State-Specific Prevalence of Cigarette Smoking and Smokeless Tobacco Use Among Adults --- United States, 2009

State-Specific Prevalence of Cigarette Smoking and Smokeless Tobacco Use Among Adults --- United States, 2009
Weekly
November 5, 2010 / 59(43);1400-1406

The health consequences of cigarette smoking and smokeless tobacco use both have been well documented, including increased risk for lung, throat, oral, and other types of cancers (1,2). To assess state-specific current cigarette smoking and smokeless tobacco use among adults, CDC analyzed data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicated wide variation in self-reported cigarette smoking prevalence (range: 6.4% [U.S. Virgin Islands (USVI)] to 25.6% [Kentucky and West Virginia]) and smokeless tobacco use (range: 0.8% [USVI] to 9.1% [Wyoming]). For 15 of the states, Puerto Rico, and Guam, smoking prevalence was significantly higher among men than among women. The prevalence of smokeless tobacco use was higher among men than women in all states and territories. Smokeless tobacco use was highest among persons aged 18--24 years and those with a high school education or less. From 0.9% (Puerto Rico) to 13.7% (Wyoming) of current smokers reported also using smokeless tobacco. Clinicians should identify all tobacco use in their patients and advise those who use any tobacco product to quit. The World Health Organization (WHO) recommends implementing this approach in combination with other measures, including raising excise taxes on tobacco and strengthening smoke-free policies to prevent tobacco-related deaths.

BRFSS* is a state-based, landline telephone survey of noninstitutionalized adults conducted annually in all 50 states, the District of Columbia (DC), Guam, Puerto Rico, and USVI. The 2009 BRFSS included data from 432,607 adults that were used to assess the prevalence of current smoking† and smokeless tobacco use.§ Respondents also were asked their age, sex, and highest grade or year of school completed. Estimates were weighted to adjust for differences in probability of selection and nonresponse, as well as noncoverage of persons in households without landline telephones. These sampling weights were used to calculate all estimates and 95% confidence intervals. Response rates for BRFSS are calculated using Council of American Survey and Research Organizations (CASRO) guidelines. Median survey response rates were 52.5%, calculated as the percentage of persons who completed interviews among all eligible persons, including those who were not contacted. Median cooperation rates were 75.0%, calculated as the percentage of persons who completed interviews among all eligible persons who were contacted. For comparisons of prevalence between men and women, statistical significance (p<0.05) was determined using a two-sided z-test.

Current Cigarette Smoking Prevalence

In 2009, current smoking prevalence was highest in Kentucky (25.6%), West Virginia (25.6%), and Oklahoma (25.5%), and lowest in Utah (9.8%), California (12.9%), and Washington (14.9%) (Table 1). Smoking prevalence was 6.4% in USVI, 10.6% in Puerto Rico, and 24.1% in Guam. For 15 of the states, Puerto Rico, and Guam, smoking prevalence was significantly higher among men than among women, and in no state was smoking prevalence significantly higher among women than men.

Current Smokeless Tobacco Use Prevalence

Smokeless tobacco use within states was highest in Wyoming (9.1%), West Virginia (8.5%), and Mississippi (7.5%); and lowest in California (1.3%), DC (1.5%), Massachusetts (1.5%), and Rhode Island (1.5%) (Table 2). Among U.S. territories, the prevalence of smokeless tobacco was 0.8% in USVI, 1.4% in Puerto Rico, and 4.1% in Guam. Smokeless tobacco use prevalence among men in the 50 states and DC ranged from 2.0% (DC) to 17.1% (West Virginia) and smokeless tobacco use among men was significantly higher than among women in all 50 states. Among the 50 states and DC, smokeless tobacco use was most common among persons aged 18--24 years (range: 1.0% [Nevada] to 17.4% [Wyoming]). Smokeless tobacco use tended to decrease with increasing education (adults with less than a high school education, range: 0.6% [California] to 14.2% [Alaska]); adults with a high school education, range: 1.6% [Connecticut] to 10.8% [Wyoming]; adults with some college, range: 0.4% [DC] to 7.7% [West Virginia]; and among adults with at least a college degree, range: 0.9% [New York] to 6.1% [South Dakota]). Nearly one quarter (23.4%) of men in Wyoming who smoke cigarettes and one fifth (20.8%) of men in Arkansas who smoke cigarettes reported also using smokeless tobacco (Table 3).

Among the 25% of states in which cigarette smoking prevalence was greatest (n = 13), seven also had the highest prevalence of smokeless tobacco use: Alabama, Alaska, Arkansas, Kentucky, Mississippi, Oklahoma, and West Virginia (Figure). In these states, at least one of every nine men who smoked cigarettes also reported using smokeless tobacco (range: 11.8% [Kentucky] to 20.8% [Arkansas]) (Table 3).
Reported by

A McClave, MPH, V Rock, MPH, S Thorne, PhD, MPH, A Malarcher, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

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State-Specific Prevalence of Cigarette Smoking and Smokeless Tobacco Use Among Adults --- United States, 2009