highlights from the california tobacco surveys elizabeth a. gilpin, ms principal investigator
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HIGHLIGHTS FROM THE CALIFORNIA TOBACCO SURVEYS
Elizabeth A. Gilpin, MSPrincipal Investigator
1999 California Tobacco SurveysCancer Prevention and Control Program
University of California, San Diego, Cancer Centerhttp://ssdc.ucsd.edu
WHY TOBACCO CONTROL?
To reduce morbidity and mortality from tobacco-related diseases:
•Cancer (lung and other)
•Heart disease
•Chronic obstructive lung disease
OVERALL GOALS OF CALIFORNIATOBACCO CONTROL PROGRAM
•Encourage smokers to quit
•Encourage smokers to reduce their exposure to harmful tobacco products
•Discourage smoking initiation
•Protect nonsmokers from secondhand smoke
MAJOR STRUCTURAL LANDMARKS OF
CALIFORNIA TOBACCO CONTROL PROGRAM
1989: Proposition 99 passed, new $0.25/pack tax1990: Media campaign beginsBy 1993, over 120 new local clean air ordinances
were adopted1994: State law: indoor workplaces smokefree1994: STAKE Act (youth access enforcement)1998: Smokefree workplace law extended to bars
and game rooms1999: Proposition 10 passed, new $0.50/pack tax
0
20
40
60
80
100
120
140
90 91 92 93 94 95 96 98 99 00Year
Ex
pe
nd
itu
res
in M
illio
ns
($
)
Competitive Grants (22.3%)School Programs (31.4%)Local Agencies (26.3%)Media (20.1%)
Expenditures of the California Tobacco Control Program
Source: Balbach et al., 1998 and 2000
THE CALIFORNIA TOBACCO SURVEYS
•Random-digit-dialed household telephone surveys
•Conducted in 1990, 1992, 1993, 1996 and 1999
•A household adult enumerates all residents and gives
demographics and smoking status
•The probability an adult is selected for a 25-minute
extended interview is determined by smoking status
•All adolescents 12-17 selected for an extended
interview in 1990, 1992, 1993 and 1996. One randomly
selected in 1999.
SURVEILLANCE OF IMPORTANTOUTCOME MEASURES
• Cigarette price
• Per capita cigarette consumption
• Adult smoking prevalence
• Adult cessation
• Adolescent smoking
• Adolescent perceptions of ease of obtaining
cigarettes
SURVEILLANCE OF IMPORTANTOUTCOME MEASURES (cont’d)
• Compliance with school smoking bans
• School classes on health effects of smoking
• Protection of nonsmokers from secondhand
smoke
• Price sensitivity/attitudes toward taxation
CIGARETTE PRICE AND PER CAPITA CIGARETTE CONSUMPTION
Cigarette price and bimonthly sales
data now reported to the Federal
Trade Commission by the consulting
firm of Orzechowski and Walker
$2.00
$2.50
$3.00
$3.50
$4.00
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Rea
l P
rice
/Pac
k (1
999
$)
Average Real Price/Pack of Cigarettesin California (1999 dollars)
Source: Tax Burden on Tobacco, 2000
4
6
8
10
12
14
16
1983 1985 1987 1989 1991 1993 1995 1997 1999 2001
Year
Pac
ks p
er M
on
th
California
California Trend
US-California
US Trend
Source: Tobacco Institute; Orzechow ski & Walker; U.S. Bureau of Census
Seasonally Adjusted Trend of Per Capita Consumptionfor Cigarettes, California vs. U.S.
ProgramStarts
22% lower
54% lower
ADULT SMOKING PREVALENCE
•Have you smoked at least 100 cigarettes in your
lifetime?
•1990-1996 screener: Do you smoke cigarettes
now?
•1996 extended, 1999 screener and extended:
Do you now smoke cigarettes everyday, some
days or not at all?
