Successes and challenges in tobacco control in California: Strategies from a quarter century

Although California has had many successes since the implementation of The Tobacco Tax and Health Protection Act of 1988 (Proposition 99), there are still many challenges ahead. Since 1988, adult smoking consumption has dropped dramatically from 23.7% to 12.0% (2011), an almost 50% decrease. However, emerging adults between the ages of 18-24 have the highest smoking prevalence among any age group. Illegal sales to minors, has increased for the first time in three years. Smoking prevalence is higher in schools in neighborhoods with five or more tobacco retail outlets than those with no tobacco retailers. There are currently 36,700 licensed tobacco retail stores in California, one for every 254 kids. Tobacco companies continue to spend more than half a billion dollars each year advertising their products in California's retail environment. In less than a decade, sales of smokeless products, including snus, cigarillos, dissolvable and flavored orbs and sticks, have nearly tripled from $77 million in 2001 to $211 million in 2011. Flavored tobacco is marketed heavily towards youth and emerging adults, as is hookah, and e-cigarettes (E-NDDs- electronic-nicotine delivery devices). The Tobacco Education and Research Oversight Committee (TEROC), California's legislatively mandated advisory committee, has developed its 2012-2014 Master Plan to meet these new challenges. As California celebrates its quarter century in tobacco control, this presentation covers lessons learned, provides the most recent data on these new challenges, and discusses strategies to improve health outcomes and reduce health care costs locally in California and globally.