Evaluation of the American Stop Smoking Intervention Study (ASSIST): A report of outcomes

Background: The National Cancer Institute funded an 8-year, nonrandomized demonstration project for tobacco prevention and control, the American Stop Smoking Intervention Study (ASSIST). To evaluate ASSIST, we compared changes in adult smoking prevalence, per capita cigarette consumption, and tobacco control policies between the 17 ASSIST states and the 33 non-ASSIST states and the District of Columbia. Methods: The strength of tobacco control index was used to measure state-level program elements directed at tobacco control, and the initial outcomes index (IOI) was used to measure states' tobacco control policy outcomes. Prevalence data were obtained from the Tobacco Use Supplement to the Current Population Survey, and consumption data were obtained from the Tobacco Institute's bimonthly sales figures for cigarette packs moved from wholesale warehouses. Two-stage regression and mixed-effects linear modeling were used to analyze the various outcomes. Statistical analyses for testing individual regression coefficients were one-sided. Results: ASSIST states had a greater decrease in adult smoking prevalence than non-ASSIST states, with an adjusted difference of -0.63% (P =.049). Per capita cigarette consumption was not statistically significantly different between ASSIST and non-ASSIST states. However, an increase in the IOI of a state from the 25(th) to the 75(th) percentile was associated with a reduction in per capita cigarette consumption by 0.57 packs per person per month. State IOI was also inversely, albeit not statistically significantly, associated with smoking prevalence (regression coefficient = -0.11; P =.06). Conclusions: The reduction in adult smoking prevalence associated with ASSIST could have translated into approximately 278 700 fewer smokers nationwide if all states had implemented ASSIST. Investment in building state-level tobacco control capacity and promoting changes in tobacco control policies are effective strategies for reducing tobacco use.