If more states introduce tobacco control programs for their residents who are regular smokers, the number of U.S. deaths due to coronary heart disease might drop, finds a new study that looks at an ongoing Massachusetts initiative.

A connection exists between coronary heart disease and cigarette smoking, and the new study determines how a reduction in smoking affected the number of related deaths in Massachusetts between 1993 and 2003. The state introduced its Massachusetts Tobacco Control Program (MTCP) in 1992, which received funding through a special cigarette tax, and the researchers say they expected to find it helped control the rate of smoking.

"California was the first state to have a statewide program like the MTCP and they witnessed substantial declines," said lead author Zubair Kabir, M.D., who at the time of the study was a research fellow at the Harvard School of Public Health. "So it was not surprising that Massachusetts, the second state, would see such declines as well, which reflect the impact of a comprehensive, integrated and at the time well-funded program."

The study appears in the August issue of the American Journal of Public Health.

Kabir and his colleagues examined data from daily smokers ages 25 to 84. They found that between 1993 and 2003, coronary heart disease mortality declined 31 percent from 199 deaths to 137 deaths per 100,000 persons each year. Smoking prevalence declined from 20.5 percent to 14.5 percent

Based on these results, the researchers calculated that 425 fewer coronary heart disease deaths were attributable to decreased smoking during the 10-year period. They concluded that expanding comprehensive tobacco control programs, such as MTCP, to other states could avoid more tobacco-related disease deaths.

Audrey Ferguson, health promotions manager at the American Lung Association of Indiana, agreed with the authors' conclusion.

"The American Lung Association strongly supports comprehensive statewide tobacco control efforts, including increased tobacco taxes and smoke-free workplace legislation," she said. "We recognize that tobacco use does not affect just the lungs or the heart of the tobacco user. Everyone would see health benefits from a comprehensive tobacco control plan."

The MTCP was not immune to roadblocks, however. According to Kabir, budget cuts stalled state funding for the program in 2002, but it is now active again.

Nevertheless, he added that, "Although funding has risen somewhat since 2002, now around $12 million per year, it is nowhere near the levels seen at the height of the program in the late 90s."

The American Journal of Public Health is the monthly journal of the American Public Health Association. Visit apha for more information. Complimentary online access to the journal is available to credentialed members of the media.

Kabir Z, et al. Coronary heart disease deaths and decreased smoking prevalence in Massachusetts, 1993 2003. Am J Public Health 98(8), 2008.

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