The passage of the California Tobacco Health Protection Act of 1988, or Proposition 99, spurred the state of California to take action to protect residents from the harmful effects of tobacco. Proposition 99 increased taxes on tobacco products, and the revenues generated by the tax were used to fund programs to reduce smoking, provide health care services, and support tobacco-related research.1 These efforts were led by the California Tobacco Control Program (CTCP) of the California Department of Public Health.
CTCP’s approach to tobacco control focuses on social norms, with the goal of changing attitudes toward the use of tobacco by creating a social environment where tobacco is less desirable, less acceptable, and less accessible.2 Key components of CTCP’s programmatic efforts include implementing a media campaign as well as engaging with local communities to effect local level tobacco control policies. CTCP’s media strategy is multifaceted. Some messages are designed to target tobacco users and encourage them to quit; others are designed to discredit the tobacco industry, and are incorporated into ads that seek to undermine the industry’s influence and increase public support for protections from secondhand smoke.
Community engagement has been critical to CTCP’s success in implementing tobacco control policies throughout the state. CTCP explicitly requires local health departments to organize efforts within their communities and involve diverse individuals who possess expertise and knowledge of the community. These efforts have resulted in the implementation of hundreds of tobacco control policies in California, many of which reduce secondhand smoke exposure and create tobacco-free environments in communities. For example, the Tobacco Free Coalition of Kern County worked with the Tehachapi Police Chief to mobilize support for a ban on smoking and alcohol use in Tehachapi City Parks. In San Francisco, efforts resulted in the passage of a smoke-free disclosure ordinance requiring that renters be informed about smoking policies within multi-unit housing facilities.
Since the passage of Proposition 99 and the implementation of CTCP, tobacco use in California has decreased significantly. The prevalence of smoking has decreased among adults (46%) and high school students (50%), and overall cigarette consumption in California has decreased by 72%. In addition, between 1989 and 2008, CTCP programs have averted $134 billion in health care costs. CTCP is continuing their efforts to address tobacco control issues in local communities in California, including new initiatives around tobacco waste, health equity, and the retail environment for tobacco.
Supplemental Material: For more information, read this study published in 2009 about CTCP's work
Citation: Lightwood, J., Glantz, S.A. (2013). The Effect of the California Tobacco Control Program on Smoking Prevalence, Cigarette Consumption, and Healthcare Costs: 1989–2008. PLoS ONE, 8(2), e47145.