rose by a factor of 17.7% between 1996 and 1999 to 65.7±1.9%. • In 1999, 79.8±6.4 of current adolescent established smokers reported they had tried to quit sometime in the past. • Adolescent use of other tobacco products is highly related to cigarette smoking. In 1999, rates of adolescent ever experimentation with cigars (15.0±1.2%) and bidis (7.0±0.8) were much higher than for chewing tobacco or snuff (3.1±0.5%).

Protection of Nonsmokers from Secondhand Tobacco Smoke • In 1999, 93.4±0.8% of California indoor workers reported that smoking was not allowed in their workplace, up from 35.0±1.3% in 1990. • In 1999, the percentage of nonsmokers exposed to someone smoking in their work area in the past two weeks increased significantly from 11.8± 1.5% in 1996 to 15 .6± 1.4% in 1999. Over the decade, however, exposure to secondhand smoke in the workplace decreased by a factor of 46.2% • In 1999, 73.3±1.1 % of Californians lived in smokefree homes, up by a factor of 30% since 1993. Further, nearly half (47.2±1.8%) of current California smokers live in smokefree homes, a factor increase of 135% since 1993. • Accordingly, the percentage of California children and adolescents protected from secondhand smoke at home increased by a factor of 15.1 % since 1993, to 88.6±1.1% in 1999.

Other Important Findings • While adult California smokers were more concerned about the price of cigarettes after the $0.50/pack excise tax increase in January 1999, about 70% buy their cigarettes at the most expensive outlets, only a few (5.4 ±0.8%) bothered to seek out untaxed sources, and 58.2±1.1.39% supported a further tax increase of $0.50 or more. • In 1999, less than half (48.0±1.5%) of California's adolescent never smokers believed that it is easy to get cigarettes, down by a factor of 16% since 1996. • Perceived compliance with smokefree school policies increased by a factor of 64% from 1996 to 1999, when 66.6±1.5% of adolescents reported that most of the students who smoke obey the no-smoking rule on school property. • In 1999, 9.0±0.9% of adolescents had a tobacco promotional item, a factor decrease of 34.5% since 1996. However, 14.9±1.1% of adolescents said they would be willing to use a promotional item. Few adults (1.2±0.2%) reported ever giving such an item to a child or adolescent, but 7.6±0.6% said they were willing to do so.

Summary

This report presents data on a partial sample of a survey of cigarette smoking behaviors and attitudes among Californians conducted during the summer of 1990. The prevalence of current smoking among adults in California is 21.2%, with males (23.8%) smoking more than females(18.8%). This represents a sharp decline in smoking following the increase in the tobacco excise tax and implementation of a comprehensive tobacco control program by the State of California,and is on track for reaching the goal of a 75% reduction in smoking prevalence by the year 1999.

Black Californians are more likely to be cigarette smokers than other racial or ethnic groups, and Hispanic and AsianlPacific Islander women are less likely to be cigarette smokers. Smoking prevalence is also lower among those who have completed more years of formal education and among those who are over the age of 65 years.

Current smoking prevalence among adolescents aged 12-17 years is 10.4%; little difference in prevalence rates is found between boys and girls.

The prevalence of smoking prior to pregnancy among women who have been pregnant in the last 5 years was 15.7%, and 36% quit before the pregnancy reached term.

Among the counties and regions, there are only modest differences in the observed prevalence of smoking, but there is a somewhat greater observed difference in the fraction of those smokers who have quit in the last 5 years.

Approximately one-half of California's smokers made an attempt to quit in the 12 months before the survey, in contrast to one-third of smokers nationally. The rate of quit attempts was highest among black smokers of both sexes and among Hispanic males. However, California smokers were unable to translate their high rate of cessation attempts into successful cessation. Only 11.7% of those who were smokers one year ago are currently nonsmokers. This high rate of failed cessation attempts is most evident for black males where 72% of those who were smoking one year ago attempted to quit but only 3.6% are currently nonsmokers.

The hazard of smoking is widely acknowledgeq; 84% of California smokers agree that smoking harms their own health. This acknowledgement is, if anything, somewhat stronger among black and Hispanic smokers, suggesting that informational campaigns have been successful but have not translated into successful cessation, particularly for black male smokers.

There is widespread support for taxation of tobacco products: 49.5% of Californian adults support a further increase in the current tax and only 15.9% want to reduce the tax. The support for increasing the tax is -lower among smokers, but black and Hispanic smokers are substantially more supportive of increasing the tax than are California smokers as a whole. Black and Hispanic smokers are also more slrongly supportive of efforts to ban the advertising and promotion of tobacco products as well as to restrict the access of children to tobacco products. This picture is consistent with a substantial level of concern in the black and Hispanic communities about the targeting of their communities by tobacco advertisers.

