HIGHLIGHTS FROM THE CALIFORNIA TOBACCO SURVEYS Elizabeth A. Gilpin, MS Principal Investigator 1999 California Tobacco Surveys Cancer Prevention and Control

HIGHLIGHTS FROM THE CALIFORNIA TOBACCO SURVEYS

Elizabeth A. Gilpin, MSPrincipal Investigator

1999 California Tobacco SurveysCancer Prevention and Control Program

University of California, San Diego, Cancer Centerhttp://ssdc.ucsd.edu

WHY TOBACCO CONTROL?

To reduce morbidity and mortality from tobacco-related diseases:

•Cancer (lung and other)

•Heart disease

•Chronic obstructive lung disease

OVERALL GOALS OF CALIFORNIATOBACCO CONTROL PROGRAM

•Encourage smokers to quit

•Encourage smokers to reduce their exposure to harmful tobacco products

•Discourage smoking initiation

•Protect nonsmokers from secondhand smoke

MAJOR STRUCTURAL LANDMARKS OF

CALIFORNIA TOBACCO CONTROL PROGRAM

1989: Proposition 99 passed, new $0.25/pack tax1990: Media campaign beginsBy 1993, over 120 new local clean air ordinances

were adopted1994: State law: indoor workplaces smokefree1994: STAKE Act (youth access enforcement)1998: Smokefree workplace law extended to bars

and game rooms1999: Proposition 10 passed, new $0.50/pack tax

0

20

40

60

80

100

120

140

90 91 92 93 94 95 96 98 99 00Year

Ex

pe

nd

itu

res

in M

illio

ns

($

)

Competitive Grants (22.3%)School Programs (31.4%)Local Agencies (26.3%)Media (20.1%)

Expenditures of the California Tobacco Control Program

Source: Balbach et al., 1998 and 2000

THE CALIFORNIA TOBACCO SURVEYS

•Random-digit-dialed household telephone surveys

•Conducted in 1990, 1992, 1993, 1996 and 1999

•A household adult enumerates all residents and gives

demographics and smoking status

•The probability an adult is selected for a 25-minute

extended interview is determined by smoking status

•All adolescents 12-17 selected for an extended

interview in 1990, 1992, 1993 and 1996. One randomly

selected in 1999.

SURVEILLANCE OF IMPORTANTOUTCOME MEASURES

• Cigarette price

• Per capita cigarette consumption

• Adult smoking prevalence

• Adult cessation

• Adolescent smoking

• Adolescent perceptions of ease of obtaining

cigarettes

SURVEILLANCE OF IMPORTANTOUTCOME MEASURES (cont’d)

• Compliance with school smoking bans

• School classes on health effects of smoking

• Protection of nonsmokers from secondhand

smoke

• Price sensitivity/attitudes toward taxation

CIGARETTE PRICE AND PER CAPITA CIGARETTE CONSUMPTION

Cigarette price and bimonthly sales

data now reported to the Federal

Trade Commission by the consulting

firm of Orzechowski and Walker

$2.00

$2.50

$3.00

$3.50

$4.00

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Rea

l P

rice

/Pac

k (1

999

$)

Average Real Price/Pack of Cigarettesin California (1999 dollars)

Source: Tax Burden on Tobacco, 2000

4

6

8

10

12

14

16

1983 1985 1987 1989 1991 1993 1995 1997 1999 2001

Year

Pac

ks p

er M

on

th

California

California Trend

US-California

US Trend

Source: Tobacco Institute; Orzechow ski & Walker; U.S. Bureau of Census

Seasonally Adjusted Trend of Per Capita Consumptionfor Cigarettes, California vs. U.S.

ProgramStarts

22% lower

54% lower

ADULT SMOKING PREVALENCE

•Have you smoked at least 100 cigarettes in your

lifetime?

•1990-1996 screener: Do you smoke cigarettes

now?

•1996 extended, 1999 screener and extended:

Do you now smoke cigarettes everyday, some

days or not at all?

