ImpacTeen is part of Bridging the Gap: Research Informing Practicefor Healthy Youth Behavior, supported by the Robert Wood JohnsonFoundation and administered by the University of Illinois at Chicago

State-Specific Trends State-Specific Trends in Tobacco Laws, Policies, in Tobacco Laws, Policies, and Behaviors – 1991-2003and Behaviors – 1991-2003

Gary Giovino, Jun Yang, Cindy Tworek, Michael Cummings, Andrew Hyland, Allison Berkowitz, Diane Cookfair; Roswell Park Cancer Inst.

Jamie Chriqui, Joanna King; MayaTech CorporationAnne Hartman, J. Todd Gibson; National Cancer Institute

Frank J. Chaloupka; University of Illinois at Chicago

National Conference on Tobacco OR HealthDecember 10, 2003

• Tobacco prevention and control activities occur at the national, state, local,

and individual levels.

• National: Warning labels, advertising restrictions, smoke-free airlines

• State: Smoke-free air laws; excise tax rate; sales to minor laws; possession, use, & purchase laws

• Local: Smoke-free air ordinances, excise tax rate

• Individual: Smoke-free homes, MD advice to quit, individual behaviors (current smoking, someday smoking)

IntroductionIntroduction

Epidemiologic Model of Tobacco Epidemiologic Model of Tobacco Addiction and ControlAddiction and Control

Agent

VectorHost

Tobacco Products

Tobacco Product Manufacturers;

Other Users

Smoker/Chewer

Incidental Host

EnvironmentFamilial, Cultural,

Political, Economic, Historical, Social,

Media

Involuntary Smoker

Adapted from Orleans & Slade, 1993

• Monitoring patterns of laws, policies, interventions, and use is an important component of public health practice.

• Monitor progress overall and in the context of desired goals and/or theoretical ranges.

IntroductionIntroduction

40.0

60.0

80.0

100.0

120.0

16 20 24 28 32Current Smoking Prevalence

Isch

emic

Hea

rt D

isea

se

Mor

tali

ty (

100,

000)

State-Specific Estimates of Current Smoking Prevalence (1) and Ischemic Heart Disease Mortality (2) among Persons 35 to 64 Years in the United

States, 1998-2000

1. Source: NCI-sponsored Tobacco Use Supplement to the Current Population Survey, 1998-99; 2. Source: NCHS mortality data from CDC Wonder System, 1999-2000.Note: Mortality data were age-adjusted to the 2000 U.S. population.

r2 =0.548

ß =3.929

P <0.001

N = 51

MS

KY

UT

CA

OK

AR

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0

120.0

130.0

140.0

150.0

160.0

22 26 30 34 38 42 46Current Smoking Prevalence

Lu

ng

Can

cer

Mor

tali

ty (

100,

000)

State-specific Estimates of Current/Former Smoking (< 15 Years) (1) and Lung Cancer Mortality (2) among Persons 35 Years or Older in the United

States, 1998-2000

1. Source: NCI-sponsored Tobacco Use Supplement to the Current Population Survey, 1998-99; 2. Source: Mortality data from CDC Wonder System, 1999-2000.Note: Smoking and mortality estimates were age-adjusted to the 2000 U.S. population

r2 =0.520

ß =4.161

P <0.001

N = 51

WV

KY

ME

UT

CA

HI

0

5

10

15

20

25

30

15 20 25 30 35

Percent Current Smokers, >25 years old

Perc

en

t C

urr

en

t S

mo

kers

, 12-

17 y

ears

old

Note: Current smokers were persons who smoked on > 1 day during the previous 30 days

Source: 1999 National Household Survey on Drug Abuse

UTCA

DCFL

SDMT

ND WVKY

Smoking Prevalence Among Youths Aged 12-17 Years Old Smoking Prevalence Among Youths Aged 12-17 Years Old and Adults Aged >26 Years Old in All 50 States and the and Adults Aged >26 Years Old in All 50 States and the

District of Columbia, 1999 NHSDADistrict of Columbia, 1999 NHSDA

r2 =0.409

ß = 0.732

P < 0.001

N = 51

Tobacco ChartbookTobacco Chartbook

• CDC has published State Highlights for 1999, 2001, and 2002 (http://

www.cdc.gov/tobacco/ntcp_exchange/links.htm.

• NCI has published Monographs that provide useful information.

• ImpacTeen (RWJF) and NCI will publish an electronic and printed chartbook. See http://www.impacteen.org/tobaccodata.htm for much of data in this presentation (TUS-CPS data to be added).

