Tobacco Progress Review

1

• Tobacco Progress Review
• May 14, 2003

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Tobacco Impact and Public Health Challenges
Annual Impact
440,000 Premature Deaths
Lung / Other Cancers Chronic Respiratory
Disease Cardiovascular Disease
14 of Medicaid Expenditures Direct and Indirect
Costs 157 Billion
Public Health Challenges
Environmental Tobacco Smoke
Current Smokers
28 of High School Students 11 of Middle
School Students
54 of Nonsmokers Exposed
22 of Adults (46 million adults)
3
Smoking-Attributable Mortality, 1995-1999
Number of average annual deaths
Respiratory disease
Cardiovascular diseases
Perinatal conditions
Burn deaths
Total
Total
Neoplasms
Lung cancer
Ischemic heart disease
Environmental Tobacco Smoke
Sources CDC. Annual Smoking Attributable
Mortality, Years of Potential Life Lost, and
Economic CostsUnited States, 1995-1999. MMWR
2002 51300-3. Burn deaths from Hall JR. The
U.S. smoking-material fire problem. Quincy,
Massachusetts National Fire Protection
Association, Fire Analysis and Research Division,
2001. Environmental tobacco smoke deaths from
National Cancer Institute. Health effects of
exposure to environmental tobacco smoke the
report of the California Environmental Protection
Agency. Smoking and tobacco control monograph 10.
Bethesda, Maryland U.S. Department of Health and
Human Services, National Institutes of Health,
National Cancer Institute, 1999.. Total does not
equal sum due to rounding.
4
3-2. Lung Cancer Death Rates
Age-adjusted death rate per 100,000 standard
population
Black male
Total male
White male
Total population
2010 Target
White female
Total female
Black female
Notes Data are age adjusted to the 2000 standard
population. The race groups white and black may
be of Hispanic or non-Hispanic origin. Source
National Vital Statistics System-Mortality
(NVSS-M), NCHS, CDC.
5
27-1a. Current Cigarette Smoking Adults 18
Years and Older
Age-adjusted percent
Black male
White male
White female
Black female
2010 Target
1975
1965
1975
1995
2001
1985
Notes Data are age adjusted to the 2000 standard
population. Survey redesigned in 1997 and data
for 1998 and subsequent years may not be directly
comparable to earlier years. Source National
Health Interview Survey (NHIS), NCHS, CDC.
6
27-1a. Current Cigarette Smoking for Adults
2010 Target
1998 Baseline
Current Level
Age-adjusted percent
American Indian/ Alaska Native only
16 years or more
Total
Males
9-11 years
Black, not Hispanic only
Females
Hispanic
Asian only
White, not Hispanic only
High school graduate
13-15 years
Education level
Preliminary data January-September 2002,
current data year for other groups is 2001.
Notes Current smokers report smoking
everyday/some days and have smoked at least 100
cigarettes. Data are age adjusted to the 2000
standard population. American Indians/Alaska
Natives or Asians/Pacific Islanders may be of
Hispanic origin. Hispanics may be of any race.
For 1998 and 2002, persons reported only one race
or reported more than one race and identified one
race as best representing their race. Adults 18
years and older.
Source National Health Interview Survey (NHIS),
NCHS, CDC.
7
27-5. Percent of Current Adult Smokers Who
Attempted to Quit in the Past Year, 2001
2010 Target
Age-adjusted percent
American Indian/ Alaska Native only
Asian only
Hispanic
Black, not Hispanic only
White, not Hispanic only
Total
I 95 confidence interval Current smokers
(everyday/some days and have smoked at least 100
cigarettes) who have quit smoking one day or
longer in the year prior to interview. Notes
American Indians/Alaska Natives or Asians may be
of Hispanic origin. Hispanics may be of any
race. Data are age adjusted to the 2000 standard
population. Adults 18 years and older.
Source National Health Interview Survey (NHIS),
NCHS, CDC.
8
27-1a, 27-2b. Current Cigarette Smoking
Percent
Students (grades 9-12)
Adults (18 and older)
2002
2010 Target Students
2010 Target Adults
1970
1975
1980
2000
1965
1985
1990
1995
Preliminary data, January-September 2002. Notes
Adults, age adjusted to the 2000 standard
population. Current Smoking Adults-every/some
days (and have smoked at least 100 cigarettes),
Students-1 day/past month.
Sources Adults, National Health Interview Survey
(NHIS), NCHS, CDC. Students, Youth Risk Behavior
Surveillance System (YRBSS), NCCDPHP, CDC.
