27

Tobacco Use

Tobacco Use in Population Groups

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27-1

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Adult tobacco use

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27-1a

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Cigarette smoking

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27-1b

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Spit tobacco

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27-1c

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Cigars

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27-1d

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Other products

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27-2

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Adolescent tobacco use

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27-2a

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Tobacco products

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27-2b

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Cigarettes

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27-2c

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Spit tobacco

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27-2d

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Cigars

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27-3

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Initiation of tobacco use

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27-4

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Age at first tobacco use

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27-4a

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Adolescents aged 12 to 17 years

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27-4b

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Young adults aged 18 to 25 years

Cessation and Treatment

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27-5

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Smoking cessation by adults

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27-6

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Smoking cessation during pregnancy

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27-7

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Smoking cessation by adolescents

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27-8

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Insurance coverage of cessation treatment

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27-8a

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Managed care organizations

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27-8b

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Medicaid programs

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27-8c

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All insurance

Exposure to Secondhand Smoke

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27-9

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Exposure to tobacco smoke at home among children

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27-10

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Exposure to environmental tobacco smoke

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27-11

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Smoke-free and tobacco-free schools

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27-12

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Worksite smoking policies


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27-13

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Smoke-free indoor air laws

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27-13a

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Private workplaces

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27-13b

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Public workplaces

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27-13c

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Restaurants

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27-13d

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Public transportation

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27-13e

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Day care centers

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27-13f

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Retail stores

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27-13g

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Tribes

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27-13h

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Territories

Social and Environmental Changes

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27-14

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Enforcement of illegal tobacco sales to minors laws

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27-14a

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States and District of Columbia

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27-14b

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Territories

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27-15

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Retail license suspension for sales to minors

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27-16

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Tobacco advertising and promotion targeting adolescents and young adults

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27-17

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Adolescent disapproval of smoking

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27-17a

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8th graders          

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27-17b

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10th graders        

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27-17c

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12th graders        

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27-18

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Tobacco control programs

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27-19

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Preemptive tobacco control laws

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27-20

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Tobacco product regulation

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27-21

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Tobacco tax

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27-21a

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Cigarettes

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27-21b

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Spit tobacco


Tobacco Use in Population Groups

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27-1.

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Reduce tobacco use by adults.

27-1a.    Cigarette smoking.

National Data Source

National Health Interview Survey (NHIS), CDC, NCHS.

State Data Source

Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.

Healthy People 2000 Objective

3.4 (Tobacco) (also 15.12 and 16.6), age adjusted to the 2000 standard population.

Leading Health Indicator

Tobacco Use.

Measure

Percent (age adjusted—see Comments).

Baseline

24 (1998).

Numerator

Number of adults aged 18 years and older who have smoked at least 100 cigarettes in lifetime and who now report smoking cigarettes everyday or some days.

Denominator

Number of adults aged 18 years and older.

Population Targeted

U.S. civilian, noninstitutionalized population.

Questions Used To Obtain the National Data

From the 1998 National Health Interview Survey:



Ø       Have you smoked at least 100 cigarettes in your entire life?



[If yes:]

o        Do you now smoke cigarettes everyday, some days, or not at all?

Expected Periodicity

Annual.

Comments

Persons are considered as using cigarettes if they report that they smoked at least 100 cigarettes in their lifetime and now report smoking cigarettes everyday or some days.



Starting in 1992, NHIS has defined current smokers as persons who have smoked at least 100 cigarettes and now smoke either everyday or some days. The 1992 inclusion of intermittent smoking increased the prevalence of smoking by approximately one percent compared with estimates derived from the previous smoking definition.



For State data, 1996 and later questions from the BRFSS are the same as those presented for 1998 NHIS.



Data are age adjusted to the 2000 standard population. Age-adjusted percents are weighted sums of age-specific percents. For a discussion on age adjustment, see Part A, section 5.



This objective is one of the measures used to track the Tobacco Use Leading Health Indicator. See Appendix H for a complete listing.



See Part C for a description of NHIS and BRFSS and Appendix A for focus area contact information.

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27-1b.    Spit tobacco.

National Data Source

National Health Interview Survey (NHIS), CDC, NCHS.

State Data Source

Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.

Healthy People 2000 Objective

Not applicable.

Measure

Percent (age adjusted—see Comments).

Baseline

2.6 (1998).

Numerator

Number of adults 18 years and older who report using snuff or chewing tobacco at least 20 times in their lifetime and now use it everyday or some days.

Denominator

Number of adults aged 18 years and older.

Population Targeted

U.S. civilian, noninstitutionalized population.

Questions Used To Obtain the National Data

From the 1998 National Health Interview Survey:



Ø       Have you used snuff such as Skoal, Skoal Bandits, or Copenhagen at least 20 times in your entire life?



[If yes:]

o        Do you now use snuff everyday, some days, or not at all?



Ø       Have you ever used chewing tobacco such as Redman, Levi Garrett, or Beechnut at least 20 times in your entire life?



[If yes:]

o        Do you now use chewing tobacco everyday, some days, or not at all?

Expected Periodicity

Periodic.

Comments

Persons are classified as using either snuff or chewing tobacco if they answer “yes” to either use of snuff or use of chewing tobacco, and they report using the snuff or chewing tobacco “everyday” or “some days.” 



For State data, the 1998 BRFSS (Optional Module) contains questions similar, but not identical, to NHIS questions.



Data are age adjusted to the 2000 standard population. Age-adjusted percents are weighted sums of age-specific percents. For a discussion on age adjustment, see Part A, section 5.