• NCI sponsored a Tobacco Use Supplement to the Current Population Survey (TUS-CPS) to evaluate ASSIST. Surveys conducted in 1992-93, 1995-96, & 1998-99. NCI and CDC co-sponsored the TUS-CPS in 2001-02.

• State estimates based on sample sizes of 2,100 – 21,800.

• NCI TUS-CPS surveys for 1992-1999 are public use data available on 2 CDs (from Census Bureau) (2001-02 data available shortly). Limited access to preliminary 2001-02 data for this presentation was granted based on collaborative Chartbook/Public Website Project with NCI.

Tobacco Use Supplements to the Tobacco Use Supplements to the Current Population Survey (TUS-CPS)Current Population Survey (TUS-CPS)

http://riskfactor.cancer.gov/studies/tus-cps/

• TUS-CPS is a household survey; civilian, non-institutionalized population ages 15 years and older (18+ here).

• National and state-specific estimates -- mostly self-reports (about 20% proxy - for measures of use).

Tobacco Use Supplements to the Tobacco Use Supplements to the Current Population Survey (TUS-CPS)Current Population Survey (TUS-CPS)

http://riskfactor.cancer.gov/studies/tus-cps/

Trends in Cigarette Smoking Among Adults by Age – United States, Utah, and Kentucky;

1992/93 to 2001/02

8

13

18

23

28

33

38

1992/93 1995/96 1998/99 2001/02

YEAR

PE

RC

EN

T

US: 25+

US: 18-2424.0%

22.6% 23.1%

20.1%

UT: 18-24

17.5%

12.1%14.5%

11.7

UT: 25+

Source: NCI Tobacco Use Supplement to the Current Population Survey Series. In 2001-02, CDC joined NCI in co-sponsoring the Supplement.

KY: 18-24

KY: 25+

32.1%30.8%

34.2%

26.0%

Prevalence of Cigarette Prevalence of Cigarette Smoking, ages 25+ years Smoking, ages 25+ years (CPS(CPS) )

92/93 (%) 01/02 (%) % Change

National 24.0 20.1 - 16.6

Low States Utah 17.5 12.1

- 30.5 California 19.3 14.6

- 24.3 Mass. 21.4 15.5 - 27.7

High StatesKentucky 32.2 26.0 - 19.0 Tennessee

29.1 25.6 - 12.0 Oklahoma 27.025.4 - 5.9

Prevalence of Cigarette Prevalence of Cigarette Smoking, ages 18-24 years Smoking, ages 18-24 years (CPS(CPS) ) 92/93 (%) 01/02 (%) % Change

National 22.6 23.1 + 2.3

Low States Utah 14.5 11.7

- 19.8 California 17.0 14.2

- 16.0 D.C. 18.9 15.8 - 16.5

High StatesKentucky 30.8 34.2 +11.0 Indiana

29.2 32.6 +11.3 Vermont 26.932.2 +19.7

Trends in Someday Smoking* Among Current Smokers, by Age – United States, California, and

West Virginia; 1992/93 to 2001/02

5

10

15

20

25

30

35

40

45

1992/93 1995/96 1998/99 2001/02

YEAR

PE

RC

EN

T

US: 25+ yrs

US: 18-24 yrs

17.1%

22.0%23.5%

18.8%

Source: NCI Tobacco Use Supplement to the Current Population Survey Series. In 2001-02, CDC joined NCI in co-sponsoring the Supplement. * Someday smokers are persons who smoke, but not on every day.

34.2%

29.7%

22.8%

31.2% CA: 18-24 yrs

CA: 25+ yrs

13.2%11.1%

WV: 18-24 yrs

WV: 25+ yrs

17.1%

11.6%

Percentage of Current Smokers Who Percentage of Current Smokers Who Are Some-Day Smokers, ages 25+ Are Some-Day Smokers, ages 25+ years (CPS)years (CPS)

92/93 (%) 01/02 (%) % Change

National 17.1 18.8 + 9.8

High States California

22.8 29.7 + 30.2 D.C.30.2 28.4 - 6.2 Minnesota17.8 24.4 + 37.6

Low StatesW. Virginia 11.1 11.6 + 4.6N. Hamp. 15.4 12.7 - 17.7Missouri 12.5 12.9 + 2.6

Percentage of Workers with Smoke-Free Work Places, by Age – United States, Utah, and Nevada; 1992/93 to

2001/02

20

30

40

50

60

70

80

90

1992/93 1995/96 1998/99 2001/02

YEAR

PE

RC

EN

T

US: 25+ yrs

US: 18-24 yrs

39.0%

47.4%

63.0%

72.1%

Source: NCI Tobacco Use Supplement to the Current Population Survey Series. In 2001-02 CDC joined NCI in co-sponsoring the Supplement.

