Quarter that changed the world

In 1988, California voters approved a 25 cent tax on cigarettes that earmarked 5 cents for tobacco use prevention and cessation and in 1989 legislation established the California Tobacco Control Program (CTCP). The CTCP is one of the most successful public health programs of its era. As a result of an integrated policy and media intervention in California, adult smoking prevalence dropped 35% since 1988; smoking rates among high schools students remain lower than the national level; tobacco consumption declined by more than 60%; and lung and bronchial cancer incidence has declined 3.5 times faster in California than the rest of the nation. Smoking prevalence declined by approximately one-quarter for each of the race/ethnicity groups of males and even larger declines occurred among women. While smoking prevalence disparities remain across race/ethnicity groups, a remarkably uniform effect on smoking prevalence has occurred suggesting that CTCP is both reaching and effecting disadvantaged populations.

Implementation of evidence-based interventions and funding have contributed to these accomplishments, but the sustainability of the Program in light of funding redirection, tobacco industry lawsuits, and the controversial media campaign suggest that the enabling legislation; strong external relationships; and organizational, ideological, and cultural practice are at the root of the Program's remarkable accomplishments and longevity. This session affords an opportunity to gain insight from one of the longest running comprehensive tobacco control programs in the U.S.which will help public health leaders build sustainable effective programs in tobacco control and other fields in the future.