Download - 2008 AlAbAmA Youth tobAcco SurveYalabamapublichealth.gov/tobacco/assets/AlabamaYTS2008.pdf · cigars, cigarillos, or little cigars (even one or two puffs) in their lifetime. • Female

2008 AlAbAmA Youth tobAcco SurveY

current cigArette SmokerSThe Alabama Youth Tobacco Survey (ALYTS) would not have been possible without the hard work and dedication of a great number of individuals from various organizations. First and foremost, we would like to thank the superintendents, principals, teachers, and students of Alabama public middle and high schools who participated in the 2008 ALYTS. Their participation made this research possible and has made a real contribution to youth tobacco control efforts in Alabama. We would also like to acknowledge the valuable assistance of the Alabama State Department of Education and Office on Smoking and Health, Centers for Disease Control and Prevention (CDC). Finally, we would like to thank the staff at ADPH for their untiring efforts to ensure the success of this project. The following staff members were involved with school recruitment, survey implementation, and review of this report.

Diane Beeson, Tobacco Prevention Branch Director

Tammie Burnette, Tobacco Prevention Coordinator

Laarni Cox, Youth Tobacco Cessation Coordinator

Clarice Davis, Tobacco Prevention Coordinator

Tina Findley, Tobacco Prevention Coordinator

Coretta Grant, Tobacco Prevention Coordinator

Elizabeth Jones, Youth Mini-Grant Coordinator

Corey Kirkland, Tobacco Prevention Coordinator

LaShondra Lewis, Administrative Assistant

Vontrese McGhee, Surveillance and Evaluation Coordinator

Demetra Peoples, Tobacco Prevention Coordinator

Niko Phillips, Tobacco Prevention Coordinator

Sondra Reese, Chronic Disease Epidemiologist

Joy Rhodes-Watkins, Tobacco Prevention Coordinator

Faye Royal, Tobacco Prevention Coordinator

Adrienne Tricksey, Tobacco Prevention Coordinator

AcknowledgementS

The Alabama Youth Tobacco Survey (ALYTS) is conducted by the Tobacco Prevention and Control Branch of the Alabama Department of Public Health (ADPH), through a grant from the Office on Smoking and Health, Centers for Disease Control and Prevention (CDC).

Alabama conducted the first ALYTS in 2000, and continues to administer the survey bi-annually. The ALYTS is a comprehensive survey of tobacco use, access, cessation, knowledge and attitudes, as well as exposure to secondhand smoke among middle school and high school students in Alabama. The ALYTS provides valuable baseline data to guide and evaluate youth prevention efforts and cessation campaigns within Alabama.

The 2008 ALYTS is a representative survey of public high school students in Alabama. The survey was administered to 1,384 high school students (grades 9-12) in 43 schools. The survey sample design is a two-stage cluster design. In the first stage, schools are selected randomly within the grade range specified with a probability proportional to enrollment size. At the second stage, classes are randomly selected from within the selected schools and all of the students within a selected class are surveyed. The school participation rate was 86% and the student participation rate was 83.12%, yielding an overall response rate of 71.49%.

The ALYTS is a voluntary, self-administered questionnaire consisting of 68 questions, which covered student use of various tobacco-related topics including prevalence of tobacco use, access to tobacco products, desire to quit, use of tobacco at school, knowledge and attitudes, media and advertising awareness, exposure to secondhand smoke, cessation, and general student demographics. Survey administration procedures are designed to protect student privacy and allow for anonymous participation.

Data gathered from the ALYTS are utilized to enhance Alabama’s capacity to design, implement, and evaluate the youth component of its Tobacco Prevention and Control Program. Results are used to identify future priority areas and monitor progress toward state plan goals.

introduction And methodS

current cigArette SmokerSUse of Any Form of Tobacco ......................................................... 1

Use of Cigarettes .......................................................................... 2

Use of Smokeless Tobacco ........................................................... 4

Use of Cigars ............................................................................... 6

Use of Bidis and Kreteks .............................................................. 8

Preferred Cigarette Brands .......................................................... 9

Usual Source and Place of Purchase .......................................... 10

Attitudes toward Cessation and Quit Attempts .......................... 11

Social Beliefs about Smoking..................................................... 12

Tobacco Use Discussion with Healthcare Professionals ............. 13

Tobacco Use Discussion with Parents ........................................ 14

School Education ....................................................................... 15

Tobacco Influences in the Media ................................................ 16

Receptiveness to Tobacco Advertising ....................................... 17

Secondhand Smoke ................................................................... 18

tAble oF contentS

Students were asked about their use of different forms of tobacco including cigarettes, smokeless tobacco, cigars, bidis or kreteks, and pipes. Students were considered “ever tobacco users” if they ever tried any tobacco product in their lifetime.

