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Objective: Recently, the tobacco industry has focused marketing efforts on young adults through bar and club promotions, such as advertising and distribution of free cigarettes in these settings. This study estimates the fraction of the California young adult population that might be exposed and potentially influenced by these efforts., Design and Participants: Data were from 9364 young adult (18-29 years) respondents to the cross sectional population based 2002 California Tobacco Survey. As background, we analysed social smoking (only smoke with other smokers), and enjoyment of smoking while drinking. Our main focus was on bar and club attendance, what was observed in bars and clubs, and how this might differ according to respondents' risk for future smoking., Results: Social smokers comprised 30.0 (2.2)% of all current smokers, including experimenters. Nearly three quarters (74.5 (2.3)%) of current smokers/experimenters said they enjoyed smoking while drinking. About one third (33.8 (1.2)%) of all young adults said they attended bars and clubs at least sometimes; attendance was significantly higher among smokers and those at risk for future smoking. Close to 60% (57.9 (2.2)%) of bar and club attenders reported seeing cigarette advertising and promotions in these settings. Again, smokers and those at risk were more likely to report seeing such advertising and promotions in these settings., Conclusions: About 20% of all young adults and about 30% of those at risk for future smoking (including current smokers) were exposed to tobacco advertising and promotions in bars and clubs. These California results may be conservative, but nonetheless indicate that the group potentially influenced is sizable.

Objective: California's comprehensive tobacco control programme was 13 years old in 2002; by then, children entering adolescence at the start of the programme were young adults. This study examines whether adolescent smoking declined over this period, whether any decline carried through to young adulthood, and whether it was specific to California., Setting and Participants: Most data were from the 1990-2002 California Tobacco Surveys (CTS) (adolescents 12-17 years, > 5000/survey, young adults 18-24 years, > 1000/survey). Additional data were from the national 1992/93-2001/02 Current Population Survey (CPS) (young adults 18-24 years, > 15,000/survey)., Results: Over the 13 year period in California, ever puffing declined by 70% in 12-13 year olds, by 53% in 14-15 year olds from 1992-2002, and by 34% in 16-17 year olds from 1996-2002 (CTS). As noted, the decline commenced progressively later in each older group. Smoking experimentation (1+ cigarettes) and established smoking (> 100 cigarettes in lifetime) showed similar patterns. Compared to 1990, the percentage of California young adults (CTS data) who ever experimented declined by 14%, with half of the decline from 1999-2002. CPS young adult smoking prevalence (established and now smoke everyday or some days) was constant in the rest of the USA over the entire period, but California showed a recent 18% decline from 1998/99 to 2001/02., Conclusions: California's comprehensive programme may have kept new adolescent cohorts from experimenting with cigarettes. Low young adolescent experimentation rates at programme start appeared to carry through to young adulthood, resulting in a recent drop in young adult smoking prevalence in California not observed in the rest of the USA.

Background: The decade long California Tobacco Control Program is unique to the nation in its duration, emphasis, and level of funding. Programme emphasis is on changing social norms about smoking as a means to discourage smoking and thus reduce the harmful health effects of tobacco to the population., Methods: Data from the 1992-93, 1995-96, and 1998-99 Tobacco Use Supplements to the national Current Population Survey (n > 175 000 each period) were used to examine changes in norms regarding where smoking should "not be allowed at all" in both California and in the rest of the USA. Venues queried were restaurants, hospitals, work areas, bars, indoor sports venues, and indoor shopping malls., Results: There were substantial increases in the percentages of the adult population (18+ years) stating that smoking should not be allowed in the venues queried in California by 1998-99 compared to 1992-93; only modest increases were observed in the rest of the USA. In fact, for most venues, the percentages for the rest of the USA were lower in 1998-99 than in California in 1992-93. Further, the percentage increase over this period in respondents stating that smoking should not be allowed in four or more of the six venues was 30% in California and 23% in the rest of the USA. The most dramatic percentage increase in California occurred among current smokers (93%)., Conclusions: A strong, comprehensive tobacco control programme such as California's can influence population norms, including those of smokers, with respect to where smoking should not be allowed.

