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Open Access Research article

Changes in smoking prevalence among U.S. adults by state and region: Estimates from the Tobacco Use Supplement to the Current Population Survey, 1992-2007

Ahmedin Jemal1*, Michael Thun1, Xue Q Yu2, Anne M Hartman3, Vilma Cokkinides1, Melissa M Center1, Hana Ross1 and Elizabeth M Ward1

Author Affiliations

1 Intramural Research, American Cancer Society, 250 Williams Street NW, Atlanta, GA 30303, USA

2 The Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW 2011, PO Box 572, Kings Cross NSW 1340, Australia

3 Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard, Rockville, MD, 20852, USA

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BMC Public Health 2011, 11:512  doi:10.1186/1471-2458-11-512

Published: 29 June 2011

Abstract

Background

Tobacco control policies at the state level have been a critical impetus for reduction in smoking prevalence. We examine the association between recent changes in smoking prevalence and state-specific tobacco control policies and activities in the entire U.S.

Methods

We analyzed the 1992-93, 1998-99, and 2006-07 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) by state and two indices of state tobacco control policies or activities [initial outcome index (IOI) and the strength of tobacco control (SOTC) index] measured in 1998-1999. The IOI reflects cigarette excise taxes and indoor air legislation, whereas the SOTC reflects tobacco control program resources and capacity. Pearson Correlation coefficient between the proportionate change in smoking prevalence from 1992-93 to 2006-07 and indices of tobacco control activities or programs was the main outcome measure.

Results

Smoking prevalence decreased from 1992-93 to 2006-07 in both men and women in all states except Wyoming, where no reduction was observed among men, and only a 6.9% relative reduction among women. The percentage reductions in smoking in men and women respectively were the largest in the West (average decrease of 28.5% and 33.3%) and the smallest in the Midwest (18.6% and 20.3%), although there were notable exceptions to this pattern. The decline in smoking prevalence by state was correlated with the state's IOI in both women and men (r = -0.49, p < 0.001; r = -0.31, p = 0.03; respectively) and with state's SOTC index in women(r = -0.30, p = 0.03 0), but not men (r = -0.21, p = 0.14).

Conclusion

State level policies on cigarette excise taxes and indoor air legislation correlate strongly with reductions in smoking prevalence since 1992. Strengthening and systematically implementing these policies could greatly accelerate further reductions in smoking.