See Part C for a description of NHIS and BRFSS and Appendix A for focus area contact information.

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27-1c.    Cigars.

National Data Source

National Health Interview Survey (NHIS), CDC, NCHS.

State Data Source

Not identified—see Comments.

Healthy People 2000 Objective

Not applicable.

Measure

Percent (age adjusted—see Comments).

Baseline

2.5 (1998).

Numerator

Number of adults 18 years and older who report having smoked at least 50 cigars in lifetime and now smoke cigars everyday or some days.

Denominator

Number of adults aged 18 years and older.

Population Targeted

U.S. civilian, noninstitutionalized population.

Questions Used To Obtain the National Data

From the 1998 National Health Interview Survey:



Ø       Have you ever smoked cigars?



[If yes:]

o        Have you smoked at least 50 cigars in your entire life?



o        Do you now smoke cigars everyday, some days, or not at all?

Expected Periodicity

Periodic.

Comments

Persons are classified as smoking cigars if they answer “yes” to smoking 50 cigars in their lifetime, and report smoking cigars “everyday” or “some days.”



For State data, questions on cigar smoking for the 2001 BRFSS (Optional Module) are proposed. They are not identical to the NHIS questions.



Data are age adjusted to the 2000 standard population. Age-adjusted percents are weighted sums of age-specific percents. For a discussion on age adjustment, see Part A, section 5.



See Part C for a description of NHIS and BRFSS and Appendix A for focus area contact information.

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27-1d.    (Developmental) Other products.

Comments

An operational definition could not be specified at the time of publication.



Other products are expected to include pipes, bidis, and possibly other herbal cigarettes. The proposed national data source is the National Health Interview Survey (NHIS), CDC, NCHS, and the proposed State data source is the Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.



The 1998 NHIS asked the following questions to obtain pipe smoking data: Have you ever smoked pipes? (If yes,) Have you smoked at least 50 pipes in your entire life? Do you now smoke pipes everyday, some days, or not at all?



See Part C for a description of NHIS and Appendix A for focus area contact information.

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27-2.

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Reduce tobacco use by adolescents.

27-2a.    Tobacco products (past month).

National Data Source

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

State Data Source

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

Healthy People 2000 Objective

Adapted from 3.9 (Tobacco) (also 13.17) and 4.6 (Substance Abuse: Alcohol and Other Drugs) (also 3.20).

Measure

Percent.

Baseline

40 (1999).

Numerator

Number of students in grades 9 through 12 who report using cigarettes, spit tobacco, or cigars on 1 or more of the 30 days preceding the survey.

Denominator

Number of students in grades 9 through 12.

Population Targeted

Students in grades 9 through 12.

Questions Used To Obtain the National Data

From the 1999 Youth Risk Behavior Surveillance System:



Ø       During the past 30 days, on how many days did you smoke cigarettes?



Ø       During the past 30 days, on how many days did you use chewing tobacco or snuff, such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, or Copenhagen?



Ø       During the past 30 days, on how many days did you smoke any cigars, cigarillos, or little cigars?

Expected Periodicity

Biennial.

Comments

Students are classified as using tobacco if they report using at least one of the tobacco products on 1 or more of the 30 days preceding the survey.



This objective differs from Healthy People 2000 objectives 3.9 and 4.6 in two ways. For the Healthy People 2000 objectives, the national data source was the National Household Survey on Drug Abuse (NHSDA), SAMHSA, and the targeted age group was 12 to 17 years.



See Part C for a description of YRBSS and Appendix A for focus area contact information.

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27-2b.    Cigarettes (past month).

National Data Source

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

State Data Source

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

Healthy People 2000 Objective

Adapted from 4.6 (Substance Abuse: Alcohol and Other Drugs) (also 3.20).

Leading Health Indicator

Tobacco Use.

Measure

Percent.

Baseline

35 (1999).

Numerator

Number of students in grades 9 through 12 who reported having smoked cigarettes on 1 or more of the 30 days preceding the survey.

Denominator

Number of students in grades 9 through 12.

Population Targeted

Students in grades 9 through 12.

Questions Used To Obtain the National Data

From the 1999 Youth Risk Behavior Survey:



Ø       During the past 30 days, on how many days did you smoke cigarettes?

Expected Periodicity

Biennial.

Comments

This objective differs from Healthy People 2000 objective 4.6 in two ways. For the Healthy People 2000 objective, the national data source was the National Household Survey on Drug Abuse (NHSDA), SAMHSA, and the targeted age group was 12 to 17 years.



This objective is one of the measures used to track the Tobacco Use Leading Health Indicator. See Appendix H for a complete listing.



See Part C for a description of YRBSS and Appendix A for focus area contact information.

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27-2c.    Spit tobacco (past month).

National Data Source

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

State Data Source

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

Healthy People 2000 Objective

Adapted from 3.9 (Tobacco) (also 13.17).

Measure

Percent.

Baseline

8 (1999).

Numerator

Number of students in grades 9 through 12 who reported having used smokeless (chewing tobacco or snuff) tobacco on 1 or more of the 30 days preceding the survey.

Denominator

Number of students in grades 9 through 12.

Population Targeted

Students in grades 9 through 12.

Questions Used To Obtain the National Data

From the 1999 Youth Risk Behavior Surveillance System:



Ø       During the past 30 days, on how many days did you use chewing tobacco or snuff, such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, or Copenhagen?

Expected Periodicity

Biennial.

Comments

This objective differs from Healthy People 2000 objective 3.9 in two ways. For the Healthy People 2000 objective, the national data source was the National Household Survey on Drug Abuse (NHSDA), SAMHSA, and the targeted age group was 12 to 17 years.



