Comparison of prevalence of smoking among youth in grades 9-12 within the

US, in comparable areas that used different strategies on tobacco control.

Yawo Akrodou

Janette Candido

Carla Freeman

Tony Unutoa

PUBH 8155

Walden University PhD Program

Fall 2009

Research Manuscript: Introduction

• Retrospective study of prevalence of tobacco use among adolescents in grades 9-12 within the US, from 2001 to 2007 in relation to tobacco control public policies

Description of Issues

• Smokers are recognized as individuals with the highest health risk and one of the few diseases that can be prevented (Potomac Center for Medical Education, 2006)

• Smoking causes cancer, heart disease, and emphysema

• Secondhand smoke can be linked to cancer, heart and Sudden Infant Death Syndrome and (Potomac Center for Medical Education, 2006)

Description of Issues

• Also it can be linked to skin damage, osteoporosis, visual impairment and ulcers.

• It is estimated that approximately 14% of

adolescents engage in smoking (YRBSS).

• Additionally it can be linked to skin damage, osteoporosis, visual impairment and ulcers.

Purpose of the Study

• To review the society and environmental factors that may have an impact on the prevalence of smoking among youth in the high school grades 9-12

• Being able to analyze previous studies

• To research some of the factors leading youths to smoke at such an early age .

Purpose of the Study

• To allow public health professional to have new data to design preventative programs

• To analyze the effectiveness some of the alternatives and prevention methods being used in society today

Significance of the study

• Need to advocate and find the ways to fight the highly funded campaigns of the tobacco industry

• Important to find and improve strategies needed to address tobacco smoking among youth

• This is needed to look at evidence-based strategies and acquire evidence on practice-based strategies.

Significance of the study

• Being able to assess the effectiveness of evidence-based strategies already applied to a population of youth in different States

• Being able to analyze the cost of the strategy, effectiveness and in communities.

• To maximize the limited resources of the public health system and their advocates in dealing with the highly funded tobacco advancement efforts.

Summary of Literature Reviews

• Tobacco dependence is considered a chronic disease and moderate and heavy smokers are recognized as individuals with the highest health risk and one of the few diseases that can be prevented (Potomac Center for Medical Education, 2006 )

• There are numerous unhealthy behaviors related to smoking and in this nation alone, 20% of all deaths can be related to tobacco. In fact, it is documented that nine out of ten smokers have started smoking before the age of 18 (CDC, 2007)

• Adolescent smokers are more likely to engage in other unhealthy behaviors than non smokers (Herbert, 2000

Summary of Literature Reviews

• The CDC (2007) has demonstrated through evidence based research that tobacco control programs delivered by peers are strengthened by encouragement and support.

• Watson & Grove (1999) who demonstrated that effectiveness of tobacco reduction and regulations have shown a drop in tobacco sales to minors from 34% to 14% , also ordinance and enforcement regulations decreased violations of selling tobacco to persons under 18 from 32.3% to 25.9%.

Summary of Literature Reviews

• According to Potomac center for medical Education (2006) 20% of all deaths related to cigarette smoking, and 9 out of 10 smokers started using cigarettes before the age of 18.

• In fact, it is documented that nine out of ten smokers have started smoking before the age of 18 (CDC, 2007).

Study Design

• Study Nature: Retrospective and quantitative study designed using archived data available from the Youth Risk Behavior Surveillance System (YRBSS) in 2001 and 2007.

• Function: To analyze the effectiveness of current public state and federal policies including environmental factors, age limit, cigarette tax per pack, fiscal year per capita tobacco control funding, and others socioeconomic factors initiated towards the reduction of the prevalence of youth smoking in US.

Study Hypotheses

• Null hypothesis. There is no significant difference in the change in prevalence of tobacco use among adolescents in grades 9-12 from the archived data in 2001 compared to the archived data in 2007 within the US.

• Alternative hypothesis. There is significant difference in the change in prevalence among youth grades 9-12 among from the archived data in 2001 compared to the archived data in 2007 within the US.

Variables• Independent Variables:

1.) Minimum tobacco-sale requirements

2.) Cigarettes tax

3.) Smoking bans

4.) Increase in age limit for tobacco sales

5.) Retailer compliance of tobacco laws

• Dependent Variable:

1.) Prevalence of smoking among students in grades 9 to 12 in the United States.