UT: 25+ yrs

UT: 18-24 yrs

59.5%

67.0%

78.1%

86.9%

NV: 25+ yrs NV: 18-24 yrs

29.1%

34.3%

51.0%49.4%

Smoke-Free Work Places –Smoke-Free Work Places –ages 25+ years ages 25+ years (CPS)(CPS)

92/93 (%) 01/02 (%) % Change

National 47.4 72.1 + 52.2

High States Utah

67.0 86.9 + 29.7 Mass. 48.2

82.0 + 70.0 Maine 56.4 81.5 + 44.5

Low StatesNevada 34.3 51.0 + 48.7Kentucky 30.4 61.8 +103.4Hawaii 47.2 62.4 + 32.1

0

5

10

15

20

25

30

35

40

45

5019

60

1964

1970

1971

1972

1973

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

YEAR

NU

MB

ER

OF

ST

AT

ES

ExtensiveModerateBasicNominal

Restrictiveness Of State Laws Regulating Smoking In Public Places – U.S., 1960-2003*

Sources: 1989 Surgeon General’s Report, ALA’s SLATI, CDC’s STATE system, MayaTech Corporation, Roswell Park Cancer Institute. Note: Includes the District of Columbia;

* 2003 data are represented for the first three quarters of the year.

Smoke-Free Air Legislation in the 50 States and the District of Columbia -- United States, 1991-2003

Sources: ALA’s SLATI, CDC’s STATE system, the MayaTech Corp., and the Roswell Park Cancer Institute.

0

5

10

15

20

25

30

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

YEAR

NU

MB

ER

OF

ST

AT

ES

Priv WS, restaurants, & bars S-FRestaurants & bars S-FPrivate WS & restaurants S-FPrivate worksites smoke freeRestaurants smoke free2+ sites smoke free1 site smoke free

1415 15

18 19 19 2021

2425 26

27

29

Mean Smoke-Free Air Law Rating in 50 States and Mean Smoke-Free Air Law Rating in 50 States and the District of Columbia, United States, 1991-2003the District of Columbia, United States, 1991-2003

0

3

6

9

12

15

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Year

Sm

oke-

Fre

e A

ir in

dex

(m

ean

)

Note: Smoke-free air index without preemption was used; theoretical range = 0~40

Sources: ALA’s SLATI, CDC’s STATE system, the MayaTech Corporation, and the Roswell Park Cancer Institute.

Mean Smoke-Free Air Law Rating in 50 States and Mean Smoke-Free Air Law Rating in 50 States and the District of Columbia, United States, 1991-2003the District of Columbia, United States, 1991-2003

-2147

1013161922252831343740

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Year

Sm

oke-

Fre

e A

ir in

dex

(m

ean

)

Note: Smoke-free air index without preemption was used; theoretical range = 0~40

Sources: ALA’s SLATI, CDC’s STATE system, the MayaTech Corporation, and the Roswell Park Cancer Institute.

6

9

12

15

18

21

24

-25 -15 -5 5 15 25 35 45 55

Smoke-Free Air Law Rating

Per

cen

t P

ast

Mo

nth

Sm

oke

rs

(Ad

ole

scen

ts)

KY

NC

ND

NV

CA UT

r2 = 0.151

ß = -0.076

P = 0.005

N = 51

Cigarette Smoking Among Youth by the Smoke-Free Air Law Rating in 50 States and the District of Columbia, 1999/2000

Sources: 1999/2000 NHSDA (12-17 year olds); ALA’s SLATI, CDC’s STATE system, the MayaTech Corporation, and the Roswell Park Cancer Institute.

Note: 1. Past Month Smoking = smoked on > 1 day in the previous 30 days; 2. Smoke-Free Air law rating for youth in 1999 was used.

MD

DC

NM

10

13

16

19

22

25

28

-20 -15 -10 -5 0 5 10 15 20 25 30 35

Smoke-Free Air Law Rating

Cu

rren

t S

mo

kin

g P

reva

len

ce

(Ad

ult

s)

TN

NC

KY

SD

CA

UT

r2 = 0.251

ß = -0.167

P < 0.001

N = 51

Cigarette Smoking Among Adults Aged 25 Years and above by the Smoke-Free Air Law Rating in 50 States and the District of

Columbia, 2001/2002

Sources: 2001/2002 TUS-CPS (25 years or older); ALA’s SLATI, CDC’s STATE system, MayaTech, and the Roswell Park Cancer Institute.

