Public health experts say California?s success in reducing the staggering public health costs of tobacco use can point the way toward achieving similar results elsewhere.

"This shows tobacco control efforts can and do pay off," says Jane Henley, MSPH, an epidemiologist with the American Cancer Society?s (ACS) department of epidemiology and surveillance research in Atlanta.

In 1988, California voters passed Proposition 99, a comprehensive effort to reduce damage to public health and lower other costs related to tobacco-caused disease. They elected to raise taxes on tobacco and spend a portion of the income gained on a multi-faceted program designed to reduce consumption of tobacco in the state.

The substantial decrease in California lung cancer rates suggest the tobacco control efforts are having an early and dramatic payoff.

Between 1988 and 1997, lung cancer rates in California fell by 14%. This dwarfed the 2.7% reduction seen in five other states and three separate metropolitan areas that are regularly studied as part of the National Cancer Institute?s Surveillance, Epidemiology, and End Results (SEER) survey of diseases and their causes. The study data came from the SEER database and from the California Cancer Registry.

The most dramatic difference between California and the other states was in lung and bronchus cancer rates among women. In California, women?s rates of developing those cancers fell by almost 5%, while in the other areas studied, women?s chances of developing those cancers went up more than 13%.

The report?s authors note that although population-based studies alone cannot prove that all of California?s decline in lung cancer rates is due to the state?s success in tobacco control, the data available suggest it played a primary role in lowering the rates there.

"Cigarette smoking is the leading cause of lung and bronchus cancer," write the CDC scientists. And when large numbers of people quit, lung cancer rates can be seen dropping within five years, they note.

Ten years have passed since Proposition 99?s approval. And, according to the authors "during 1988 ? 1997, per capita [average per person] cigarette smoking in California declined more than twice as rapidly as in the rest of the country," with the drop after 1989 due mainly to the higher taxes Proposition 99 tacked on to the price of cigarettes there.

Those facts, write CDC scientists in an accompanying editorial note, lend strength to the notion that lowered smoking rates in California "are likely responsible for the reduction in lung and bronchus cancer" there in the years since its voters passed Proposition 99.

The CDC report suggests other states could achieve similar health benefits if tobacco use were to become less common. "The results of this report suggest that a comprehensive tobacco prevention and education program may reduce rates of lung and bronchus cancer," concludes the report.

A tobacco control expert with the ACS agrees. "The results from California tobacco control efforts are exactly what you would expect," says Ron Todd, MSEd, director of tobacco control for the ACS. "If states invest sufficient resources and implement comprehensive tobacco control programs, then fewer people will smoke and consequently fewer people will die of smoking related diseases," says Todd. "It''s unfortunate that only a few states have allocated funds from the tobacco settlement that would support efforts on the same scale as those in California."