• Cigarettes were the most commonly tried tobacco product among high school students, followed by cigars, smokeless tobacco, and bidis/kreteks.

• In 2008, 59.6% of high students in Alabama have ever tried any form of tobacco. That was a decline from 2006 at 68.4%.

• Male students were more likely than females to have ever tried any form of tobacco (66% and 52.7% respectively) and whites (60.5%) were more likely than blacks (58%).

1 Bidis are small brown cigarettes from India consisting of tobacco wrapped in a leaf tied with thread and kreteks are cigarettes containing tobacco and clove extract.

percent oF high School StudentS who ever uSed tobAcco bY product, 2008

perc

entA

ge

70

60

50

40

30

20

10

0cigarettes Smokeless tobacco cigars bidis or kreteks Any tobacco product

52.3

34.5

22.2

10.2

59.6

uSe oF AnY Form oF tobAcco

percent oF StudentS who ever uSed tobAcco bY gender And rAce, 2008

perc

entA

ge

75

60

45

30

15

0Female male white black

52.7

6660.5 58

1

percent oF StudentS who ever tried cigArette Smoking bY SurveY YeAr

perc

entA

ge

75

60

45

30

15

02004 2006 2008

61.3 61.6

52.3

percent oF StudentS who ever tried cigArette Smoking bY gender And rAce, 2008

perc

entA

ge

75

60

45

30

15

0white Female white male black Female black male

51.655.1

41.5

57.7

current cigArette SmokerS

2

Students were asked whether they had ever tried cigarette smoking (even one or two puffs) in their lifetime.

• Experimentation with cigarettes decreased among high school students from 2004 to 2008.

• Male high school students reported higher rates of experimentation than female high school students.

• Black males had the highest rate of experimentation (57.7%) while black females had the lowest experimentation rate (41.5%).

uSe oF cigAretteS: ever tried cigArette Smoking

2

Students were asked about their use of cigarette during the past 30 days. Students were considered “current smokers” if they reported smoking cigarettes at least once within the past 30 days.

• From 2006 to 2008, the reported rate of current smoking decreased among high school students from 26.8% to 22.1%.

• The reported current smoking rates among Whites were higher than Blacks for both males and females.

• The lowest reported rate of current smoking was 7.2% among black females and the highest is white males at 30.8%.

• In 2008, the reported rate of current smoking was comparable among students in grades 9th through 11th. The rate increased among 12th graders to 26.3%.

• There was a decrease in the current smoking rate among all grades (9th through 12th) from 2006 to 2008.

percent oF StudentS who reported current Smoking bY SurveY uSer

perc

entA

ge

50

40

30

20

10

02004 2006 2008

24.1 26.822.1


percent oF StudentS who reported current Smoking bY gender And rAce, 2008

perc

entA

ge

50

40

30

20

10


23.3

30.8

7.2

20.2


perc

entA

ge

40

30

20

10

09th 10th 11th 12th

26 25 29.5 28.8

20.7 20.8 21.6 26.3

2006

2008

3


4

Students were asked whether they had ever used chewing tobacco, snuff, or dip.

• The rate of experimentation of smokeless has decreased from 2004 (26.8%) to 2008 (22.2%).

• White males (47.1%) were significantly more likely to have tried smokeless tobacco when compared to others.

• Whites (30.5%) experiment with smokeless tobacco at a much higher rate than blacks (8%).

• The prevalence rate among high school students who have experimented with smokeless tobacco decreased from 2006 to 2008 in all grades with the exception of 12th grade.

percent oF StudentS who reported ever uSing SmokeleSS tobAcco bY SurveY YeAr

perc

entA

ge

50

40

30

20

10

02004 2006 2008

26.8 25.122.2

uSe oF SmokeleSS tobAcco: ever uSed SmokeleSS tobAcco

percent oF StudentS who report ever uSing SmokeleSS tobAcco bY gender And rAce, 2008

perc

entA

ge

75

60

45

30

15


13.9

47.1

4.112.2

percent oF StudentS who reported ever uSing SmokeleSS tobAcco bY grAde And SurveY YeAr

perc

entA

ge

40

30

20

10

09th 10th 11th 12th

26.5 24.6 25.7 23.1

20.8 21.3 20.8 27

2006

2008

4

Students were asked about their use of smokeless tobacco during the past 30 days. Students were considered current smokeless tobacco users if they reported using smokeless tobacco at least once within the past 30 days.

