Update on performance in tobacco control: A longitudinal analysis of the impact of tobacco control policy and the US adult smoking rate, 2011-2013

Context: Tobacco use remains the leading cause of preventable death in the United States. States and municipalities have instituted a variety of tobacco control measures (TCMs) to address the significant impact tobacco use has on population health. The American Lung Association annually grades state performance of tobacco control using the State of Tobacco Control grading framework. Objective: To gain an updated understanding of how recent efforts in tobacco control have impacted tobacco use across the United States, using yearly State of Tobacco Control TCM assessments. Design: The independent TCM variables of smoke-free air score, cessation score, excise tax, and percentage of recommended funding were selected from the American Lung Association State of Tobacco Control reports. Predictors of adult smoking rates were determined by a mixed-effects model. Setting/Participants: The 50 US states and District of Columbia. Main Outcome Measure: Adult smoking rate in each state from 2011 to 2013. Results: The average adult smoking rate decreased significantly from 2011 to 2013 (21.3%[SD: 3.5] to 19.3%[SD: 3.5], P=.016). All forms of TCMs varied widely in implementation levels across states. Excise taxes (β=-.812, P=.006) and smoke-free air regulations (β=-.057, P=.008) were significant, negative predictors of adult smoking. Cessation services (β=.015, P=.46) did not have a measurable effect on adult smoking. Conclusion: Tobacco control measures with the strongest influence on adult smoking include the state excise tax and state smoke-free air regulations. The lack of robust funding for tobacco cessation services across the majority of US states highlights an important shortfall in current tobacco control policy.