9
Healthy People 2010 Objectives Past Month
Tobacco Users Students (Grades 9-12), 2001
Tobacco use on one or more days in the 30 days
preceding the survey. Note Tobacco users may
have used more than one tobacco product.
Source Youth Risk Behavior Surveillance System
(YRBSS), NCCDPHP, CDC.
10
27-2b. Cigarette Use in Past MonthStudents
(grades 9-12)
2010 Target
1999 Baseline
2001
Percent
In 2000, 11 of students in grades 6-8 smoked
Males
Black, not Hispanic
White, not Hispanic
Total
Females
Hispanic
I 95 confidence interval Smoked cigarette(s)
on one or more days of the 30 days preceding the
survey. Note Data for American Indians, Alaska
Natives, and Pacific Islanders are unreliable.
Sources Youth Risk Behavior Surveillance System
(YRBSS), NCCDPHP, CDC and National Youth
Tobacco Survey, OSH, CDC and The American Legacy
Foundation.
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Current Cigarette Smoking, Price and Tax
Students (12th Grade)
Dollars
Percent
Current smoking
Current smoking
Real price per pack
Mean excise tax on a pack of cigarettes
Current cigarette smoking Have smoked at least
once in the past 30 days. Real price is
Consumer Price Index-adjusted national average
retail price. Real price and mean excise tax per
pack of cigarettes adjusted for inflation.
Sources Original analysis/slide prepared by
the ImpacTeen Project. Estimated prices for the
period covered by the survey data are based on
the 11/01 price for each year reported by
Orzechowski and Walker, adjusted for changes in
state and federal cigarette taxes and trends in
the non-tax component of price. Price data from
Orzechowski W, Walker RC. The tax burden on
tobacco historical compilation 2001. Arlington,
Virginia Orzechowski and Walker, 2002. Smoking
prevalence data from Monitoring the Future
Study, NIH, NIDA. Tax data from The Tax Burden
on Tobacco, The Tobacco Institute.
12
Current Smoking and Price Students (12th
Grade), 1975-2002
Cigarette price
Current smoking
Current cigarette smoking Have smoked at least
once in the past 30 days. Real price is
Consumer Price Index-adjusted national average
retail price. Sources Original analysis/slide
prepared by the ImpacTeen Project. Estimated
prices for the period covered by the survey data
are based on the 11/01 price for each year
reported by Orzechowski and Walker, adjusted for
changes in state and federal cigarette taxes and
trends in the non-tax component of price. Price
data from Orzechowski W, Walker RC. The tax
burden on tobacco historical compilation 2001.
Arlington, Virginia Orzechowski and Walker,
2002. Smoking prevalence data from Monitoring
the Future Study, NIH, NIDA.
13
27-10. Exposure to Environmental Tobacco Smoke
Nonsmokers with Detectable Cotinine Levels,
Ages 4 and Older
1988-94 Baseline
Percent with detectable serum cotinine
1999-2000
2010 Target
Total
Mexican American
White, not Hispanic
Black, not Hispanic
I 95 confidence interval Nonsmokers defined by
serum cotinine levels lt 11 ng/mL.
Detectable serum cotinine levels gt .05 ng/mL
and lt 10 ng/mL. Notes Age adjusted to the
2000 standard population. Data for other
Hispanics, American Indians, Alaska Natives,
Asians and Pacific Islanders are unreliable.
Source National Health and Nutrition Examination
Survey (NHANES), NCHS, CDC.
14
27-13. Smoke-Free Indoor Air Laws
Total number of States with laws (including D.C.)
2010 Target
1998 Baseline
2002
24
18
22
17
16
13
6
5
3
1
4
3
Transportation
Workplace
Indoor air laws smoking bans or limited to
separately ventilated areas.
Source State Tobacco Activities Tracking and
Evaluation System (STATE System), OSH, NCCDPHP,
CDC .
15
27-8b. States With Medicaid Coverage for
Treatment of Nicotine Dependency
2010 Target 51 (50 States D.C.)
16
15
25
35
34
25
1
1
1
1998
1999
2000
Complete Coverage
Partial Coverage
No Coverage
Source Health Policy Tracking Service, National
Conference of State Legislators.
16
Progress review data and slides can be found on
the web at
http//www.cdc.gov/nchs/hphome.htm
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Healthy People 2010 ObjectivesCurrent Regular
Tobacco Users Adults
(2001)
Notes Data are age adjusted to the 2000 standard
population. Estimated number of users are
rounded to the nearest thousand. Users may
regularly use more than one tobacco product.