• The usage of smokeless tobacco has decreased from 12% in 2004 to 10.9% in 2008.

• The percent of current smokeless tobacco users is significantly greater among white males, with a rate of 26.8%.

• Male students (19.7%) are significantly more likely than female students (2%) to currently use smokeless tobacco.

• There was a decrease in current smokeless tobacco usage among 9th through 11th grade students from 2006 to 2008. However, there was an increase from 8.5% to 11.4% among 12th grade students.

percent oF StudentS who reported current uSe oF SmokeleSS tobAcco bY SurveY YeAr

perc

entA

ge

25

20

15

10

5

02004 2006 2008

12 12.210.9

current uSe oF SmokeleSS tobAcco

percent oF StudentS who reported current uSe oF SmokeleSS tobAcco bY gender And rAce, 2008

perc

entA

ge

50

40

30

20

10


3.1

26.8

0.4 5.9


perc

entA

ge

20

15

10

5

09th 10th 11th 12th

14.8 11.7 12.5 8.5

10.8 11.3 10.5 11.4

2006

2008

5

Students were asked whether they had ever tried cigars, cigarillos, or little cigars (even one or two puffs) in their lifetime.

• Female students had a much lower experimentation rate with cigar smoking than male students.

• Rate of experimentation with cigars has decreased from 41.1% in 2004 to 34.5% in 2008.

• The rate of experimentation is highest among white males and lowest among black females.

• The rate of experimentation decreased among 9th , 10th, and 11th graders, while 12th graders increased their experimentation rate.

percent oF StudentS who reported ever uSing cigArS bY SurveY YeAr

perc

entA

ge

50

40

30

20

10

02004 2006 2008

41.1

36.5 34.5

uSe oF cigArS: ever uSed cigArS

percent oF StudentS who report ever uSing cigArS bY gender And rAce, 2008

perc

entA

ge

50

40

30

20

10


27.7

44.2

25.1

40.7

percent oF StudentS who reported ever uSing cigArS bY grAde And SurveY YeAr

perc

entA

ge

60

45

30

15

09th 10th 11th 12th

35.5 33.3 38.7 39.4

33.4 30.3 32.6 43.4

2006

2008

6

Students were asked about their use of cigars, cigarillos, or little cigars during the past 30 days. Students were considered “current cigar smokers” if they reported smoking cigars at least once within the past 30 days.

• The rate of current cigar use among students remained stable from 2004 to 2008.

• Cigar use among female students (8.4%) is much less than cigar use among male students (21.3%).

• The rate reported among white (21.6%) and black (20.8%) males is comparable.

• Current cigar use decreased from 16.5% in 2006 to 11.8% in 2008 among 11th graders and increased from 12.3% to 17.2% among 12th graders.

percent oF StudentS who reported current uSe oF cigArS bY SurveY YeAr

perc

entA

ge

50

40

30

20

10

02004 2006 2008

17 14.8 15

current uSe oF cigArS

percent oF StudentS who report current uSe oF cigArS bY gender And rAce, 2008

perc

entA

ge

50

40

30

20

10


7

21.6

10.4

20.8

percent oF StudentS who reported current uSe oF cigArS bY grAde And SurveY YeAr

perc

entA

ge

40

30

20

10

09th 10th 11th 12th

16.1 14.1 16.5 12.3

15.7 15.2 11.8 17.2

2006

2008

7

percent oF StudentS who reported ever uSing bidiS or kretekS bY Sex And SurveY YeAr

perc

entA

ge

20

15

10

5

0total Female male

11.1 6.9 5.1

10.2 5.3 14.6

2006

2008

Students were asked whether they had ever tried bidis or kreteks1 (even one or two puffs) in their lifetime.

• The rate of experimentation of bidis or kreteks among male students was nearly three times that of female students.

• In 2008, male students’ experimentation rate was 14.6% compared to female students at 5.3%.