Note: Smoke-Free Air law rating for adults in 2001 was used.

MD

MA

NM

Prevalence of Smoke-Free Homes, by Age – United States, Utah, and Kentucky;

1992/93 to 2001/02

20

30

40

50

60

70

80

90

1992/93 1995/96 1998/99 2001/02

YEAR

PE

RC

EN

T

US: 25+

US: 18-24

43%

65.1%

67.5%

Source: NCI Tobacco Use Supplement to the Current Population Survey Series. In 2001-02, CDC joined NCI in co-sponsoring the Supplement.

68.7%

77.7%

85.8%88.4%

UT: 18-24

UT: 25+

KY: 25+ yrs

KY: 18-24 yrs

51.6%

45.0%

24%

Smoke-Free Homes –Smoke-Free Homes –ages 25+ years (CPS)ages 25+ years (CPS)

92/93 (%) 01/02 (%) % Change

National 43.1 67.5 + 56.7

High States Utah

68.7 85.8 + 24.8 California 59.2

79.4 + 34.2 Idaho 51.7 75.8 + 46.6

Low StatesKentucky 24.4 51.6 +111.6Missouri 33.4 57.8 + 73.1N. Carolina 34.3 58.3 + 69.9

Percent of Smokers who Received Advice to Quit from a Physician During the Previous Year – United States,

Hawaii, and Texas, 1992/93 to 2001/02

30

35

40

45

50

55

60

65

70

75

80

1992/93 1995/96 1998/99 2001/02

YEAR

PE

RC

EN

T

US: 25+ yrs

US: 18-24 yrs

51.5%

41.1%

63.0%

52.7%

Source: NCI Tobacco Use Supplement to the Current Population Survey Series. In 2001-02, CDC joined NCI in co-sponsoring the Supplement. Note: Percentages are among current smokers who had visited a physician during the previous year. Estimates for 18-24 year old smokers in Hawaii were not reliable and thus are not presented.

HI 25+ yrs

TX: 25+ yrs

TX: 18-24 yrs

54.6%

46.0%46.2%

33.5%

58.5%

75.7%

Receipt of Stop-Smoking Advice from a Receipt of Stop-Smoking Advice from a Physician During Previous Year – ages Physician During Previous Year – ages

25+ years (CPS)25+ years (CPS)

92/93 (%) 01/02 (%) % Change

National 51.5 63.0 + 22.2

High States Hawaii

58.5 75.7 + 29.5 Maine 54.6 72.3 + 32.5 R. Island 58.4 71.8 + 23.0

Low States Texas 46.2 54.6 + 18.1Arkansas 43.0 55.6 + 29.3Nebraska 41.3 55.9 + 35.2Note: Percentages are among current smokers who had visited a physician during the previous year

Cigarette Taxes as a Percentage Cigarette Taxes as a Percentage of Retail Price (Tax Burden of Retail Price (Tax Burden on Tobacco) on Tobacco)

1991 (%) 2001 (%) % Change

National 25.5 22.5 - 11.8

High States

New York 30.4 34.5 + 13.5

Rhode Island 30.9 32.7 + 5.8

Hawaii 18.5 32.5 + 75.9

Low States

North Carolina 16.7 13.6 - 18.3

Kentucky 17.4 13.2 - 24.5

Virginia 14.8 12.7 - 14.4

20.030.040.050.060.070.080.090.0

100.0110.0120.0130.0140.0150.0

270 290 310 330 350 370 390 410 430 450Average Price of a Pack of Cigarettes (Cents)

Tot

al T

ax f

or a

Pac

k o

f C

igar

ette

s (C

ents

)

Total Tax for a Pack of Cigarettes (1) and Average Price of a Pack of Cigarettes (2) in the United States, 2001

Note: Tax and price of cigarettes were adjusted for inflation; Price of cigarettes included generic cigarettes.

r2 = 0.942

ß = 0.723

P < 0.001

N = 51

NY

KY

CA

VA

HI AK

Cigarette Taxes and Prices, 1970-2003

$0.00

$0.50

$1.00

$1.50

$2.00

$2.50

$3.00

$3.50

1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

State Tax Federal Tax Net of Tax Price

Tax as Percentage of Price, 1970-2003

20%

25%

30%

35%

40%

45%

50%

1970 1974 1978 1982 1986 1990 1994 1998 2002

Year

Tax as Percentage of Price

5

10

15

20

25

250 290 330 370 410 450

Average Price of a Pack of Cigarettes (in cents)

Pe

rce

nt

Pa

st

Mo

nth

Sm

ok

ers

(A

do

les

ce

nts

)

AK

HINY

CAUT

ND

KY

r2 = 0.148

ß = -0.027

P = 0.005

N = 51

Cigarette Smoking Among Youth by the Average Price of a Pack of Cigarettes in 50 States and the District of Columbia, 1999/2000

Sources: 1999/2000 NHSDA (12-17 year olds); 1999/2000 Tax Burden On Tobacco.

