Source: Massachusetts BRFSS Prepared by: Health Survey Program Health Survey Program Center for Health Information, Statistics, Research, and Evaluation Tobacco Control Program Center for Community Health Massachusetts Department of Public Health October 2006 BRFSS Annual Report: A Profile of Health Among Massachusetts Adults, 2005 A Presentation Highlighting Tobacco Use in Massachusetts

Source: Massachusetts BRFSS Prepared by: Health Survey Program Overview of the Presentation  Introduction to the Behavioral Risk Factor Surveillance System (BRFSS)  2005 BRFSS data highlights  20-year of BRFSS tobacco data: trend in smoking prevalence health correlates secondhand smoke exposure

Source: Massachusetts BRFSS Prepared by: Health Survey Program What is the BRFSS? Random digit dial telephone survey Adults ages 18 and older Collaboration between CDC and States Massachusetts BRFSS administered since 1986 Data are weighted: provide population-based estimates of health 2005 Sample Size: 8,906 2

Source: Massachusetts BRFSS Prepared by: Health Survey Program Massachusetts BRFSS The Massachusetts BRFSS survey includes:  CDC core questions  Questions designed by the CDC which are optional  Questions we design in collaboration with other programs of the Massachusetts Department of Public Health. The questions we design ourselves constitute between 40% and 50% of the questions we ask each year. Our questions  Are responsive to changing MA public health needs  Have sometimes been adopted by the CDC in the national BRFSS effort to address national health issues 4

Source: Massachusetts BRFSS Prepared by: Health Survey Program BRFSS TOBACCO CANCER CONTROL DRUG & ALCOHOL DISABILITY DIABETES OBESITY/ OVERWEIGHT ORAL HEALTH HEALTH CARE ACCESS WOMEN’S HEALTH QUALITY OF LIFE 50+ OTHER TOPICS MA BRFSS TOPICS

Source: Massachusetts BRFSS Prepared by: Health Survey Program Content of the 2005 MA BRFSS Annual Report  Summarizes results for 25 health topics and more than 40 indicators  For each indictor, we provide  A description of survey questions for the indicator  Overall percentage estimates along with key findings of interest  Figures on trend over time  The US median data when available

Source: Massachusetts BRFSS Prepared by: Health Survey Program HP2010 Objectives Tracked by MA BRFSS, 2005 Risk Factors –Binge drinking –Smoking –No Physical Activity Use of Preventive Services –Immunization –Cancer screening –Cholesterol screening Health Care –Personal health care provider Health Conditions –Diabetes –Obesity –High Blood Pressure

Source: Massachusetts BRFSS Prepared by: Health Survey Program Massachusetts 2005 and HP2010 MA %US%HP2010 % Current Smoker Quit Attempt Binge Drinking Obesity Leisure Time Physical Activity Diabetes High Blood Pressure Cholesterol Checked Flu Shot (65+) Pneumonia Vaccination (65+) Blood Stool Test (50+) Personal Health Care Provider

Source: Massachusetts BRFSS Prepared by: Health Survey Program Keeping Current – Tobacco Data 1986 –BRFSS goes into the field in Massachusetts –Smoking prevalence in Massachusetts was 28% 1990’s –Debate in the media and scientific literature regarding the benefit of low- tar cigarettes – , Massachusetts adds questions on smokers use of light and ultra-light cigarettes and their beliefs about the benefits Late 90’s – 2000’s –Legislation is developed to eliminate smoking in restaurants – , Massachusetts gathers public opinions about support of smoking bans in restaurants

Source: Massachusetts BRFSS Prepared by: Health Survey Program 2000’s –Price of cigarettes in Massachusetts continues to rise –2002, BRFSS adds questions on mail order and internet purchases of cigarettes Ongoing –1992-present, BRFSS asks smokers about their quitting plans – , where do Massachusetts residents get advise on quitting smoking (i.e. train ads, billboards, television, radio, etc.) –1994-present, BRFSS asks whether smokers are offered advise to quit smoking when they attend regular doctor visits –1992-present, what are the policies around smoking in Massachusetts homes – , BRFSS asks smokers the age when they first smoked a cigarette 2005 – , BRFSS gathers data on workplace smoking policies –In 2005, Massachusetts bans smoking in all places of work –Massachusetts smoking prevalence is 18% Keeping Current – Tobacco Data (cont’d)

Source: Massachusetts BRFSS Prepared by: Health Survey Program Tobacco Use in Massachusetts Tobacco use causes significant morbidity and mortality Tobacco use causes significant healthcare costs in Massachusetts Tobacco use is preventable

Source: Massachusetts BRFSS Prepared by: Health Survey Program Tobacco Use in Massachusetts 20 year trend in Massachusetts Massachusetts compared to the national trend Smoking prevalence by race Smoking prevalence by education Geographic differences in smoking prevalence Smoking prevalence by health insurance status Smoking prevalence by health status Part 1: Adult Smoking Prevalence

