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6/3/99 Best Practices for Comprehensive Tobacco Control Programs--June 1999 Executive Summary Tobacco use is the single most preventable cause of death and disease in our society. Most people begin using tobacco in early adolescence, typically by age 16; almost all first use occurs before high school graduation. Annually, tobacco use causes more than 430,000 deaths and costs the Nation approximately $50-$73 billion in medical expenses alone. Data from California and Massachusetts have shown that implementing comprehensive tobacco control programs produces substantial reductions in tobacco use. The goal of comprehensive tobacco control programs is to reduce disease, disability, and death related to tobacco use by Preventing the initiation of tobacco use among young people. Promoting quitting among young people and adults. Eliminating nonsmokers' exposure to environmental tobacco smoke (ETS). Identifying and eliminating the disparities related to tobacco use and its effects among different population groups. In this guidance document, CDC recommends that States establish tobacco control programs that are comprehensive, sustainable, and accountable. This document draws upon "best practices" determined by evidence-based analyses of comprehensive State tobacco control programs. Evidence supporting the programmatic recommendations in this guidance document are of two types. Recommendations for community programs to reduce the burden of tobacco-related diseases, school programs, cessation programs, enforcement, and counter marketing program elements are based primarily upon published evidence-based practices. Other program categories rely mainly upon the evidence of the efficacy of the large-scale and sustained efforts of two States (California and Massachusetts) that have been funding comprehensive tobacco prevention and control programs using State tobacco excise taxes. Based upon this evidence, specific funding ranges and programmatic recommendations are provided. Based upon the local analysis of each State's priorities, decisions can be made regarding funding allocations for each recommended program component. The funding required for implementing programs will vary depending on state characteristics, such as demographic factors, tobacco use prevalence, and other factors. While the type of supporting evidence for each of the recommended nine program components differs, there is evidence to support the implementation of some level of activity in each program area. In general, States typically have selected a funding level around the middle of the recommended ranges. Current allocations range from $2.50 to over $10; however, no State is currently implementing all of the recommended program components fully. Approximate annual costs to implement all of the recommended program components have been estimated to range from $7 to $20 per capita in smaller States (population under 3 million), $6 to $17 per capita in medium-sized States (population 3 to 7 million), and $5 to $16 per capita in larger States (population over 7 million). The best practices address nine components of comprehensive tobacco control programs: I. Community Programs to Reduce Tobacco Use (Base funding of $850,000-$1,200,000 per year for State personnel and resources; $0.70-$2.00 per capita per year for local governments and organizations). Local community programs address a wide range of prevention activities including engaging youth in developing and implementing tobacco control interventions; developing partnerships with local