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Tobacco control in California compared with the rest of the USA: trends in adult per capita cigarette consumption
  1. John P Pierce1,2,
  2. Yuyan Shi2,
  3. Erik M Hendrickson2,
  4. Martha M White1,
  5. Madison L Noble1,2,
  6. Sheila Kealey1,
  7. David R Strong1,2,
  8. Dennis R Trinidad1,2,
  9. Anne M Hartman3,
  10. Karen Messer1,2
  1. 1 Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
  2. 2 Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA
  3. 3 Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
  1. Correspondence to Dr John P Pierce, Department of Family Medicine and Public Health, University of California, San Diego, CA 92093-0901, USA; jppierce{at}


Background In the 1990s, California led the USA in state-level tobacco control strategies. However, after 2000, California lost ground on cigarette taxes, although it maintained higher levels of smoke-free homes among smokers.

Methods Trends in per capita cigarette consumption were assessed through taxed sales data and from self-report in repeated national cross-sectional surveys. Linear regressions identified changes in trends after year 2000 separately for California and the rest of the USA. Using data from each state, a linear regression tested the association between different tobacco control strategies and per capita consumption. Change in self-reported per capita consumption was partitioned into contributions associated with initiation, quitting and reduction in cigarette consumption level.

Results Both taxed cigarette sales and per capita consumption declined rapidly in the USA from 1985 to 2015. Declines were particularly fast in California before 2000 but slowed thereafter. In 2014, per capita consumption in California was 29.4 packs/adult/year, but 90% higher in the rest of the USA. Modelling state-level data, every $1 increase in cigarette taxes reduced consumption by 4.8 (95% CI 2.9 to 6.8) packs/adult/year. Every 5% increase in the proportion of smokers with smoke-free homes reduced consumption by 8.0 (95% CI 7.0 to 8.9) packs/adult/year. The different patterns in California and the rest of the USA are at least partially explained by these two variables. The slow down in per capita consumption in California can be attributed to changes in initiation, quitting and especially smokers reducing their consumption level.

Conclusions Tobacco control strategies need to be continually updated to maintain momentum towards a smoke-free society.

  • cessation
  • surveillance and monitoring
  • public policy
  • denormalization

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  • Contributors JPP and YS conceptualised and designed the study. Under the supervision of KM, EMH and MW carried out analyses. All authors reviewed and revised the manuscript and approved the final manuscript as submitted.

  • Funding This study is supported with funds from the Tobacco-Related Disease Research Program (23RT-0016, 24RT-0036, and 24ST-0050).

  • Disclaimer The study was reviewed and approved by the University of California, San Diego Human Research Protections Program. The views expressed here are those of the authors only and do not represent any official position of the National Cancer Institute orNational Institutes of Health.

  • Competing interests None declared.

  • Ethics approval University of California, San Diego Human Research Protections Program.

  • Provenance and peer review Not commissioned; externally peer reviewed.