Cancer Causes & Control

, Volume 15, Issue 7, pp 689–695 | Cite as

Association of the California Tobacco Control Program with Declines in Lung Cancer Incidence

  • Joaquin Barnoya
  • Stanton Glantz


Objective: The California tobacco control program enacted in 1988 has been associated with declines in smoking and heart disease mortality. Since smoking also causes lung cancer, we investigated whether the program was associated with a decline in lung and other cancer incidence.

Methods: Age-adjusted incidence rates of lung and bladder cancer (which are caused by smoking) and prostate and brain cancer (which are not) in the San Francisco-Oakland (SFO) Surveillance Epidemiology End Results (SEER) registry and other eight SEER registries from 1975 to 1999 were fitted in multiple regression analyses accounting for the time lag between program implementation and its effects on cancer incidence. Cigarette consumption over time was also analyzed and related to lung cancer incidence.

Results: With a one year lag, the incidence of lung cancer in SFO, relative to eight other SEER registries, fell significantly below that predicted from the pre-1990 rates, by −0.981 (cases/100,000/year)/year (p= 0.001). With a three year lag, the incidence of bladder cancer fell by −0.234 (cases/100,000/year)/year (p= 0.066). No association of the program was observed on prostate or brain cancers in SFO. During the first decade, the Program was associated with about a 6% reduction in lung cancer incidence; state-wide that corresponds to about 11,000 cases avoided.

Conclusion: A comprehensive tobacco control program is associated with a lower incidence of lung cancer.

