Despite more than 30 years of public health programs to reduce tobacco use, smoking is still the leading preventable cause of death in the United States. In response to this continuing epidemic, voters in California (1988), Massachusetts (1992), Arizona (1994), and Oregon (1996) approved ballot initiatives that established statewide tobacco control programs funded by cigarette excise tax revenues. Evaluating these innovative public health interventions is important, both to improve existing programs and to guide other states in developing and implementing similar interventions. In this paper we describe the methods being used to evaluate the statewide anti-tobacco campaigns in California and Massachusetts, and review the findings of process and outcome evaluations of both programs. Our review suggests that both programs have had a substantial impact on the public's health by reducing cigarette consumption and stimulating the development of policies to reduce environmental tobacco smoke exposure. However it does not appear that either program has reduced smoking initiation among adolescents. Our evaluation suggests three problems in program implementation that future anti-tobacco campaigns must avoid in order to produce long-term, sustained effects: (1) the gradual erosion of program funding by the state legislatures and governors; (2) the lack of a consistent, supportive constituency within state government; and (3) inconsistency in campaign themes, messages, and programs. We conclude by offering recommendations to correct these problems so that statewide cigarette-tax-funded anti-tobacco campaigns can realize their potential to become one of the most effective public health interventions available.
