title: The quarter that changed the world.
abstract: BACKGROUND
  The California Department of Public Health (CDPH), California Tobacco Control Program (CTCP) is one of the longest-running comprehensive tobacco control programmes in the USA, resulting from a 1988 ballot initiative that added a 25-cent tax on each pack of cigarettes and a proportional tax increase on other tobacco products. This programme used a social norm change approach to reduce tobacco use.
  
  
  METHODS
  The operation, structure, evolution, programme dissemination and results are reviewed.
  
  
  RESULTS
  The sustained programme implementation has reduced adult per capita cigarette consumption by over 60% and adult smoking prevalence by 35%, from 22.7% in 1988 to 13.8% in 2007. From 1988 to 2004, lung and bronchus cancer rates in California declined at nearly four times the rate of decline seen in the rest of the USA and the programme is associated with an $86 billion savings in healthcare costs. Youth smoking rates among 12-17 years olds are the second lowest in the nation.
  
  
  CONCLUSIONS
  The social norm change approach is effective at reducing tobacco consumption, adult smoking and youth uptake. This approach resulted in declines in tobacco-related diseases and is associated with savings in healthcare expenditures. In considering CTCP's effectiveness, the takeaway message is that it should be viewed as a unified programme rather than a collection of independent interventions. The programme was designed and implemented as one where the parts complement and reinforce each other. Its effectiveness is dependent on its comprehensive strategy rather than any one part of the intervention.
authors.affiliation: California Department of Public Health, California Tobacco Control Program, PO Box 997377, MS 7206, Sacramento, CA 95899-7377, USA. april.roeseler@cdph.ca.gov
authors.forename: April
authors.initials: A
authors.lastname: Roeseler
authors.forename: David
authors.initials: D
authors.lastname: Burns
mesh_terms: D000293:Adolescent; D000328:Adult; D000329:Advertising; D002140:California / Q000453:epidemiology; D002648:Child; D003469:Culture; D017048:Health Care Costs; D006293:Health Promotion / Q000191:economics / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D015397:Program Evaluation / Q000191:economics; D015980:Public Health Practice; D012907:Smoking / Q000191:economics / Q000453:epidemiology* / Q000331:legislation & jurisprudence / Q000639:trends; D012931:Social Environment; D019460:Tobacco Industry / Q000331:legislation & jurisprudence; D020340:Tobacco Use Cessation / Q000191:economics / Q000706:statistics & numerical data*; D014029:Tobacco Use Disorder / Q000191:economics / Q000517:prevention & control*; D014026:Nicotiana
references.citation: Cancer. 1998 Dec 15;83(12 Suppl Robert):2717-21
references.pmid: 9874384
references.citation: Health Aff (Millwood). 1996 Spring;15(1):58-72
references.pmid: 8920569
references.citation: Health Psychol. 2005 Jan;24(1):22-31
references.pmid: 15631559
references.citation: Public Health Rep. 2005 Sep-Oct;120(5):482-95
references.pmid: 16224981
references.citation: Am J Public Health. 1998 Jun;88(6):918-23
references.pmid: 9618620
references.citation: Am J Public Health. 2002 Jun;92(6):975-83
references.pmid: 12036792
references.citation: Tob Control. 1998 Winter;7(4):397-408
references.pmid: 10093175
references.citation: Tob Control. 1996 Autumn;5(3):189-91
references.pmid: 9035352
references.citation: JAMA. 1994 Oct 19;272(15):1176-82
references.pmid: 7933347
references.citation: Cancer Causes Control. 2004 Sep;15(7):689-95
references.pmid: 15280627
references.citation: Tob Control. 2006 Feb;15(1):50-8
references.pmid: 16436406
references.citation: Am J Public Health. 2000 May;90(5):762-7
references.pmid: 10800426
references.citation: MMWR Morb Mortal Wkly Rep. 2000 Dec 1;49(47):1066-9
references.pmid: 11186612
references.citation: Public Health Rep. 2000 Mar-Jun;115(2-3):212-5
references.pmid: 10968756
references.citation: PLoS Med. 2008 Aug 26;5(8):e178
references.pmid: 18752344
references.citation: J Clin Oncol. 2001 Sep 15;19(18 Suppl):69S-73S
references.pmid: 11560977
references.citation: N Engl J Med. 2000 Dec 14;343(24):1772-7
references.pmid: 11114317