15
20
25
30
35
1975 1980 1985 1990 1995 2000
%
NHIS
CATS/BRFS
CPS
CTS
Predicted
95% CI
Smoking Prevalence Among California Adults,Aged 18 or Older
Source: NHIS, 1978, 1979, 1980, 1983, 1985, 1987, 1988, 1990, 1991, 1993, 1994; CTS 1990, 1992, 1993, 1996, 1999; BRFS/CATS 1991-1999; CPS 1992-1993, 1995-1996, 1998-1999
15
20
25
30
35
40
1975 1980 1985 1990 1995 2000
%
NHIS
CPS
Predicted
95% CI
Smoking Prevalence Among Adultsin the Rest of the United States, Aged 18 and Older
Source: NHIS 1978, 1979, 1980, 1983, 1985, 1987, 1988, 1990, 1991, 1993, 1994; CPS 1992-1993, 1995-1996, 1998-1999
ADULT DAILY SMOKING
•1990,1992: If answered yes to smoke
now question, then asked: Do you now
smoke cigarettes everyday or some
days?
•1996,1999: Answered everyday to the
prevalence question.
13.013.0
17.5
14.1
16.4
13.9
15.9
14.7
12
14
16
18
20
22
1988 1990 1992 1994 1996 1998 2000
%
Unstandardized Standardized
Adult Daily Smoking,Standardized and Unstandardized
Source: CTS 1990, 1992, 1996, 1999
SELF-REPORTED CONSUMPTION
Daily Smokers: •How many cigarettes on average do you
smoke per day?
Occasional Smokers:•On how many of the past 30 days did you
smoke cigarettes?•On the past 30 days, on the days that you did
smoke, about how many cigarettes did you
usually smoke?
16.8 17.724.6
29
26.8 26.4
30.530.4
0
20
40
60
80
1990 1992 1996 1999
% C
urr
ent S
mo
kers
Occasional Smokers All Light Smokers
Light Smoking (<15 Cigarettes/Day)Among Current Smokers
Source: CTS 1990, 1992, 1996, 1999
13.9
11.2
8.27.3
0
2
4
6
8
10
12
14
16
None Work ban only Home ban only Both
Cig
aret
tes/
Day
Daily Cigarette Consumption and Smoking Bans
Source: CTS 1999
ADULT SMOKING CESSATION
Current smokers:
•During the past 12 months, have you quit
smoking intentionally for one day or longer?
•How long did you actually stay off cigarettes
during that quit attempt?
Former smokers:
•Date when last smoked a cigarette
61.5
56.0
38.1
48.9
0
10
20
30
40
50
60
70
1990 1992 1996 1999
%
Source: CTS 1990, 1992, 1996, 1999
Quit Attempts Among Smokers in the Last Year
0
10
20
30
40
50
60
70
80
90
100
0 30 60 90 120 150 180
Time (days)
% A
bs
tin
en
t
1990 1996 1999
Relapse Following Most Recent Quit Attemptfor Smokers in Last Year
Source: CTS 1990, 1996, 1999
ADOLESCENT SMOKING
•Have you ever smoked a cigarette?
•Have you ever tried or experimented with
cigarette smoking, even a few puffs?
•Have you smoked at least 100 cigarettes in
your life?
•Think about the last 30 days. On how many of
these days did you smoke?
9.2 9.2
12
7.7
9.0
11.6
9.0
7.8
6
8
10
12
14
1988 1990 1992 1994 1996 1998 2000
%
UnstandardizedStandardized
The Effect of Removing Population Distribution Changes from Adolescent (12-17 years)Smoking Prevalence in the Last 30 Days
Source: CTS 1990, 1993, 1996, 1999
COMMITTED NEVER SMOKERS
•Do you think in the future you might experiment
with cigarettes?
•If one of your best friends were to offer you a
cigarette, would you smoke it?
•At any time during the next year do you think
you will smoke a cigarettes?
55.8
40.935.5
65.7
41.338.043.9
62.2
49.0
0
10
20
30
40
50
60
70
80
12 to 13 14 to 15 16 to 17
Age Group
%
1993 1996 1999
12-17 Year Old Committed Never Smokers
Source: CTS 1993,1996,1999
13.8
10.2
5.8
17.3
12.8
7.0
3.8
10.79.9
0
5
10
15
20
25
15 16 17Age (years)
%
1993 1996 1999
15-17 Year Old Established Smokers
Source: CTS 1993,1996,1999
•Do you think it would be easy or hard for you to
get cigarettes if you wanted some?