Source: Massachusetts BRFSS Prepared by: Health Survey Program Trend in the percentage of adults who are current smokers: MA Overall smoking rates in Massachusetts have declined steadily over the past 20 years.* * Statistically significant (p<.05)

Source: Massachusetts BRFSS Prepared by: Health Survey Program Percentage of Adult Current Smokers MA and US, * * Statistically significant (p<.05)

Source: Massachusetts BRFSS Prepared by: Health Survey Program Smoking Prevalence by Race MA, * * No significant differences between groups

Source: Massachusetts BRFSS Prepared by: Health Survey Program Smoking Prevalence by Education Level MA, * * Statistically significant (p<.05)

Source: Massachusetts BRFSS Prepared by: Health Survey Program Smoking Prevalence by Education Level, MA, * No 4-Year Degree 4 Year College Degree  3.3%* per year  1.7% per year * Statistically significant (p<.05)

Source: Massachusetts BRFSS Prepared by: Health Survey Program

Source: Massachusetts BRFSS Prepared by: Health Survey Program Smoking Prevalence by Health Insurance Status, MA, 2001 to 2005* * No difference between Medicaid and No Health Insurance groups. Rate for Private Health Insurance significantly less (p<.05) than other two groups. All groups include adults 18 to 64 years of age.

Source: Massachusetts BRFSS Prepared by: Health Survey Program Smoking Prevalence by Health Status MA, * * Statistically significant (p<.05)

Source: Massachusetts BRFSS Prepared by: Health Survey Program Tobacco Use in Massachusetts The statewide Smoke-Free Workplace Law “No Smoking in Home” rule Secondhand smoke and children Part 2: Secondhand Smoke

Source: Massachusetts BRFSS Prepared by: Health Survey Program Secondhand Tobacco Smoke Exposure (>1 hour/week), MA, * Smoke Free Workplace Law became effective July 5, 2004 * Statistically significant (p<.05)

Source: Massachusetts BRFSS Prepared by: Health Survey Program "No Smoking in Home" Rule in Households, MA, * Statistically significant (p<.05) 44.3% 39.8% 75.0% 82.9% 5.3% per year 4.9% per year

Source: Massachusetts BRFSS Prepared by: Health Survey Program Secondhand Smoke and Children The Report of the Surgeon General June 27, 2006 Sudden Infant Death Syndrome more frequent and severe asthma attacks increased risk for ear infections acute lower respiratory infections such as bronchitis and pneumonia respiratory symptoms, including cough, phlegm, wheezing, and breathlessness

Source: Massachusetts BRFSS Prepared by: Health Survey Program Tobacco Data Highlights Smoking rates have declined steadily over the past 20 years The overall drop has been fueled by a large decrease in the smoking rates among college educated adults. The rates for other groups have dropped more slowly. Smoking rates are highest in Western and Southeastern Massachusetts. They are lowest in the Metro West region.

Source: Massachusetts BRFSS Prepared by: Health Survey Program Tobacco Data Highlights Smokers are less likely to have health insurance than non-smokers and much more likely to have health problems Exposure to second hand smoke has dropped significantly since the beginning of the campaign for a statewide Smoke-Free Workplace Law Nearly one-quarter million children live in homes where smoking is permitted

Source: Massachusetts BRFSS Prepared by: Health Survey Program Program Implications How the data drive the program Despite decline in prevalence, more than 850,000 smokers Promotion and education campaigns must highlight the importance of smoking cessation and encourage quitting among: –Less Educated, Medicaid, uninsured –Physically and mentally ill –Women of childbearing age –Cultural and linguistic minorities 12

Source: Massachusetts BRFSS Prepared by: Health Survey Program Program Implications How the data drive the program Targeted programming, based on estimated smoking prevalence data available for each municipality –Community intervention programs to funded geographic areas with high smoking prevalence in progress –Planning grants to support community readiness (to address tobacco related issues) in progress –Hospital pilot projects to address high smoking rates among pregnant women and women of childbearing age in Western Mass. 12

Source: Massachusetts BRFSS Prepared by: Health Survey Program

Source: Massachusetts BRFSS Prepared by: Health Survey Program

Source: Massachusetts BRFSS Prepared by: Health Survey Program

Source: Massachusetts BRFSS Prepared by: Health Survey Program How the data drive the program Partnership with Medicaid to design, implement and evaluate the new tobacco cessation program/benefit Partnership with Blue Cross/Blue Shield to provide information about local smoking rates so provider reps might target physician practices in high smoking rate communities to promote Quitworks Partnership with community health centers to promote cessation and the Medicaid benefit Collaboration and qualitative research with cultural and linguistic communities to plan appropriate education, outreach and cessation strategies. 12

Source: Massachusetts BRFSS Prepared by: Health Survey Program Accessing BRFSS data BRFSS Annual Report: A Profile of Health Among Massachusetts Adults, 2005 Health Survey Program – MassCHIP – 8