See Part C for a description of YRBSS and Appendix A for focus area contact information.

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27-2d.    Cigars (past month).

National Data Source

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

State Data Source

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

Healthy People 2000 Objective

Not applicable.

Measure

Percent.

Baseline

18 (1999).

Numerator

Number of students in grades 9 through 12 who reported having smoked cigars on 1 or more of the 30 days preceding the survey.

Denominator

Number of students in grades 9 through 12.

Population Targeted

Students in grades 9 through 12.

Questions Used To Obtain the National Data

From the 1999 Youth Risk Behavior Surveillance System:



Ø       During the past 30 days, on how many days did you smoke any cigars, cigarillos, or little cigars?

Expected Periodicity

Biennial.

Comments

See Part C for a description of YRBSS and Appendix A for focus area contact information.

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27-3.

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(Developmental) Reduce the initiation of tobacco use among children and adolescents.

Comments

An operational definition could not be specified at the time of publication. A proposed data source is the National Household Survey on Drug Abuse (NHSDA), SAMHSA.



This objective is modified from Healthy People 2000 objective 3.5 (Tobacco).



See Appendix A for focus area contact information.

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27-4.

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Increase the average age of first use of tobacco
products by adolescents and young adults.

27-4a.  Adolescents aged 12 to 17 years.

National Data Source

National Household Survey on Drug Abuse (NHSDA), SAMHSA.

State Data Source

Not identified.

Healthy People 2000 Objective

4.5 (Substance Abuse: Alcohol and Other Drugs) (also 3.19).

Measure

Mean.

Baseline

12 (1997).

Numerator

Sum of the ages of first cigarette use of adolescents aged 12 to 17 years who ever smoked, including those who ever smoked one or two puffs in their lifetime.

Denominator

Number of adolescents aged 12 to 17 years who ever smoked, including those who ever smoked one or two puffs in their lifetime.

Population Targeted

U.S. civilian, noninstitutionalized population.

Questions Used To Obtain the National Data

From the 1997 National Household Survey on Drug Abuse:



Ø       How old were you the first time you smoked a cigarette, even one or two puffs?

The first time I smoked a cigarette I was _____ years old.
I have never smoked a cigarette in my life.

Expected Periodicity

Annual.

Comments

See Part C for a description of NHSDA and Appendix A for focus area contact information.

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27-4b.    Young adults aged 18 to 25 years.

National Data Source

National Household Survey on Drug Abuse (NHSDA), SAMHSA.

State Data Source

Not identified.

Healthy People 2000 Objective

Adapted from 4.5 (Substance Abuse: Alcohol and Other Drugs) (also 3.19).

Measure

Mean.

Baseline

15 (1997).

Numerator

Sum of the ages of first cigarette use of young adults aged 18 to 25 years who ever smoked, including those who ever smoked one or two puffs in their lifetime.

Denominator

Number of young adults aged 18 to 25 years who ever smoked cigarettes, including those who ever smoked one or two puffs in their lifetime.

Population Targeted

U.S. civilian, noninstitutionalized population.

Questions Used To Obtain the National Data

See Questions Used To Obtain the National Data provided with objective 27-4a.

Expected Periodicity

Annual.

Comments

This objective differs from Healthy People 2000 objective 4.5, which did not target the age group of 18 to 25 years.



See Part C for a description of NHSDA and Appendix A for focus area contact information.

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Cessation and Treatment

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27-5.

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Increase smoking cessation attempts by adult smokers.

National Data Source

National Health Interview Survey (NHIS), CDC, NCHS.

State Data Source

Not identified.

Healthy People 2000 Objective

Adapted from 3.6 (Tobacco).

Measure

Percent (age adjusted—see Comments).

Baseline

41 (1998).

Numerator

Number of current, everyday cigarette smokers aged 18 years and older who quit smoking for 1 day or longer during the 12 months prior to the interview.

Denominator

Number of adults in the survey population aged 18 years and older who are current, everyday cigarette smokers.

Population Targeted

U.S. civilian noninstitutionalized population.

Questions Used To Obtain the National Data

From the 1998 National Health Interview Survey:



Ø       Have you smoked at least 100 cigarettes in your entire life?



[If yes:]

o        Do you now smoke cigarettes everyday, some days, or not at all?



[If yes:]

§         During the past 12 months, have you stopped smoking for 1 day or longer BECAUSE YOU WERE TRYING TO QUIT SMOKING?

Expected Periodicity

Annual.

Comments

Adults are classified as current smokers if they report currently smoking cigarettes “everyday” or “some days.”



This objective is measured differently than Healthy People 2000 objective 3.6. For objective 3.6, the question asked, “During the past 12 months, have you quit smoking for 1 day or longer?” Beginning in 1997, the question on quitting smoking was modified by adding “because you were trying to quit smoking,” and may affect trends.



Data are age adjusted to the 2000 standard population. Age-adjusted percents are weighted sums of age-specific percents. For a discussion on age adjustment, see Part A, section 5.



See Part C for a description of NHIS and Appendix A for focus area contact information.

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27-6.

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Increase smoking cessation during pregnancy.

National Data Source

National Health Interview Survey (NHIS), CDC, NCHS.

State Data Source

Not identified.

Healthy People 2000 Objective

Adapted from 3.7 (Tobacco).

Measure

Percent.

Baseline

14 (1998).

Numerator

Number of females aged 18 to 49 years who reported having a live birth in the past 5 years and smoking at any time during their pregnancy with their last child and who quit smoking in their first trimester and stayed off cigarettes for the rest of their pregnancy.

