Trends in prevalence of current smoking, Massachusetts and states without tobacco control programmes, 1990 to 1999

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Abstract
Objective: To assess the effect of a comprehensive tobacco control programme initiated in Massachusetts in 1993, and to compare the 1990 to 1999 trend in smoking prevalence to that in 41 states without tobacco control programmes, controlling for demographic shifts over time. Design: Data from the Behavioral Risk Factor Surveillance System for the years 1990 to 1999 were used to examine changes and trends in prevalence of smoking using multivariate logistic regression models. Main outcome measures: Trend in prevalence of current smoking for the years 1990 to 1999. Results: In 1990, the prevalence of current smoking in Massachusetts was 23.5% (95% confidence interval (CI) 21.0% to 26.1%), and 24.2% in the rest of the USA (95% CI 23.7% to 24.7%). By 1999, the prevalence had declined in Massachusetts to 19.4%, and to 23.3% in 41 other US states. Controlling for sex, age, race, and education, there was a greater decline in current smoking between 1990 and 1999 among Massachusetts men than among Massachusetts women, and the decline was greater in Massachusetts than in the rest of the USA for men and for both sexes combined. Conclusions: These results suggest that the Massachusetts Tobacco Control Program is having a beneficial impact, but suggest a need for additional targeted efforts to achieve similar declines among Massachusetts women.