A successful program is not simply directed at keeping kids from smoking, but protecting nonsmokers from secondhand smoke and creating environments that facilitate smokers' decisions to cut down or quit.

A successful campaign de-legitimizes tobacco use and the tobacco industry. Industry de-normalization is the foundation upon which a successful campaign is based.

When the California program followed these principles, the rate of decline in tobacco consumption tripled and the rate of decline in smoking prevalence increased significantly. When the Wilson Administration toned down and scaled back the program, including shifting the focus to children, the progress slowed or stopped.

The single most important target -- for both the tobacco industry and public health -- is young adults.

The tobacco industry is concentrating marketing efforts on young adults to avoid criticism of targeting children.

Young adults are open to pro-health messages because they are having kids, are concerned about secondhand smoke, and prefer to work in smoke free environments.

Those who quit smoking after only a few years avoid most of the health consequences.

Young adults are the real role models for teens.

Nonsmokers are as important and audience as smokers.

The tobacco industry does not give up.

The more effective the program the more vigorously the tobacco industry and its allies will attack it. They fight to stop tobacco control programs from being enacted and, when that is not possible, seek to subvert those programs by channeling them into unproductive areas, such as concentrating solely on children, the younger the better.

Despite all the political problems, in its first 8 years the California Tobacco Control Program:

• Prevented 2 billion packs of cigarettes (worth $3 billion to the tobacco industry) from being smoked.
• Held teen smoking well below the increases that were occurring nationally.
• Saved lives. Because the risk of heart disease falls rapidly when someone quits smoking, during these eight years Proposition 99 prevented more than 14,000 heart attacks and strokes, including over 2500 lives saved. It prevented over 10,800 low birth weight infants.

The $500 million in medical costs that were avoided from these causes of death alone amounted to more than the anti-smoking media and community programs cost.