Cigarette smoking in 99 Metropolitan areas — United States, 2000

Morbidity and Mortality Weekly Report, Dec 14, 2001

Editorial Note: This is the first report using consistent methodology to examine variations in smoking prevalence across U.S. MSAs. The findings demonstrated an approximately twofold difference, with the lowest prevalencefor MSAs in California and Utah and the highest for MSAs in Ohio, Indiana, and Tennessee. Only three (Orange County and San Diego, California, and Salt Lake City, Utah) of the 99 MSAs met the national health objective for 2000 of [leq] 15% for prevalence of current smoking (objective 3.4) (4). The proportion of smokers who quit for [geq] 1 day also varied substantially across communities and was highest in the West and lowest in the Midwest. The proportion of smokers who quit for [geq]1 day during the 12 months preceding the survey is an indicator of success in cessation initiatives and may reflect implementation of programs or policies at the individual, health-care provider, or community level (e.g., although clean indoor air policies are in place nationwide, their implementation varies sub stantially across the country and may account for some of the variation observed) (5).

The findings in this report are subject to at least five limitations. First, although the median response was relatively low, BRFSS estimates are similar to estimates from other surveys with higher response rates such as the National Health Interview Survey (NHIS) (6). Nationwide smoking estimates from BRFSS and NHIS for 1997 were 23.1% and 24.7%, respectively. BRFSS and NHIS estimates for smoking among population subgroups differed by 0.4% to 4.1% (E. Powell-Griner, Ph.D., CDC, personal communication, August 2001). Second, the data are self-reported. Third, institutionalized persons or persons residing in households without a telephone were not eligible for interviews. Fourth, the precision of estimates varied across MSAs because of different sample sizes. Finally, smoking estimates may differ markedly within an MSA (e.g., between inner cities and suburbs).

To control the use of tobacco requires an approach that includes successful activities such as increases in the cigarette excise tax, mass media education, counteradvertising, comprehensive school-based programs, policies on clean indoor air, telephone quit lines, reducing out-of-pocket costs for cessation services and products, and increasing cessation interventions in the health-care setting (5,7). Many communities have instituted local tobacco-control programs that have reduced the availability of tobacco products, lowered exposure to environmental tobacco smoke, and increased cessation activities (5). In California, state-based programs with a strong community focus have contributed to reductions in tobacco-related mortality (8).

The National Association of County and City Health Officials (NACCHO) has published Program and Funding Guidelines for Comprehensive Local Tobacco Prevention and Control Program (9). With funds from state tobacco programs, routine and consistent tracking of smoking prevalence within MSAs can provide the tools to assess the impact of tobacco-control activities. States and local areas should implement aggressive and comprehensive programs at the community level that follow the NACCHO guidelines and recommendations from the CDC Best Practices for Comprehensive Tobacco Control Programs (10), Reducing Tobacco Use: A Report of the Surgeon General (5), and The Guide to Community Preventive Services: Tobacco Use Prevention and Control (7). Effective local tobacco control will be essential for reaching the 2010 national adult smoking prevalence goal of <12%.