15

20

25

30

35

1975 1980 1985 1990 1995 2000

%

NHIS

CATS/BRFS

CPS

CTS

Predicted

95% CI

Smoking Prevalence Among California Adults,Aged 18 or Older

Source: NHIS, 1978, 1979, 1980, 1983, 1985, 1987, 1988, 1990, 1991, 1993, 1994; CTS 1990, 1992, 1993, 1996, 1999; BRFS/CATS 1991-1999; CPS 1992-1993, 1995-1996, 1998-1999

15

20

25

30

35

40

1975 1980 1985 1990 1995 2000

%

NHIS

CPS

Predicted

95% CI

Smoking Prevalence Among Adultsin the Rest of the United States, Aged 18 and Older

Source: NHIS 1978, 1979, 1980, 1983, 1985, 1987, 1988, 1990, 1991, 1993, 1994; CPS 1992-1993, 1995-1996, 1998-1999

ADULT DAILY SMOKING

•1990,1992: If answered yes to smoke

now question, then asked: Do you now

smoke cigarettes everyday or some

days?

•1996,1999: Answered everyday to the

prevalence question.

13.013.0

17.5

14.1

16.4

13.9

15.9

14.7

12

14

16

18

20

22

1988 1990 1992 1994 1996 1998 2000

%

Unstandardized Standardized

Adult Daily Smoking,Standardized and Unstandardized

Source: CTS 1990, 1992, 1996, 1999

SELF-REPORTED CONSUMPTION

Daily Smokers: •How many cigarettes on average do you

smoke per day?

Occasional Smokers:•On how many of the past 30 days did you

smoke cigarettes?•On the past 30 days, on the days that you did

smoke, about how many cigarettes did you

usually smoke?

16.8 17.724.6

29

26.8 26.4

30.530.4

0

20

40

60

80

1990 1992 1996 1999

% C

urr

ent S

mo

kers

Occasional Smokers All Light Smokers

Light Smoking (<15 Cigarettes/Day)Among Current Smokers

Source: CTS 1990, 1992, 1996, 1999

13.9

11.2

8.27.3

0

2

4

6

8

10

12

14

16

None Work ban only Home ban only Both

Cig

aret

tes/

Day

Daily Cigarette Consumption and Smoking Bans

Source: CTS 1999

ADULT SMOKING CESSATION

Current smokers:

•During the past 12 months, have you quit

smoking intentionally for one day or longer?

•How long did you actually stay off cigarettes

during that quit attempt?

Former smokers:

•Date when last smoked a cigarette

61.5

56.0

38.1

48.9

0

10

20

30

40

50

60

70

1990 1992 1996 1999

%

Source: CTS 1990, 1992, 1996, 1999

Quit Attempts Among Smokers in the Last Year

0

10

20

30

40

50

60

70

80

90

100

0 30 60 90 120 150 180

Time (days)

% A

bs

tin

en

t

1990 1996 1999

Relapse Following Most Recent Quit Attemptfor Smokers in Last Year

Source: CTS 1990, 1996, 1999

ADOLESCENT SMOKING

•Have you ever smoked a cigarette?

•Have you ever tried or experimented with

cigarette smoking, even a few puffs?

•Have you smoked at least 100 cigarettes in

your life?

•Think about the last 30 days. On how many of

these days did you smoke?

9.2 9.2

12

7.7

9.0

11.6

9.0

7.8

6

8

10

12

14

1988 1990 1992 1994 1996 1998 2000

%

UnstandardizedStandardized

The Effect of Removing Population Distribution Changes from Adolescent (12-17 years)Smoking Prevalence in the Last 30 Days

Source: CTS 1990, 1993, 1996, 1999

COMMITTED NEVER SMOKERS

•Do you think in the future you might experiment

with cigarettes?

•If one of your best friends were to offer you a

cigarette, would you smoke it?

•At any time during the next year do you think

you will smoke a cigarettes?

55.8

40.935.5

65.7

41.338.043.9

62.2

49.0

0

10

20

30

40

50

60

70

80

12 to 13 14 to 15 16 to 17

Age Group

%

1993 1996 1999

12-17 Year Old Committed Never Smokers

Source: CTS 1993,1996,1999

13.8

10.2

5.8

17.3

12.8

7.0

3.8

10.79.9

0

5

10

15

20

25

15 16 17Age (years)

%

1993 1996 1999

15-17 Year Old Established Smokers

Source: CTS 1993,1996,1999

•Do you think it would be easy or hard for you to

get cigarettes if you wanted some?