• The experimentation rate among males increased from 5.1% in 2006 to 14.6% in 2008.

uSe oF bidiS or kretekS

8

Students who are current smokers (had smoked a cigarette on at least one of the past 30 days) were asked which brand of cigarettes they usually smoked in the past 30 days. Promotion, advertising, and product placement play an important role in determining which brand students typically smoked.

• Marlboro (50.4%) is listed as the most frequently smoked brand of cigarettes among students.

• Approximately 85% of high school smokers reported that they usually smoke one of the most heavily advertised brands (Camel, Marlboro, or Newport).

• Marlboro was preferred by 63.2% of white smokers and Newport was preferred by 81.6% of black smokers.

preFerred cigArette brAnd oF StudentS who reported Smoking during the pASt thirtY dAYS, 2008

perc

entA

ge

50

40

30

20

10

0no usual camel marlboro newport other

5.1

24.3

911.1

preFerred cigArette brAndS

percent oF StudentS who uSuAllY Smoke mArlboro And newport bY gender And rAce, 2008

perc

entA

ge

100

80

60

40

20


67.2

4.6

14.6

5.1 3

56.9

8.414.8

12.1

3.5 2.84 3.6

83.3

6.3 10.5

1.7 0

78.4

5.9

9

50.4

no usual camel marlboro newport other

Students were asked about their usual source of cigarettes in the past 30 days. Students also were asked about where they purchased their last pack of cigarettes within the past 30 days.

• More than one-half of students (64.6%) who currently smoke obtain their cigarettes from social sources , rather than buying them directly from a store or vendor.

• The most common ways to obtain cigarettes among students who smoke are by giving money to someone else to buy them (31.9%) or by “bumming” them from someone else (23.%); 21.8% of students reported that they usually bought their cigarettes from a store.

• Gas stations and “other” sources are the most common places of purchases for students who currently smoke (52.4% and 23.6% respectively).

2 Social sources include giving money to other people to purchase cigarettes, “bumming” them from someone else, being given cigarettes by an adult, or taking them from a store or family member.

uSuAl Source And plAce oF purchASe

10

uSuAl Source oF cigAretteS during the pASt thirtY dAYS Among underAge current SmokerS, 2008

perc

entA

ge

40

30

20

10

0Store vending

machinegave

money to Someone

to buy

borrowed or “bummed”

given by an Adult

took from store or family

member

Some other way

21.8

1.2

31.9

23.2

6.2 3.3

12.2

plAce oF purchASe oF lASt pAck oF cigAretteS during the pASt 30 dAYS Among underAge current SmokerS, 2008

perc

entA

ge

60

50

40

30

20

10

0gas

Stationconvenience

Storegrocery

Storedrug Store

vending machine

internet other

52.4

3.1 0.9 2.2 3.1

23.6

14.7

Students were asked if they want to quit smoking cigarettes. Students were also asked about their attempts to quit smoking. Students were considered to be current smokers if they reported smoking cigarettes at least once within the past 30 days.

• Approximately one-half of students (54.2%) who currently smoke cigarettes want to quit.

• The rates of current smokers who want to quit are comparable across grades 10th, 11th, and 12th.

• Approximately one-half of students (52.7%) who currently smoke have tried to quit smoking in the past 12 months.

• The rate of students who currently smoke and have tried to quit smoking in the past 12 months is higher among 10th graders (61.8%).

AttitudeS towArd ceSSAtion And Quit AttemptS

11

percent oF StudentS who currentlY Smoke And wAnt to Quit Smoking cigAretteS bY grAde, 2008

perc

entA

ge

80

60

40

20

09th

42

61.7 60.855.5

10th 11th 12th

percent oF StudentS who currentlY Smoke And hAve tried to Quit Smoking cigAretteS At leASt once during the pASt 12 monthS bY grAde, 2008

perc

entA

ge

80

60

40

20

09th

44.861.8

54.951.7

10th 11th 12th

Students were asked to rate a series of statements about the perceived social benefits of smoking. They were asked if they believed that young people who smoke have more friends and if smoking made young people look cool or fit in.

Students were considered to be current smokers if they reported smoking cigarettes at least once within the past 30 days. Students were considered to have never smoked if they have never tried cigarette smoking, even one or two puffs.

• Current smokers (32.7%) are more likely than never smokers (17.7%) to believe that smokers have more friends.