Objectives: Several states, including California, have implemented large cigarette excise tax increases, which may encourage smokers to purchase their cigarettes in other lower taxed states, or from other lower or non-taxed sources. Such tax evasion thwarts tobacco control objectives and may cost the state substantial tax revenues. Thus, this study investigates the extent of tax evasion in the 6-12 months after the implementation of California's 0.50 dollars/pack excise tax increase., Design and Setting: Retrospective data analysis from the 1999 California Tobacco Surveys (CTS), a random digit dialled telephone survey of California households., Main Outcome Measures: Sources of cigarettes, average daily cigarette consumption, and reported price paid., Results: Very few (5.1 (0.7)% (+/-95% confidence limits)) of California smokers avoided the excise tax by usually purchasing cigarettes from non- or lower taxed sources, such as out-of-state outlets, military commissaries, or the internet. The vast majority of smokers purchased their cigarettes from the most convenient and expensive sources: convenience stores/gas (petrol) stations (45.0 (1.9)%), liquor/drug stores (16.4 (1.6)%), and supermarkets (8.8 (1.2)%)., Conclusions: Despite the potential savings, tax evasion by individual smokers does not appear to pose a serious threat to California's excise tax revenues or its tobacco control objectives.

Objective: To determine whether changes in news media coverage of smoking and health issues are associated with changes in smoking behaviour in the USA., Design and Main Outcome Measures: Issue importance in the US news media is assessed by the number of articles published annually in major magazines indexed in The Reader's Guide to Periodical Literature. Annual incidence rates for cessation and initiation in the USA were computed from the large, representative National Health Interview Surveys (1965-1992). Patterns in cessation incidence were considered for ages 20-34 years and 35-50 years. Initiation incidence was examined for adolescents (14-17 years) and young adults (18-21 years) of both sexes., Results: From 1950 to the early 1980s, the annual incidence of cessation in the USA mirrored the pattern of news media coverage of smoking and health, particularly for middle aged smokers. Cessation rates in younger adults increased considerably when second hand smoke concerns started to increase in the US population. Incidence of initiation in young adults did not start to decline until the beginning of the public health campaign against smoking in the 1960s. Among adolescents, incidence rates did not start to decline until the 1970s, after the broadcast ban on cigarette advertising., Conclusions: The level of coverage of smoking and health in the news media may play an important role in determining the rate of population smoking cessation, but not initiation. In countries where cessation has lagged, advocates should work to increase the newsworthiness of smoking and health issues.

Objective: To assess the association of household and workplace smoking restrictions with quit attempts, six month cessation, and light smoking., Design: Logistic regressions identified the association of household and workplace smoking restrictions with attempts to quit, six month cessation, and light smoking., Setting: Large population surveys, United States., Subjects: Respondents (n = 48,584) smoked during the year before interview in 1992-1993, lived with at least one other person, and were either current daily smokers or were former smokers when interviewed., Main Outcome Measures: The outcome measures were an attempt to quit during the last 12 months, cessation for at least six months among those who made an attempt to quit, and light smoking (< 15 cigarettes a day)., Results: Smokers who lived (odds ratio (OR) = 3.86; 95% confidence interval (CI) = 3.57 to 4.18) or worked (OR = 1.14; 95% CI = 1.05 to 1.24) under a total smoking ban were more likely to report a quit attempt in the previous year. Among those who made an attempt, those who lived (OR = 1.65, 95% CI = 1.43 to 1.91) or worked (OR = 1.21, 95% CI = 1.003 to 1.45) under a total smoking ban were more likely to be in cessation for at least six months. Current daily smokers who lived (OR = 2.73, 95% CI = 2.46 to 3.04) or worked (OR = 1.53, 95% CI = 1.38 to 1.70) under a total smoking ban were more likely to be light smokers., Conclusions: Both workplace and household smoking restrictions were associated with higher rates of cessation attempts, lower rates of relapse in smokers who attempt to quit, and higher rates of light smoking among current daily smokers.