Denominator

Number of females aged 18 to 49 years who reported having a live birth in the past 5 years and smoking at any time during their pregnancy with their last child.

Population Targeted

U.S. civilian, noninstitutionalized population.

Questions Used To Obtain the National Data

From the 1998 National Health Interview Survey:



Ø       (Has/have) (you/Person) given birth to a liveborn infant in the past 5 years?



[If yes:]

o        Were you smoking cigarettes when you became pregnant with your last child?



[If yes:]

§         Did you smoke cigarettes at any time during your pregnancy with your last child?



[If yes:]

·         Did you quit smoking for 7 days or longer during your pregnancy with your last child?



[If yes:]

o        In what month of your pregnancy did you first quit for 7 days or longer?



o        Did you start smoking again during that pregnancy or did you stay off cigarettes for the rest of the pregnancy?

Expected Periodicity

Periodic.

Comments

Females classified as smoking during pregnancy and quitting are those who answered “Yes” to smoking at any time during their pregnancy with their last child, Yes” to quitting smoking for 7 days or longer, reported that the month they quit was the first through the third, and answered No” to starting smoking again during the pregnancy.



This objective is measured differently than Healthy People 2000 objective 3.7. For objective 3.7, the numerator was the number of females who quit smoking for 7 days or longer during their most recent pregnancy in the past 5 years. Quitting in the first trimester was not measured. Healthy People 2010 objective 27-6 specifies quitting in the first trimester (months 1 through 3), and adds a specific question about smoking cigarettes at any time during pregnancy with the last child.



See Part C for a description of NHIS and Appendix A for focus area contact information.

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27-7.

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Increase tobacco use cessation attempts among adolescent smokers.

National Data Source

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

State Data Source

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

Healthy People 2000 Objective

Not applicable.

Measure

Percent.

Baseline

76 (1999).

Numerator

Number of students in grades 9 through 12 who ever smoked at least one cigarette everyday for 30 days and ever tried to quit smoking cigarettes.

Denominator

Number of students in grades 9 through 12 who ever smoked at least one cigarette everyday for 30 days.

Population Targeted

Students in grades 9 through 12.

Questions Used To Obtain the National Data

From the 1999 Youth Risk Behavior Surveillance System:



Ø       Have you ever tried cigarette smoking, even one or two puffs?

[If yes:]

o        During the past 30 days, on how many days did you smoke cigarettes?

0 days
1 or 2 days
3 to 5 days
6 to 9 days
10 to 19 days
20 to 29 days
All 30 days



Ø       Have you ever tried to quit smoking cigarettes?

Expected Periodicity

Biennial.

Comments

See Part C for a description of YRBSS and Appendix A for focus area contact information.

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27-8.

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Increase insurance coverage of evidence-based treatment
for nicotine dependency.

27-8a.    Managed care organizations.

National Data Source

Addressing Tobacco in Managed Care: 1997–98 Health Plan Survey (ATMC), Robert Wood Johnson Foundation.

State Data Source

Not identified.

Healthy People 2000 Objective

Adapted from 3.24 (Tobacco).

Measure

Percent.

Baseline

75 (1997–98).

Numerator

Number of managed care organizations with health plans that partially or fully covered one or more smoking cessation interventions.

Denominator

Number of managed care organizations.

Population Targeted

Managed care organizations.

Questions Used To Obtain the National Data

From the Addressing Tobacco in Managed Care: 1997–98 Health Plan Survey:



Ø       Which of the following cessation interventions are available in your plan and which are included in your plan’s formulary?

Nicotine Replacement therapy:

Over-the-counter
Prescription
Only w/ enrollment in cessation program

Bupropion (for example, Zyban)
Telephone counseling
Face-to-face counseling
Classes or group meeting
Self-help materials

[Response categories: mark all that apply:]
Unavailable;
Full coverage;
Partial coverage;
In formulary

Expected Periodicity

Periodic.

Comments

The ATMC survey will not be repeated. However, the American Association of Health Plans will be surveying managed care organizations annually, with selected tobacco-related questions every 2 or 3 years.



This objective is measured by a different data source than Healthy People 2000 objective 3.24, which had no updates to the 1985 baseline during the decade.



See Appendix A for focus area contact information.

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27-8b.    Medicaid programs in States and the District of Columbia.

National Data Source

Health Policy Tracking Service, National Conference of State Legislators.

State Data Source

Health Policy Tracking Service, National Conference of State Legislators.

Healthy People 2000 Objective

Adapted from 3.24 (Tobacco).

Measure

Number.

Baseline

24 (1998).

Numerator

Number of Medicaid programs in States and the District of Columbia that cover smoking cessation services, including counseling and nicotine replacement therapies.

Denominator

Number of Medicaid programs in States and the District of Columbia.

Questions Used To Obtain the National Data

Not applicable.

Expected Periodicity

Periodic.

Comments

See Appendix A for focus area contact information.

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27-8c.    (Developmental) All insurance.

Comments

An operational definition could not be specified at the time of publication.



This objective is modified from Healthy People objective 3.24 (Tobacco).



See Appendix A for focus area contact information.

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Exposure to Secondhand Smoke

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27-9.

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Reduce the proportion of children who are regularly exposed to tobacco smoke at home.

National Data Source

National Health Interview Survey (NHIS), CDC, NCHS.

State Data Source

Not identified.

Healthy People 2000 Objective

3.8 (Tobacco).

Measure

Percent.

Baseline

27 (1994).

Numerator

Number of children aged 6 years and under living in households where a household resident smoked inside the home at least 4 days a week.

