Study suggests US stop smoking effort paying off

States that took part in an 8-year demonstration project on smoking cessation have achieved a reduction in the prevalence of adult smoking, according to an assessment of the project in the November 19 issue of the Journal of the National Cancer Institute.

The American Stop Smoking Intervention Study (ASSIST), initiated in 1991 by the National Cancer Institute, provided funding to 17 states to promote smoke-free environments, counter tobacco advertising and promotion, limit tobacco access and availability, and increase tobacco prices through new excise taxes.

To evaluate the impact of ASSIST on the states' smoking behavior, Frances A. Stillman, Ed.D., of the Johns Hopkins Bloomberg School of Public Health, and her colleagues compared changes in adult smoking prevalence, per capita cigarette consumption, and tobacco control policies between the 17 ASSIST states and the 33 non-ASSIST states and the District of Columbia.

During the intervention period, ASSIST states achieved a greater reduction in adult smoking prevalence than non-ASSIST states. The authors note that ASSIST states also had lower per capita cigarette consumption that non-ASSIST states, although the difference was not statistically significant. States with larger increases in IOI score (a summary measure of tobacco control policy outcomes) during the intervention period had larger decreases in per capita cigarette consumption, suggesting that changes in tobacco control policy could influence tobacco consumption. The authors estimate that if all 50 states and the District of Columbia had implemented ASSIST, there would be approximately 278,700 fewer smokers nationwide.

The authors caution that study was not powered to detect small but important changes in per capita consumption rates. In addition, states may have differed in the ability to carry out the intervention strategies. Other factors that may have reduced the ability to detect some of the effects of ASSIST include the use of similar antitobacco interventions in non-ASSIST states and counterefforts by the tobacco industry.

Nevertheless, "the small but statistically significant differences in the reduction of adult smoking prevalence in ASSIST states, when applied on a population basis, could be expected to have a large impact on the public," the authors write. "More investment (i.e., both time and money) is needed to improve state-level capacity to implement comprehensive tobacco control programs."

Contact: Tim Parsons, Johns Hopkins University Bloomberg School of Public Health, 410-955-7619; fax: 410-955-4775, tmparson@jhsph.edu.

Stillman FA, Hartman AM, Graubard BI, Gilpin EA, Murray DM, Gibson JT. Evaluation of the American Stop Smoking Intervention Study (ASSIST): A report of outcomes. J Natl Cancer Inst 2003;95:1681–91.

Note: The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage.

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