•Would you say it would be easy, somewhat
difficult, or hard for you to buy
a few cigarettes,
a pack of cigarettes?
EASE OF ACCESS
48.0
57.256.957.9
0
10
20
30
40
50
60
70
1990 1993 1996 1999
% o
f N
ev
er
Sm
ok
ers
Source: CTS 1990, 1993, 1996, 1999
Never Smokers Who Think It Would BeEasy To Get Cigarettes
54.7
44.7 42.3
28.4
0
20
40
60
80
100
%
1996 1999
Perception of Ease of Buying a Few Cigarettes(Age 12-14 years)
Committed Never Smoker Susceptible Never Smoker
Source: CTS 1996, 1999
93.486.8
73.263.7
52.5
45.7
0
20
40
60
80
100
%
1996 1999
Perception of Ease of Buying a Pack of Cigarettes(Age 15-17 Years)
Experimenter
Established Smoking
Occasional Daily
Source: CTS 1996, 1999
•How many students who smoke obey the rule
not to smoke on school property?
•Have you seen anyone smoke in school in the
last two weeks?
•Do you think that all smoking by anyone
should be banned on school grounds at all
times, including meetings and sporting events?
COMPLIANCE WITHSCHOOL SMOKING BANS
55.8
88.2
56.9
33.337.541.7
64.4
91.2
46.1
24.7
57.0
68.1
0
10
20
30
40
50
60
70
80
90
100
%
1996
1999
School Policy Against Smokingby Current Smoking Status and Year
Most or all obey Seen someonesmoking (yes)
Preference forsmokefree school
Nonsmokers CurrentSmokers
Nonsmokers CurrentSmokers
Nonsmokers CurrentSmokers
Source: CTS 1996, 1999
RECALL OF CLASS ON HEALTH DANGERS OF SMOKING
•Have you ever taken a class or course at
school in which the health risks of smoking
were discussed?
•Do you think that kids who took the health
class on the effects of smoking are more
against smoking, less against smoking, or had
no change in attitudes toward smoking as a
result of taking this class?
73.275.7 76.1 77.8
0
10
20
30
40
50
60
70
80
Year
%Students Who Recall Taking a Course
on the Health Dangers of Smoking
1990 199919961993
Source: CTS 1990, 1993, 1996, 1999
69.2
50.3
61.7
42.4
0
10
20
30
40
50
60
70
80
Never Smokers Ever Smokers
%
1996 1999
Class on Health Dangers of Smoking Ineffective
Source: CTS 1990, 1993, 1996, 1999
PROTECTION OF NONSMOKERS FROM SECONDHAND TOBACCO SMOKE
•In the workplace
•In the home
SECONDHANDSMOKE IN THE WORKPLACE
•Do you currently work for money in an
indoor setting, such as an office, plant,
or store, outside of your home?
•Is the building where you work
completely smoke-free indoors?
35
46.3
90.593.4
0
20
40
60
80
100
%
Source: CTS 1990, 1992, 1996, 1999
Indoor Workers Reporting Smokefree Workplaces
1990 1992 1996 1999
NONSMOKER EXPOSURE TO SECONDHAND SMOKE IN THE
WORKPLACE
During the past two weeks, has anyone
smoked in the area in which you work?