Data set to be used for data analysis

• Data on tobacco control strategies were taken from the State Legislated Actions on Tobacco Issues (SLATI )

• Prevalence of current smokers among adolescents grades 9 to 12 were taken from the archived data Youth Risk Behavior Surveillance System (YRBSS) in 2001 and 2007 and

• Rates of retailer non-compliance of tobacco control rules were taken from the Substance Abuse & Mental Health Services Administration (SAMHSA) of the American Lung Association

Data set to be used for data analysis

• Other sources of data included archived data from the United States Census Bureau, CDC Behavioral Risk Factor Surveillance Systems (BRFSS), American Cancer Society, and American Lung Association.

Raw Data Used of Study Participants

State Legislated Actions on Tobacco Issues Tax on Tobacco

States Taxes States Taxes States Taxes States Taxes States Taxes

Alabama $0.43 Georgia $0.37 Massachuse

tts $2.51 N. Carolina $0.35 S. Dakota $1.53

Alaska $2.00 Hawaii $2.60 Michigan $2.00 N. Dakota $0.44 Tennessee $0.62

Arizona $2.00 Idaho $0.57 Minnesota $1.56 Ohio $1.25 Texas $1.41

Arkansas $1.15 Illinois $0.98 Mississippi $0.68 Oklahoma $1.03 Utah $0.70

California $0.87 Indiana $1.00 Missouri $0.17 Oregon $1.18 Vermont $2.24

Colorado $0.84 Iowa $1.36 Montana $1.70 Pennsylvani

a $1.35 Virginia $0.30

Connecticut $2.00 Kansas $0.79 Nebraska $0.64 R. Island $3.46 Washington $2.03

Delaware $1.60 Kentucky $0.60 Nevada $0.80 S. Carolina $0.07 W.Virginia $0.55

D C $2.00 Louisiana $0.36 N.Hampshir

e $1.78 N. Carolina $0.35 Wisconsin $1.77

Florida $1.34 Maine $2.00 New Jersey $2.70 N. Dakota $0.44 Wyoming $0.60

Sources: American Lung Association: State Ledislated Actions on Tobacco Issues. Factsheets, Tobacco Policy

Raw Data Used of Study Participants

.

State Listed Prevalence for Age under 12. Factsheets 2007

States Prevalence States Prevalence States Prevalence States Taxes States Prevalence

Alabama - Georgia 11.7Massachuse

tts 8.6 N. Carolina - S. Dakota -

Alaska 6.1 Hawaii 7 Michigan 10.1 N. Dakota 9.1 Tennessee 11.5

Arizona - Idaho 9.4 Minnesota 10 Ohio 6.1 Texas 15.5

Arkansas 11.1 Illinois 11.1 Mississippi 10.6 Oklahoma 8 Utah 7.4

California 7.4 Indiana 7 Missouri - Oregon - Vermont 7.4

Colorado 7.3 Iowa 9.4 Montana 6.8Pennsylvani

a 10.5 Virginia 7.7

Connecticut 11.5 Kansas 11.1 Nebraska 14.1 R. Island 12.5 Washington 7.3

Delaware - Kentucky 7.8 Nevada 4.9 S. Carolina 3 W.Virginia 8..5

D C 7.6 Louisiana 7.9N.Hampshir

e - N. Carolina 11.9 Wisconsin 9.3

Florida 8.6 Maine 7.9 New Jersey 7.1 N. Dakota 5.8 Wyoming -

Data Analysis

• The archived data of The YRBSS for the prevalence of 2001 and 2007 was entered into SPSS along with the computation of the difference of these two years along with the tax rate. Descriptive statistics of these variables were compiled in (see Table 1).

Data Analysis Descriptive Statistics

Descriptive Statistics (N=33)

Variable Mean SD Statistic Min Max

2001 Preval 22.812 6.758 45.674 8.3 35.3

2007 Preval 16.039 4.767 22.729 7.3 16.04

Diff. in Prev -6.773 3.736 13.963 -14.2 0.9

Tax Rate in dollar

1.3 $0.71 0.5 $0.17 $3.46

Data Analysis (Box Plot)

Data Analysis (Pearson Relation )

Correlation between Tax Rate and 2007 Adolescent Smoking Prevalence

Variable Pearson Correlation

Sum of Squares Df Sig r2

Tax Rate 0.121 -13.087 31 0.501 1.50%

2007 Preval. 0.121 727.339 31 0.5 1.50%

Discussion of Statistical Results

• The association between the state tax rate increases and prevalence of tobacco use by adolescents in grades 9-12 only yield p-value = .501 which means that there is no statistical significance between tax increases and youth smoking prevalence alone and therefore the null hypothesis is accepted.

Discussion of Statistical Results

• Due to the fact that, the tax rates in states are not uniform, but observational analysis of the effect tax increases in some states have contributed to the reduction of youth smoking (Correlation Table 2). In addition, the regression analysis has been performed in order to examine the correlation between youth smoking prevalence and other independent variables as described in the later on.

