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Open Access Publications from the University of California

The Center for Tobacco Control Research and Education provides a focal point for work designed to reduce the 5 million deaths a year tobacco and the tobacco industry cause each year. The work of the Center spans policy and historical research, economics, and science. The work is designed to inform and improve the effectiveness of public health interventions to reduce tobacco use. It works closely with the UCSF Library's efforts to collect and preserve previously secret tobacco industry documents, such as those available at the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu).

The Director is:
Stanton A. Glantz, PhD
Professor of Medicine
Suite 366 Library
530 Parnassus
University of California
San Francisco, CA 94143-1390
phone: (415) 476-3893
fax: (415) 514-9345
email: glantz@medicine.ucsf.edu

Books

Cover page of Economic and Health Effects of a State Cigarette Excise Tax Increase in California

Economic and Health Effects of a State Cigarette Excise Tax Increase in California

(2012)

The Coalition for a Healthy California is sponsoring a comprehensive statewide ballot initiative to raise the tobacco excise tax by $2.60 per pack of cigarettes in order to provide funding to qualified hospitals for emergency services, nursing education and health insurance to eligible children. This paper uses the best possible science to estimate the effect of a new tax on cigarette consumption, adult and youth smoking rates, tax revenues, and long term health outcomes. The additional tax would raise the average price of cigarettes to $6.55 per pack.

Cover page of Going Smoke-free in the Land of Lakes: Law and Politics in Minnesota Smoke-free Campaigns

Going Smoke-free in the Land of Lakes: Law and Politics in Minnesota Smoke-free Campaigns

(2010)

Between 2000 and 2006, many Minnesota communities were engaged in protracted campaigns to pass ordinances that regulated smoking. Challenges were compounded in communities where multiple cities and counties shared regulatory power within what was, for economic purposes, a single population center. In 2005, ClearWay MinnesotaSM awarded the Public Health Law Center a two-year research grant to study the legal and political obstacles that seven multi-jurisdictional Minnesota regions faced in smoke-free campaigns over this six-year period. The purpose of our study was to examine the approaches regulatory authorities took in these campaigns; to analyze the significance of legal and political obstacles in obstructing or supporting progress toward smoke-free regulation; and to develop recommendations to help public health advocates, health organizations, policymakers, and legal professionals anticipate, avoid, and address these obstacles.

Cover page of The Economic Impact of Secondhand Smoke in Maryland

The Economic Impact of Secondhand Smoke in Maryland

(2008)

This study calculates the economic costs of exposure to secondhand tobacco smoke (SHS) in Maryland – for individuals, employers, and society as a whole. The total costs reported in this study for calendar year 2005 are as follows:

Costs related to childhood illness and death – $73.8 million.

Costs related to adult illness and premature death – $523.8 million.

This study should be considered as an estimate of the lower limit of the true economic costs due to secondhand smoke in Maryland, for the following reasons:

This study documents the costs of specific medical conditions that have been conclusively shown to be causally related to exposure to secondhand smoke. For children, these conditions include Respiratory Syncytial Virus (RSV) bronchiolitis, otitis media, asthma, and burns. For adults, the conditions are lung cancer, nasal sinus cancer, cervical cancer, heart attacks, arteriosclerosis, stroke, and asthma. There are additional potential health problems related to SHS that are not included in this study.

Several categories of costs for medical care are not included – these include outpatient and pharmacy costs, as well as indirect costs related to the opportunity cost of time lost due to illness and medical care. The psychological costs of the negative effects of SHS – pain and suffering – are not included.

Although the costs reported in this study underestimate the true economic costs of secondhand smoke in Maryland, they provide a compelling argument to curtail exposure to secondhand smoke – by limiting smoking in public areas.

Cover page of American Legacy Foundation, First Look Report 18. Character Smoking in Top Box Office Movies

American Legacy Foundation, First Look Report 18. Character Smoking in Top Box Office Movies

(2007)

A strong body of evidence now links exposure to smoking in movies with adolescent smoking, identifying it as a key risk factor. Given this link, it is important to examine the way movies portray smoking and to monitor how often smoking occurs in movies over time. With support from the National Cancer Institute and the American Legacy Foundation, researchers at Dartmouth Medical School have conducted an extensive content analysis of 1000 movies, the top 100 box office hits each year from 1996-2005. This Legacy First Look Report examines how smokers are portrayed in these movies and describes trends in movie smoking, by movie and by movie character.

