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Matthew C. Farrelly, PhD, Terry F. Pechacek, PhD, Kristin Y. Thomas, MsPH and David Nelson, MD, MPH

Matthew C. Farrelly is with the Division of Public Health and Environment, RTI International, and the RTI–UNC Center of Excellence in Health Promotion Economics, Research Triangle Park, NC. Terry F. Pechacek and David Nelson are with the Office of Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Ga. Kristin Y. Thomas is with the Division of Public Health and Environment, RTI International, Washington, DC.

Correspondence: Requests for reprints should be sent to Matthew C. Farrelly, PhD, RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC 27709 (e-mail: mcf{at}rti.org).

Objectives. We examined whether state tobacco control programs are effective in reducing the prevalence of adult smoking.

Methods. We used state survey data on smoking from 1985 to 2003 in a quasi-experimental design to examine the association between cumulative state antitobacco program expenditures and changes in adult smoking prevalence, after we controlled for confounding.

Results. From 1985 to 2003, national adult smoking prevalence declined from 29.5% to 18.6% (P<.001). Increases in state per capita tobacco control program expenditures were independently associated with declines in prevalence. Program expenditures were more effective in reducing smoking prevalence among adults aged 25 or older than for adults aged 18 to 24 years, whereas cigarette prices had a stronger effect on adults aged 18 to 24 years. If, starting in 1995, all states had funded their tobacco control programs at the minimum or optimal levels recommended by the Centers for Disease Control and Prevention, there would have been 2.2 million to 7.1 million fewer smokers by 2003.

Conclusions. State tobacco control program expenditures are independently associated with overall reductions in adult smoking prevalence.