Tobacco Progress Review May 14, 2003

Public Health Challenges Tobacco Impact and Public Health Challenges 28% of High School Students 11% of Middle School Students 22% of Adults (46 million adults) Current Smokers Environmental Tobacco Smoke 54% of Nonsmokers Exposed Annual Impact ~440,000 Premature Deaths Lung / Other Cancers Chronic Respiratory Disease Cardiovascular Disease 14% of Medicaid Expenditures Direct and Indirect Costs: $157 Billion

Smoking-Attributable Mortality, Number of average annual deaths Sources: CDC. Annual Smoking –Attributable Mortality, Years of Potential Life Lost, and Economic Costs—United States, MMWR ; Burn deaths from: Hall JR. The U.S. smoking-material fire problem. Quincy, Massachusetts: National Fire Protection Association, Fire Analysis and Research Division, Environmental tobacco smoke deaths from: National Cancer Institute. Health effects of exposure to environmental tobacco smoke: the report of the California Environmental Protection Agency. Smoking and tobacco control monograph 10. Bethesda, Maryland: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Total does not equal sum due to rounding. Neoplasms Cardiovascular diseases Respiratory disease Total Perinatal conditions Burn deaths Total Lung cancer Ischemic heart disease Environmental Tobacco Smoke

3-2. Lung Cancer Death Rates Age-adjusted death rate per 100,000 standard population Black male Total population White male White female Black female Notes: Data are age adjusted to the 2000 standard population. The race groups white and black may be of Hispanic or non-Hispanic origin. Source: National Vital Statistics System-Mortality (NVSS-M), NCHS, CDC Target Total male Total female

27-1a. Current Cigarette Smoking: Adults 18 Years and Older Age-adjusted percent 2010 Target Black male White male White female Black female Notes: Data are age adjusted to the 2000 standard population. Survey redesigned in 1997 and data for 1998 and subsequent years may not be directly comparable to earlier years. Source: National Health Interview Survey (NHIS), NCHS, CDC.

27-1a. Current Cigarette Smoking for Adults American Indian/ Alaska Native only Asian only Hispanic * Black, not Hispanic only* White, not Hispanic only* 2010 Target1998 BaselineCurrent Level *Preliminary data: January-September 2002, current data year for other groups is Notes: Current smokers report smoking everyday/some days and have smoked at least 100 cigarettes. Data are age adjusted to the 2000 standard population. American Indians/Alaska Natives or Asians/Pacific Islanders may be of Hispanic origin. Hispanics may be of any race. For 1998 and 2002, persons reported only one race or reported more than one race and identified one race as best representing their race. Adults: 18 years and older. Total* Source: National Health Interview Survey (NHIS), NCHS, CDC. Males* 9-11 years High school graduate years 16 years or more Females* Age-adjusted percent Education level

27-5. Percent of Current Adult Smokers Who Attempted to Quit in the Past Year, 2001 American Indian/ Alaska Native only Asian only HispanicBlack, not Hispanic only White, not Hispanic only 2010 Target I 95% confidence interval *Current smokers (everyday/some days and have smoked at least 100 cigarettes) who have quit smoking one day or longer in the year prior to interview. Notes: American Indians/Alaska Natives or Asians may be of Hispanic origin. Hispanics may be of any race. Data are age adjusted to the 2000 standard population. Adults: 18 years and older. Age-adjusted percent Total Source: National Health Interview Survey (NHIS), NCHS, CDC.

27-1a, 27-2b. Current Cigarette Smoking Percent 2010 Target: Students Students (grades 9-12) Adults (18 and older) 2010 Target: Adults *Preliminary data, January-September Notes: Adults, age adjusted to the 2000 standard population. Current Smoking: Adults-every/some days (and have smoked at least 100 cigarettes), Students-1+ day/past month. 2002* Sources: Adults, National Health Interview Survey (NHIS), NCHS, CDC. Students, Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC.

