The nation should take some lessons from the state of California to help decrease adult smoking. California's aggressive tobacco control intervention program has resulted in a continuing decline in adult smoking, while nationally, the rate of decline has been stable.

"There had been a remarkable decline in the national prevalence of smoking among adults from 1965 to 1990. During that period, the rate of smoking among adults decreased from 42 percent to 26 percent. However, since 1990, this downward trend has slowed or even halted," said Gary A. Giovino, Ph.D., Department of Cancer Prevention, Epidemiology and Biostatistics at Rosewell Park Cancer Institute (RPCI). "Except in California, where the downward trend continued, most likely due to aggressive anti-smoking measures initiated in 1989."

California was the first state to implement a comprehensive tobacco control program funded by an increase in the state cigarette excise tax (Proposition 99).

In California and the remainder of the United States, adult smoking prevalence declined more rapidly between 1985 and 1990 than between 1978 and 1985. After this period of accelerated decline, the rate slowed significantly after 1990, to the point where adult smoking prevalence was stable across the United States between 1990-1994, except in California.

"The observation that adult smoking behaviors only declined in California cannot be explained by changes in age, sex, ethnicity or level of education. One possible explanation is that the extensive tobacco control efforts in California influenced adult behavior," noted Giovino. "As more states extend their efforts against smoking, education and prevention programs must also continue to discourage young people from ever starting to smoke. Additional efforts to protect non-smokers from environmental tobacco smoke are also warranted and effective."