Impact Data - Massachusetts Tobacco Control Programme
Date
This report is apart of an annual, ongoing evaluation of the Massachusetts Tobacco Control Programme (MTCP) activities and the progress made towards the programme goals.
Methodologies
The data for this evaluation comes from the core samples for the Behavioral Risk Factor Surveillance System (BRFSS) for 1990-2000. The BRFSS is a standardised, state-based, random digit-dialed telephone survey of non-institutionalised adults 18 years of age and above. The survey is coordinated by the Center for Disease Control and Prevention (CDC) and conducted by each state.
The total 1990-2000 sample included 1,123,858 respondents, of whom 30,289 (2.9%) were in Massachusetts and 1,093,569 (97.1%) in 41 comparison states. As in the previous analysis, the study excluded data from California because of its comprehensive tobacco control program similar to that in Massachusetts, allowing for assessment of the effects of the MTCP (7 other states were excluded because of reporting gaps). Respondents in the 41 comparison states represent a population that was not subject to comprehensive tobacco control programming for most of the study period.
As in previous reports, this analysis tests the main null hypothesis that there was no difference in the time trends of current smoking prevalence between Massachusetts and the 41 comparison states, controlling for demographic factors. This test was controlled for variances in sex, age, race, and education level using multiple logistic regression models.
The total 1990-2000 sample included 1,123,858 respondents, of whom 30,289 (2.9%) were in Massachusetts and 1,093,569 (97.1%) in 41 comparison states. As in the previous analysis, the study excluded data from California because of its comprehensive tobacco control program similar to that in Massachusetts, allowing for assessment of the effects of the MTCP (7 other states were excluded because of reporting gaps). Respondents in the 41 comparison states represent a population that was not subject to comprehensive tobacco control programming for most of the study period.
As in previous reports, this analysis tests the main null hypothesis that there was no difference in the time trends of current smoking prevalence between Massachusetts and the 41 comparison states, controlling for demographic factors. This test was controlled for variances in sex, age, race, and education level using multiple logistic regression models.
Practices
18.1% of Massachusetts adults were current smokers in 2002, representing a reduction of more than 4 percentage points from the 22.6% prevalence rate found in 1993; this amounts to a 20% decrease that is statistically significant, and also means a difference of 219,000 fewer smokers (2001 Census base). In 2002, 40% of adult smokers consumed half a pack of cigarettes or less per day. This an improvement from 1993, when only 27% smoked less than half a pack a day. The number of heavy smokers has also decreased.
Only 16% smoked more than a pack a day in 2002, versus 26% in 1993. Among youth, 26% of Massachusetts high school students smoked within the month prior to the survey (2001 Massachusetts Youth Risk Behavior Survey (YRBS)), a substantial and statistically significant improvement from the 36% smoking rate reported in 1995, and the 30% rate found for 1999.
Fewer pregnant women are smoking, down from 17% in 1993 to 10% in 2000. This 39% decline is much steeper than the national decline of 24% during the same period.
Only 16% smoked more than a pack a day in 2002, versus 26% in 1993. Among youth, 26% of Massachusetts high school students smoked within the month prior to the survey (2001 Massachusetts Youth Risk Behavior Survey (YRBS)), a substantial and statistically significant improvement from the 36% smoking rate reported in 1995, and the 30% rate found for 1999.
Fewer pregnant women are smoking, down from 17% in 1993 to 10% in 2000. This 39% decline is much steeper than the national decline of 24% during the same period.
Attitudes
The majority of Massachusetts towns have now adopted local ordinances or regulations intended to reduce young people's ability to purchase tobacco products and limit their exposure to tobacco advertising. By the end of 2001, 252 towns and cities, home to 92% of Massachusetts residents, had one or more youth access provisions in place. This is quadruple the 24% population coverage by these provisions in 1993. Towns receiving MTCP funding were significantly more likely to adopt such provisions. Retailer attitudes have also improved - the violation rate (percentage of purchase attempts resulting in an illegal sale) fell to its lowest level of 9% in 2002.
Public support for smoking bans in public continues to grow. By 2001-2002, 60% or more of Massachusetts residents supported complete smoking bans in shopping malls, public buildings, indoor sporting events, and restaurants. All of these represent significant increases since 1995 when levels were in the mid 30% range.
Public support for smoking bans in public continues to grow. By 2001-2002, 60% or more of Massachusetts residents supported complete smoking bans in shopping malls, public buildings, indoor sporting events, and restaurants. All of these represent significant increases since 1995 when levels were in the mid 30% range.
Access
The authors note that the programme budget faced substantial cutbacks from the FY 2002 to the FY 2003, which has curtailed some activities, though these effects are only partially reported in this study because its intended coverage in only up to 2001. The media campaign was largely discontinued midway through 2001. In 2001, 20 Tobacco Free Community Mobilization Networks (CMN) were funded (down to 11 in 2003), along with 47 Youth Action Alliances projects (programme cut in 2003).
Other Impacts
The authors discuss the relationship between the activities of the MTCP and the reductions in smoking noted above. They suggest the existence of a "Massachusetts effect" in which analyses conducted as part of the evaluation show that both adult and youth smoking prevalence have declined faster in Massachusetts than in the nation as a whole. The evidence suggests that the MTCP's multiple initiatives strategy has contributed to this favourable result.
Source
Hamilton WL, Rodger CN, Chen X, Njobe TK, Kling R, Norton G. "Independent Evaluation of the Massachusetts Tobacco Control Program. Eighth Annual Report: January 1994-June 2001." Cambridge, MA. Abt Associates Inc., 2003.
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