Healthy People 2010 Objectives Past Month* Tobacco Users: Students (Grades 9-12), 2001 Tobacco Product Any Tobacco Product CigarettesSpit Tobacco Cigars Current Rate 34% (total) 30% (females) 39% (males) 28% (total) 28% (females) 29% (males) 8% (total) 2% (females) 15% (males) 15% (total) 9% (females) 22% (males) 2010 Target 21%16%1%8% Objective Number 27-2a.27-2b.27-2c.27-2d. *Tobacco use on one or more days in the 30 days preceding the survey. Note: Tobacco users may have used more than one tobacco product. Source: Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC.

27-2b. Cigarette Use in Past Month*: Students (grades 9-12) Males Hispanic Black, not Hispanic White, not Hispanic 2010 Target1999 Baseline2001Percent TotalFemales Sources: Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC and **National Youth Tobacco Survey, OSH, CDC and The American Legacy Foundation. I 95% confidence interval *Smoked cigarette(s) on one or more days of the 30 days preceding the survey. Note: Data for American Indians, Alaska Natives, and Pacific Islanders are unreliable. In 2000, 11% of students in grades 6-8 smoked**

Current Cigarette Smoking, Price and Tax: Students (12 th Grade) Dollars Mean excise tax on a pack of cigarettes Current smoking Real price per pack Current smoking Percent *Current cigarette smoking: Have smoked at least once in the past 30 days. ** Real price is Consumer Price Index-adjusted national average retail price. Real price and mean excise tax per pack of cigarettes adjusted for inflation. Sources: Original analysis/slide prepared by the ImpacTeen Project. Estimated prices for the period covered by the survey data are based on the 11/01 price for each year reported by Orzechowski and Walker, adjusted for changes in state and federal cigarette taxes and trends in the non-tax component of price. Price data from: Orzechowski W, Walker RC. The tax burden on tobacco: historical compilation Arlington, Virginia: Orzechowski and Walker, Smoking prevalence data from: Monitoring the Future Study, NIH, NIDA. Tax data from: The Tax Burden on Tobacco, The Tobacco Institute.

Current Smoking* and Price: Students (12 th Grade), *Current cigarette smoking: Have smoked at least once in the past 30 days. ** Real price is Consumer Price Index-adjusted national average retail price. Sources: Original analysis/slide prepared by the ImpacTeen Project. Estimated prices for the period covered by the survey data are based on the 11/01 price for each year reported by Orzechowski and Walker, adjusted for changes in state and federal cigarette taxes and trends in the non-tax component of price. Price data from: Orzechowski W, Walker RC. The tax burden on tobacco: historical compilation Arlington, Virginia: Orzechowski and Walker, Smoking prevalence data from: Monitoring the Future Study, NIH, NIDA. Cigarette priceCurrent smoking

Exposure to Environmental Tobacco Smoke: Nonsmokers* with Detectable Cotinine Levels**, Ages 4 and Older 2010 Target Baseline Percent with detectable serum cotinine Mexican American Total White, not Hispanic Black, not Hispanic Source: National Health and Nutrition Examination Survey (NHANES), NCHS, CDC. I 95% confidence interval * Nonsmokers defined by serum cotinine levels < 11 ng/mL. **Detectable serum cotinine levels: >.05 ng/mL and < 10 ng/mL. Notes: Age adjusted to the 2000 standard population. Data for other Hispanics, American Indians, Alaska Natives, Asians and Pacific Islanders are unreliable.

Smoke-Free Indoor Air Laws* 2010 Target Total number of States with laws (including D.C.) Workplace Transportation Source: State Tobacco Activities Tracking and Evaluation System (STATE System), OSH, NCCDPHP, CDC. *Indoor air laws: smoking bans or limited to separately ventilated areas Baseline

2010 Target: 51 (50 States + D.C.) Source: Health Policy Tracking Service, National Conference of State Legislators. 27-8b. States With Medicaid Coverage for Treatment of Nicotine Dependency Complete CoveragePartial Coverage No Coverage

Progress review data and slides can be found on the web at:

