Changes in smoking prevalence among U.S. adults by state and region: Estimates from the Tobacco Use Supplement to the Current Population Survey, 1992-2007.

Ahmedin Jemal,Anne M Hartman,Melissa M Center,Michael Thun,Hana Ross,Vilma Cokkinides,Elizabeth M Ward,Xue Q Yu

doi:10.1186/1471-2458-11-512

Abstract

BackgroundTobacco control policies at the state level have been a critical impetus for reduction in smoking prevalence. We examine the association between recent changes in smoking prevalence and state-specific tobacco control policies and activities in the entire U.S.MethodsWe analyzed the 1992-93, 1998-99, and 2006-07 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) by state and two indices of state tobacco control policies or activities [initial outcome index (IOI) and the strength of tobacco control (SOTC) index] measured in 1998-1999. The IOI reflects cigarette excise taxes and indoor air legislation, whereas the SOTC reflects tobacco control program resources and capacity. Pearson Correlation coefficient between the proportionate change in smoking prevalence from 1992-93 to 2006-07 and indices of tobacco control activities or programs was the main outcome measure.ResultsSmoking prevalence decreased from 1992-93 to 2006-07 in both men and women in all states except Wyoming, where no reduction was observed among men, and only a 6.9% relative reduction among women. The percentage reductions in smoking in men and women respectively were the largest in the West (average decrease of 28.5% and 33.3%) and the smallest in the Midwest (18.6% and 20.3%), although there were notable exceptions to this pattern. The decline in smoking prevalence by state was correlated with the state's IOI in both women and men (r = -0.49, p < 0.001; r = -0.31, p = 0.03; respectively) and with state's SOTC index in women(r = -0.30, p = 0.03 0), but not men (r = -0.21, p = 0.14).ConclusionState level policies on cigarette excise taxes and indoor air legislation correlate strongly with reductions in smoking prevalence since 1992. Strengthening and systematically implementing these policies could greatly accelerate further reductions in smoking.

Highlights

Tobacco control policies at the state level have been a critical impetus for reduction in smoking prevalence
Tobacco control policies at the state level have been a major impetus for reductions in smoking prevalence in the United States
We observed that states with higher indices of tobacco control, and measured by cigarette excise taxes, smoke-free work places and legislation (IOI), had larger reductions in smoking prevalence over the 15 years of observation than states with weaker policies

Summary

Introduction

Tobacco control policies at the state level have been a critical impetus for reduction in smoking prevalence. The aim of ASSIST was to demonstrate that the application of statewide tobacco prevention and control programs and policies would reduce cigarette consumption and smoking prevalence. The studies that evaluated ASSIST either did not systematically evaluate the changes in smoking prevalence in relation to state tobacco control policies and programs [3,4,5] or were limited to observations through 1998-99 [6,7]. Several other analyses [8,9,10,11,12,13,14,15] have observed accelerated reductions in per capita consumption and/or smoking prevalence in states or cities that have implemented major increases in cigarette excise taxes and other elements of comprehensive tobacco control programs

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