• Current smokers (25.1%) are significantly more likely than never smokers (8.4%) to believe that smoking cigarettes makes young people look cool or fit in.

percent oF StudentS who believe thAt SmokerS hAve more FriendS bY Smoking StAtuS, 2008

perc

entA

ge

50

40

30

20

10

0current Smokers never Smokers total

32.7

17.7

24.3

percent oF StudentS who believe thAt Smoking cigAretteS mAkeS Young people look cool or Fit in bY Smoking StAtuS, 2008

perc

entA

ge

50

40

30

20

10

0current Smokers never Smokers total

25.1

8.4

13.9

SociAl belieFS About Smoking

12

Students were asked whether a doctor, dentist, nurse, or other health professional had asked if they smoked within the past 12 months. Students were also asked whether a doctor, dentist, nurse, or other health professional had advised them not to smoke within the past 12 months.

• Approximately one out of four students was asked by a doctor, dentist, nurse, or other health professional if they smoke.

• 23.1% of students were advised by a doctor, dentist, nurse, or other health professional not to smoke.

tobAcco uSe diScuSSion with heAlthcAre proFeSSionAlS

13

percent oF StudentS who were ASked bY A doctor, dentiSt, nurSe or other heAlth proFeSSionAl iF theY Smoke, 2008

perc

entA

ge

100

80

60

40

20

0Yes no don’t know

26.7

64.2

9.1

percent oF StudentS who were AdviSed bY A doctor, dentiSt, nurSe or other heAlth proFeSSionAl not to Smoke, 2008

perc

entA

ge

100

80

60

40

20


23.1

65.8

11.1

Students were asked if their parents or guardians discussed the dangers of tobacco use with them within the past 12 months. Students were also asked whether their parents knew they smoke cigarettes.

• Approximately six out of ten students reported they have discussed with their parents the dangers of tobacco use.

• There is no significant difference between students who currently smoke (69.5%) and those who have never smoked (59.8%) in the percentage who have discussed the dangers of tobacco with their parents in the past 12 months.

• 10.5% of currents students who report that their parents know they smoke cigarettes.

tobAcco uSe diScuSSion with pAtientS

14

percent oF StudentS who hAve diScuSSed with their pArentS the dAngerS oF tobAcco uSe bY Smoking StAtuS, 2008

perc

entA

ge

100

80

60

40

20

0never Smokers current Smokers total

59.8

69.561.5

percent oF StudentS whoSe pArentS know theY Smoke cigAretteS, 2008

perc

entA

ge

25

20

15

10

5


10.512.5

6.7

percent oF StudentS who were tAught during the current School YeAr About the dAngerS oF tobAcco uSe bY grAde And SurveY YeAr

perc

entA

ge

80

60

40

20

09th 10th 11th 12th

43.8 58.9 33.4 40.6

43.2 56.7 37.9 42.2

2006

2008

Students were asked about the education they received during the current school year regarding the dangers of tobacco use.

• The percentage of students in 9th through 12th grade who report they were taught about the dangers of tobacco use during the current school year has remained constant for the past two survey years.

• Nearly one-half of students (42.8%) report they were taught about the dangers of tobacco use during the current school year.

School educAtion

percent oF StudentS who were tAught during the current School YeAr About the dAngerS oF tobAcco uSe bY gender And rAce, 2008

perc

entA

ge

50

40

30

20

10

0maleFemale white black total

44.341.5 42.2 43.9 42.8

15

Students continue to be exposed to tobacco use and promotions through media outlets although direct advertising of tobacco products to youth is restricted. Students were asked how often they saw actors using tobacco on TV or in movies and how often they saw tobacco ads on the Internet. Students were also asked about their exposure to anti-tobacco messages in the media in the past 30 days.

• There is no significant difference between male (71.4%) and female (75.9%) students in the rates of exposure to anti-tobacco messages in the media.

• There is no significant difference among white (75.5%) and black (71.5%) students in the rates of exposure to anti-tobacco messages.

percent oF StudentS who uSe the internet or go to movieS who See (moSt oF Some oF the time) AdS For tobAcco productS, 2008

perc

entA

ge

100

80

60

40

2

0internet tv/movies total

41.9

85.7 87.4

tobAcco inFluenceS in the mediA

16

percent oF StudentS who were tAught during the current School YeAr About the dAngerS oF tobAcco uSe bY gender And rAce, 2008

perc

entA

ge

100

80

60

40

20


75.9 71.4 75.5 71.5 73.7

Students were asked if they have received or bought items with tobacco company names or logos. Students were also asked if they would ever use or wear something that has a tobacco company name or picture on it such as a lighter, t-shirt, hat, or sunglasses.

