Tobacco use is responsible for 35 percent of cancer deaths, including cancers of the lung, oral cavity, larynx, esophagus, bladder, stomach, pancreas, kidney, uterus, cervix, and liver, as well as heart and other diseases. The tobacco industry develops and implements specific strategies to promote adoption, continuation, and public tolerance of smoking and to counter efforts by public health professionals to reduce tobacco use. In this way, it serves as a """"""""vector"""""""" for the spread of tobacco-induced disease. As with any disease, it is important to understand the vector to develop and implement effective prevention and control strategies. Understanding the tobacco industry's strategies and tactics will increase the likelihood of successful development and implementation of effective tobacco use prevention and control policies and, hence, reduce tobacco-induced disease and death. Public policies, including smoke free environments, aggressive media campaigns, and tax increases, are cost-effective interventions to prevent and reduce tobacco use. There have been major changes in the environment for tobacco control policy making and program implementation in recent years: during the 1990s, state initiatives and settlements of major litigation against the tobacco industry yielded substantial resources for tobacco control programs, which was associated with significant drops in smoking and smoking-induced disease. Despite these successes, during the past few years there has been a reduction in public attention and funding for tobacco control. This project seeks to continue our research strategy of combining case studies and quantitative methods to address four specific aims in this rapidly changing environment: (1) Document and analyze variations in tobacco control policy making and program implementation across a variety of states with varying levels of success at developing and implementing tobacco control programs, to serve as the basis for recommendations to create the most effective and efficient tobacco control strategies and policies;(2) Identify and describe new and evolving tobacco industry strategies for using third party allies to oppose or weaken tobacco control policies;(3) Continue our comparative analysis of the effectiveness of tobacco control strategies in different legal and financial contexts, to identify the most cost-effective strategies;and (4) Investigate the effects of smoke free policies on bar and casino businesses.
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