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From the Centers for Disease Control and Prevention
January 6, 1999

State-Specific Prevalence Among Adults of Current Cigarette Smoking and Smokeless Tobacco Use and Per Capita Tax-Paid Sales of Cigarettes—United States, 1997

JAMA. 1999;281(1):29-30. doi:10.1001/jama.281.1.29-JWR0106-2-1

MMWR. 1998;47:922-926

2 tables omitted

In the United States each year, tobacco use causes approximately 400,000 deaths and is the single most preventable cause of death and disease.1,2 Consequently, state and local public health agencies closely monitor tobacco use and its correlates.3 In 1996, the prevalence of current cigarette smoking among adults was the first health behavior and the first noninfectious condition added by the Council of State and Territorial Epidemiologists (CSTE) to the list of nationally notifiable conditions reported to CDC.4 In 1998, per capita sales of cigarettes (along with prevalence among youth of current cigarette smoking and current smokeless tobacco use) was added by CSTE to the list of notifiable conditions reported by states to CDC. This report summarizes state-specific findings for current cigarette and current smokeless tobacco use by adults from the Behavioral Risk Factor Surveillance System (BRFSS) and number of packs of tax-paid cigarettes sold per capita in each state from data compiled annually by The Tobacco Institute. The findings indicate that current adult cigarette smoking prevalence by state ranged from 13.7% to 30.8%, annual per capita tax-paid cigarette sales ranged from 49.1 packs to 186.8 packs, and adult smokeless tobacco use prevalence ranged from 1.4% to 8.8%.

State- and sex-specific prevalences of current cigarette smoking and current smokeless tobacco use among adults are available from the 1997 BRFSS. The BRFSS is a state-specific, random-digit-dialed telephone survey of health behaviors of the civilian, noninstitutionalized U.S. population aged ≥18 years5 conducted by state health departments with assistance from CDC. In 1996 and 1997, respondents were asked, "Have you smoked at least 100 cigarettes in your entire life?" and "Do you now smoke cigarettes every day, some days, or not at all?" Current cigarette smokers were defined as persons who reported having smoked at least 100 cigarettes during their lifetime and who currently smoke every day or some days. To determine current smokeless tobacco use, respondents were asked, "Have you ever used or tried any smokeless tobacco products such as chewing tobacco or snuff?" and "Do you currently use any smokeless tobacco products such as chewing tobacco or snuff?" Current smokeless tobacco users were defined as persons who reported having ever used or tried any smokeless tobacco product and who currently use a smokeless tobacco product. To estimate prevalence, responses for each state were weighted to the current age, race, and sex distribution of the state's population (i.e., crude prevalence). To allow comparison of findings across states that had different age distributions, age-adjusted prevalences for each state were estimated by using direct standardization to 10-year age groups of the U.S. population in 1997 derived from U.S. census estimates.6 The number of packs of tax-paid cigarettes sold per capita in each state is compiled yearly by The Tobacco Institute by using information on federal, state, and local excise taxes and total population estimates.7

In 1997, the median state prevalence of current cigarette smoking by adults was 23.2%; prevalence was 25.5% for men and 21.3% for women (Table 1). The crude median prevalence of current cigarette smoking was similar in 1997 and in 1996 (25.5% for men, 22.0% for women, and 23.6% for both groups combined).4 In 1997, for every state except Florida, the crude prevalence of current cigarette smoking was within 1% of the age-adjusted prevalence for that state.

Current adult cigarette smoking prevalence differed approximately twofold across the states. In 1997, the current cigarette smoking prevalence was highest in Kentucky (30.8%), Missouri (28.7%), Arkansas (28.5%), Nevada (27.7%), and West Virginia (27.4%), and lowest in Utah (13.7%), California (18.4%), Hawaii (18.6%), the District of Columbia (18.8%), and Idaho (19.9%). The current cigarette smoking prevalence for men was highest in Kentucky (33.1%), and for women in Nevada (29.8%). For both men and women, current smoking prevalence was lowest in Utah.

Per capita tax-paid sales of cigarettes for July 1, 1996, through June 30, 1997, varied approximately fourfold across the states (Table 1). The state median tax-paid cigarette sales was 90 packs per person per year. Sales were highest in Kentucky (186.8 packs) and lowest in Hawaii (49.1 packs).