Healthy People 2010 Objectives Current Regular* Tobacco Users: Adults Tobacco Product (Year) Cigarettes (2002, Jan.-Sept., preliminary ) Spit Tobacco (2000) Cigars (2000) Pipes (2000) Bidis (2000) Number of Users 46,155,000 persons 4,444,000 persons 4,386,000 persons 973,000 persons 167,000 persons Current Rate 22% (total) 20% (females) 25% (males) 2.3% (total) 0.3% (females) 4.4% (males) 2.2% (total) 0.2% (females) 4.4% (males) 0.5% (total) 0.06% (females 0.06% (females)** 1.0% (males) 0.09% (total) 0.08% (females) 0.09% (males) 2010 Target 12%0.4%1.2% Targets: to be determined Objective Number 27-1a27-1b27-1c 27-1d 27-1e Notes: Data are age adjusted to the 2000 standard population. Estimated number of users are rounded to the nearest thousand. Users may regularly use more than one tobacco product. Adults: 18 years and older. *Everyday or somedays.**Unreliable estimate, relative standard error >30%. Source: National Health Interview Survey (NHIS), NCHS, CDC. (2001)

27-1a. Current Cigarette Smoking for Adults 18 years and older: 1998, 2001, and 2002 American Indian/ Alaska Native only Asian only Hispanic Black, not Hispanic only White, not Hispanic only 2010 Target1998 Baseline2001 I 95% confidence interval *Preliminary data: January-September Notes: Current smokers report smoking everyday/some days and have smoked at least 100 cigarettes. Data are age adjusted to the 2000 standard population. American Indians/Alaska Natives or Asians/Pacific Islanders may be of Hispanic origin. Hispanics may be of any race. For 1998 and 2002, persons reported only one race or reported more than one race and identified one race as best representing their race. Age-adjusted percent Total 2002* Source: National Health Interview Survey (NHIS), NCHS, CDC.

27-1a. Current Cigarette Smoking for Adults 18 years and older: 1998, 2001, and 2002 Age-adjusted percent I 95% confidence interval. * Preliminary data: January-September Note: Data are age adjusted to the 2000 standard population. Education Level 1998 Baseline 2010 Target 9-11 yrs. All adults HS graduate years16 years or more FemalesMales 2001 Source: National Health Interview Survey (NHIS), NCHS, CDC. 2002*

27-5. Percent of Current Adult Smokers Who Attempted to Quit in the Past Year American Indian/ Alaska Native only Asian only HispanicBlack, not Hispanic only White, not Hispanic only 2010 Target1998 Baseline2001 I 95% confidence interval *Current smokers (everyday/some days who have smoked at least 100 cigarettes) who have quit smoking one day or longer in the year prior to interview. Notes: American Indians/Alaska Natives or Asians may be of Hispanic origin. Hispanics may be of any race. For 1998, persons reported only one race or reported more than one race and identified one race as best representing their race. Data are age adjusted to the 2000 standard population. Adults: 18 years and older. Age-adjusted percent Total Source: National Health Interview Survey (NHIS), NCHS, CDC.

27-2a. Tobacco Use in Past month*: Students (grades 9-12) Males Hispanic Black, not Hispanic White, not Hispanic 2010 Target1999 Baseline2001 I 95% confidence interval *Smoked cigarettes or cigars or used chewing tobacco, snuff, or dip on one or more of the 30 days preceding the survey. Note: Data for American Indians, Alaska Natives, and Pacific Islanders are unreliable. Percent TotalFemales Source: Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC. 19

Tobacco Use in the Past Month: Students (Grades 9-12) Direction of change desired 2010 Target % 8% 1% 16% 34% 28% 8% 15% Source: Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC. (27-2a.) (27-2c.) (27-2d.) (27-2b.)

27-3a,b. Persons Who First Used Any Cigarettes During 1965 to 2000 Age-specific rate per 1,000 person-years exposure Targets: to be determined. Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse,

Percent of Mothers Who Reported Smoking During Pregnancy*, years20-24 years Notes: *Total of 49 reporting States and D.C., excludes data for California, which did not require reporting of tobacco use during pregnancy on birth certificates. **14% quit during their first trimester (age adjusted to the 2000 standard population - objective 27-6) years25-29 years years years years Age of Mother In 1998, 20% of mothers years who smoked quit smoking during their pregnancy** Percent Sources: *National Vital Statistics System-Natality (NVSS-N), and **National Health Interview Survey (NHIS), NCHS, CDC years

Percent of Mothers Who Reported Smoking During Pregnancy by Race/Ethnicity, 2001 Total* Notes: Persons of Hispanic origin may be of any race. Total of 49 reporting States and D.C., excludes data for California, which did not require reporting of tobacco use during pregnancy on birth certificates. HispanicBlack, not Hispanic White, not Hispanic Mother’s Age Total*HispanicWhite, not Hispanic Black, not Hispanic Percent Mother’s Age Source: National Vital Statistics System-Natality (NVSS-N), NCHS, CDC. *Totals include origin not stated.