•Would you say it would be easy, somewhat

difficult, or hard for you to buy

a few cigarettes,

a pack of cigarettes?

EASE OF ACCESS

48.0

57.256.957.9

0

10

20

30

40

50

60

70

1990 1993 1996 1999

% o

f N

ev

er

Sm

ok

ers

Source: CTS 1990, 1993, 1996, 1999

Never Smokers Who Think It Would BeEasy To Get Cigarettes

54.7

44.7 42.3

28.4

0

20

40

60

80

100

%

1996 1999

Perception of Ease of Buying a Few Cigarettes(Age 12-14 years)

Committed Never Smoker Susceptible Never Smoker

Source: CTS 1996, 1999

93.486.8

73.263.7

52.5

45.7

0

20

40

60

80

100

%

1996 1999

Perception of Ease of Buying a Pack of Cigarettes(Age 15-17 Years)

Experimenter

Established Smoking

Occasional Daily


•How many students who smoke obey the rule

not to smoke on school property?

•Have you seen anyone smoke in school in the

last two weeks?

•Do you think that all smoking by anyone

should be banned on school grounds at all

times, including meetings and sporting events?

COMPLIANCE WITHSCHOOL SMOKING BANS

55.8

88.2

56.9

33.337.541.7

64.4

91.2

46.1

24.7

57.0

68.1

0

10

20

30

40

50

60

70

80

90

100

%

1996

1999

School Policy Against Smokingby Current Smoking Status and Year

Most or all obey Seen someonesmoking (yes)

Preference forsmokefree school

Nonsmokers CurrentSmokers




RECALL OF CLASS ON HEALTH DANGERS OF SMOKING

•Have you ever taken a class or course at

school in which the health risks of smoking

were discussed?

•Do you think that kids who took the health

class on the effects of smoking are more

against smoking, less against smoking, or had

no change in attitudes toward smoking as a

result of taking this class?

73.275.7 76.1 77.8

0

10

20

30

40

50

60

70

80

Year

%Students Who Recall Taking a Course

on the Health Dangers of Smoking

1990 199919961993

Source: CTS 1990, 1993, 1996, 1999

69.2

50.3

61.7

42.4

0

10

20

30

40

50

60

70

80

Never Smokers Ever Smokers

%

1996 1999

Class on Health Dangers of Smoking Ineffective

Source: CTS 1990, 1993, 1996, 1999

PROTECTION OF NONSMOKERS FROM SECONDHAND TOBACCO SMOKE

•In the workplace

•In the home

SECONDHANDSMOKE IN THE WORKPLACE

•Do you currently work for money in an

indoor setting, such as an office, plant,

or store, outside of your home?

•Is the building where you work

completely smoke-free indoors?

35

46.3

90.593.4

0

20

40

60

80

100

%

Source: CTS 1990, 1992, 1996, 1999

Indoor Workers Reporting Smokefree Workplaces

1990 1992 1996 1999

NONSMOKER EXPOSURE TO SECONDHAND SMOKE IN THE

WORKPLACE

During the past two weeks, has anyone

smoked in the area in which you work?

15.6

11.8

22.4

29

0

5

10

15

20

25

30

35

1 2 3 4

%

Source: CTS 1990, 1993, 1996, 1999

Exposure of Nonsmoking Indoor Workersto Secondhand Smoke

1990 1993 1996 1999

7.1 7.911.7

17.724.5

31.9

50.2

0

10

20

30

40

50

60

70

80

%

Source: CTS 1999

Exposure of Nonsmoking Indoor Workers by Type of Workplace in 1999

Classroom Hospital Plant/Factory

Office Store/Warehouse

Restaurant/Bar

Vehicle

12.1

20.6

18.117.8

0

5

10

15

20

25

30

Number of Employees at Workplace

%

Source: CTS 1999

<5 5-24 25-50 >50

Exposure of Nonsmoking Indoor Workersby Size of Workplace in 1999

3.8

12.5

3.25.34.1

31.7

8.2

2.1

13.2

0

5

10

15

20

25

30

35

40

Place Most Recently Exposed

% N

on

sm

ok

ers

Source: CTS 1999

Place of Exposure to Someone Smoking in Last 6 MonthsOther Than Own Home or Work in 1999

