Frances Stillman

By Tim Parsons
School of Public Health

Investment in statewide tobacco control programs can reduce smoking rates, according to an evaluation of the American Stop Smoking Intervention Study. The ASSIST study, which was established by the National Cancer Institute in partnership with the American Cancer Society, intended to reduce smoking by funding the development of state tobacco control programs to promote smoke-free environments, increase taxes and limit youths' access to tobacco products. The evaluation found that ASSIST states had a greater decrease in the prevalence or number of people smoking compared to non-ASSIST states.

The study is published in the Nov. 19 edition of the Journal of the National Cancer Institute and is the most comprehensive evaluation ever conducted on a large, multistate tobacco control study.

"Our research emphasizes the importance of strong tobacco control programs and effective policies," said Frances A. Stillman, director of the ASSIST evaluation and an associate research professor with the Department of Epidemiology and Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health. "States can reduce smoking prevalence and the enormous health and economic burden of smoking if they put in place proven programs and policies."

ASSIST provided $128 million to fund smoking reduction initiatives in 17 states over an eight-year period. The states that received funding were Colorado, Indiana, Maine, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, New Mexico, New York, North Carolina, Rhode Island, South Carolina, Virginia, West Virginia, Washington and Wisconsin. The money was administered in two phases, between 1991 and 1993, and from 1993 to 1999.

For the evaluation, Stillman and her colleagues compared changes in tobacco control policies and the effect on per capita cigarette consumption and smoking prevalence among adults in ASSIST states, non-ASSIST states and Washington, D.C. They developed the Initial Outcomes Index to access the intensity of a state's tobacco control policies and the Strength of Tobacco Control Index to measure the capacity and infrastructure developed to carry out tobacco control efforts in all states.

According to the researchers, ASSIST states had a small but significant decrease in smoking prevalence, which would translate to about 280,000 fewer smokers nationwide if all 50 states and the District of Columbia had implemented ASSIST. Overall, states that made greater improvement in their tobacco control policies had greater decreases in cigarette consumption. States that developed greater capacity and infrastructure to deliver tobacco control programs also had greater decreases in cigarette consumption.

"The National Cancer Institute spent $128 million for the ASSIST project, which was the largest federally funded tobacco control initiative at the time. Finding a positive effect from ASSIST is significant considering that the tobacco industry actively opposed ASSIST and its policy interventions as well as spending $47 billion in product advertising over the study period," Stillman said. In addition, non-ASSIST states received funding for tobacco control initiatives beginning in 1994, which made it more difficult to measure the impact of ASSIST. "Even given these factors, the results add to the body of research documenting that strong policy-focused interventions can have a significant effect on smoking behavior."

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