Departments of Family Medicine (Dr Morley and Ms Pratte), Public Health and Preventive Medicine (Dr Morley), and Psychiatry (Dr Morley), SUNY Upstate Medical University, Syracuse; and Program in Biomedical Sciences, SUNY University at Buffalo, Buffalo (Ms Pratte), New York.
J Public Health Manag Pract. 2013 Nov-Dec;19(6):E20-7. doi: 10.1097/PHH.0b013e31828000de.
A variety of population-level tobacco control measures (TCMs) exist, such as excise taxation, smoking restrictions, cessation program funding, counter-advertising, and restrictions on tobacco marketing. Several factors may contribute to often-suboptimal levels of implementation of TCMs at the state level.
To use the American Lung Association (ALA) grading framework to assess impacts of TCMs and to explore relationships between environmental factors and level of implementation of TCMs as rated by the ALA.
Secondary data analysis of publicly available data, using linear regression to examine relative effects of state TCMs on adult smoking rates and the extent to which environmental factors influence the strength of each TCM in states.
The 50 US states, excluding territories, districts, and possessions.
Cigarette excise taxes, state-level tobacco control expenditures relative to Center for Disease Control and Prevention recommendations, smoking restrictions, and support for smoking cessation by state Medicaid programs.
Adult smoking rate in each state for 2010; strength of TCMs as measured by the ALA.
The ALA smokefree score (β = -.045, P = .005) and tax rate per pack (β = -1.205, P = .019) were significant negative predictors of state adult smoking rates in 2010. Percentage of seats in lower houses of state legislatures held by Republicans was significant in predicting tax per pack (β = -.032, P < .001), and ALA smokefree score was negatively influenced by tobacco revenue as a percentage of state gross product (β = -15.663, P = .039), although this effect was not significant in the presence of covariates. State funding both for TCMs and for cessation coverage was also negatively influenced by tobacco-related economic factors.
Consistent with previous literature, taxation and smoking restrictions have the most immediate statewide impacts on smoking rate. Probusiness/antitax politics and tobacco manufacturing affect level of implementation of these and other effective TCMs.
存在多种控烟措施（TCMs），如消费税、禁烟令、戒烟项目资金、反广告和烟草营销限制。有几个因素可能导致州一级 TCM 的实施水平往往不太理想。
使用美国肺脏协会（ALA）评分框架评估 TCM 的影响，并探索环境因素与 ALA 评定的 TCM 实施水平之间的关系。
使用线性回归分析对公开数据进行二次数据分析，以检验州 TCM 对成年吸烟率的相对影响，以及环境因素对各州每种 TCM 强度的影响程度。
美国 50 个州，不包括领土、地区和属地。
香烟消费税、州级相对于疾病控制与预防中心建议的烟草控制支出、禁烟令以及州医疗补助计划对戒烟的支持。
2010 年各州的成年吸烟率；ALA 衡量的 TCM 强度。
ALA 无烟评分（β=-.045，P=.005）和每包香烟的税率（β=-1.205，P=.019）是 2010 年各州成年吸烟率的显著负预测因素。州立法机构下议院中共和党席位的比例在预测每包香烟的税率方面具有统计学意义（β=-.032，P<.001），而 ALA 无烟评分受到州总产品中烟草收入比例的负面影响（β=-15.663，P=.039），尽管在存在协变量的情况下，这种影响并不显著。TCMs 和戒烟覆盖范围的州级资金也受到与烟草相关的经济因素的负面影响。
与之前的文献一致，税收和禁烟令对吸烟率的全州范围内影响最为直接。亲商业/反税政治和烟草制造影响这些和其他有效 TCM 的实施水平。
