Tobacco industry marketing, population-based tobacco control, and smoking behavior.

Two of the major influences of cigarette smoking behavior are tobacco industry marketing and public health tobacco-control activities. These vie with each other to influence the proportion of each generation who initiate smoking, the intensity level reached by smokers, and the time before smokers are able to quit successfully. This article provides a brief summary of the evidence associating tobacco marketing practices (organized under the four "Ps" of marketing), with smoking behavior. The evidence for causality in this association is considered convincing. Publicly funded, comprehensive, statewide tobacco-control programs were introduced into the United States in the late 1980s, with money either from tobacco taxes or from legal settlements of states with the tobacco industry. These programs use organized statewide approaches to implement current recommendations on "best practices" to discourage tobacco use, recommendations that have changed over time. During the 1990s, "best practices" evolved to include protection against secondhand smoke, sale of cigarettes to minors, and restrictions on tobacco advertising. Evaluations have been published on four statewide tobacco-control programs (Sydney/Melbourne, California, Massachusetts, and Florida) and a national program aimed at youth (American Legacy Program). For each program, there was a positive association with reduced smoking. The evidence supporting the conclusion that tobacco-control programs reduce smoking behavior is evaluated as strong.