Consequences of Tobacco Control Policies: Intended and Unintended

This dissertation investigates the consequences of tobacco control policies --- both intended and unintended -- with a focus on the understudied policy of state comprehensive tobacco control programs. This is the second study to use national data for the adult population to assess the intended effect of comprehensive tobacco control programs to reduce cigarette smoking. In addition, this is the first study to explore the possibility that comprehensive tobacco control programs may have unintended consequences on other behaviors such as leisure time physical activity and alcohol consumption. In order to fully explore this possibility, this is the first study to test for a causal relationship between cigarette smoking and leisure time physical activity, and analyzes the relationship between cigarette smoking and alcohol consumption.;After reviewing the literature and providing a discussion of comprehensive tobacco control programs, data from the Behavioral Risk Factor Surveillance System 1991-2006 are analyzed along with policy variables (cigarette excise tax, smoke-free air laws and comprehensive tobacco control program expenditures). In order to model for the possibility that it may take time for tobacco control expenditures to change smoking behavior, cumulative versions of the tobacco control expenditure variable are tested in addition to a contemporaneous expenditure variable. Models are evaluated for cigarette smoking (prevalence and average number of daily cigarettes), participation in leisure time physical activity, and alcohol consumption (prevalence and intensity of consumption of alcoholic drinks and binge drinking).;State comprehensive tobacco control programs and the other tobacco control policies (cigarette excise taxes and smoke-free air laws) examined are found to have their intended effect to reduce cigarette smoking. In addition, unintended effects of these policies are revealed for leisure time physical activity and alcohol consumption. Specifically, tobacco control policies are found to reduce cigarette smoking and there could be a corresponding increase in leisure time physical activity (due to a causal link revealed in this study) and increase in alcohol consumption (due to a potential substitute relationship detected between cigarette smoking and alcohol consumption). This dissertation highlights the importance of addressing multiple substance abuse behaviors simultaneously.