Findings

Our data about movie character smoking show: The portrayal of smokers is often unrealistic, with affluent male characters accounting for a much larger proportion of the tobacco users in movies than in the U.S.;

Smokers in movies are rarely portrayed as having a motive for smoking, and smoking status tends not to differentiate types of characters;

Tobacco use in movies is not related to box office success.

Our data on movie trends in the top 100 box office hits from 1996-2005 show:

Although the percent of movies with tobacco imagery has declined, the majority of movies continued to depict tobacco use or imagery, with 56% of youth rated movies in 2005 containing smoking. Smoking delivered by youth rated movies as an aggregate increased by 12%, from 238 episodes in 2004 to 267 in 2005.

Cover page of Taking On Goliath - Civil Society's Leadership Role in Tobacco Control

Taking On Goliath - Civil Society's Leadership Role in Tobacco Control

(2007)

The global tobacco control movement is more than three decades old, but its impact is inconsistent. For every city or nation that takes strong action to reduce tobacco use, there is another where little if anything has been done to help people stop smoking or to establish tobacco control policies opposed by powerful tobacco industries. Tobacco continues to kill and cause debilitating illnesses, severely retarding progress in improving local, national, and global health and economic conditions.

Recent data indicate that smoking is the leading cause of deaths from cardiovascular diseases (1.69 million deaths annually), cancer (1.4 million deaths), and chronic obstructive pulmonary diseases (970,000 deaths). About 1.25 billion people smoke cigarettes, representing more than one-sixth of the Earth’s population. According to reports from the World Cancer Congress and the 13th World Conference on Tobacco OR Health, held in Washington, D.C., in July 2006, if current trends hold, tobacco will kill a billion people in the 21st century, 10 times the toll it took in the 20th century.

These sobering statistics are counterbalanced by some good news. In numerous countries, public health officials, civil society organizations, and various other advocacy groups have joined forces to initiate policies and programs designed to reduce tobacco use. Most comprehensive efforts have included a mixture of awareness raising; restrictions on the sale, promotion, and place of use of tobacco products; and taxes and laws that affect the price and availability of these products. A major milestone was achieved when the landmark Framework Convention on Tobacco Control (FCTC), a global treaty initiated by the World Health Organization (WHO), entered into force on February 27, 2005. As of the end of March 2007, a total of 168 countries had signed the treaty, and 146 of those had ratified it. Parties to the FCTC are expected to create national action plans to meet the treaty’s minimum requirements in areas such as tobacco advertising, access to smoking cessation programs, the size of warnings on cigarette packs, and the creation and enforcement of smoke-free public spaces.

Wealthier countries have more potential resources at their disposal to implement tobacco control policies, yet there are plenty of examples—some of which are examined in this report’s case studies—of innovative and increasingly successful tobacco control efforts in resource-limited places.

Central and Eastern Europe and Central Asia, however, remain in dire need of more extensive tobacco control. According to the World Health Organization, tobacco related diseases kill more than 700,000 people a year in the region and nearly 40 percent of middle-aged men die prematurely as a result of tobacco use.

In some Eastern European countries, lung cancer mortality rates in men are the highest ever recorded anywhere in the world. The WHO has concluded that tobacco use is the major preventable cause of poor health in the region—and that comprehensive tobacco control is the best investment in health reform.

Policymakers have been listening. By 2006, all Central and Eastern European countries and a majority of those in the former Soviet Union had enacted some tobacco control legislative and policy measures. However, many legislative regulations and national tobacco control programs, especially in the less developed countries farther east, are not effectively enforced and still have serious loopholes that prevent them from meeting WHO standards.

One common thread has been the leadership of civil society groups in devising, implementing, and demanding the enforcement of tobacco control policies and regulations. Local nongovernmental organizations often have been among the first entities of any kind to advocate for tobacco control in their countries, including accession to the FCTC. Many of these civil society groups have received support from the Open Society Institute (OSI), which first provided grants for tobacco control in 2002.

Among OSI’s most successful grantees is Poland’s Health Promotion Foundation (HPF), which since 1991 has played a leading role in lowering the burden of smoking-related diseases through tobacco control in its home country. Recently, HPF began planning the development of a regional center for tobacco control to enable the sharing of information and expertise on tobacco control throughout the region. Based in Warsaw, the Regional Tobacco Control Network and Center (RTCNC) is expected to be fully operational by the end of 2007.

The case studies in this report document the advocacy efforts of NGOs in four countries expected to participate significantly in such regional engagement. The nations—Kazakhstan, Moldova, Romania, and Ukraine—are at different stages in tobacco control. The activities of these civil society groups represent a range of strategies reflecting the opportunities, obstacles, and expectations unique to their own nations and circumstances.