Denominator

Number of households with children aged 6 years and under.

Population Targeted

U.S. civilian, noninstitutionalized population.

Questions Used To Obtain the National Data

From the 1994 National Health Interview Survey:



Ø       Does ANYONE who lives here smoke cigarettes, cigars, or pipes ANYWHERE INSIDE this home?



Ø       On the average, about how many days per week do people who live here smoke ANYWHERE INSIDE this home?

Expected Periodicity

Periodic.

Comments

Only households with children aged 6 years and under are used in the calculation.



The first update for this objective will not be comparable to the baseline. In the 1998 NHIS questionnaire, the wording of the second question in the two-question series was changed to: On the average, about how many DAYS PER WEEK is there smoking ANYWHERE INSIDE this home?  



See Part C for a description of NHIS and Appendix A for focus area contact information.

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27-10.

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Reduce the proportion of nonsmokers exposed to environmental tobacco smoke.

National Data Source

National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

State Data Source

Not identified.

Healthy People 2000 Objective

Not applicable.

Leading Health Indicator

Environmental Quality.

Measure

Percent (age adjusted—see Comments).

Baseline

65 (1988–94).

Numerator

Number of nonsmokers aged 4 years and older who had a serum cotinine level above 0.10 ng/mL.

Denominator

Number of nonsmokers aged 4 years and older.

Population Targeted

U.S. civilian, noninstitutionalized population.

Questions Used To Obtain the National Data

From the 1988–94 National Health and Nutrition Examination Survey:



[For ages 8 years and older:]

Ø       How many cigarettes have you smoked in the past 5 days?



Ø       How many pipes and how many cigars have you smoked in the past 5 days?



Ø       How many containers of chewing tobacco or snuff have you used in the past 5 days?



Ø       How many pieces of nicotine gum have you chewed in the past 5 days? (Nicotine gum is a sugar-free flavored chewing gum prescribed by a doctor to help people stop smoking or chewing tobacco.)

Expected Periodicity

Annual, beginning with 1999 data.

Comments

Children aged 4 to 7 years are classified as nonsmokers. Children aged 8 years and older are classified as nonsmokers if the responses to all four types of nicotine exposure were “0” or “None.” Only responses to the questions asked of persons who participated in the examination component of the survey were used, so that serum levels of cotinine could be available for analysis.



Data are age adjusted to the 2000 standard population. Age-adjusted percents are weighted sums of age-specific percents. For a discussion on age adjustment, see Part A, section 5.



This objective is one of the measures used to track the Environmental Quality Leading Health Indicator. See Appendix H for a complete listing.



See Part C for a description of NHANES and Appendix A for focus area contact information.

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27-11.

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Increase smoke-free and tobacco-free environments in schools, including all school facilities, property, vehicles, and school events.

National Data Source

School Health Policies and Programs Study (SHPPS), CDC, NCCDPHP.

State Data Source

School Health Policies and Programs Study (SHPPS), CDC, NCCDPHP.

Healthy People 2000 Objective

Adapted from 3.10 (Tobacco).

Measure

Percent.

Baseline

37 (1994).

Numerator

Number of junior high, middle, and senior high schools that reported that no smoking or no smokeless tobacco use was allowed by students, staff, or visitors on school facilities, property, vehicles, and school events.

Denominator

Number of junior high, middle, and senior high schools.

Population Targeted

Public and private junior high, middle, and senior high schools.

Questions Used To Obtain the National Data

From the 1994 School Health Policies and Programs Study:



Handcard #1:    

School building
School grounds
School-sponsored events off-campus
School vehicles



[Show Handcard #1]

Ø       I’m going to ask you a series of questions about student smoking policies. By smoking, I mean all forms of smoking tobacco, including cigarettes, pipes, and cigars. Looking at Handcard #1, are students permitted to smoke in any of these places during regular school hours?



[If yes:]

o        Where are students permitted to smoke during regular school hours?



o        Are students permitted to smoke in any of these places during non-school hours?



[Show Handcard #1]

Ø       I’m going to ask you the same series of questions about student smokeless tobacco use policies. By smokeless tobacco, I mean snuff or chewing tobacco. Looking at Handcard #1, are students permitted to use smokeless tobacco in any of these places during regular school hours?



[If yes:]

o        Where are students permitted to use smokeless tobacco during regular school hours?



o        Are students permitted to use smokeless tobacco in any of these places during non-school hours?



[Show Handcard #1]

Ø       Looking at Handcard #1, are school staff permitted to smoke in any of these places during regular school hours?



[If yes:]

o        Where are school staff permitted to smoke during regular school hours?



o        Are school staff permitted to smoke in any of these places during non-school hours?



[Show Handcard #1]

Ø       Looking at Handcard #1, are school staff permitted to use smokeless tobacco in any of these places during regular school hours?



[If yes:]

o        Where are school staff permitted to use smokeless tobacco during regular school hours?



o        Are school staff permitted to use smokeless tobacco in any of these places during non-school hours?



o        Do your smoking and smokeless tobacco policies apply to visitors at your school?

No
Yes, smoking policies apply
Yes, smokeless tobacco policies apply

Expected Periodicity

Periodic.

Comments

SHPPS 2000 tobacco use prevention questions, which will provide the first update for this objective, are different from those used in the 1994 SHPPS. The updated questions, summarized, will include:



Ø       Has this school adopted a policy prohibiting [cigarette smoking/cigar and pipe smoking/smokeless tobacco use] by [students/faculty and staff/school visitors]?



Ø       Does that policy specifically prohibit [cigarette smoking/smokeless tobacco use] by [students/faculty and staff/school visitors]...

