title: Update on Performance in Tobacco Control: A Longitudinal Analysis of the Impact of Tobacco Control Policy and the US Adult Smoking Rate, 2011-2013.
abstract: Tobacco use remains the leading cause of preventable death in the United States. States and municipalities have instituted a variety of tobacco control measures (TCMs) to address the significant impact tobacco use has on population health. The American Lung Association annually grades state performance of tobacco control using the State of Tobacco Control grading framework.
  
  
  
  To gain an updated understanding of how recent efforts in tobacco control have impacted tobacco use across the United States, using yearly State of Tobacco Control TCM assessments.
  
  
  
  The independent TCM variables of smoke-free air score, cessation score, excise tax, and percentage of recommended funding were selected from the American Lung Association State of Tobacco Control reports. Predictors of adult smoking rates were determined by a mixed-effects model.
  
  
  
  The 50 US states and District of Columbia.
  
  
  
  Adult smoking rate in each state from 2011 to 2013.
  
  
  
  The average adult smoking rate decreased significantly from 2011 to 2013 (21.3% [SD: 3.5] to 19.3% [SD: 3.5], P = .016). All forms of TCMs varied widely in implementation levels across states. Excise taxes (β = -.812, P = .006) and smoke-free air regulations (β = -.057, P = .008) were significant, negative predictors of adult smoking. Cessation services (β = .015, P = .46) did not have a measurable effect on adult smoking.
  
  
  
  Tobacco control measures with the strongest influence on adult smoking include the state excise tax and state smoke-free air regulations. The lack of robust funding for tobacco cessation services across the majority of US states highlights an important shortfall in current tobacco control policy.
authors.affiliation: Departments of Family Medicine (Mss Mader and Cameron and Dr Morley), Public Health and Preventive Medicine (Ms Cameron and Dr Morley), and Psychiatry (Dr Morley), SUNY Upstate Medical University, Syracuse, New York; Research Institute, Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois (Dr Lapin); and American Lung Association National Headquarters, Washington, District of Columbia (Mr Carr).
authors.forename: Emily M
authors.initials: EM
authors.lastname: Mader
authors.forename: Brittany
authors.initials: B
authors.lastname: Lapin
authors.forename: Brianna J
authors.initials: BJ
authors.lastname: Cameron
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Carr
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Morley
mesh_terms: D015438:Health Behavior; D006801:Humans; D008137:Longitudinal Studies; D008913:Minority Groups / Q000706:statistics & numerical data; D061845:Smoke-Free Policy; D012907:Smoking / Q000453:epidemiology; D013660:Taxes / Q000706:statistics & numerical data; D019460:Tobacco Industry / Q000706:statistics & numerical data / Q000639:trends; D000073869:Tobacco Smoking / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology; D014026:Nicotiana