As the Tobacco-Related Disease Research Program approaches its 20th anniversary, there is much to celebrate and, at the same time, there are reasons for concern. Since the passage of Proposition 99, the Tobacco Control Section (TCS), the Tobacco Use Prevention Program (TUPE), and the TRDRP have all worked to create a smoke-free California. The efforts of these three programs, spearheaded by the TCS, to change social norms regarding smoking in California, have led to a dramatic reduction in smoking rates and have set the standard, worldwide, for the creation and implementation of smoking-related policies that safeguard the public’s health.

Since its inception in 1989, TRDRP has awarded 1,260 grants to over 900 investigators at 81 California institutions for a total of over $393 million. These funds have supported a broad research portfolio ranging from studies of molecular cellular processes disrupted by tobacco smoking to studies that evaluate the impact of smoking on California’s burgeoning multiracial and multiethnic populations. Our research efforts have played an important role in crafting tobacco-control efforts, which have resulted in the striking reduction in California’s smoking rate and corresponding decline in the health care costs associated with tobacco-related disease. A recent study found that during the period from 1989 to 2004, an estimated $86 billion in savings on health care expenditures can be attributed to the tobacco control and research efforts in California (1). Indeed, this same study showed that 3.6 billion fewer packs of cigarettes were sold in California between Fiscal years 1989–90 and 2003–04. This represents a loss of $9.2 billion to the tobacco industry in pre-tax cigarette sales (1).

Of course, as anyone who is either familiar with tobacco-related public health issues or the tobacco industry knows, the battle is far from over. For example, while lung cancer mortality rates have declined, it continues to be a leading cause of death in California and the nation. Lung cancer is still the leading cause of cancer death in the U.S. (one in three cancer deaths are attributable to lung cancer), and the majority of people diagnosed with the disease die within a year. Despite these grim statistics, less than 5% of the National Cancer Institute’s budget is devoted to lung cancer. TRDRP has stepped into this breach and has made lung cancer one of its top research priorities.

Another need for expanded research is in the area of tobacco control policy and strategy. The tobacco industry continues to have a significant impact on the political process as demonstrated by its recent involvement in the defeat of CA Prop. 86 (2,3) as well as its role in manipulating federal legislation that would on the one hand give the Food and Drug Administration (FDA) jurisdiction over tobacco products, while at the same time prevent the removal of menthol from those products (see article in this current issue; Menthol Moves Center Stage by P. Gardiner). Since California represents the largest tobacco market in the country, it is unlikely that the industry will willingly reduce its inroads to the state’s political process or voluntarily modify its marketing strategies in a way that would cut into profits. Previous TRDRP-sponsored research has revealed how the industry operates and pointed the way to more effective strategies to counter one of the most profitable and deadly industries in the world (4). In addition, ironically, cigarette sales have been shown to increase during times of economic uncertainty; the tobacco-related product market is therefore considered recession-proof (5). New research is needed to guide tobacco-control efforts and strategy, including assessing the cost-benefit of various tobacco-control efforts, evaluating existing and improved interventions and strategies, and developing new models for social marketing and control efforts in disenfranchised and highly impacted populations within the state.

The Challenging Road Ahead
Despite the current state of fiscal crisis in California and the nation, the challenge remains to invest in effective efforts to prevent and curtail tobacco use in addition to improving detection and treatment of tobacco-related diseases. The Prop. 99-based research, control, and education funds are vital resources needed to have an impact on one of the most significant public health issues in this state, and must be safeguarded to ensure the improved health and well-being of current and future citizens. This makes TRDRP’s mission just as vital and relevant today as it was 20 years ago.

References
1. Lightwood JM, Dinno A, Glantz, SA. “Effect of the California tobacco control program on personal health care expenditures.” Plos Med; vol. 5(8) e178, August 2008.

2. Asotra K. “Proposition 86 in California: ‘Smoked’ and rests in peace for now!” Burning Issues, Vol. 9 No.1, Jan. 2007.

3. Gardiner P. “The Empire Still Standing: The tobacco industry took a few on the chin, but won the prize of the day.” Burning Issues, Vol. 9 No.1, Jan. 2007.

4. Malone R. TRDRP Awards 9RT-0095, Tobacco Industry Targeting African Americans; 11RT-0139, Tobacco industry responses to industry-focused campaigns; 12AT-1701, Protecting the "hood" against tobacco: cessation project and 16RT-0149, Tobacco Industry Targeting of Older Persons. http://www.trdrp.org/fundedresearch/GrantSearch.asp

5. Wardell J. “Recession Proof.” Associated Press as printed in the Washington Times, Wed, August 13, 2008; http://www.washingtontimes.com/news/2008/aug/13/recession-proof/