CALIFORNIA ANTI-SMOKING PROGRAM MAY HAVE SAVED MORE THAN 30,000
LIVES FROM HEART DISEASE, UCSF STUDY SHOWS; CUTBACKS LINKED TO 8,300
WEDNESDAY, DECEMBER 13, 2000
See also: PUBLICATION IN THE
NEW ENGLAND JOURNAL OF MEDICINE
AN ESTIMATED 33,300 heart-disease deaths were prevented during the first
nine years of the voter-approved anti-smoking program in California,
according to a new report by researchers at UCSF. The report represents the
first time that scientists have attributed savings in lives to a tobacco
In addition, the researchers estimate that 8,300 excess deaths from heart
disease can be attributed to budget cuts and changes made to focus the
program primarily on youth steps which they say weakened the effort in the
The study published in the December 14 issue of The New England Journal of
Medicine examined the relationship between the tobacco control program and
death rates for heart disease because, unlike lung cancer, the harmful
effects of smoking on the heart develop rapidly and resolve rapidly.
Research has shown that when people quit smoking, their excess risk of a
heart attack is cut in half in just one year.
In 1988 the voters of California approved Proposition 99, which increased
the tax on cigarettes by 25 cents per package and allocated five cents of
the new tax to an anti-tobacco education program, including an aggressive
media campaign attacking the tobacco industry and programs promoting clean
indoor air. It became the largest such program ever undertaken.
Previous studies by UCSF researchers and others have estimated that the
California Tobacco Control Program accelerated a decline in the prevalence
of smoking and in per capita cigarette consumption. In the new study, the
researchers compared death rates from heart disease in California with the
rest of the United States beginning in 1980 nine years before the
California Tobacco Control Program began until 1997 (the last year for
which statistics were available). As is customary in such studies, the
comparison was age-adjusted adjusted to take into account differences in
age distributions between California and the U.S.
The study used the relationship between heart disease death rates outside
and inside California to estimate the death rates that would have existed
without the program. Comparing those figures to the actual pattern of
deaths, the researchers were able to estimate the number of lives saved
through implementation of the tobacco control program.
"Our results show that large-scale, aggressive tobacco control
programs save lives," said Stanton Glantz, PhD, UCSF professor of
medicine. "They also show that there is a real human price to be paid when
the tobacco industry succeeds in convincing politicians to cut back and
water down these programs."
Glantz is a member of the UCSF Cardiovascular Research Institute and the
UCSF Institute for Health Policy Studies. Lead author on the paper is
Caroline Fichtenberg, MS, a post-graduate researcher in the Institute for
Health Policy Studies.
Glantz and Fichtenberg also compared per capita cigarette consumption in
California with the rest of the country and found that the state's tobacco
control program was associated with about 2.9 billion fewer packs of
cigarettes being smoked (worth $4 billion in pre-tax sales to the tobacco
industry) between 1989 and 1997.
The reduced effectiveness of the program due to cutbacks and program
changes in the mid-1990s is associated with an extra one billion packs of
cigarettes being consumed in the state between 1993 and 1997, they report.
The changes in heart disease death rates paralleled the changes in
cigarette consumption in about the proportion that would be expected given
the known risk of heart disease associated with smoking, they estimate.
Fichtenberg and Glantz conclude that well-designed, aggressive tobacco
control programs are associated with major reductions in deaths from heart
disease in a short period of time.
"Our study also shows that scaling back or weakening such programs by
limiting them to children, as the tobacco industry and some representatives
of the public health community advocate, is associated with an increase in
death," they write. The research was supported by the National Cancer Institute.
In the NEJM paper the researchers note that a simple calculation shows that
the changes in the rate of death from heart disease were quantitatively
consistent with the changes in cigarette consumption. "Values for the risk
of death from coronary heart disease that is attributable to smoking range
from 40 to 55 percent," they write. "In 1997, the rate of per capita
cigarette consumption in California was 21 percent lower than the predicted
rate had the pre-1989 relation between the rates in California and the rest
of the United States been maintained. A 40 to 55 percent reduction of 21
percent is 8 to 12 percent, which is similar to the actual 13 percent
difference between the actual rate of death from heart disease in
California and the predicted rate had the pre-1989 trend been maintained."