Background: Despite public denials, internal tobacco company documents indicate that adolescents have long been the target of cigarette advertising and promotional activities. Recent longitudinal evidence suggests that 34% of new experimentation occurs because of advertising and promotions., Objective: To apportion responsibility for smoking experimentation and future smoking-attributable mortality among major cigarette brands attractive to young people (Camel and Marlboro). DATA SOURCES, SETTING, AND PARTICIPANTS: Data were from confirmed never-smoking adolescents (12-17 years old) responding to the 1993 (n = 2659) and 1996 (n = 2779) population-based California Tobacco Surveys., Main Outcomes: Adolescents named the brand of their favourite cigarette advertisements and tobacco promotional items. Using these "market shares" and the relative importance of advertising and promotions in encouraging smoking, we estimated how many new experimenters from 1988 to 1998 in the United States can be attributed to Camel and Marlboro. From other data on the natural history of smoking, we projected how many future deaths in the United States can be attributed to each brand., Results: Although Camel advertisements were favoured more than Marlboro and other brands in 1993 and 1996, the "market share" for promotional items shifted markedly during this period from Camel and other brands towards Marlboro. We estimated that between 1988 and 1998, there will be 7.9 million new experimenters because of tobacco advertising and promotions. This will result in 4.7 million new established smokers: 2.1, 1.2, and 1.4 million due to Camel, Marlboro, and other brands' advertising and promotions, respectively. Of these, 1.2 million will eventually die from smoking-attributable diseases: 520,000 from Camel, 300,000 from Marlboro, and the remainder from other brands., Conclusions: Our analysis provides a reasonable first estimate at sharing the blame for the long-term health consequences of smoking among the major brands that encourage adolescents to start smoking.

Objective: To compare recent trends in smoking initiation by adolescents with trends in inflation-adjusted cigarette pricing and tobacco marketing expenditures., Design: We examined smoking initiation trends in demographic subgroups of adolescents aged 14-17 years during the decade 1979-1989. Data on cigarette pricing and tobacco marketing expenditures were adjusted for inflation and plotted over this same period., Setting: Large population surveys, United States., Subjects: 140,975 ever-smokers aged 17-38 when surveyed in 1992 or 1993, who reported on age of smoking initiation during the decade 1979-1989., Main Outcome Measure: Initiation rate was calculated as the number in an age group who reported starting to smoke regularly in a year, divided by the number of never-smokers at the start of the year. Trends were evaluated by linear and quadratic models., Results: From 1979 to 1984, adolescent initiation rates decreased, but increased thereafter, particularly among males, whites, and those who, as adults, reported never having graduated from high school. Cigarette price increased throughout the decade as did tobacco marketing expenditures, especially for coupons, value-added items, and promotional allowances., Conclusion: Availability of cheaper cigarettes is not likely to be a cause of increased smoking initiation by adolescents. Although other influences cannot be ruled out, we suspect that the expanded tobacco marketing budget, with its increased emphasis on tactics that may be particularly pertinent to young people, affected adolescent initiation rates.

Objective: To obtain an early estimate of the effectiveness of the American Stop Smoking Intervention Study (ASSIST)., Design, Setting, and Participants: Seventeen American states funded through ASSIST are compared with 32 others regarding per capita cigarette consumption from 1989 to 1995. California, which already had an extensive tobacco control programme, was omitted. ASSIST states were selected competitively (not randomly) based on their proposals' merit, state smoking prevalence, and geographical distribution., Interventions: Comprehensive tobacco control programmes, emphasising policy interventions, were implemented in the ASSIST states beginning in 1993., Main Outcome Measures: Trends in aggregated per capita cigarette consumption and inflation-adjusted average price/pack of cigarettes in the intervention states were compared. Percentage change in per capita consumption is also compared with percentage change in inflation-adjusted cigarette price by state in each group from 1992 to 1994., Results: Per capita consumption and inflation-adjusted cigarette price were nearly identical in both groups of states before 1993, when full funding for the ASSIST interventions began. However, by 1996 smokers in the intervention states were consuming about 7% less cigarettes per capita (P<0.05, beginning in 1994), and in 1994 the average price was over $0.12/pack higher in the intervention states. All but three states (all intervention) showed decreases in cigarette price. Nonetheless, 76% of the intervention and 55% of the comparison states showed some decrease in consumption despite decreases in price. The relationship between changes in price and consumption was considerably diminished in the intervention group., Conclusions: These interim results suggest that the ASSIST programme is associated with a substantial difference in tobacco consumption in a third of the United States, and that increased price from taxation may not be the only programme influence.