lung cancer epidemiology tobacco control 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Glantz SA, Balback E (2000) Tobacco War: Inside the California Battles. Berkeley: University of California.Google Scholar
  2. 2.
    Bal DG, Kizer KW, Felten PG, Mozar HN, Niemeyer D (1990) Reducing tobacco consumption in California. Development of a statewide anti-tobacco use campaign. Jama 264(12): 1570–1574.Google Scholar
  3. 3.
    Pierce JP, Gilpin EA, Emery SL, et al. (1998) Has the California tobacco control program reduced smoking? Jama 280(10): 893–899.Google Scholar
  4. 4.
    Lightwood JM, Glantz SA (1997) Short-term economic and health benefits of smoking cessation: myocardial infarction and stroke. Circulation 96(4): 1089–1096.Google Scholar
  5. 5.
    Fichtenberg CM, Glantz SA (2000) Association of the California Tobacco Control Program with declines in cigarette consumption and mortality from heart disease. N Engl J Med 343(24): 1772–1777.Google Scholar
  6. 6.
    Fichtenberg CM, Glantz SA (2001) Controlling tobacco use. N Engl J Med 344: 1798–1799.Google Scholar
  7. 7.
    American Cancer Society (2001) Cancer Facts & Figures 2001. Report. Atlanta, GA: ACS.Google Scholar
  8. 8.
    Thun MJ, Henley SJ, Calle EE (2002) Tobacco use and cancer: an epidemiologic perspective for geneticists. Oncogene 21(48): 7307–7325.Google Scholar
  9. 9.
    Alberg AJ, Samet JM (2003) Epidemiology of Lung Cancer. Chest 123(90010): 21S–S49.Google Scholar
  10. 10.
    Jemal A, Cokkinides VE, Shafey O, Thun MJ (2003) Lung cancer trends in young adults: an early indicator of progress in tobacco control (United States). Cancer Causes Control 14: 579–585.Google Scholar
  11. 11.
    Centers for Disease Control and Prevention (2000) Declines in Lung Cancer Rates–California, 1988-1997. MMWR Weekly Mortality Rep 49(47): 1066–1069.Google Scholar
  12. 12.
    Scott L, Cowling D, Schumacher J, Kwong S, Hoegh H. Tobacco and Cancer in California, 1988–1999 (2003 August) Sacramento, CA: California Department of Health Services, Cancer Surveillance Section.Google Scholar
  13. 13.
    USDHHS. The Health Consequences of Smoking: Cancer. A report of the Surgeon General: U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health; 1982. Report No.: DHHS Publication Number (PHS) 82-50179.Google Scholar
  14. 14.
    Levi F, La Vecchia C (2001) Tobacco smoking and prostate cancer: time for an appraisal. Ann Oncol 12(6): 733–738.Google Scholar
  15. 15.
    Lotufo PA, Lee IM, Ajani UA, Hennekens CH, Manson JE (2000) Cigarette smoking and risk of prostate cancer in the physicians' health study (United States). Int J Cancer 87(1): 141–144.Google Scholar
  16. 16.
    Zheng T, Cantor KP, Zhang Y, Chiu BC, Lynch CF (2001) Risk of brain glioma not associated with cigarette smoking or use of other tobacco products in Iowa. Cancer Epidemiol Biomarkers Prev 10(4): 413–414.Google Scholar
  17. 17.
    Ries L, Eisner M, Kosary C, et al. (2002) SEER Cancer Statistics Review, 1973–1999. Bethesda, MD: National Cancer Institute.Google Scholar
  18. 18.
    Orzechowski and Walker, eds. (2001) The Tax Burden on Tobacco. Arlington, Virginia.Google Scholar
  19. 19.
    Eberhardt M, Ingram D, Makuc D, et al. (2001) Urban and Rural Health Chartbook. Health, United States, 2001. Hyattsville, Maryland: National Center for Health Statistics.Google Scholar
  20. 20.
    Center for Health Statistics (1999) Heart disease deaths, California 1997. Sacramento: California: California Department of Health Services. Report No.: DS99-09001.Google Scholar
  21. 21.
    Aguirre-Molina M, Molina CW, Enid Zambrana R, eds. (2001) Health Issues in the Latino Community. San Francisco: Jossey-Bass.Google Scholar
  22. 22.
    USDHHS. (1990) The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic disease Prevention and Health Promotion, Office on Smoking and Health. Report No.: DHHS Publication No. (CDC) 90–8416.Google Scholar
  23. 23.
    Burns DM (2000) Primary prevention, smoking, and smoking cessation: implications for future trends in lung cancer prevention. Cancer 89(11 Suppl): 2506–2509.Google Scholar
  24. 24.
    Speizer FE, Colditz GA, Hunter DJ, Rosner B, Hennekens C (1999) Prospective study of smoking, antioxidant intake, and lung cancer in middle-aged women (USA). Cancer Causes Control 10(5): 475–482.Google Scholar
  25. 25.
    Ebbert JO, Yang P, Vachon CM, et al. (2003) Lung cancer risk reduction after smoking cessation: observations from a prospective cohort of women. J Clin Oncol 21(5): 921–926.Google Scholar
  26. 26.
    Brown CC, Chu KC (1987) Use of multistage models to infer stage affected by carcinogenic exposure: example of lung cancer and cigarette smoking. J Chronic Dis 40 (Suppl 2): 171S–179S.Google Scholar
  27. 27.
    Rockhill B, Colditz GA (2000) Smoking. In: Colditz GA, ed. Cancer Prevention: The Causes and Prevention of Cancer. The Netherlands: Kluwer Academy Publishers, pp. 3–13.Google Scholar
  28. 28.
    Stratton K, Shetty P, Wallace R, Bondurant S, eds. (2001) Clearing the Smoke. Washington, D.C.: National Academy Press.Google Scholar
  29. 29.
    Lee JS, Lippman SM, Benner SE, et al. (1994) Randomized placebo-controlled trial of isotretinoin in chemoprevention of bronchial squamous metaplasia. J Clin Oncol 12(5): 937–945.Google Scholar
  30. 30.
    Lee JJ, Liu D, Lee JS, et al. (2001) Long-term impact of smoking on lung epithelial proliferation in current and former smokers. JNCI Cancer Spectrum 93(14): 1081–1088.Google Scholar
  31. 31.
    California Department of Health Services. (2002) Fact sheet on adult Smoking prevalence in California. California Department of Health Services. Access Date: March 8, 2003. URL: http:// Scholar
  32. 32.
    Rothman KJ, Greenland S. (1998) Modern Epidemiology, 2nd edn. Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  33. 33.
    Campaign for Tobacco Free Kids, American Lung Association, American Cancer Society, American Heart Association. (2002) Show us the money: A Mid-year update on the states' allocation of the tobacco settlement dollars. National Center for Tobacco Free Kids. July 22, 2002. Access Date: August 4. URL: http:// Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Joaquin Barnoya
    • 1
  • Stanton Glantz
    • 1
  1. 1.Center for Tobacco Control Research and Education, Cardiovascular Research Institute, Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoUSA

Personalised recommendations