Cigarette smoking in 99 Metropolitan areas — United States, 2000

Morbidity and Mortality Weekly Report, Dec 14, 2001

Geographic variation in the prevalence of cigarette smoking contributes to differences in the mortality patterns of smoking-related diseases such as lung cancer, chronic obstructive lung disease, and coronary heart disease (1). National and state-specific data on cigarette smoking are available but may be limited in their usefulness in guiding local or county smoking-related health interventions. CDC's Behavioral Risk Factor Surveillance System (BRESS) is an annual, state-based survey that includes questions about tobacco use and has sufficiently large samples to permit analyses of risk factor data for many metropolitan statistical areas (MSAs). This report summarizes estimates of smoking behavior for the 99 MSAs with [greater than or equal to]300 respondents (maximum: 7,264) in the 2000 BRFSS. The prevalence of smoking among the 99 MSAs ranged from 13.0% to 31.2% (median: 22.7%), and the percentage of daily smokers who quit for [greater than or equal to]1 day ranged from 33.0% to 62.2% (median: 50.3%). The findings in this report indicate that BRFSS can provide baseline data for monitoring local programs and a benchmark for comparing data from local surveys.

In 2000, BRFSS was conducted in 50 states, the District of Columbia, and Puerto Rico; randomly selected noninstitutionalized persons aged [greater than or equal to]18 years were interviewed by telephone. The median response rate was 53.2% (range: 35.5%-77.7%) (2). BRFSS response rates for MSAs are not available. Estimates are poststratified by age and sex and for some states by race/ethnicity to adjust for nonresponses. MSAs were identified using the standard definitions from the U.S. Bureau of the Census (3).

In the 2000 BRFSS, 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 smokers were persons who reported having smoked [greater than or equal to]100 cigarettes during their lifetimes and who currently smoked every day or some days. Respondents who smoked every day were asked, "During the past 12 months, have you quit smoking for a day or longer?" Data were weighted to each MSA based on age, sex, and race/ethnicity; 95% confidence intervals for point estimates were calculated using SUDAAN. Statistical significance was determined on the basis of nonoverlapping confidence intervals.

The median adult prevalence of current smoking for the 99 MSAs was 22.7% (range: 13.0%-31.2%) (Table 1). The five MSAs with the highest prevalence of current smoking (Toledo, Ohio; Knoxville, Tennessee; Indianapolis, Indiana; Cleveland-Lorain-Elyria, Ohio; and Huntington-Ashland, West Virginia) differed significantly from the five MSAs with the lowest prevalence (Orange County, California; Salt Lake City-Ogden, Utah; San Diego, California; Miami, Florida; Bergen-Passaic, New Jersey; and Las Cruces, New Mexico) (Table 1). By region, median prevalence was highest in the Midwest (23.7%), followed by the South (23.2%), Northeast (20.8%), and West (20.6%). Prevalence was higher for men than women in 73 of 99 MSAs; the difference by sex was significant in six (Los Angeles, California; Honolulu, Hawaii; Wichita, Kansas; New Orleans, Louisiana; Charlotte, North Carolina; and Dallas, Texas).

Among daily smokers, the median percentage that had quit for [greater than or equal to]1 day during the 12 months preceding the survey was 50.3% (range: 33.0%-62.2%). The two MSAs with the lowest percentage (Charleston, West Virginia, and Toledo, Ohio) differed significantly from the two MSAs with the highest percentage (Fort Worth-Arlington, Texas, and Detroit, Michigan). The percentage was highest in the West (52.1%) followed by the Northeast (51.5%), South (50.4%), and Midwest (49.1%).

Reported by: D Nelson, S Marcus, National Cancer Institute, Bethesda, Maryland. H Wells, G Laird, J Dever, Research Triangle Institute, North Carolina. The following BRFSS coordinators: S Reese, Alabama; P Owen, Alaska; R Weyant, Arizona; B Woodson, Arkansas; B Davis, California; D Brand, Colorado; M Adams, Connecticut; F Breukelman, Delaware; J Davies-Cole, District of Columbia; S Oba, Florida; L Martin, Georgia; F Reyes-Salvail, Hawaii; J Aydelotte, Idaho; B Steiner, Illinois; L Stemnock, Indiana; D Shepard, Iowa; CM Arnold, Kansas; T Sparks, Kentucky; B Bates, Louisiana; J Graber, Maine; H Lopez, Maryland; Z Zhang, Massachusetts; H McGee, Michigan; N Salem, Minnesota; D Johnson, Mississippi; J Jackson, Missouri; P Feigley, Montana; L Andelt, Nebraska; E DeJan, Nevada; J Porter, New Hampshire; G Boeselager, New Jersey; W Honey, New Mexico; C Baker, New York; Z Gizlice, North Carolina; L Shireley, North Dakota; P Coss, Ohio; K Baker, Oklahoma; K Pickle, Oregon; L Mann, Pennsylvania; Y Cintron, Puerto Rico; J Hesser, Rhode Island; M Wu, South Carolina; M Gildemaster, South Dakota; D Ridings, Tennessee; K Condon, Texas; K Marti, Utah; R McCormick, Vermont; G Seifen, Virginia; K Wynkoop-Simmons, Washington; F King, West Virginia; K Pearson, Wisconsin; M Futa, Wyoming. Behavioral Surveillance Br, Div of Adult and Community Health; and Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.