15.6
11.8
22.4
29
0
5
10
15
20
25
30
35
1 2 3 4
%
Source: CTS 1990, 1993, 1996, 1999
Exposure of Nonsmoking Indoor Workersto Secondhand Smoke
1990 1993 1996 1999
7.1 7.911.7
17.724.5
31.9
50.2
0
10
20
30
40
50
60
70
80
%
Source: CTS 1999
Exposure of Nonsmoking Indoor Workers by Type of Workplace in 1999
Classroom Hospital Plant/Factory
Office Store/Warehouse
Restaurant/Bar
Vehicle
12.1
20.6
18.117.8
0
5
10
15
20
25
30
Number of Employees at Workplace
%
Source: CTS 1999
<5 5-24 25-50 >50
Exposure of Nonsmoking Indoor Workersby Size of Workplace in 1999
3.8
12.5
3.25.34.1
31.7
8.2
2.1
13.2
0
5
10
15
20
25
30
35
40
Place Most Recently Exposed
% N
on
sm
ok
ers
Source: CTS 1999
Place of Exposure to Someone Smoking in Last 6 MonthsOther Than Own Home or Work in 1999
Restaurant Bar/Tavern
Park/Outdoors
ShoppingMall
CommunitySportsEvent
GamblingVenue
Others’Homes
Others’Cars
Bar/Restaurant
HOME SMOKING RESTRICTIONS
What are the smoking rules or restrictions in your household, if any? Would you say…
•Smoking is completely banned for everyone
•Smoking is generally banned for everyone with few exceptions
•Smoking is allowed in some rooms only, or
•There are no restrictions on smoking.
50.9
29.1
64.5
16.6 18.9
73.2
14.820.0
12.0
0
10
20
30
40
50
60
70
80
Smokefree Some Restrictions No Restrictions
Home Smoking Policy
%
1993 1996 1999
Home Smoking Restrictions AmongAll Californians (Smokers and Nonsmokers)
Source: CTS 1993, 1996, 1999
20.1
26.1
53.9
38.1
26.3
35.6
47.2
21.8
31.0
0
10
20
30
40
50
60
Smokefree Some Restrictions No Restrictions
Home Smoking Policy
%
1993 1996 1999
Source: CTS 1993, 1996, 1999
Home Smoking Restrictions Reportedby California Smokers
56.7
41.6
19.3
73.0
62.4
44.8
0
20
40
60
80
100
1993 1996 1999
% P
rote
cte
d
All adults smoke At least 1 adult smokes
Protection of Young Children (0-5 Years)in Households Where Adults Smoke
Source: CTS 1993, 1996, 1999
•At work: no recent exposure in work area
•At home: live in a smokefree home
•Other: have not had to put up with someone smoking near them at any other place besides work or home in the last 6 months
In 1999, 37.1% of California nonsmokers fit these criteria.
EXPOSURE TO SECONDHAND SMOKE IN VENUES BESIDES THE WORKPLACE OR HOME
PRICE SENSITIVITY
•How much additional tax on a pack of
cigarettes would you be willing to support if the
money raised was used to fund programs
aimed at preventing smoking among children
and other health care programs?
0
10
20
30
40
50
60
70
80
$3.00 $2.00 $1.50 $1.00 $0.75 $0.50 $0.25
Additional Excise Tax
Cu
mu
lati
ve
%
1996 1999
Cumulative Percentage Favoring Additional Cigarette Excise Tax
Source: CTS 1996, 1999
0
10
20
30
40
50
Liquor/drugstores
($3.52/pack)
Conveniencestores/gas
stations($3.47/pack)
Supermarkets($3.28/pack)
Discount stores($2.91/pack)
Non/lower-taxedsources
($2.33/pack)
Other ($3.32/pack)
%
Buyers Cigarettes
Percent of Buyers and Cigarettes Purchased by Store Type
Source: CTS 1999
-12.64%
-5.45%-4.24% -4.22%
-5.58%-6.96%
1.05%
-3.85% -4.00%
-8.94%
-19.97%
0.81%
3.79%
0.00%0.73%
-20.78%
-1.07%-1.86%
0.18%
-1.86%-2.90%
-9.51%
-25.0%
-20.0%
-15.0%
-10.0%
-5.0%
0.0%
5.0%
10.0%
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
Annual % Change in Trended Demand
Expected Change in Demand Due to Price Changes
Expected and Actual Percentage Changesin Cigarette Consumption
Due to Price Changes in California, 1989-1999
Source: CA BOE, 1999; Tax Burden on Tobacco, 1999
0.0%
28.8%
-33.0%
4.3%1.4%
-32.8%
-40.0%
-30.0%
-20.0%
-10.0%
0.0%
10.0%
20.0%
30.0%
40.0%
1990-1993 1993-1996 1996-1999
Actual % Change in Prevalence
Expected % Change in PrevalenceDue to Price Changes
Actual and Expected Changes in Adolescent Prevalence
Source: CTS 1993, 1996, 1999; Tax Burden on Tobacco, 1999
CONCLUSIONS
•Although adult smoking prevalence is static,
smokers are smoking less.