Adults 18 years and older. Everyday or
somedays.Unreliable estimate, relative
standard error gt30.
Source National Health Interview Survey (NHIS),
NCHS, CDC.
18
27-1a. Current Cigarette Smoking for Adults 18
years and older 1998, 2001, and 2002
Age-adjusted percent
2010 Target
1998 Baseline
2001
2002
Black, not Hispanic only
White, not Hispanic only
American Indian/ Alaska Native only
Hispanic
Total
Asian only
I 95 confidence interval Preliminary data
January-September 2002. Notes Current
smokers report smoking everyday/some days and
have smoked at least 100 cigarettes. Data are
age adjusted to the 2000 standard population.
American Indians/Alaska Natives or Asians/Pacific
Islanders may be of Hispanic origin. Hispanics
may be of any race. For 1998 and 2002, persons
reported only one race or reported more than one
race and identified one race as best representing
their race.
Source National Health Interview Survey (NHIS),
NCHS, CDC.
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27-1a. Current Cigarette Smoking for Adults18
years and older 1998, 2001, and 2002
2001
2002
1998 Baseline
Age-adjusted percent
Females
Males
All adults
HS graduate
9-11 yrs.
13-15 years
16 years or more
Education Level
I 95 confidence interval. Preliminary data
January-September 2002. Note Data are age
adjusted to the 2000 standard population.
Source National Health Interview Survey (NHIS),
NCHS, CDC.
20
27-5. Percent of Current Adult Smokers Who
Attempted to Quit in the Past Year
2010 Target
1998 Baseline
2001
Age-adjusted percent
American Indian/ Alaska Native only
Asian only
Hispanic
Black, not Hispanic only
White, not Hispanic only
Total
I 95 confidence interval Current smokers
(everyday/some days who have smoked at least 100
cigarettes) who have quit smoking one day or
longer in the year prior to interview. Notes
American Indians/Alaska Natives or Asians may be
of Hispanic origin. Hispanics may be of any
race. For 1998, persons reported only one race
or reported more than one race and identified one
race as best representing their race. Data are
age adjusted to the 2000 standard population.
Adults 18 years and older.
Source National Health Interview Survey (NHIS),
NCHS, CDC.
21
(No Transcript)
22
27-2a. Tobacco Use in Past monthStudents
(grades 9-12)
2010 Target
1999 Baseline
2001
Percent
19
Males
Black, not Hispanic
White, not Hispanic
Total
Females
Hispanic
I 95 confidence interval Smoked cigarettes or
cigars or used chewing tobacco, snuff, or dip on
one or more of the 30 days preceding the
survey. Note Data for American Indians, Alaska
Natives, and Pacific Islanders are unreliable.
Source Youth Risk Behavior Surveillance System
(YRBSS), NCCDPHP, CDC.
23
Tobacco Use in the Past Month Students (Grades
9-12)
Direction of change desired
2010 Target
2001
34
28
21
15
16
8
8
1
(27-2d.)
(27-2c.)
(27-2b.)
(27-2a.)
Source Youth Risk Behavior Surveillance System
(YRBSS), NCCDPHP, CDC.
24
27-3a,b. Persons Who First Used Any Cigarettes
During 1965 to 2000
Age-specific rate per 1,000 person-years exposure
Targets to be determined. Source SAMHSA,
Office of Applied Studies, National Household
Survey on Drug Abuse, 1999-2001.
25
Percent of Mothers Who Reported Smoking During
Pregnancy, 2001
In 1998, 20 of mothers 18-49 years who smoked
quit smoking during their pregnancy
Percent
10-54 years
15-17 years
20-24 years
18-19 years
25-29 years
40-54 years
30-34 years
35-39 years
Age of Mother
Notes Total of 49 reporting States and D.C.,
excludes data for California, which did not
require reporting of tobacco use during pregnancy
on birth certificates. 14 quit during their
first trimester (age adjusted to the 2000
standard population - objective 27-6).
Sources National Vital Statistics
System-Natality (NVSS-N), and National Health
Interview Survey (NHIS), NCHS, CDC.
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Percent of Mothers Who Reported Smoking During
Pregnancy by Race/Ethnicity, 2001
Percent
Mothers Age 15-19
Mothers Age 20-54
30.5
17.5
14.2
11.3
9.6
7.2
4.0
3.1
Total
Hispanic
White, not Hispanic
Black, not Hispanic
Total
Hispanic
Black, not Hispanic
White, not Hispanic
Totals include origin not stated.