Questions about current adult smokeless tobacco use were included in the 1997 BRFSS in 17 states. The difference in prevalence was more than sixfold (from 1.4% in Arizona to 8.8% in West Virginia). Among men, the prevalence of current smokeless tobacco use was highest in West Virginia (18.4%) and Wyoming (14.7%); five states (Alabama, Alaska, Kansas, Kentucky, and Montana) reported prevalences of 9%-12%, and 10 states reported prevalences of ≤8%. For women, the prevalence of current smokeless tobacco use was ≤1.7% in all 17 states.

Reported by the following BRFSS coordinators:

J Cook, Alabama, MBA; P Owen, Alaska; B Bender, MBA, Arizona; J Senner, PhD, Arkansas; B Davis, PhD, California; M Leff, MSPH, Colorado; M Adams, MPH, Connecticut; F Breukelman, Delaware; C Mitchell, District of Columbia; S Hoecherl, Florida; L Martin, MS, Georgia; A Onaka, PhD, Hawaii; J Aydelotte, Idaho; B Steiner, MS, Illinois; K Horvath, Indiana; A Wineski, Iowa; M Perry, Kansas; K Asher, Kentucky; R Jiles, PhD, Louisiana; D Maines, Maine; A Weinstein, MA, Maryland; D Brooks, MPH, Massachusetts; H McGee, MPH, Michigan; N Salem, PhD, Minnesota; D Johnson, Mississippi; T Murayi, PhD, Missouri; P Feigley, PhD, Montana; M Metroka, Nebraska; E DeJan, MPH, Nevada; L Powers, MA, New Hampshire; G Boeselager, MS, New Jersey; W Honey, MPH, New Mexico; T Melnik, DrPH, New York; K Passaro, PhD, North Carolina; J Kaske, MPH, North Dakota; P Pullen, Ohio; N Hann, MPH, Oklahoma; J Grant-Worley, MS, Oregon; L Mann, Pennsylvania; J Hesser, PhD, Rhode Island; T Aldrich, PhD, South Carolina; M Gildemaster, South Dakota; D Ridings, Tennessee; K Condon, Texas; R Giles, Utah; C Roe, MS, Vermont; L Redman, MPH, Virginia; K Wynkoop-Simmons, PhD, Washington; F King, West Virginia; P Imm, MS, Wisconsin; M Futa, MA, Wyoming. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

CDC Editorial Note:

This report includes information about two CSTE-recommended indicators of tobacco use for all states (current cigarette smoking by adults and per capita tax-paid sales of cigarettes) and current smokeless tobacco use among adults for 17 states. Information on cigarette and smokeless tobacco use by youth in 1997 is available elsewhere.8 National surveys provide information about tobacco use and are useful for monitoring overall trends, but their effectiveness is limited for monitoring state-level year-to-year changes in tobacco consumption. National surveys also mask the twofold variation in current adult cigarette smoking prevalence among the states.

In the BRFSS, the crude and age-adjusted prevalences of current adult cigarette smoking were similar, indicating that differences in prevalence among states are related primarily to factors other than differences in adult age distributions. Although the median prevalence for current cigarette smoking among adults was nearly the same in 1996 and 1997, the twofold difference in prevalence among states, the wide variation in per capita tax-paid cigarette sales, and the wide variation in smokeless tobacco prevalence among adults suggest that further reductions in tobacco use are achievable.

The findings in this report are subject to at least three limitations. First, the BRFSS standardizes procedures among states, but the quality and completeness of the surveys can vary by state and year. Second, the changes in questions about current cigarette use in 1996 limit comparisons with previous years.9 Finally, estimates of per capita tax-paid cigarette sales provide populationwide rather than individual-based estimates of behaviors; because these estimates are based on tax revenues they may not accurately estimate actual consumption.10

By monitoring tobacco-related health effects, policy changes, and public attitudes at state and local levels, tobacco-related activities can be evaluated and public health programs can be tailored to local populations. CDC and state health departments are working together to improve state-specific measures of tobacco-related health outcomes, policy interventions, and related activities to improve the prevention and control of tobacco use. In 1999, CDC will provide all states with funding for tobacco-use prevention and control programs. CDC also is collaborating with states that have other sources of funding for activities related to tobacco-use prevention to develop effective public health intervention, surveillance, and evaluation activities.

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