•Both increased tobacco excise taxes and other
Program strategies (e.g., smoking restrictions)
appear to be contributing to the decline in
consumption.
CONCLUSIONS (cont’d)
ENCOURAGING TRENDS:
•More quitting activity among adult smokers
•Less adolescent smoking
•Less perception by adolescents that cigarettes
are easy to obtain
•More compliance with school smoking bans
CONCLUSIONS (cont’d)
ENCOURAGING TRENDS:
•More smokefree worksites
•More protection of indoor workers from
secondhand smoke
•More children protected from secondhand
smoke in the home
•Continued support for excise tax increaseshttp://ssdc.ucsd.edu
Back-up slides
ADOLESCENT USE OF OTHERTOBACCO PRODUCTS
•Have you ever tried ...
-Chewing tobacco or snuff
-Cigars, cigarillos, or little cigars
-Bidis, a specially flavored cigarette
from India
•On how many of the last 30 days did you use product?
0
10
20
30
40
50
60
70
Adolescent Smoking Experience
% E
ver
Used
1996 1999
CommittedNever
Smokers
SusceptibleNever
Smokers
NoncurrentUsers
CurrentExperimenters
CurrentEstablished
Smokers
Experimentation with Smokeless Tobacco by CigaretteSmoking Experience in Adolescent Boys
Source: CTS 1996, 1999
0
20
40
60
80
100
Adolescent Smoking Status
% E
ve
r U
se
d
1996 1999
Experimentation with Cigarsby Cigarette Smoking Experience
CommittedNever
Smokers
SusceptibleNever
Smokers
NoncurrentUsers
CurrentExperimenters
CurrentEstablished
Smokers
Source: CTS 1996, 1999
Source: CTS 1996, 1999
0
10
20
30
40
50
60
70
80
90
100
Adolescent Smoking Experience
%
Ever
In Last 30 Days
Bidi Use by Traditional Cigarette Smoking Status
CommittedNever
Smokers
SusceptibleNever
Smokers
NoncurrentUsers
CurrentExperimenters
CurrentEstablished
Smokers
Bidi Use
ADULT CIGAR USE
•Do you currently smoke cigars everyday some
days or not at all?
•On how many of the last 30 days did you
smoke cigars?
•On the days you smoked cigars, about how
many cigars did you usually smoke?
•Do you usually inhale the cigars you smoke?
1.1
0.10.20.30.3
3.84.85.4
4.0
0
0.3
1.3
3.1
1.8
6.2
11.0
12.3
00.3
1.5
2.7
7.0
9.2
10.5
0
2
4
6
8
10
12
14
16
18-24 25-44 45-64 65+ 18-24 25-44 45-64 65+Age
% C
urr
en
t C
iga
r S
mo
ke
rs
1990 1996 1999
Current Cigar Use by Gender and Age
Men Women
Source: CTS 1990, 1996, 1999
0.8 0.50.3 0.6 0.90.10.1
10.9
3.9
2.22.9
14.8
6.57.5
2.6
15.4
7.8
5.0
0
5
10
15
20
NeverSmoker
FormerSmoker
CurrentSmoker
NeverSmoker
FormerSmoker
CurrentSmoker
% C
urr
ent
Cig
ar S
mo
kers
1990 1996 1999
Current Cigar Use by Gender and Cigarette Smoking Status
Men Women
Source: CTS 1990, 1996,1999
Cigar Use PatternsAmong Current Cigar Smokers
by Cigarette Smoking Status, 1999
Never Former Current% % %
Days in Last Month None 48.3 36.1 44.4 Every Day 1.5 10.4 3.6Cigars on Days When Smoked 1 96.2 80.4 82.4 2 2.1 12.9 9.8 3+ 1.4 6.4 5.3Monthly Cigar Consumption >5 10.3 26.4 15.3 >10 6.3 19.0 11.6 >30 1.9 14.5 4.7Usually Inhale 10.8 20.5 45.7
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