title: Smoking patterns in Oregon youth: effects of funding and defunding of a comprehensive state tobacco control program.
abstract: OBJECTIVE
  Comprehensive tobacco control programs have included school-based prevention programs as a key strategy to reach adolescents. Unfortunately, these programs have undergone extensive budget reductions in recent years. In 2003, funding for the Oregon Tobacco Prevention and Education Program was reduced by about 70%, and the school component was entirely defunded. To assess the effects of program funding and subsequent defunding on smoking prevalence within targeted Oregon schools, we compared the change in 30-day smoking prevalence between grades 8 and 11 in school districts in two periods: namely, during funding and after funding was eliminated.
  
  
  METHODS
  We used annual school-based survey data for grades 8 and 11 to describe district-level changes in smoking prevalence in five age cohorts: two during the funding period and three after defunding. Each cohort was comprised of districts whose 8th-graders completed the survey and participated again 3 years later. Using mixed models, we compared the change in 30-day adjusted smoking prevalence among cohorts in funded districts, defunded districts, and districts that never received funding.
  
  
  RESULTS
  Smoking prevalence growth was significantly higher among cohorts from the defunded period than for cohorts from the funded period (p=.04) and was not significantly different from schools that were never-funded (p=.79).
  
  
  CONCLUSIONS
  In Oregon, funding a school component of a comprehensive tobacco control strategy was associated with depressed uptake of smoking. Gains were quickly lost upon program defunding. School programs are an important strategy if they are long term, comprehensive, and reinforced in the larger environment.
authors.affiliation: Program Design and Evaluation Services, Multnomah County Health Department and Oregon Public Health Division, Portland, Oregon 97232, USA. barbara.a.pizacani@state.or.us
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Pizacani
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Dent
authors.forename: Julie E
authors.initials: JE
authors.lastname: Maher
authors.forename: Kristen
authors.initials: K
authors.lastname: Rohde
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stark
authors.forename: Anthony
authors.initials: A
authors.lastname: Biglan
authors.forename: Jill
authors.initials: J
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D015331:Cohort Studies; D005380:Financing, Government; D006293:Health Promotion / Q000191:economics*; D006306:Health Surveys; D006801:Humans; D009922:Oregon / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology*; D000074606:Smoking Prevention; D013219:State Government