In school buildings?
Outside, on school grounds?
In school buses or other vehicles used to transport students?
At off-campus, school-sponsored events?



This objective differs from Healthy People 2000 objective 3.10, which not only tracked school districts providing tobacco-free environments, but also the proportion of school districts providing antismoking education. This objective focuses on smoke- and tobacco-free environments only.



See Part C for a description of SHPPS and Appendix A for focus area contact information.

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27-12.

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Increase the proportion of worksites with formal smoking policies that prohibit smoking or limit it to separately ventilated areas.

National Data Sources

1999 National Worksite Health Promotion Survey (NWHPS), Association for Worksite Health Promotion (AWHP) and OPHS, ODPHP.

State Data Source

Not identified.

Healthy People 2000 Objective

Adapted from 3.11 (Tobacco) (also 10.18).

Measure

Percent.

Baseline

79 (1998–99).

Numerator

Number of nongovernmental worksites with 50 or more employees that have a formal smoking policy that prohibits or severely restricts smoking at the worksite or on the job.

Denominator

Number of nongovernmental worksites with 50 or more employees.

Population Targeted

Nongovernmental worksites with 50 or more employees.

Questions Used To Obtain the National Data

From the 1999 National Worksite Health Promotion Survey:



Ø       Does your worksite have a formal smoking policy that prohibits or severely restricts smoking at the worksite/on the job?

Expected Periodicity

Periodic.

Comments

Data for this objective are not comparable to the data for Healthy People 2000 objective 3.11 from the 1992 National Survey of Worksite Health Promotion Activities. The 1992 questionnaire had a more explicit list of questions to determine the type of formal smoking policy.



The 1999 question was similar to the 1992 question: Does your worksite have a formal smoking policy that prohibits or severely restricts smoking at the workplace? In 1992, if the answer was “yes,” the respondent was asked: “How would you describe the rules on smoking at the worksite?  Possible responses were: (a) Smoking not allowed anywhere inside/smoke-free environment, (b) Smoking not allowed except in separately ventilated smoking areas, (c) Smoking not allowed except in designated areas without separate ventilation, (d) Smoking allowed everywhere except in a few no smoking areas, (e) Each area decides on its own policy, (f) Smoking permitted everywhere/no rules, (g) Designated areas, ventilation unknown, (h) Other.



See Part C for a description of NWHPS and Appendix A for focus area contact information.

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27-13.

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Establish laws on smoke-free indoor air that prohibit
smoking or limit it to separately ventilated areas in public
places and worksites.

27-13a. Private workplaces.

National Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

State Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

Healthy People 2000 Objective

3.12 (Tobacco) (also 10.19).

Measure

Number.

Baseline

1 (1998).

Numerator

Number of States and the District of Columbia with comprehensive laws for private workplaces prohibiting smoking or limiting it to separately ventilated areas.

Denominator

Not applicable.

Questions Used To Obtain the National Data

Not applicable.

Expected Periodicity

Quarterly.

Comments

Every 3 months (March 31, June 30, September 30, December 31), newly enacted State tobacco-control legislation is downloaded from Lexis-Nexis, an on-line legal database. CDC, OSH searches two Lexis-Nexis subfiles: the StateTrack System and the Advanced Legislative Services System. The downloads are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed. In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.



See Part C for a description of the STATE System and Appendix A for focus area contact information.

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27-13b.     Public workplaces.

National Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

State Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

Healthy People 2000 Objective

3.12 (Tobacco) (also 10.19).

Measure

Number.

Baseline

13 (1998).

Numerator

Number of States and the District of Columbia with comprehensive laws for public workplaces prohibiting smoking or limiting it to separately ventilated areas.

Denominator

Not applicable.

Questions Used To Obtain the National Data

Not applicable.

Expected Periodicity

Quarterly.

Comments

See Comments provided with objective 27-13a for more information.

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27-13c. Restaurants.

National Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

State Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

Healthy People 2000 Objective

3.12 (Tobacco) (also 10.19).

Measure

Number.

Baseline

3 (1998).

Numerator

Number of States and the District of Columbia with comprehensive laws for restaurants prohibiting smoking or limiting it to separately ventilated areas.

Denominator

Not applicable.

Questions Used To Obtain the National Data

Not applicable.

Expected Periodicity

Quarterly.

Comments

See Comments provided with objective 27-13a for more information.

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27-13d. Public transportation.

National Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

State Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

Healthy People 2000 Objective

3.12 (Tobacco) (also 10.19).

Measure

Number.

Baseline

16 (1998).

Numerator

Number of States and the District of Columbia with comprehensive laws for public transportation prohibiting smoking or limiting it to separately ventilated areas.

Denominator

Not applicable.

Questions Used To Obtain the National Data

Not applicable.

Expected Periodicity

Quarterly.

Comments

For this objective, data on enforcement authority, penalty for violation, and signage required are not currently included in the STATE System. See Comments provided with objective 27-13a for more information.

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27-13e. Day care centers.

National Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

State Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

Healthy People 2000 Objective

3.12 (Tobacco) (also 10.19).

Measure

Number.

Baseline

22 (1998).

Numerator

Number of States and the District of Columbia with comprehensive laws for day care centers (commercial or home-based) prohibiting smoking or limiting it to separately ventilated areas.

Denominator

Not applicable.

Questions Used To Obtain the National Data

Not applicable.

Expected Periodicity

Quarterly.

Comments

Commercial and home-based day care centers are tracked separately; this objective combines them. See Comments provided with objective 27-13a for more information.