27-9. Reported Exposure to Tobacco Smoke at Home: Children ages 6 and under, 1998 Hispanic Black, not Hispanic White, not Hispanic 2010 Target I 95% confidence interval. ##Unreliable estimate, relative standard error >30%. Notes: Exposure is defined as anyone smoking inside the home at least 4 days a week. Hispanics may be of any race. American Indians, Alaska Natives, Asians, and Pacific Islanders may be of Hispanic origin. Percent Total PoorMiddle /High Source: National Health Interview Survey (NHIS), NCHS, CDC. Near poor American Indian /Alaska Native Asian/Pacific Islander ## 6 Family Income Level

 Rode in Car with Someone Who Was Smoking on at Least One of the Preceding Seven Days: Middle School Students: 34.3%** (range of 26 States: 21.7% in DC, to 45.5% in WV) High School Students: 29.2%** (range of 24 States: 19.9% in CO, to 43.3% in KY)  Were in Same Room with Someone Who Was Smoking on at Least One of the Preceding Seven Days: Middle School Students: 49.1%** (range of 26 States: 36.4% in CA, to 63.7% in WV) High School Students: 56.5%** (range of 24 States: 39.7% in DC, to 71.5% in KY). Reported Environmental Tobacco Smoke Exposure in Nonsmokers*, 2000 Source: National Youth Tobacco Survey (NYTS), OSH, NCCDPHP, CDC and American Legacy Foundation. *Never cigarette smokers. ** Median of State rates.

Exposure to Environmental Tobacco Smoke (ETS): Nonsmokers* with Detectable Serum Cotinine Levels** 2010 Target Baseline I 95% confidence interval * Nonsmokers defined by serum cotinine levels < 11 ng/mL. **Detectable serum cotinine levels: >.05 ng/mL and < 10 ng/mL. ***Age adjusted to the 2000 standard population. Source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. Percent with detectable serum cotinine Ages 4-17 Ages 4 and older*** Ages 18+*** Source: National Health and Nutrition Examination Survey (NHANES), NCHS, CDC. Annually, ETS causes about 3,000 lung cancer deaths and 35,000 deaths from ischemic heart disease in adult nonsmokers

Exposure to Environmental Tobacco Smoke: Nonsmokers* with Detectable Cotinine Levels**, Ages 4 to Target Baseline Percent with detectable serum cotinine Mexican American Total White, not Hispanic Black, not Hispanic Source: National Health and Nutrition Examination Survey (NHANES), NCHS, CDC. I 95% confidence interval * Nonsmokers defined by serum cotinine levels < 11 ng/mL. **Detectable serum cotinine levels: >.05 ng/mL and < 10 ng/mL. ), Note: Data for other Hispanics, American Indians, Alaska Natives, Asians and Pacific Islanders are unreliable.

Exposure to Environmental Tobacco Smoke: Nonsmokers* with Detectable Cotinine Levels**, Ages 18 and older 2010 Target Baseline Note: Age adjusted to the 2000 standard population. Data for other Hispanics, American Indians, Alaska Natives, Asians and Pacific Islanders are unreliable. Percent with detectable serum cotinine Mexican American Total White, not Hispanic Black, not Hispanic Source: National Health and Nutrition Examination Survey (NHANES), NCHS, CDC. I 95% confidence interval *Nonsmokers defined by serum cotinine levels < 11 ng/mL. **Detectable serum cotinine levels: >.05 ng/mL and < 10 ng/mL.

Exposure to Environmental Tobacco Smoke: Nonsmokers* with Detectable Cotinine Levels** 2010 Target Baseline Percent with detectable serum cotinine Adults Ages 18 and older*** Source: National Health and Nutrition Examination Survey (NHANES), NCHS, CDC. I 95% confidence interval * Nonsmokers defined by serum cotinine levels < 11 ng/mL. **Detectable serum cotinine levels: >.05 ng/mL and < 10 ng/mL. Note: ***Age adjusted to the 2000 standard population. ), CDC, NCHS.