Taken together, though, the case studies offer important lessons for future tobacco control efforts anywhere in the world. No matter where they live, committed activists generally are able to utilize even a small amount of funding to initiate a process of change; the success of their efforts is multiplied many times over with each increase in resources and capacity. Local leadership of this sort is essential to reversing the current trends in tobacco use, illness, and death that place millions of people at risk.

Among the notable lessons are the following:

Civil society is crucial to successful tobacco control efforts. The Polish experience in the early 1990s is instructive. After restrictions were lifted on civil society, groups pushed for greater openness about all political, economic, and social issues—including health. Tobacco control efforts gained momentum and policy reforms soon followed, including tobacco control legislation and improved public- and private-sector services designed to raise awareness and promote healthy lifestyles. Experience elsewhere reinforces the strong correlation between comprehensive tobacco control and engaged, fully independent civil societies.

Effective tobacco control efforts require comprehensive, multipronged approaches and strategies. Given the power and influence of the tobacco industry in most countries, tobacco control advocates must continually seek to broaden the ways in which they raise awareness of tobacco’s negative medical, social, and financial consequences. Important strategies include extensive media campaigns; expanding coalitions within civil society and with government partners; directly challenging policymakers to publicly justify their opposition to tobacco control or reluctance to make it a priority; and collecting and disseminating solid health data, such as the number of deaths and hospitalizations due to tobacco-related illnesses.

Economic research is an important, yet often neglected, component of effective advocacy. Policymakers and the general public are often unaware of the massive financial costs to society of tobacco use. Tobacco-related sickness and premature death reduce economic productivity in ways that can be quantified through rigorous data collection. Disabling tobacco-related conditions also force a redirection of individual and public resources from investment and savings—needed to help grow economies and raise living standards—to health care. Tax policies can be used to raise revenues for health promotion activities that lead to a reduction in tobacco-related health care costs. For example, several European countries and U.S. states have raised cigarette taxes and earmarked a portion of the higher revenues specifically for tobacco control activities, such as education and media campaigns. Enshrining health promotion earmarks in laws or government policies improves the likelihood of withstanding tobacco industry pressure to counter comprehensive tobacco control efforts.

Media can be a powerful tool for and ally of tobacco control advocates. Tobacco control advocates in Kazakhstan invited members of the media on several tours of Almaty, pointing out violations of the national antitobacco law. The resulting newspaper articles and television coverage helped prompt local officials to introduce the “Smoke-free Almaty” initiative. Such effective use of media is relatively rare in the region. Civil society groups need to train in media advocacy and to share successful strategies and experiences more consistently.

Tobacco control regulations and affordable “quit smoking” services are equally important in reducing tobacco use. Restrictions are far more effective in reducing tobacco use when accompanied by health promotion campaigns and accessible, affordable services to help people quit smoking. Incentives for changing behavior must be based on recognition of the medical and psychological elements of tobacco addiction. On their own, punitive measures rarely make an impact on complex behaviors that require extensive treatment and support.

Expanded regional learning and cooperation offer clear benefits to local tobacco control efforts. Strategies used successfully in one country or context can have similarly positive impacts elsewhere. Expertise should be tapped more effectively through greater sharing of information and resources across the region, down to the grassroots level. Regional cooperation will also help sustain and expand civil society advocacy that has already shown great promise for improving health. The creation of the Regional Tobacco Control Network and Center should help facilitate such efforts.

Cover page of Economic and Health Effects of a State Cigarette Excise Tax Increase in California

Economic and Health Effects of a State Cigarette Excise Tax Increase in California

(2006)

The Coalition for a Healthy California is sponsoring a comprehensive statewide ballot initiative to raise the tobacco excise tax by $2.60 per pack of cigarettes in order to provide funding to qualified hospitals for emergency services, nursing education, and health insurance to eligible children. This paper uses the best possible science to estimate the effect of a new tax on cigarette comsuption, adult and youth smoking rates, tax revenues, and long term health outcomes. The additional tax would raise the average price of cigarettes to $6.55 per pack.

