A public policy review of tobacco control in Puerto Rico

Background: In Puerto Rico, smoking accounts for an estimated 4,300 premature deaths yearly and $1.1 billion in annual health care expenditures and productivity losses. This work reviews Puerto Rico's tobacco control initiatives.

Methods: State policy measures that have proven effective in tobacco control such as excise taxes, smoke-free laws, the level of government expenditures for tobacco control, the implementation of cessation resources such as a Quitline, and media campaigns were examined. Also, trends in tobacco use among both adults (using BRFSS) and youth (using Consulta Juvenil survey) were examined.

Results: The percentage of adults who currently smoke cigarettes in Puerto Rico dropped from 14.5% in 1996 to 13.1% in 2005; while the percentage of adolescents who smoked in the past month decreased from 24.7% in 1994-1996 to 15.6% in 2000-2002. Per capita consumption of cigarettes (packs/year) decreased from 56 in 1966 to 31 in 2003, its lowest level ever. With respect to tobacco control initiatives, Puerto Rico ranks 17th among states and territories with respect to the largest cigarette excise taxes ($1.23), and only five states and territories, including Puerto Rico (beginning in March 2, 2007), have laws that prohibit smoking within restaurants, bars, and workplaces. Puerto Rico spends less than 7% of the CDC's recommended level of expenditures on tobacco control.

Conclusion: Despite the lack of a comprehensive tobacco control program, Puerto Rico has one of the lowest smoking rates in the United States, which is likely attributable to the combined impact of local policy measures and socio-cultural factors.