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27-13f.   Retail stores.

National Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

State Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

Healthy People 2000 Objective

Adapted from 3.12 (Tobacco) (also 10.19).

Measure

Number.

Baseline

4 (1998).

Numerator

Number of States and the District of Columbia with comprehensive laws for malls and grocery stores prohibiting smoking or limiting it to separately ventilated areas.

Denominator

Not applicable.

Questions Used To Obtain the National Data

Not applicable.

Expected Periodicity

Quarterly.

Comments

Retail stores, as a general category, are not tracked. Measures are only available for malls and grocery stores. Data on enforcement authority, penalty for violation, and signage required are not currently included in the STATE System for this objective.



This objective differs from Healthy People 2000 objective 3.12, which did not specifically track retail stores.



See Comments provided with objective 27-13a for more information.

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27-13g. (Developmental) Tribes.

Comments

An operational definition could not be specified at the time of publication.



See Appendix A for focus area contact information.

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27-13h. (Developmental) Territories.

Comments

An operational definition could not be specified at the time of publication.



A proposed data source is Lexis-Nexis, an online legal database. CDC searches two Lexis-Nexis subfiles: the StateTrack system and the Advanced Legislative Services system. As data become available, some U.S. territories may also be tracked.



See Appendix A for focus area contact information.

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Social and Environmental Changes

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27-14.

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Reduce the illegal sales rate to minors through enforcement
of laws that prohibit such sales.

27-14a. States and the District of Columbia.

National Data Source

State Synar Enforcement Reporting, SAMHSA, CSAP.

State Data Source

State Synar Enforcement Reporting, SAMHSA, CSAP.

Healthy People 2000 Objective

Adapted from 3.13 (Tobacco).

Measure

Number.

Baseline

0 (1998).

Numerator

Number of States and the District of Columbia with a 5 percent or less illegal sales rate to minors in compliance checks.

Denominator

Not applicable.

Questions Used To Obtain the National Data

Not applicable.

Expected Periodicity

Annual.

Comments

As required by the Synar Amendment, all 50 States and the District of Columbia submit their baseline sales rates in compliance checks to SAMHSA as part of their annual Substance Abuse Prevention and Treatment (SAPT) block grant applications.



This objective is defined differently from Healthy People 2000 objective 3.13, which targets States and the District of Columbia that have a 20 percent or less illegal buy rate among minors.



See Appendix A for focus area contact information.

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27-14b.  Territories.

National Data Source

State Synar Enforcement Reporting, SAMHSA, CSAP.

State Data Source

State Synar Enforcement Reporting, SAMHSA, CSAP.

Healthy People 2000 Objective

Adapted from 3.13 (Tobacco).

Measure

Number.

Baseline

0 (1998).

Numerator

Number of U.S. territories with a 5-percent or less illegal buy rate among minors in compliance checks.

Denominator

Not applicable.

Questions Used To Obtain the National Data

Not applicable.

Expected Periodicity

Annual.

Comments

U.S. territories eligible for inclusion are: American Samoa, Guam, Marshall Islands, Federated States of Micronesia, Commonwealth of the Northern Mariana Islands, Republic of Palau, Puerto Rico, and the Virgin Islands.



This objective differs from Healthy People 2000 objective 3.13, which did not target U.S. territories.



See Comments provided with objective 27-14a for more information.



See Appendix A for focus area contact information.

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27-15.

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Increase the number of States and the District of Columbia that suspend or revoke State retail licenses for violations of laws prohibiting the sale of tobacco to minors.

National Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

State Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

Healthy People 2000 Objective

Not applicable.

Measure

Number.

Baseline

34 (1998).

Numerator

Number of States and the District of Columbia with minors access laws with provisions for license suspension and/or revocation for violation.

Denominator

Not applicable.

Questions Used To Obtain the National Data

Not applicable.

Expected Periodicity

Quarterly.

Comments

Every 3 months (March 31, June 30, September 30, December 31), newly enacted State tobacco-control legislation is downloaded from Lexis-Nexis, an on-line legal database. CDC, OSH searches two Lexis-Nexis subfiles: the State Track System and the Advanced Legislative Services System. The downloads are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, that is, minimum age for legal sale, inclusion of chewing tobacco and/or snuff, enforcement authority, penalty for violation, prohibition of purchase, possession and/or use by minors, etc.



See Part C for a description of the STATE System and Appendix A for focus area contact information.

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27-16.

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(Developmental) Eliminate tobacco advertising and promotions that influence adolescents and young adults.

Comments

An operational definition could not be specified at the time of publication.



Proposed national data sources are the American Legacy Foundation and the National Association of Attorneys General.



See Appendix A for focus area contact information.

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27-17.

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Increase adolescents’ disapproval of smoking.

27-17a. 8th grade.

National Data Source

Monitoring the Future Study (MTF), NIH, NIDA.

State Data Source

Not identified.

Healthy People 2000 Objective

Adapted from 4.9 (Substance Abuse: Alcohol and Other Drugs) (also 3.21).

Measure

Percent.

Baseline

80 (1998).

Numerator

Number of students in the 8th grade who disapprove or strongly disapprove of people smoking one or more packs of cigarettes per day.

Denominator

Number of students in the 8th grade.

Population Targeted

Public and private schools in the coterminous United States.

Questions Used To Obtain the National Data

From the 1998 Monitoring the Future Study:



Ø       Individuals differ in whether or not they disapprove of people doing certain things. Do YOU disapprove of people doing each of the following:

[Response categories include:]
Smoking one or more packs of cigarettes per day?

