Background: The decade long California Tobacco Control Program is unique to the nation in its duration, emphasis, and level of funding. Programme emphasis is on changing social norms about smoking as a means to discourage smoking and thus reduce the harmful health effects of tobacco to the population. Methods: Data from the 1992 - 93, 1995 - 96, and 1998 - 99 Tobacco Use Supplements to the national Current Population Survey (n> 175 000 each period) were used to examine changes in norms regarding where smoking should "not be allowed at all'' in both California and in the rest of the USA. Venues queried were restaurants, hospitals, work areas, bars, indoor sports venues, and indoor shopping malls. Results: There were substantial increases in the percentages of the adult population (18+ years) stating that smoking should not be allowed in the venues queried in California by 1998 - 99 compared to 1992 - 93; only modest increases were observed in the rest of the USA. In fact, for most venues, the percentages for the rest of the USA were lower in 1998 - 99 than in California in 1992 - 93. Further, the percentage increase over this period in respondents stating that smoking should not be allowed in four or more of the six venues was 30% in California and 23% in the rest of the USA. The most dramatic percentage increase in California occurred among current smokers (93%). Conclusions: A strong, comprehensive tobacco control programme such as California's can influence population norms, including those of smokers, with respect to where smoking should not be allowed.

Objective: Recently, the tobacco industry has focused marketing efforts on young adults through bar and club promotions, such as advertising and distribution of free cigarettes in these settings. This study estimates the fraction of the California young adult population that might be exposed and potentially influenced by these efforts. Design and participants: Data were from 9364 young adult ( 18-29 years) respondents to the cross sectional population based 2002 California Tobacco Survey. As background, we analysed social smoking ( only smoke with other smokers), and enjoyment of smoking while drinking. Our main focus was on bar and club attendance, what was observed in bars and clubs, and how this might differ according to respondents' risk for future smoking. Results: Social smokers comprised 30.0 ( 2.2)% of all current smokers, including experimenters. Nearly three quarters ( 74.5 ( 2.3)%) of current smokers/experimenters said they enjoyed smoking while drinking. About one third ( 33.8 ( 1.2)%) of all young adults said they attended bars and clubs at least sometimes; attendance was significantly higher among smokers and those at risk for future smoking. Close to 60% ( 57.9 ( 2.2)%) of bar and club attenders reported seeing cigarette advertising and promotions in these settings. Again, smokers and those at risk were more likely to report seeing such advertising and promotions in these settings. Conclusions: About 20% of all young adults and about 30% of those at risk for future smoking ( including current smokers) were exposed to tobacco advertising and promotions in bars and clubs. These California results may be conservative, but nonetheless indicate that the group potentially influenced is sizable.

Objective: California's comprehensive tobacco control programme was 13 years old in 2002; by then, children entering adolescence at the start of the programme were young adults. This study examines whether adolescent smoking declined over this period, whether any decline carried through to young adulthood, and whether it was specific to California. Setting and participants: Most data were from the 1990-2002 California Tobacco Surveys ( CTS) ( adolescents 12-17 years,. 5000/survey, young adults 18-24 years,. 1000/survey). Additional data were from the national 1992/93-2001/02 Current Population Survey ( CPS) ( young adults 18-24 years,. 15000/survey). Results: Over the 13 year period in California, ever puffing declined by 70% in 12-13 year olds, by 53% in 14-15 year olds from 1992-2002, and by 34% in 16-17 year olds from 1996-2002 ( CTS). As noted, the decline commenced progressively later in each older group. Smoking experimentation ( 1+ cigarettes) and established smoking (. 100 cigarettes in lifetime) showed similar patterns. Compared to 1990, the percentage of California young adults ( CTS data) who ever experimented declined by 14%, with half of the decline from 1999-2002. CPS young adult smoking prevalence ( established and now smoke everyday or some days) was constant in the rest of the USA over the entire period, but California showed a recent 18% decline from 1998/99 to 2001/02. Conclusions: California's comprehensive programme may have kept new adolescent cohorts from experimenting with cigarettes. Low young adolescent experimentation rates at programme start appeared to carry through to young adulthood, resulting in a recent drop in young adult smoking prevalence in California not observed in the rest of the USA.

Telephone counseling for smoking cessation has gained popularity as studies demonstrate its efficacy. What comprises a successful program, however, has not yet been detailed in the literature. In this article, an innovative telephone counseling intervention for smoking cessation is described, with attention to the clinical issues of client assessment, motivation, self-efficacy, planning, coping, relapse-sensitive call scheduling, and self-image. Counselor training and supervision, ethical and legal considerations regarding this form of service delivery, and suggestions for future direction are also discussed.