The Centers for Disease Control and Prevention (CDC) believe that adequate funding of tobacco control programs by all 50 states would reduce the number of adults who smoke by promoting quitting, preventing young people from ever starting, reducing exposure to secondhand smoke, and eliminating disparities in tobacco use among population groups. CDC has established guidelines for comprehensive tobacco control programs, including recommended funding levels, in Best Practices for Comprehensive Tobacco Control Programs (CDC 1999; hereafter called Best Practices). Recommendations are based on best practices in nine program elements: community programs to reduce tobacco use, chronic disease programs to reduce the burden of tobacco-related diseases, school programs, enforcement, statewide programs, countermarketing, cessation programs, surveillance and evaluation, and administration and management. CDC recommends annual funding per capita to range from 87 to $20 in smaller states (population less than 3 million), $6-817 in medium-sized states (population 3-7 million), and $5-$16 in larger states (population more than 7 million).
CDC (2002) estimates that total expenditures of $861.9 million in 2002 were allocated to tobacco control from national and state sources in the United Sates, or $3.16 per capita. Actual spending in all states was roughly 56 percent of the "lower-bound" or minimum Best Practices funding recommendation for that year, with only six states (Hawaii, Maine, Maryland, Minnesota, Mississippi, and Ohio) meeting or exceeding minimum recommendations, and 18 states providing less than 33 percent of recommended floors (CDC 1999). CDC called for more than $3 billion in additional tobacco control spending in each of 2001 and 2002 to meet minimum Best Practices recommendations.
This article examines whether state tobacco control programs lowered both adult tobacco consumption and youth smoking during 2001 and 2002 using newly available data published in CDC (2001, 2002) on expenditures of these programs. A secondary issue is whether or not divergence of actual funding from minimum Best Practices recommendations explains any of the differences between tobacco consumption in the states. That is, does the fact that a state funds above or below minimum levels indicate anything about tobacco consumption in that state relative to other states'? The informational content of the Best Practices funding guidelines has not been previously examined. This study examines whether spending expansion along the lines of the Best Practices guidelines provides a useful benchmark based on past effectiveness of those programs in controlling tobacco consumption.
Studies of the impact of tobacco control programs often focus on consumption changes following a particular policy event such as a new control program. Manley et al. (1997) concluded that per capita monthly sales fell in states participating in the ASSIST (American Stop Smoking Intervention Study) program relative to states not participating. Pierce et. al. (1998) reported that California control programs significantly lowered tobacco use. While these and other studies show falling tobacco use following implementation of new tobacco control programs, they fail to control for factors that may also cause consumption to fall. Tobacco control programs themselves therefore may or may not be causing observed declines in tobacco use and, even if in fact they do contribute, studies overstate impacts of control programs on tobacco use when they do not properly control for other contributing factors.
Three studies control for one or more factors outside of the tobacco control programs themselves. Hu, Sung, and Keeler (1995a) control for state excise taxes and tobacco firm media expenditures when concluding that state media expenditures, or counteradvertising, exert a negative impact on cigarette consumption. The authors measured tobacco control expenditures as "media placement expenditures" by the Tobacco Control Section of the California Department of Health Services and calculated that California spent almost $20 million over the 1980-93 study period. …