Notes Persons of Hispanic origin may be of any
race. Total of 49 reporting States and D.C.,
excludes data for California, which did not
require reporting of tobacco use during pregnancy
on birth certificates.
Source National Vital Statistics System-Natality
(NVSS-N), NCHS, CDC.
27
27-9. Reported Exposure to Tobacco Smoke at
HomeChildren ages 6 and under, 1998
Percent
2010 Target

6

Total
American Indian /Alaska Native
Black, not Hispanic
White, not Hispanic
Poor
Middle /High
Near poor
Asian/Pacific Islander
Hispanic
Family Income Level
I 95 confidence interval. Unreliable
estimate, relative standard error gt30. Notes
Exposure is defined as anyone smoking inside the
home at least 4 days a week. Hispanics may be of
any race. American Indians, Alaska Natives,
Asians, and Pacific Islanders may be of Hispanic
origin.
Source National Health Interview Survey (NHIS),
NCHS, CDC.
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Reported Environmental Tobacco Smoke Exposure in
Nonsmokers, 2000

• Rode in Car with Someone Who Was Smoking on at
  Least
• One of the Preceding Seven Days
• Middle School Students 34.3
• (range of 26 States 21.7 in DC, to 45.5 in
  WV)
• High School Students 29.2
• (range of 24 States 19.9 in CO, to 43.3 in
  KY)
• Were in Same Room with Someone Who Was Smoking on
  at Least One of the Preceding Seven Days
• Middle School Students 49.1
• (range of 26 States 36.4 in CA, to 63.7 in
  WV)
• High School Students 56.5
• (range of 24 States 39.7 in DC, to 71.5 in
  KY)
• .

Never cigarette smokers. Median of State
rates.
Source National Youth Tobacco Survey (NYTS),
OSH, NCCDPHP, CDC and American Legacy Foundation.
29
27-10. Exposure to Environmental Tobacco Smoke
(ETS)Nonsmokers with Detectable Serum Cotinine
Levels
1988-94 Baseline
Percent with detectable serum cotinine
1999-2000
2010 Target
Ages 4-17
Ages 4 and older
Ages 18
Annually, ETS causes about 3,000 lung cancer
deaths and 35,000 deaths from ischemic heart
disease in adult nonsmokers
I 95 confidence interval Nonsmokers defined by
serum cotinine levels lt 11 ng/mL. Detectable
serum cotinine levels gt .05 ng/mL and lt 10
ng/mL. Age adjusted to the 2000 standard
population. Source National Health and
Nutrition Examination Survey (NHANES), CDC, NCHS.
Source National Health and Nutrition Examination
Survey (NHANES), NCHS, CDC.
30
27-10. Exposure to Environmental Tobacco Smoke
Nonsmokers with Detectable Cotinine Levels,
Ages 4 to 17
1988-94 Baseline
Percent with detectable serum cotinine
1999-2000
2010 Target
Total
White, not Hispanic
Black, not Hispanic
Mexican American
I 95 confidence interval Nonsmokers defined
by serum cotinine levels lt 11 ng/mL. Detectable
serum cotinine levels gt .05 ng/mL and lt 10
ng/mL. ), Note Data for other Hispanics,
American Indians, Alaska Natives, Asians and
Pacific Islanders are unreliable.
Source National Health and Nutrition Examination
Survey (NHANES), NCHS, CDC.
31
27-10. Exposure to Environmental Tobacco Smoke
Nonsmokers with Detectable Cotinine Levels,
Ages 18 and older
1988-94 Baseline
Percent with detectable serum cotinine
1999-2000
2010 Target
Total
White, not Hispanic
Black, not Hispanic
Mexican American
I 95 confidence interval Nonsmokers defined by
serum cotinine levels lt 11 ng/mL. Detectable
serum cotinine levels gt .05 ng/mL and lt 10
ng/mL.
Note Age adjusted to the 2000 standard
population. Data for other Hispanics, American
Indians, Alaska Natives, Asians and Pacific
Islanders are unreliable.
Source National Health and Nutrition Examination
Survey (NHANES), NCHS, CDC.
32
27-10. Exposure to Environmental Tobacco Smoke
Nonsmokers with Detectable Cotinine Levels
Percent with detectable serum cotinine
1988-94 Baseline
1999-2000
2010 Target
40.7
Adults Ages 18 and older
18-24
25-44
45-64
65
I 95 confidence interval Nonsmokers defined by
serum cotinine levels lt 11 ng/mL. Detectable
serum cotinine levels gt .05 ng/mL and lt 10
ng/mL. Note Age adjusted to the 2000
standard population. ), CDC, NCHS.
