Statewide comprehensive tobacco control programs coordinate state and community-level cessation and prevention interventions and provide information on the dangers of tobacco via educational, regulatory, clinical, social, and economic strategies1, such as restrictions on tobacco product marketing and availability, mass media campaigns, cessation services, or smoke-free policies. Programs often provide assistance to community-based organizations and coalitions that implement local tobacco control programs and policies. Statewide programs also conduct surveillance, evaluation, and program monitoring2.
The term “tobacco” in this strategy refers to commercial tobacco, not ceremonial or traditional tobacco. County Health Rankings & Roadmaps recognizes the important role that ceremonial and traditional tobacco play for many Tribal Nations, and our tobacco-related work focuses on eliminating the harms and inequities associated with commercial tobacco.
Expected Beneficial Outcomes (Rated)
Reduced number of tobacco users
Reduced youth smoking
Improved health outcomes
Reduced tobacco use
Increased quit rates
Reduced exposure to secondhand smoke
Reduced health care costs
Evidence of Effectiveness
There is strong evidence that statewide comprehensive tobacco control programs reduce the number of tobacco users and amount of tobacco used, increase quit rates, reduce exposure to secondhand smoke (SHS), improve health outcomes, and reduce health care costs2.
Statewide comprehensive tobacco control programs reduce long-term smoking by adults and youth. States with programs have greater reductions in youth smoking, smoking initiation among adolescents (ages 11 to 17), and higher quit rates for adult smokers than states without programs. Statewide programs reduce SHS exposure in homes and workplaces, and residents of states with programs are more likely to adopt home smoking bans than those in states without programs. Comprehensive tobacco control programs can reduce smoking-related cancers, deaths, and hospitalizations2.
In the long-term, states with comprehensive tobacco control programs have greater reductions in daily tobacco use and reduced cigarette pack sales than states without programs2.
Statewide programs reduce tobacco use and SHS exposure similarly across racial and ethnic groups, as well as education and income levels2. A study of Oklahoma’s statewide comprehensive tobacco control program suggests that such programs can be more effective in rural than urban areas3.
Statewide comprehensive tobacco control programs are cost effective; savings from averted health care costs exceed program costs. Programs funded at Centers for Disease Control and Prevention (CDC) recommended levels are more effective than programs funded at lower levels2.
Impact on Disparities
The Centers for Disease Control and Prevention (CDC) prepared recommended funding levels for each state’s and Washington DC’s comprehensive tobacco control programs1. The Campaign for Tobacco-Free Kids lists the projected spending on an annual basis. States’ spending projections range from 0% to 89.4% of the CDC recommendation in fiscal year 2019; Connecticut, Tennessee, and West Virginia are projected to spend 0% and Alaska to spend 89.4%4, 5. Cumulatively, states will spend 19.8% of the total funding the CDC recommends spending on tobacco control programs in 20195.
The California Tobacco Control Branch leads statewide and local health programs in promoting a tobacco free environment; it also provides information about tobacco control policies, community resources, media tools, and research and evaluation results6. The New York State Tobacco Control Program includes community programs and partnerships, health communications, the New York State Smokers’ Quitline, and surveillance, evaluation, and research efforts7.
CDPH-CTCB - California Department of Public Health (CDPH). California Tobacco Control Program (CTCP). 2018.
CTFK-Issues - US state and local issues. Prevention and cessation programs: Reducing smoking, saving lives, saving money. Campaign for Tobacco-Free Kids. 2018.
CTFK-Tobacco settlement - Broken promises to our children: A state-by-state look at the 1998 tobacco settlement 19 years later. Campaign for Tobacco-Free Kids. 2018.
CDC-King 2014 - Centers for Disease Control and Prevention (CDC). Best practices for comprehensive tobacco control programs - 2014. Atlanta: US Department of Health and Human Services (US DHHS); 2014.
CTFK-TFR - Campaign for Tobacco-Free Kids (CTFK), Tobacco Free Retailers (TFR). You can shop tobacco-free: find stores that don't sell tobacco products.
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1 CDC-King 2014 - Centers for Disease Control and Prevention (CDC). Best practices for comprehensive tobacco control programs - 2014. Atlanta: US Department of Health and Human Services (US DHHS); 2014.
2 CG-Tobacco - The Guide to Community Preventive Services (The Community Guide). Tobacco.
3 Rhoades 2015* - Rhoades RR, Beebe LA, Boeckman LM, Williams MB. Communities of excellence in tobacco control: Changes in local policy and key outcomes. American Journal of Preventive Medicine. 2015;48(1):S21-S28.
4 CTFK-Tobacco settlement - Broken promises to our children: A state-by-state look at the 1998 tobacco settlement 19 years later. Campaign for Tobacco-Free Kids. 2018.
5 CTFK-State spending - Campaign for Tobacco-Free Kids (CTFK). History of spending for state tobacco prevention programs FY2000 - FY2019.
6 CDPH-CTCB - California Department of Public Health (CDPH). California Tobacco Control Program (CTCP). 2018.
7 NYS TCP - New York State Department of Public Health. New York State Tobacco Control Program (NYS TCP). 2018.
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