Note: 1) Past Month Smoking = smoking on > 1 day during the previous 30 days;

2) Price of cigarettes was adjusted for inflation, and it did not include generic

brands of cigarettes.

WV

DC

10

13

16

19

22

25

28

270 300 330 360 390 420 450

Average Price of a Pack of Cigarettes (in cents)

Cu

rre

nt

Sm

ok

ing

Pre

va

len

ce

AK

HINY

CA

UT

KYr2 = 0.219

ß = -0.034

P = 0.001

N = 51

Current Smoking Prevalence among People Aged 25 Years or Older by the Average Price of a Pack of Cigarettes in 50 States and

the District of Columbia, 2001/2002

Sources: 2001/2002 TUS-CPS; 2001 Tax Burden On Tobacco.

Note: 1) Current smoking prevalence was based on crude estimate;

2) Price of cigarettes was adjusted for inflation, and it included generic brands of cigarettes.

MA

TN

0

0.5

1

1.5

2

2.5

3

Year

Pos

sess

ion

, Use

, an

d P

urc

has

e In

dex

(M

ean

)

Mean Number of Possession, Use, and Purchase Laws per State* -- United States, 1988-2003**

Mean Number of Possession, Use, and Purchase Laws per State* -- United States, 1988-2003**

*Includes the District of Columbia; Theoretical Range = 0-3; Includes 1st quarter of 2003 only.

**Sources: ALA’s SLATI, CDC’s STATE system, the MayaTech Corporation, and the Roswell Park Cancer Institute.

0

5

10

15

20

25

0 4 8 12 16 20PUP Legislation Rating

Pe

rce

nt

Pa

st

Mo

nth

Sm

ok

ers

(A

do

les

ce

nts

)

Cigarette Smoking Among Youth in 1999/2000 by the Cigarette Smoking Among Youth in 1999/2000 by the Historical PUP Legislation Rating in 50 States and the Historical PUP Legislation Rating in 50 States and the

District of Columbia from 1995 to 2000*District of Columbia from 1995 to 2000*

Note: Past Month Smoking = smoked on > 1 day during the previous 30 days; Historical PPU Legislation Rating = Sum of PPU laws for previous 1995-2000; (0 = no law; 1 = law present, from 0 to 3 laws)

Sources: Prevalence data from 1999-2000 NHSDA (12-17 year olds); PUP data from ALA’s SLATI, CDC’s STATE system, the MayaTech Corporation, and the Roswell Park Cancer Institute

Sales to Minor Law Strength (Alciati) in 50 States and the District of Columbia, United States 1991-2001

-2

2

6

10

14

18

22

26

30

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Year

Med

ian

Alc

iati

Sco

re

Note: Median scores of Alciati index were used. Theoretical range = 0-30.

Sources: The MayaTech Corporation and the Roswell Park Cancer Institute.

Sales to Minor Law Strength and NHSDA Past Month Cigarette Use Prevalence among 12-17 Years Old--United States, 1995 to 2000

8

12

16

20

24

2 6 10 14 18 22 26 30

Sales to Minor Law Strength

Pas

t M

onth

Cig

aret

te U

se

Pre

vale

nce

r2 = 0.034

ß = -0.093

P = 0.198

N = 51

CA

NY

UT

MD

DC

KY

AZWA

ND

Sources: Past month cigarette use from 1999/2000 NHSDA (12-17 year olds); STM index data from the MayaTech Corporation. Based on Alciati et al. in Tobacco Control, 1998;7:345-352.

Notes: 1. Past Month Smoking = smoking on > 1 day during the previous 30 days; STM Index was averaged from 1995 to 2000.

• Many encouraging prevalence trends – even some slopes in lagging states are

often similar to those in leading states.

• Many state-specific policies also improving.

• Ecologic data presented here are consistent with tobacco control literature: price/tax and smoke-free air laws are generally considered the most effective policies.

• Visit http://www.impacteen.org/tobaccodata.htm.

• Analyses of media and tobacco control expenditures are available from other sources.

ConclusionsConclusions