Source National Health and Nutrition Examination
Survey (NHANES), NCHS, CDC.
33
27-13. Smoke-Free Indoor Air Laws 2002
Number of States with laws (including D.C.)
2010 Target
Transportation
Workplace
Indoor air laws smoking bans or limited to
separately ventilated areas.
Source State Tobacco Activities Tracking and
Evaluation System (STATE System), OSH, NCCDPHP,
CDC.
34
24-2a,b,c. Hospitalizations for Asthma 1998,
1999, and 2000
Hospitalizations per 10,000 population
2010 Target
1998 Baseline
1999
2000
17.5
13.6
Total
Female
Male
Total
Female
Male
Male
Female
Total
Children under 5 years
Persons 5 to 64 years
Adults 65 and older
I 95 confidence interval Note Data are age
adjusted to the 2000 standard population.
Source National Hospital Discharge Survey
(NHDS), NCHS, CDC.
35
24-2a,b,c. Hospitalizations for Asthma 1998,
1999, and 2000
Hospitalizations per 10,000 population
2010 Target
1998 Baseline
1999
2000
103.0
27.9
21.2
13.6
Total
Black
White
Total
Black
White
White
Black
Total
Children under 5 years
Persons 5 to 64 years
Adults 65 and older
I 95 confidence interval Notes Data are age
adjusted to the 2000 standard population. Data
for Hispanics, American Indians, Alaska Natives,
Asians and Pacific Islanders are unreliable.
Source National Hospital Discharge Survey
(NHDS), NCHS, CDC.
36
3-2. Lung Cancer Death Rates
Age-adjusted death rate per 100,000 standard
population
Male
Total
2010 Target
Female
Note Data are age adjusted to the 2000 standard
population.
Source National Vital Statistics
System-Mortality (NVSS-M), NCHS, CDC.
37
3-2. Lung Cancer Death Rates
Age-adjusted death rate per 100,000 standard
population
Black male
White male
Total population
2010 Target
White female
Black female
Notes Data are age adjusted to the 2000 standard
population. The race groups white and black may
be of Hispanic or non-Hispanic origin. Source
National Vital Statistics System-Mortality
(NVSS-M), NCHS, CDC.
38
3-2. Lung Cancer Death Rates, 2000
Age-adjusted death rate per 100,000 standard
population
2010 Target
American Indian/ Alaska Native
Total
Asian/ Pacific Islander
Black, not Hispanic
White, not Hispanic
Hispanic
Notes American Indians/Alaska Natives or
Asians/Pacific Islanders may be of Hispanic
origin. Hispanics may be of any race.
Malignant neoplasms of trachea, bronchus and
lung ICD-10 codes C33-C34. Data are age
adjusted to the 2000 standard population. Source
National Vital Statistics System-Mortality
(NVSS-M), NCHS, CDC.
Source National Vital Statistics
System-Mortality (NVSS-M), NCHS, CDC.
39
Age-Adjusted Lung Cancer Incidence Rates
New Cases per 100,000 population
Estimated annual percent change (EAPC) is
significantly different from 0 (plt0.05). EAPC
has been calculated by fitting a linear
regression model to the natural logarithm of the
yearly rates from 1990-99. Notes Estimates
for American Indians or Alaska Natives are not
shown because of the small number of cases. The
race groups, white, black and Asian or Pacific
Islander include persons of Hispanic and
non-Hispanic origin. ICD-9-CM codes
162.2-162.9. Source National Institutes of
Health, National Cancer Institute, Surveillance,
Epidemiology, and End Results (SEER) Program.
40
27-21a. Average Federal and State Tax on
CigarettesMean Excise Tax on a Pack of
Cigarettes
Dollars
Source The Tax Burden on Tobacco, The Tobacco
Institute.
41
12-1. Coronary Heart Disease Death Rates, 2000
Age-adjusted death rate per 100,000 standard
population
156
Black, Not Hispanic
Hispanic
White, Not Hispanic
Male
Female
Total
Asian or Pacific Islander
American Indian or Alaska Native
Total
NOTE Coronary heart disease ICD-10 codes I11,
I20-I25. American Indian or Alaska Natives,
Asian or Pacific Islanders may be of Hispanic
origin. Hispanics may be of any race.
Source National Vital Statistics System
Mortality (NVSS-M), NCHS, CDC.