摘要：Objectives. We sought to determine the impact of comprehensive tobacco control measures in New York City. Methods. In 2002, New York City implemented a tobacco control strategy of (1) increased cigarette excise taxes; (2) legal action that made virtually all work-places, including bars and restaurants, smoke free; (3) increased cessation services, including a large-scale free nicotine-patch program; (4) education; and (5) evaluation. The health department also began annual surveys on a broad array of health measures, including smoking. Results. From 2002 to 2003, smoking prevalence among New York City adults decreased by 11% (from 21.6% to 19.2%, approximately 140000 fewer smokers). Smoking declined among all age groups, race/ethnicities, and education levels; in both genders; among both US-born and foreign-born persons; and in all 5 boroughs. Increased taxation appeared to account for the largest proportion of the decrease; however, between 2002 and 2003 the proportion of cigarettes purchased outside New York City doubled, reducing the effective price increase by a third. Conclusions. Concerted local action can sharply reduce smoking prevalence. However, further progress will require national action, particularly to increase cigarette taxes, reduce cigarette tax evasion, expand education and cessation services, and limit tobacco marketing. Cigarette smoking remains the leading cause of preventable death in the United States. Smoking causes serious illness among an estimated 8.6 million persons, costs $157 billion annually in medical costs and lost productivity, and kills approximately 440000 people each year. 1 , 2 Nationally, adult smoking prevalence has declined rapidly, from 42.4% in 1964, the year the first surgeon general’s report on smoking was issued, to 25.5% in 1990. 3 Since 1990, adult smoking prevalence in the United States has declined more slowly, to 21.7% in 2003. 3 From 1993 to 2001, the proportion of New York City adult residents who smoke remained constant, at approximately 22%. 4 A growing body of evidence documents the effectiveness of public health and clinical interventions in reducing cigarette consumption. 5 – 15 In 2002, New York City initiated a comprehensive tobacco control program and also began to conduct a large-scale, systematic collection of population-based data on smoking and other health-related behaviors.
