Many tobacco control advocates around the world regard California as one of the world’s most successful pioneers in some aspects of tobacco control. It is easy to admire tobacco control programmes that may cost the equivalent of the entire health budget of many a small, less affluent country; and the US west coast super-state has also had its share of setbacks from recalcitrant politicians taking the easy way out to gain popularity with taxpayers. What really counts is the long term change in society’s attitudes to tobacco control, and whether people back progressive programmes to the extent that they are willing to pay for them. Recent research in California appears to have confirmed the state’s success in winning the battle for the hearts and minds, as well as the lungs, of its population.

A state wide survey by San Jose State University has shown that Californians with health insurance overwhelmingly support the inclusion of smoking cessation treatment in standard health insurance coverage. Seventy one per cent believed medications and programmes to help smokers quit should be part of standard health benefits, and 72% agreed that employers should offer employees insurance that includes coverage for stop-smoking benefits. Despite evidence that shows stop-smoking medications and counselling programmes can double the success of smokers trying to quit, coverage for such comprehensive services varies widely among health insurance products. Yet smoking related medical costs account for almost 12% of all health care expenses in California, where the direct medical costs of smoking are more than $8.6 billion annually.

Perhaps most interestingly, when asked whether they thought the cost of smoking was so great that it was worth paying a little more for health insurance to cover smoking cessation benefits, 61% agreed. In other words, a majority of insured Californians, including smokers and non-smokers, are willing to pay slightly higher health premiums to include stop-smoking medicines and programmes in standard health benefits. As Traci Verardo, executive director of the Next Generation California Tobacco Control Alliance put it: “Californians want to take the next step and give smokers access to resources to quit successfully. It is a real testament that even in this difficult healthcare marketplace, insured Californians—even non-smokers—are willing to make an additional investment to reduce the impact of smoking in our state.”