Don’t disapprove
Disapprove
Strongly disapprove
Can’t say, Drug Unfamiliar

Expected Periodicity

Annual.

Comments

This objective differs from Healthy People 2000 objective 4.9, which tracked high school seniors only.



See Part C for a description of the MTF and Appendix A for focus area contact information.

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27-17b. 10th grade.

National Data Source

Monitoring the Future Study (MTF), NIH, NIDA.

State Data Source

Not identified.

Healthy People 2000 Objective

Adapted from 4.9 (Substance Abuse: Alcohol and Other Drugs) (also 3.21).

Measure

Percent.

Baseline

75 (1998).

Numerator

Number of students in the 10th grade who disapprove or strongly disapprove of people smoking one or more packs of cigarettes per day.

Denominator

Number of students in the 10th grade.

Population Targeted

Public and private schools in the coterminous United States.

Questions Used To Obtain the National Data

From the 1998 Monitoring the Future Study:



Ø       Individuals differ in whether or not they disapprove of people doing certain things. Do YOU disapprove of people doing each of the following:

[Response categories include:]
Smoking one or more packs of cigarettes per day?

Don’t disapprove
Disapprove
Strongly disapprove
Can’t say, drug unfamiliar

Expected Periodicity

Annual.

Comments

This objective differs from Healthy People 2000 objective 4.9, which tracked high school seniors only.



See Part C for a description of MTF and Appendix A for focus area contact information.

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27-17c. 12th grade.

National Data Source

Monitoring the Future Study (MTF), NIH, NIDA.

State Data Source

Not identified.

Healthy People 2000 Objective

4.9 (Substance Abuse: Alcohol and Other Drugs) (also 3.21).

Measure

Percent.

Baseline

69 (1998).

Numerator

Number of students in the 12th grade who disapprove or strongly disapprove of people smoking one or more packs of cigarettes per day.

Denominator

Number of students in the 12th grade.

Population Targeted

Public and private schools in the coterminous United States.

Questions Used To Obtain the National Data

From the 1998 Monitoring the Future Study:



Ø       Individuals differ in whether or not they disapprove of people doing certain things. Do YOU disapprove of people (who are 18 or older) doing each of the following?  (Mark one circle for each line.)

[Response categories include:]
Smoking one or more packs of cigarettes per day?

Don’t disapprove
Disapprove
Strongly disapprove

Expected Periodicity

Annual.

Comments

Refer to Part for a description of MTF and Appendix A for focus area contact information.

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27-18.

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(Developmental) Increase the number of Tribes, territories, and States and the District of Columbia with comprehensive, evidence-based tobacco control programs.

Comments

An operational definition could not be specified at the time of publication.



A proposed data source is the State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH; for Tribes, a proposed data source is the IHS.



See Appendix A for focus area contact information.

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27-19.

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Eliminate laws that preempt stronger tobacco control laws.

National Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

State Data Source

State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.

Healthy People 2000 Objective

Adapted from 10.20 (Occupational Safety and Health) (also 3.25).

Measure

Number.

Baseline

30 (1998).

Numerator

Number of States and the District of Columbia with preemptive laws in the areas of clean indoor air, minors access, or marketing.

Denominator

Not applicable.

Questions Used To Obtain the National Data

Not applicable.

Expected Periodicity

Quarterly.

Comments

Every 3 months (March 31, June 30, September 30, December 31), newly enacted State tobacco-control legislation is downloaded from Lexis-Nexis, an on-line legal database. CDC, OSH searches two Lexis-Nexis subfiles: the StateTrack System and the Advanced Legislative Services System. The downloads are coded according to variables identified by CDC, OSH, which include preemption related to smoke-free indoor air, minors access, and marketing. As data become available, some U.S. territories may also be tracked.



This objective differs from Healthy People 2000 objective 3.25, which tracked States and the District of Columbia that had preemptive laws regarding smoke-free indoor air only.



See Part C for a description of the STATE System and Appendix A for focus area contact information.

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27-20.

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(Developmental) Reduce the toxicity of tobacco products by establishing a regulatory structure to monitor toxicity.

Comments

An operational definition could not be specified at the time of publication. A proposed national data source is the Food and Drug Administration.



See Appendix A for focus area contact information.

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27-21.

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  Increase the average Federal and State tax on tobacco products.

27-21a. Cigarettes.

National Data Source

The Tax Burden on Tobacco,1 The Tobacco Institute.

State Data Source

The Tax Burden on Tobacco,1 The Tobacco Institute.

Healthy People 2000 Objective

Adapted from 3.23 (Tobacco).

Measure

Mean.

Baseline

$0.63 (1998).

Numerator

Sum of the State excise taxes on the retail price of a package of 20 cigarettes (full-priced brands) in all 50 States and the District of Columbia.

Denominator

All 50 States and the District of Columbia.

Questions Used To Obtain the National Data

Not applicable.

Expected Periodicity

Quarterly.

Comments

The State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH, is proposed as a future data source for this objective.



This objective is modified from Healthy People 2000 objective 3.23, which tracks tobacco excise tax by percent of the retail price.



See Appendix A for focus area contact information.

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27-21b. (Developmental) Spit tobacco.

Comments

An operational definition could not be specified at the time of publication.



Federal tax in 1999 was 2.7 cents; 7 States and the District of Columbia did not tax smokeless tobacco products.



A proposed data source is the State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.



This objective is modified from Healthy People 2000 objective 3.23 (Tobacco).



See Appendix A for focus area contact information.

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Reference

1. The Tobacco Institute. The Tax Burden on Tobacco. Vol. 33. Washington, DC: the Institute, 1998.


 



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