New Report on Cigarette Smoking in USA

An important new report funded by the Robert Wood Johnson Foundation was released this week by Dr Gary Giovino and colleagues. This report provides details on recent changes in cigarette smoking in every state. It used the best quality data from large national surveys (e.g. the Current Population Survey and the National Health Interview Survey) and so it is the best available guide to cigarette consumption.

Here are some of the main findings:
From 1955 to 2007 U.S. cigarette smoking rates fell from 57% to 22% in men and from 28% to 17% in women, with an overall rate (both sexes) of 20% in 2007.

However, the smoking rates vary considerably by educational status. Around a third of people without a completed high school education smoke, compared with less than 10% of those with at least 16 years of education smoke.

There are also fairly dramatic differences in smoking rates between states. Smoking rates range from lows of 12.4% in Utah, 12.6% in California and 13.7% in New Jersey, up to 25.6% in Oklahoma, 26.2% in West Virginia and 28.2% in Kentucky.

The places with the highest smoking rates also have the highest death rates from smoking. Thus in California the mortality rate per 100,000 is 235, whereas in Kentucky it is 371. In Utah the age-standardized death rate from lung cancer in men is 34/100,000 whereas in Kentucky it is 108/100.000.

This report makes it easy to find out how your own state compares to the rest of the country, on a whole range of measures related to cigarette use. I was very pleased to find that my home state, New Jersey, has the third lowest smoking rate in the country (13.7%)_and the highest proportion of smokers who have quit smoking (62%, compared with 52% nationally and 41% in West Virginia).

Important progress is being made on increasing state and federal cigarette taxes, and broadening smoke-free workplaces (by legislation) and homes (by family choice). However, there are some warning signs. While CDC recommends that 12% of the money received by states from the Master Settlement Agreement should be invested in tobacco control, that figure was only 2.7% in 2007, a drop from 2001-2.

You can view the complete report online at:
www.impacteen.org/tobaccodata.htm

Reference:
Giovino GA et al. Cigarette Smoking Prevalence and Policies in the 50 States: an Era of Change.. The Robert Wood Johnson Foundation Impacteen Tobacco Chart Book. Buffalo, NY. University at Buffalo, State University of New York, 2009.

Labels: cigarette smoking, Gary Giovino, jonathan foulds, prevalence, Robert Wood Johnson Foundation

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Which U.S. states smoke most and least?

The latest data on cigarette smoking prevalence by state was just released in the U.S.
Before I tell you the results, make a guess at what percentage of adults you think are cigarette smokers (a) in your state and (b) in the whole of the US?

The data are from a survey called the Behavioral Risk Factor Surveillance System (BRFSS) which is organized by CDC. It obtains a representative sample of adults in each state, and asks them loads of questions about health-related behaviors.

In 2007 (latest year data is available for), the median state cigarette smoking prevalence was 19.7%, of whom only 14.5% were daily smokers and 5.2% smoke somedays.

The states with the lowest smoking rates were Utah (11.7), California (14.3), Massachusetts (16.4), Minnesota (16.5), Washington (16.8), Oregon (16.9), Rhode Island (17), Hawaii (17) and my home state of New Jersey (17.1).

At the other end, the states with the highest smoking rates are: Kentucky (28.2), West Virginia (26.9), Oklahoma (25.8), Missouri (24.5), and Tennessee (24.3).

I find that most people overestimate the proportion of people who smoke, often by a large amount. How did you do?

So here in the United States we have some states where smoking is twice as common as in others. The main factors influencing this are the strength of tobacco control policies such as excise taxes, clean indoor air legislation, media campaigns and smoking cessation services. Utah is a bit of an outlier in that the smoking prevalence there is largely determined by the high proportion of people following the Mormon religion.

Clearly an individual smoker’s ability to quit, or the chances that your kids might start smoking is highly influenced by the environment in which we live. If you live in Kentucky, almost one in three people smoke, cigarettes are cheap, and there are few services to help smokers quit. In California only one in ten people are daily smokers, you are not allowed to smoke in any indoor public place, and there have consistent media campaigns warning about the health effects of smoking. These differences have a massive impact on the health profiles in these states, such that people living their life in Kentucky are more likely to die of lung cancer than people in California.

So if you want a healthy life for you and your kids, either advocate for tobacco control policies in your state, or move to a state that already has them.

Data on the 2007 BRFSS can be found and searched at:
http://apps.nccd.cdc.gov/brfss/display.asp?cat=TU&yr=2007&qkey=4394&state=UB

Labels: cigarette smoking, jonathan foulds, prevalence, United States

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State-specific prevalence of cigarette smoking.

In previous posts I’ve discussed international differences in tobacco use, which showed that by international standards, male cigarette smoking prevalence is relatively low in the United States, but female smoking prevalence is higher in the US than most other parts of the world. The clearest contrast is with a countries like China, where almost two-thirds of men smoke, but only a few percent of women smoke.

On Friday (Sept 28th, 2007) the US Centers for Disease Control published the latest (2006) figures for adult cigarette smoking prevalence within each U.S. state. The median prevalence was 20.2%, but consistent with recent years, there were some large between-state differences. The highest smoking rates were in tobacco-growing states such as Kentucky (28.6%), or West Virginia (25.7%). The lowest smoking rates were in places with strong cultural prohibitions against tobacco such as Utah (9.8%) and California (14.9%).

Overall, the median smoking rates were higher for men (22.2%) than for women (18.5%). Although it is probably unwise to make too much of single-year prevalence estimates for relatively small geographic regions, such as individual states, I like to look at these to see if anything potentially interesting pops out. The California figures are always of interest as a guide to how low we can go in the rest of the United States. Although the low smoking rates in California are partly related to the high number of non-smoking immigrants to that state, they are largely due to California’s comprehensive tobacco control program that was the first to be reasonably well funded, to increase cigarette taxes, and to pass legislation requiring smoke-free indoor public places. The California program also used a hard hitting media campaign to publicize the harmfulness of tobacco smoke (including to non-smokers), and to encourage smokers to try to quit.

Kentucky provides us with a good example of what happens in a state where the tobacco industry dominates the political agenda – you get very weak tobacco control and very high smoking rates. One thing that stood out was the low smoking rate in Idaho (16.8%). I must say I have no idea why Idaho’s smoking rates are so low, but would be grateful if someone could tell me! The other odd thing I noticed was that despite the fact that men generally smoke more than women, in two states that wasn’t the case. In West Virginia 25.4% of men smoke cigarettes and 26% of women smoke them, and in Montana 18.5% of men smoke as do 19.6% of women. The very high female smoking rate in W.V. may just be a blip in the data, (?) but the Montana difference looks to be related to unusually low male smoking rates in that state. The only other part of the world where the proportion of men who smoke is consistently lower than women is Sweden, and in that case it is because many men have switched from smoking to snuff (smokeless) tobacco. If anyone out there has an explanation for the male/female smoking pattern in Montana and West Virginia I’d be interested to hear it.

If you would like to find out the latest figures for your own state, check them out via this link: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5638a2.htm

Labels: cigarette, cigarette smoking, prevalence

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