Cover page of Cigarette Purchasing Patterns among New York Smokers: Implications for Health, Price, and Revenue

Cigarette Purchasing Patterns among New York Smokers: Implications for Health, Price, and Revenue

(2006)

Executive Summary

Raising the price of cigarettes is one of the most effective interventions to prevent and reduce cigarette use. Local, state, and federal governments can change the price of cigarettes by raising or lowering cigarette excise taxes and by implementing and enforcing minimum price laws. Smokers can also adjust their behavior by choosing discount or “bargain” brands, buying fewer cigarettes, and avoiding paying cigarette taxes by purchasing from retailers that do not levy all applicable state and local taxes, such as Indian reservations and Internet cigarette vendors.

Purchasing low price or untaxed cigarettes is common among smokers in New York. The most common source of cigarette tax avoidance in New York is purchasing from Indian reservations, especially in the western areas of the state. This behavior undermines the state’s efforts to prevent and reduce tobacco use. Cigarette tax avoidance not only reduces smokers’ incentives to quit smoking or reduce the amount they smoke, but it also results in a significant loss of state tax revenue that could be devoted to public health interventions aimed at reducing smoking. Lost revenue due to unpaid cigarette taxes also deprives the state of resources to address other public health issues.

This report examines smokers’ cigarette purchasing patterns with a focus on quantifying the extent of tax evasion in New York and identifying the characteristics of smokers who most frequently seek out and purchase low price and untaxed cigarettes. This report also examines the overall health and financial impacts of cigarette tax avoidance in New York by calculating the reduction in cessation and quantifying the amount of tax revenue lost due to tax avoidance via specific low price and untaxed sources. Specific findings include the following:

· Thirty-seven percent of New York smokers report purchasing cigarettes from low price (mainly untaxed) sources “all the time” or “sometimes.”

· Purchase of lower price cigarettes is associated with reduced intentions to quit smoking and fewer attempts to quit smoking.

· If all smokers paid the average retail price for cigarettes (including the excise tax), the current prevalence of smoking would be 2 to 3 percent lower, representing between 51,026 and 76,539 fewer adult smokers in New York.

· Revenue lost to the state as a result of purchasing low price (mainly untaxed) cigarettes is estimated to be between $436 million and $576 million in 2004.

Cover page of Center for Tobacco Policy Research at Saint Louis University. Project LEAP. North Carolina

Center for Tobacco Policy Research at Saint Louis University. Project LEAP. North Carolina

(2006)

In 2004, The Center for Tobacco Policy Research (CTPR) partnered with North Carolina and several other states to evaluate how unstable state financial climates were affecting state tobacco control funding reductions. Using both quantitative methodologies, information was collected from the eight state tobacco control programs on topics such as state financial and political climates, partner relationships, program capacity, and the effects of funding reductions on program implementation. This report provides an overview of project LEAP and summary highlights from the series of four reports presenting North Carolina evaluation results.

Cover page of American Legacy Foundation, Getting to the Truth: Assessing Youths' Reactions to the truth and "think. Don't Smoke" Tobacco Countermarketing Campaigns

American Legacy Foundation, Getting to the Truth: Assessing Youths' Reactions to the truth and "think. Don't Smoke" Tobacco Countermarketing Campaigns

(2006)

In February 2000, the American Legacy Foundation launched a national media campaign know as truth to counter the influence of tobacco marketing and imagery targeting youths. The primary target audience for the truth campaign is 12 to 17 year old youths who are susceptible or open to smoking. The purpose of this report is to summarize awareness of tobacco countermarketing and reactions to truth and TDS campaign messages. In addition, we examine how awareness of and and reaction to these messages varies by gender, race/ethnicity, and stage of smoking (e.g., nonsmoker, smoker) This report focuses on several key questions: 1)What health and safety messages have youths seen or hear on TV, radio, billboards, or in magazines in the past months? 2)Where are youths seeing and/or hearing tobacco countermarketing messages? 3)How has overall awareness of countermarketing campaigns changed since the launch of the truth campaign? 4)What specific tobacco countermarketing television ads have youths recently seen? 5)How did youth s react to truth and TDS ads they saw on TV? 6)How did youths respond to different styles of countermarketing television ads?

Cover page of Center for Tobacco Policy Research at Saint Louis University. Project LEAP. Florida

Center for Tobacco Policy Research at Saint Louis University. Project LEAP. Florida

(2005)

In 2004, The Center for Tobacco Policy Research (CTPR) partnered with Florida and sever other states to evaluate how unstable state financial climates were affecting state tobacco control conrol funding reductions. Using both quantitative methodologies, information was collected from the eight state tobacco control programs on topics such as state financial and political climates, partner relationships, program capacity, and the effects of funding reductions on program implementation. This report provides an overview of project LEAP and summary highlights from the series of four reports presenting Florida evaluation results.