California as a model.

One of every three persons who starts smoking falls ill and dies prematurely because he or she smoked. Smoking has been causally linked to heart disease, cancer, and respiratory diseases and continues to be the number one preventable cause of death in this country. To prevent these deaths and the incidence of these diseases, California's Tobacco Control Program was established in 1989 specifically to reduce tobacco use in the state. The strategy of the program is to "denormalize" tobacco. This strategy emphasizes three areas of programmatic activity: to counter pro-tobacco influences, to reduce exposure to environmental tobacco smoke, and to reduce access to tobacco products, with a focus on both social and commercial sources. A fourth priority area, cessation, is considered more of an outcome. California's Tobacco Control Program has touched the life of every Californian. Adult smoking prevalence in the state has gone from approximately 11% lower than the rest of the nation in 1988 to 20% lower in 1996. There are now approximately one million fewer smokers in California than would have been expected. Overall, per capita cigarette consumption has fallen by more than 50%. Seventy percent of adult smokers reported that they tried to quit in the last year. Exposure to secondhand smoke has plummeted. California's lung and bronchus cancer incidence is already declining at a significantly higher rate than that seen elsewhere in the nation. Youth smoking rates have also declined significantly. However, contrary to the message of its massive public relations campaign, the tobacco industry has not changed its stripes after the national tobacco settlement. They are still aggressively marketing their products to teenagers, ethnic minority groups, and young adults. They need to be combatted with renewed vigor by a vigilant health community.

A centralised telephone service for tobacco cessation: the California experience.

OBJECTIVE: To provide an overview of the California Smokers' Helpline, an increasingly popular telephone program for tobacco cessation in California since 1992. As many states, regions, and nations are contemplating various telephone programs as part of large scale anti-tobacco campaigns, this paper presents a practical model. DESIGN: The Helpline provides Californians with free cessation services that include counselling, self help quit kits, and cessation related information. Services are provided in six spoken languages plus a line for the hearing impaired. The program is promoted statewide by media campaigns, health care providers, local tobacco control programs, and the public school system. SETTING: The Helpline is centrally operated through the University of California, San Diego and provides services statewide via telephone. RESULTS: The Helpline has served over 100 000 tobacco users and has become the chief cessation resource for the Comprehensive Tobacco Control Program in California. Media was the most important referral source for Helpline callers (50%), followed by health care providers (20%). About one third of the callers were ethnic minorities and 17% were 24 years old or younger. Compared to California smokers in general, the callers were more dependent on nicotine and more likely to live with other smokers, but they were also more likely to have tried to quit recently and were more ready to try again. Two randomised trials have demonstrated the efficacy of the Helpline's counselling protocol. CONCLUSION: A centralised helpline operation can be an accessible and effective service for tobacco users and should be included in any large scale, comprehensive tobacco control program.

Store tobacco policies: a survey of store managers, California, 1996-1997.

OBJECTIVE: To identify store tobacco policies and retailer perception and beliefs that may have contributed to changes in compliance with youth access laws in California. DESIGN: In the winter of 1996-7, a cross sectional, follow up telephone survey was conducted of California store managers whose stores were anonymously surveyed for illegal tobacco sales in the summer of 1996 (that is, 1996 Youth Tobacco Purchase Survey, YTPS). SETTING: A simple random sample of stores from a list of California stores likely to sell tobacco, used in the 1996 YTPS. PARTICIPANTS: 334 managers (77%) of the 434 stores surveyed in 1996 responded to the survey. After eliminating stores that stopped selling tobacco or were under new management or ownership, 320 responses of store managers were included in the analysis. The stores were analysed by type of ownership: chain, which included corporate managed (n = 61); franchise owned (n = 56); and independent (n = 203). MAIN OUTCOME MEASURES: Responses of store managers were linked with the 1996 YTPS outcomes. Manager responses were compared by chi2 tests. Logistic regression analyses were conducted to identify store factors associated with illegal tobacco sales. RESULTS: A lower likelihood of illegal sales rate was associated with the chain stores when compared with the independent stores (odds ratio (OR) = 0.4, 95% confidence interval (CI) 0.2 to 0.9). A lower likelihood of illegal tobacco sales was found in stores that implemented tobacco related activities in the previous year such as changing tobacco displays (OR = 0.5, 95% CI 0.2 to 0.9) or adding new warning signs (OR = 0.7, 95% CI 0.4 to 1.2). Store managers' beliefs that youth were sent to their stores to do compliance checks also resulted in a lower likelihood of illegal sales (OR = 0.7, 95% CI 0.4 to 1.1). CONCLUSIONS: Store tobacco youth access policies, and managers' beliefs about the extent of youth access enforcement in the community, are important in reducing illegal tobacco sales to minors.