The Effects of Arkansas Master Settlement Spending on Disparities in Smoking

Abstract

Objectives. We assessed the effect of Master Settlement Agreement (MSA) spending on smoking disparities in Arkansas, which distinguished itself from other states by investing all of its MSA funds in health-related programs. Methods. In 1996–2009 data from the Behavioral Risk Factor Surveillance System, we specified multivariate logistic models to examine gender and racial/ethnic disparities in smoking rates within Arkansas (a pre–post analysis) and between Arkansas and its 6 neighboring states. Results. Before the MSA programs started in 2001, male Arkansans smoked more than did female Arkansans (P < .05). After the programs, smoking declined significantly among men (but not women), eliminating the gender disparity by 2009. Smoking among men in Arkansas also declined more than it did in neighboring states (P < .05). Hispanics showed a greater decline in smoking than did non-Hispanic Whites in Arkansas (but not in neighboring states). In 2001, Hispanic Arkansans smoked more than did non-Hispanic Whites (P < .05); by 2009, Hispanic Arkansans smoked significantly less than did non-Hispanic Whites (P < .05). Conclusions. MSA-funded programs were more effective in some segments of the Arkansas population than in others. Policymakers should consider targeting future MSA tobacco control programs to populations most resistant to change.

One Size Fits All? Disentangling the Effects of Tobacco Taxes, Laws, and Control Spending on Adult Subgroups in the United States

“…It is the largest telephone health survey in the world, with more than 350,000 adults interviewed annually. 21 , 22 Our study period covered 15 years (1995–2009). We chose this period because 1995 was the year when the CDC started data collection about SFA laws.…”

“…The BRFSS included 2 questions about cigarette smoking status: “Have you smoked at least 100 cigarettes in your entire life?” and “Do you smoke cigarettes now?” Like previous studies, 21 , 22 we considered individuals to be current smokers if they answered yes to both questions.…”

“…and "Do you smoke cigarettes now?" Like previous studies, 21,22 we considered individuals to be current smokers if they answered yes to both questions.…”

“…Even less is known about how interactions among tobacco control policies may impact smoking among population subgroups. Within the last 15 years, research has shown that statelevel tobacco control policies can have different impacts on subgroups, including those defined by gender, age, socioeconomic status (SES), ethnicity, [17][18][19][20][21] urbanicity, 22 and sexual orientation. 23,24 Although small clusters of studies are beginning to suggest, for example, that low-SES groups are particularly responsive to price, [18][19][20] and that youth and higher-SES and urban groups are particularly responsive to SFA laws, 19,23,25 in general more research is needed to confirm the individual and combined impact of tobacco control policies across and within groups.…”

Evaluation of the Arkansas Tobacco Settlement Program: Progress Through 2011

“…Data are from RAND's analysis of the BRFSS, adjusting for sociodemographic factors. Note: There is a group of "Other non-Hispanic" in the study sample, but the group was too small (<5 percent of Arkansans) to provide interpretable results and is thus omitted from the figure.3 Additional RAND analyses of Arkansas smoking disparities can be found inYu et al (2012).…”