California's tobacco control efforts losing steam, finds report

"The combination of weak leadership at the state level, willingness of political leaders to accept tobacco industry money, and inflation eroding the spending power of the California Tobacco Control Program are compromising its effectiveness, which will lead, even in the short term, to more smoking," said Stanton Glantz, PhD, UCSF professor of medicine and director of the UCSF Center for Tobacco Control Research and Education.

The report will be published on Oct. 23 in eScholarship, which provides open-access scholarly publishing services to the University of California.

The report covers tobacco policymaking and tobacco industry political influence in California from 2007 to 2014 and is the latest in a series of reports on the state dating to 1976. It is part of a longstanding research project that tracks the effect of tobacco programs in protecting public health. To date, 29 states have been studied.

The California report draws from a comprehensive collection of sources including legislative records, campaign contribution data, lobbying reports, media reports, interviews, and peer reviewed journals.

In 1989, the California Tobacco Control Program was established after voters enacted Proposition 99 -- the Tobacco Tax and Health Protection Act. It has since achieved great success in reducing tobacco use by Californians. From 1989 to 2012, the percentage of adult smokers in California dropped from 22.7 percent to 12.6 percent, and while nearly 2.5 billion packs of cigarettes were sold in California in 1988, only 951 million packs were sold by 2012. Between 1989 and 2008, the California Tobacco Control Program cost $2.4 billion to run but led to a cumulative healthcare savings of $134 billion.

Despite these triumphs, the program is now much smaller and less aggressive than in its early years. By 2014, inflation had reduced the program's spending power to 53 percent of what it was when it began.

Furthermore, the rate of decline in tobacco consumption in California has slowed compared to the national rate. From 2004 to 2013, consumption per capita in California dropped 28.2 percent, while national consumption decreased 34.8 percent. In the previous ten-year period, however, the reverse was true, with California consumption dropping 40.8 percent, compared to a national decline of 20.5 percent.

The decrease in youth smoking in California was lower than that nationally between 2000 and 2011, especially among middle school students, who saw a 28.4 percent decline in California compared to a 60.9 percent decline nationally.

"It's unquestionably concerning to see that where we once were a leader we are now starting to fall behind," said lead author Elizabeth Cox, an assistant research specialist at the UCSF Center for Tobacco Control Research and Education. "The resources just aren't there anymore, and state leaders are no longer prioritizing tobacco control."

The report details how the tobacco industry has utilized its massive spending power in recent years to influence tobacco policymaking in California through campaign contributions and powerful lobbyists. Between 2007 and 2013, the industry spent nearly $64.5 million on California political activity. This period also saw an increase in the Democratic leadership's willingness to accept tobacco industry money, including the first California governor to take tobacco money in years, Governor Edmund G. Brown Jr.

Despite the need for new tobacco control funding sources, California leaders have fallen short in making this a priority, explains the report. California has the 33rd lowest cigarette tax in the nation, and yet none of the seven bills introduced to increase the cigarette excise tax from 2007 to 2014 moved past the legislature.

"Public health advocates need to increase pressure on politicians to again refuse tobacco industry money and to prioritize public health," Glantz said. "Only concerned action by health organizations to hold the politicians accountable will change this situation."

The new report also documents the influence of the rising electronic cigarette industry. According to the authors, as e-cigarettes become increasingly popular, they pose an unregulated threat to undermine tobacco control efforts. Despite the strong connection between cigarette smoking and e-cigarette use, the California Department of Public Health has not integrated e-cigarettes into its media campaign or other aspects of the California Tobacco Control Program. Furthermore, only one state bill has been passed to prohibit the sale of e-cigarettes to minors, but it lacks any enforcement measures.

With state leaders failing to take action, local policymaking has remained the most effective form of tobacco control. California led the nation on efforts to protect residents of multiunit housing from secondhand smoke. By 2014, 37 localities had passed ordinances restricting smoking in multiunit housing. In addition, 14 strong local tobacco retail licensing ordinances passed, and 40 percent of California residents were protected from e-cigarette smoke in public places by local ordinances from Eureka to Los Angeles.

"The bright spot in California is clearly at the local level, where political leaders have been putting the public interest above the tobacco companies by enacting strong legislation," Glantz said. "It is my sincere hope that state policymakers will take note of these successes and begin to follow suit, beginning by announcing that they are refusing and returning campaign cash from tobacco companies."

The full report will be available online at http://www.escholarship.org/uc/item/4jj1v7tv. Reports on other states are available at http://tobacco.ucsf.edu/states and for other countries at http://escholarship.org/uc/search?entity=ctcre_tcpmi.