• Students who currently use tobacco (36.4%) are significantly more likely than students who have never used tobacco (7.5%) to have bought or received an item with a tobacco company name or logo.

• Students who currently use tobacco (57.6%) are significantly more likely than students who have never used tobacco (13.2%) to ever use or wear anything with a tobacco company name or picture on it.

percent oF StudentS who hAve bought or received AnYthing with A tobAcco compAnY nAme or logo on it bY Smoking StAtuS, 2008

perc

entA

ge

50

40

30

20

10

0never tobacco users current tobacco users total

7.5

36.4

17.7

percent oF StudentS who ever uSe or weAr AnYthing with A tobAcco compAnY nAme or picture on it bY Smoking StAtuS, 2008

perc

entA

ge

100

80

60

40

20

0never tobacco users current tobacco users total

13.2

57.6

31.4

receptiveneSS to tobAcco AdvertiSing

17

Students were asked if they think secondhand smoke is harmful. Sound knowledge of the harmful effects of tobacco may help students in their decision to avoid cigarette smoking.

• Nearly nine out of 10 students believe secondhand smoke is harmful to them.

• Students who have never smoked (90.7%) are more likely than those who currently smoke (83.5%) to believe that secondhand smoke is harmful.

• Female students (74.8%) are more likely than males (62.8%) to believe that secondhand smoke is harmful to them.

• White students (73%) are more likely than blacks (62.2%) to believe that secondhand smoke is harmful.

percent oF StudentS who think SecondhAnd Smoke iS hArmFul bY Smoking StAtuS, 2008

perc

entA

ge

100

80

60

40

20


90.783.5

87.8

SecondhAnd Smoke: hArmFul eFFectS oF SecondhAnd Smoke

18

percent oF StudentS who think SecondhAnd Smoke iS hArmFul bY gender And rAce, 2008

perc

entA

ge

100

80

60

40

20


74.8

62.8

73

62.2

87.8

To assess how many students are being exposed to cigarette smoke at home, students were asked if they live with someone who smokes cigarettes. Students were also asked if they were in the same room with someone who was smoking cigarettes during the past seven days.

• Overall, 42.9% of students live with someone who smokes cigarettes.

• There is no significant difference between white students (44%) and black students (42%) who live with someone who smokes cigarettes.

• Students who currently smoke (87.9%) are significantly more likely than students who have never smoked (44.5%) to have been in the same room with someone smoking cigarettes during the past seven days.

• Approximately six out of 10 students reported being in the same room with someone smoking cigarettes during the past seven days.

percent oF StudentS who were in the SAme with Someone Smoking cigAretteS during the pASt Seven dAYS bY Smoking StAtuS, 2008

perc

entA

ge

100

80

60

40

20


44.5

87.9

59.9

expoSure to SecondhAnd Smoke in the home

19

percent oF StudentS who live with Someone who SmokeS cigAretteS bY gender And rAce, 2008

perc

entA

ge

50

40

30

20

10


44.641.4

4442 42.9

Students were asked if they had ridden in a car with someone who was smoking cigarettes during the past seven days.

• White students (49.8%) were more likely than black students (37.5%) to have been exposed to secondhand smoke in a car.

• The percentage of students who reported recent exposure to secondhand smoke in a car remains relatively stable across genders.

• Current smokers (82.9%) are significantly more likely than students who have never smoked (26.7%) to have ridden in a car with someone who was smoking.

expoSure to SecondhAnd Smoke in the cAr

20

percent oF StudentS who rode in A cAr with Someone who wAS Smoking bY Smoking StAtuS, 2008

perc

entA

ge

100

80

60

40

20


26.7

82.9

45.2

percent oF StudentS who rode in A cAr with Someone who wAS Smoking cigAretteS bY gender And rAce, 2008

perc

entA

ge

50

40

30

20

10


43.347.3 49.8

37.5

45.2

Funding for this project was providedthrough a Cooperative Agreement with the

Centers for Disease Control andPrevention/Office on Smoking and Health

Requests for additional copies should be directed to:Alabama Department of Public Health

Tobacco Prevention and Control ProgramP. O. Box 303017

Montgomery, Alabama 36130-3017(334) 206-2777

Tobacco Prevention and Control BranchBureau of Health Promotion and Chronic Disease

Alabama Department of Public HealthJuly 2009