PROJECT SUMMARY Tobacco use remains the nation's leading cause of preventable death. The emergence of e-cigarettes and legalized marijuana use, and the increasing concentration of tobacco use among some racial and ethnic groups, poor people, people with mental illness, and young adults are all changing the environment in which tobacco control efforts take place. High quality state and local tobacco control policies and programs not only prevent tobacco use and disease, but can be an important component of health care cost containment, a key concern at all levels of government and in the private sector. The tobacco industry continues to work to stop or blunt these efforts' effectiveness. All tobacco control programs are not equally effective at reducing smoking and health care costs, making it important to quantify the effects of tobacco control policies and programs. Our research will inform the development and implementation of effective tobacco control policies and programs in this rapidly changing environment through three specific aims: 1. Identify and analyze the new challenges to state and local tobacco control policymaking and program implementation to inform the development of effective responses to these challenges. 2. Identify policy and demographic determinants of smoking initiation, progression and cessation, including smokefree policy coverage and cigarette taxes, as well as variation in these determinants by race/ethnicity and socioeconomic status. 3. Quantify the magnitude and quality of tobacco control program spending across states and the relationship between associated changes in smoking behavior and healthcare expenditures. We will pursue Aim 1 through a series of detailed case studies of the development and effects of state tobacco control policies and programs on tobacco use. For Aim 2 we will merge national datasets, beginning with the National Longitudinal Survey of Youth, with policy data on clean indoor air laws, tobacco taxes, price and demographic variables to develop new models of smoking behavior that will provide a framework for better understanding how these policies affect individual behavior and health disparities. We will pursue Aim 3 using modern econometric methods to quantify the effects of state tobacco control programs, allowing for differences in program effectiveness on smoking behavior and, in turn, the effects of both smoking and tobacco control programs on health care costs. This more sophisticated understanding of what tobacco control policies and programs are most effective, together with understanding the tobacco industry's evolving efforts to block these policies, will help public health professionals develop, implement, and defend effective tobacco control policies and strategies that respond to this changing environment.

PROJECT NARRATIVE (RELEVANCE) Smoking is the leading preventable cause of death, accounting for 1/3 of all cancer deaths and 540,000 deaths annually. Reducing this burden requires understanding the health impact (including on associated healthcare costs) of different tobacco control programs and policies as well as how the tobacco industry works to block these efforts and maintain a favorable environment to promote tobacco use. This research will inform health authorities on how to use increasingly limited resources most efficiently to prevent tobacco use and promote cessation.