Restaurant Bar/Tavern

Park/Outdoors

ShoppingMall

CommunitySportsEvent

GamblingVenue

Others’Homes

Others’Cars

Bar/Restaurant

HOME SMOKING RESTRICTIONS

What are the smoking rules or restrictions in your household, if any? Would you say…

•Smoking is completely banned for everyone

•Smoking is generally banned for everyone with few exceptions

•Smoking is allowed in some rooms only, or

•There are no restrictions on smoking.

50.9

29.1

64.5

16.6 18.9

73.2

14.820.0

12.0

0

10

20

30

40

50

60

70

80

Smokefree Some Restrictions No Restrictions

Home Smoking Policy

%

1993 1996 1999

Home Smoking Restrictions AmongAll Californians (Smokers and Nonsmokers)

Source: CTS 1993, 1996, 1999

20.1

26.1

53.9

38.1

26.3

35.6

47.2

21.8

31.0

0

10

20

30

40

50

60

Smokefree Some Restrictions No Restrictions

Home Smoking Policy

%

1993 1996 1999

Source: CTS 1993, 1996, 1999

Home Smoking Restrictions Reportedby California Smokers

56.7

41.6

19.3

73.0

62.4

44.8

0

20

40

60

80

100

1993 1996 1999

% P

rote

cte

d

All adults smoke At least 1 adult smokes

Protection of Young Children (0-5 Years)in Households Where Adults Smoke

Source: CTS 1993, 1996, 1999

•At work: no recent exposure in work area

•At home: live in a smokefree home

•Other: have not had to put up with someone smoking near them at any other place besides work or home in the last 6 months

In 1999, 37.1% of California nonsmokers fit these criteria.

EXPOSURE TO SECONDHAND SMOKE IN VENUES BESIDES THE WORKPLACE OR HOME

PRICE SENSITIVITY

•How much additional tax on a pack of

cigarettes would you be willing to support if the

money raised was used to fund programs

aimed at preventing smoking among children

and other health care programs?

0

10

20

30

40

50

60

70

80

$3.00 $2.00 $1.50 $1.00 $0.75 $0.50 $0.25

Additional Excise Tax

Cu

mu

lati

ve

%

1996 1999

Cumulative Percentage Favoring Additional Cigarette Excise Tax


0

10

20

30

40

50

Liquor/drugstores

($3.52/pack)

Conveniencestores/gas

stations($3.47/pack)

Supermarkets($3.28/pack)

Discount stores($2.91/pack)

Non/lower-taxedsources

($2.33/pack)

Other ($3.32/pack)

%

Buyers Cigarettes

Percent of Buyers and Cigarettes Purchased by Store Type

Source: CTS 1999

-12.64%

-5.45%-4.24% -4.22%

-5.58%-6.96%

1.05%

-3.85% -4.00%

-8.94%

-19.97%

0.81%

3.79%

0.00%0.73%

-20.78%

-1.07%-1.86%

0.18%

-1.86%-2.90%

-9.51%

-25.0%

-20.0%

-15.0%

-10.0%

-5.0%

0.0%

5.0%

10.0%

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Annual % Change in Trended Demand

Expected Change in Demand Due to Price Changes

Expected and Actual Percentage Changesin Cigarette Consumption

Due to Price Changes in California, 1989-1999

Source: CA BOE, 1999; Tax Burden on Tobacco, 1999

0.0%

28.8%

-33.0%

4.3%1.4%

-32.8%

-40.0%

-30.0%

-20.0%

-10.0%

0.0%

10.0%

20.0%

30.0%

40.0%

1990-1993 1993-1996 1996-1999

Actual % Change in Prevalence

Expected % Change in PrevalenceDue to Price Changes

Actual and Expected Changes in Adolescent Prevalence

Source: CTS 1993, 1996, 1999; Tax Burden on Tobacco, 1999

CONCLUSIONS

•Although adult smoking prevalence is static,

smokers are smoking less.