Executive Summary This report reviews evidence of progress in achieving the goals set for the California Tobacco Control Program that was funded by the voter sponsored Tobacco Tax Initiative (Proposition 99 of 1988). In addition, this report provides information about influences on adolescent smoking behavior; these data have become available as part of the evaluation of this Program. Three overall conclusions are presented on the impact of the Tobacco Control Program though 1992 and the major barriers to the Program’s success with adolescents. These conclusions are followed by summary of the findings for each topic considered in this report. Detailed analyses of the findings are included in the chapters indicated.

Summary

This report presents data from a survey of cigarette smoking behaviors and attitudes among Californians conducted between June, 1990 and July, 1991. The prevalence of current smoking among adults in California was 22.2%, with males (25.5%) smoking more than females (19.1%). This represents a sharp decline in smoking following the increase in the tobacco excise tax and implementation of a comprehensive tobacco control program by the State of California. The decline in prevalence is on track for reaching the goal of a 75% reduction in smoking prevalence by the year 1999.

Black Californians were more likely to be cigarette smokers than other racial or ethnic groups, and Hispanic and Asian/Pacific Islander women were less likely to be cigarette smokers. Smoking prevalence was also lower among those who have completed more years of formal education and among those who were over the age of 65 years.

Current smoking prevalence among adolescents aged 12-17 years was 9.3%; little difference in prevalence rates was found between boys and girls.

The prevalence of smoking prior to pregnancy among women who had been pregnant in the last 5 years was 16.1%, and 32.8% of those who did smoke quit before the pregnancy reached term.

Approximately one-half of California smokers made an attempt to quit in the 12 months before the survey. The rate of quit attempts was higher among Black smokers of both sexes and among Hispanic males. However, California smokers were unable to translate their high rate of cessation attempts into successful cessation. Only 11.3% of those who were smokers one year ago were nonsmokers at the time of the survey. This high rate of failed cessation attempts is most evident for Black males where 60.2% of those who were smoking one year ago attempted to quit, but only 4% were current nonsmokers.

The status and effectiveness of several of the components of the tobacco control campaign were assessed. Among adolescents, 72.6% reported receiving at least one class in school directed at tobacco education.

Among nonsmoking Californians who work indoors, 31.3% reported recent exposure to environmental tobacco smoke at work, but this exposure was substantially lower among the 38.7% of indoor workers who work where there was at least a ban on smoking in the immediate work area. Exposure was further reduced for those workers who work in jurisdictions that have strong ordinances to limit smoking in the workplace. Those who worked in worksites that ban smoking in the work area are less likely to be cigarette smokers, and male smokers who worked where there was a ban on smoking in the work area were more likely to be successful when they attempted to quit. Social pressure not to smoke, as manifested by the reluctance of smokers to smoke when they were the only smoker, was associated with an increased frequency of quit attempts by smokers, particularly female smokers.

Tobacco advertising, particularly the Camel cigarette advertising campaign using cartoon characters, was differentially recognized by younger adolescents. The recognition of cigarette brand advertising was closely related to the brand of cigarettes purchased by adolescent smokers, suggesting that tobacco advertising may promote smoking initiation among adolescents.

Over 60% of adults and two-thirds of adolescents reported exposure to some anti-smoking media message in the 7 days prior to their survey interview. Those who reported exposure to the television spots funded by the tobacco tax revenues were more likely to support anti-tobacco education in schools.

Adolescents reported that tobacco products were readily available, even among those aged 12-14. Small stores were the most common site of purchase of cigarettes for adolescents of all ages, but there was a suggestion that purchases from vending machines were relatively more common among younger adolescents than among older adolescents.

Only 40.4% of those smokers who saw a physician in the last year were advised to quit on the last visit. Advice to quit on the last visit appeared to be associated with both an increased interest in quitting and an increased number of quit attempts.

There was widespread support for taxation to tobacco products. The support for increasing the tax was lower among smokers, but Hispanic smokers were more supportive of increasing the tax than were California smokers as a whole. Black and Hispanic smokers were more strongly supportive of efforts to ban advertising and promotion of tobacco products as well as to restrict access of children to tobacco products. This picture is consistent with a substantial level of concern in the Black and Hispanic communities about the targeting of their communities by the tobacco advertisers.