Smoke-Free Indoor Air Laws*: Target Number of States with laws (including D.C.) Workplace Transportation Source: State Tobacco Activities Tracking and Evaluation System (STATE System), OSH, NCCDPHP, CDC. *Indoor air laws: smoking bans or limited to separately ventilated areas.

24-2a,b,c. Hospitalizations for Asthma: 1998, 1999, and Target1998 Baseline I 95% confidence interval Note: *Data are age adjusted to the 2000 standard population. Hospitalizations per 10,000 population 1999 Children under 5 years Persons 5 to 64 years*Adults 65 and older* TotalFemaleMaleTotalFemaleMale FemaleTotal Source: National Hospital Discharge Survey (NHDS), NCHS, CDC

24-2a,b,c. Hospitalizations for Asthma: 1998, 1999, and Target1998 Baseline I 95% confidence interval Notes: *Data are age adjusted to the 2000 standard population. Data for Hispanics, American Indians, Alaska Natives, Asians and Pacific Islanders are unreliable. Hospitalizations per 10,000 population 1999 Children under 5 years Persons 5 to 64 years*Adults 65 and older* TotalBlackWhiteTotalBlackWhite BlackTotal Source: National Hospital Discharge Survey (NHDS), NCHS, CDC.

3-2. Lung Cancer Death Rates Age-adjusted death rate per 100,000 standard population 2010 Target Female Male Total Note: Data are age adjusted to the 2000 standard population. Source: National Vital Statistics System-Mortality (NVSS-M), NCHS, CDC.

3-2. Lung Cancer Death Rates Age-adjusted death rate per 100,000 standard population Black male Total population White male White female Black female Notes: Data are age adjusted to the 2000 standard population. The race groups white and black may be of Hispanic or non-Hispanic origin. Source: National Vital Statistics System-Mortality (NVSS-M), NCHS, CDC Target

3-2. Lung Cancer Death Rates, 2000 Age-adjusted death rate per 100,000 standard population Notes: American Indians/Alaska Natives or Asians/Pacific Islanders may be of Hispanic origin. Hispanics may be of any race. Malignant neoplasms of trachea, bronchus and lung: ICD-10 codes C33-C34. Data are age adjusted to the 2000 standard population. Source: National Vital Statistics System-Mortality (NVSS-M), NCHS, CDC Target American Indian/ Alaska Native Asian/ Pacific Islander Hispanic Black, not Hispanic White, not Hispanic Total Source: National Vital Statistics System-Mortality (NVSS-M), NCHS, CDC.

Group Estimated Annual Percent Change Male * White * Black / African American * Asian or Pacific Islander Hispanic or Latino * Female White Black / African American Asian or Pacific Islander Hispanic or Latino * Age-Adjusted Lung Cancer Incidence Rates New Cases per 100,000 population *Estimated annual percent change (EAPC) is significantly different from 0 (p<0.05). EAPC has been calculated by fitting a linear regression model to the natural logarithm of the yearly rates from Notes: Estimates for American Indians or Alaska Natives are not shown because of the small number of cases. The race groups, white, black and Asian or Pacific Islander include persons of Hispanic and non-Hispanic origin. ICD-9-CM codes: Source: National Institutes of Health, National Cancer Institute, Surveillance, Epidemiology, and End Results (SEER) Program.

27-21a. Average Federal and State Tax on Cigarettes: Mean Excise Tax on a Pack of Cigarettes Dollars Source: The Tax Burden on Tobacco, The Tobacco Institute.

Total Coronary Heart Disease Death Rates, 2000 Black, Not Hispanic Asian or Pacific Islander American Indian or Alaska Native White, Not Hispanic Male Female Source: National Vital Statistics System – Mortality (NVSS-M), NCHS, CDC. NOTE: Coronary heart disease: ICD-10 codes I11, I20-I25. American Indian or Alaska Natives, Asian or Pacific Islanders may be of Hispanic origin. Hispanics may be of any race target Total 156 Age-adjusted death rate per 100,000 standard population