In November 1992, residents of Massachusetts approved a ballot petition (Question 1) that increased the tax on each pack of cigarettes from $.26 to $.51 beginning January 1, 1993, and requested that the legislature spend the proceeds on tobacco control and health education. The Massachusetts Tobacco Control Program (MTCP), administered by the Massachusetts Department of Public Health (MDPH), was established in response to the approval of the petition. In October 1993, MTCP initiated a statewide mass-media antismoking campaign. In early 1994, the program began funding local boards of health and school health and other youth programs to promote policies to reduce public exposure to environmental tobacco smoke and to restrict youth access to cigarettes. Efforts also included support to health education programs, primary-care providers, and other services to help smokers quit. Through June 1996, MTCP expenditures totaled $116 million, including $43 million for the mass-media campaign. To assess the effects of the excise tax increase and the antismoking campaign on cigarette smoking in Massachusetts, CDC and MDPH analyzed data about the number of packs of cigarettes taxed per capita and the prevalence of cigarette smoking during the period preceding (1990-1992) and following (1993-1996) implementation of the ballot petition. This report summarizes the findings of the assessment and compares trends in cigarette consumption (i.e., purchases) in Massachusetts, in California (where a voter-mandated cigarette tax increase in January 1989 funded a statewide antismoking campaign that began in April 1990, and in the 48 remaining states and the District of Columbia combined. The findings suggest that the number of packs of cigarettes taxed per capita declined substantially in Massachusetts after implementation of the ballot petition.