Evolution of a comprehensive tobacco control programme: building system capacity and strategic partnerships-lessons from Massachusetts

Background-Since the passage of a voter approved state referendum in 1992 to establish a 25 cent increase on the excise tax on cigarettes and smokeless tobacco, Massachusetts has received an average of $40 million annually for its tobacco control programme. This funding allowed Massachusetts to expand and develop its tobacco control programme to become one of the most comprehensive in the world. Objectives-The development of the Massachusetts Tobacco Control Program is outlined, focusing on three stages of development: formation, strategic partnership building,and shared leadership. Methods-The development of management structures, programmatic infrastructure, communication and partnership networks, and advisory structures are tracked throughout the three phases. Results-The use of pre-existing public health resources, implementation of a strong training component, a geographical management structure, the creation of public and private partnerships, and the development of a shared leadership model contributed to building consensus and provided the foundation for coordinated approaches to tobacco control. Conclusion-Other states and countries can use lessons learned from Massachusetts about the organisational development of a comprehensive tobacco control programme as they embark upon similar efforts.