•Both increased tobacco excise taxes and other

Program strategies (e.g., smoking restrictions)

appear to be contributing to the decline in

consumption.

CONCLUSIONS (cont’d)

ENCOURAGING TRENDS:

•More quitting activity among adult smokers

•Less adolescent smoking

•Less perception by adolescents that cigarettes

are easy to obtain

•More compliance with school smoking bans

CONCLUSIONS (cont’d)

ENCOURAGING TRENDS:

•More smokefree worksites

•More protection of indoor workers from

secondhand smoke

•More children protected from secondhand

smoke in the home

•Continued support for excise tax increaseshttp://ssdc.ucsd.edu

Back-up slides

ADOLESCENT USE OF OTHERTOBACCO PRODUCTS

•Have you ever tried ...

-Chewing tobacco or snuff

-Cigars, cigarillos, or little cigars

-Bidis, a specially flavored cigarette

from India

•On how many of the last 30 days did you use product?

0

10

20

30

40

50

60

70

Adolescent Smoking Experience

% E

ver

Used

1996 1999

CommittedNever

Smokers

SusceptibleNever

Smokers

NoncurrentUsers

CurrentExperimenters

CurrentEstablished

Smokers

Experimentation with Smokeless Tobacco by CigaretteSmoking Experience in Adolescent Boys


0

20

40

60

80

100

Adolescent Smoking Status

% E

ve

r U

se

d

1996 1999

Experimentation with Cigarsby Cigarette Smoking Experience

CommittedNever

Smokers

SusceptibleNever

Smokers

NoncurrentUsers


CurrentEstablished

Smokers



0

10

20

30

40

50

60

70

80

90

100

Adolescent Smoking Experience

%

Ever

In Last 30 Days

Bidi Use by Traditional Cigarette Smoking Status

CommittedNever

Smokers

SusceptibleNever

Smokers

NoncurrentUsers


CurrentEstablished

Smokers

Bidi Use

ADULT CIGAR USE

•Do you currently smoke cigars everyday some

days or not at all?

•On how many of the last 30 days did you

smoke cigars?

•On the days you smoked cigars, about how

many cigars did you usually smoke?

•Do you usually inhale the cigars you smoke?

1.1

0.10.20.30.3

3.84.85.4

4.0

0

0.3

1.3

3.1

1.8

6.2

11.0

12.3

00.3

1.5

2.7

7.0

9.2

10.5

0

2

4

6

8

10

12

14

16

18-24 25-44 45-64 65+ 18-24 25-44 45-64 65+Age

% C

urr

en

t C

iga

r S

mo

ke

rs

1990 1996 1999

Current Cigar Use by Gender and Age

Men Women

Source: CTS 1990, 1996, 1999

0.8 0.50.3 0.6 0.90.10.1

10.9

3.9

2.22.9

14.8

6.57.5

2.6

15.4

7.8

5.0

0

5

10

15

20

NeverSmoker

FormerSmoker

CurrentSmoker

NeverSmoker

FormerSmoker

CurrentSmoker

% C

urr

ent

Cig

ar S

mo

kers

1990 1996 1999

Current Cigar Use by Gender and Cigarette Smoking Status

Men Women

Source: CTS 1990, 1996,1999

Cigar Use PatternsAmong Current Cigar Smokers

by Cigarette Smoking Status, 1999

Never Former Current% % %

Days in Last Month None 48.3 36.1 44.4 Every Day 1.5 10.4 3.6Cigars on Days When Smoked 1 96.2 80.4 82.4 2 2.1 12.9 9.8 3+ 1.4 6.4 5.3Monthly Cigar Consumption >5 10.3 26.4 15.3 >10 6.3 19.0 11.6 >30 1.9 14.5 4.7Usually Inhale 10.8 20.5 45.7

Documents

HIGHLIGHTS FROM THE CALIFORNIA TOBACCO SURVEYS Elizabeth A. Gilpin, MS Principal Investigator 1999 California Tobacco Surveys Cancer Prevention and Control