Pearson Correlation Results

Pearson Correlation

Years Tax Funding More than 18 Smoke Ban Compliance

Current smoker 2005

0.094 -0.152 0.414 -0.277 0.373

Current smoker 2007

0.135 -0.034 0.761 -0.334 0.246

Ever smoked 2005

-0.079 -0.558 0.418 -0.628 0.821

Ever smoked 2007

0.233 0.142 0.591 -0.982 0.773

*All are not statistically significant.

Pearson Correlation ResultsDiscussion

• Pearson Correlation (see Table 3) showed higher correlation between independent variables essentially for increasing the legal tobacco buying age for those who are current smokers in 2007. We can see also positive correlation for retail compliance, minimum age adjustment, and taxation in other hand negative correlation are noticed for tobacco funding and smoke bans because these are not consistently enforced in all states

Data Results(2007 Prevalence)

• The following graph processed through Excel illustrates the 2007 prevalence of adolescent smoking in relation to the respective tax rates in the geographic region.

Discussion of ResultsStates with lowest Prevalence

• The top 3 geographic locations that have the lowest prevalence of adolescent smoking in 2007 is Boston, Massachusetts with a prevalence of 7.5% with a tax rate of $2.51, followed by Utah at 7.9% with a tax rate of $0.70 and San Francisco at 8% with a tax rate of $2.51.

Discussion of ResultsStates with High Prevalence

• The top 3 geographic locations with the highest prevalence of adolescent smoking in 2007 South Dakota with a prevalence of 24.7% and a tax rate of $1.53, followed by Missouri at 23.8% with a tax rate of $0.17, and North Carolina at 22.5% with a tax rate of $0.35. In looking at the lowest tax rates, Rhode Island leads with a tax rate of $3.46, followed by Massachusetts at $2.51 and Vermont at $2.24.

Results Limitations

• In this preliminary data analysis one can notice that the associations were not statistically significant for these independent variables due to the fact that the data in each state is implementing its smoking policy which impact the end result

Conclusion

• We can relate the result of our test and analysis to the research of Watson & Grove (1999) who demonstrated that effectiveness of tobacco reduction and regulations have shown a drop in tobacco sales to minors from 34% to 14% , also ordinance and enforcement regulations decreased violations of selling tobacco to persons under 18 from 32.3% to 25.9%. Consequently, these measures did in general reduce the prevalence of youth smoking essentially in the states which have applied strictly to these to the pre-cited measures.

Acknowledgement

• Our Group would like to thank Dr. Cynthia Lanier who has made it possible for us to finish this project.

• We would like to thank our classmates for their constructive discussion in this quarter.

• Thank you all

References• American Lung Association. State Legislated Actions on Tobacco Issues (SLATI)

Overview. Retrieved from http://slati.lungusa.org/StateLegislateAction.asp• Albuquerque, M., Starr, G., Schooley, M., Pechacek, T., & Henson, R. (2003).

Advancing tobacco control through evidence-based programs. Healthy Youth, Centers for Disease Control and Prevention [Online Article]. Retrieved from http://www.cdc.gov/HealthyYouth/publications/pdf/PP-Ch8.pdf

• Barbeau, E., DeLaurier, G., Kelder, G., & McLellan, D. (2007). A decade of work on organized labor and tobacco control: Reflections on research and coalition building in the United States. Journal of Public Health Policy. 28 (1),

118-135. • Center for Disease Control and Prevention. (2008).Smoking & tobacco use [Data file].

Retrieved from http://www.cdc.gov/tobacco/data_statistics/Factsheets/cessation2.htm

• Center for Disease Control and Prevention (2008). Cigarette Use among High School Students-United States, 1991—2007. Retrieved from

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5725a.htm

References • Fichtenberg, C. & Glantz, S. (2002). Youth Access Interventions Do Not Affect

Youth Smoking. Pediatrics, 109(6), 1088-1093.• Fisher, E.B., Auslander, W.F., Munro, J.F., Arfken, C.L., Brownson, R.C., & Owens,

N.W. (1998). Neighbors for a smoke free north side: Evaluation of a community organization approach to promoting smoking cessation among African Americans. American Journal of Public Health, 88 (11), 1658-

1663.• Healthy People 2010: Chapter 27, Tobacco Use. Retrieved from

http://www.healthypeople.gov/Document/tableofcontents.htm#volume1• Herbert, R. (2000). What’s new in nicotine and tobacco research. Nicotine and

Tobacco Research, 2, 109-111.• Jason, L., Pokorny, S., & Schoeny, M. (2003). Evaluating the effects of enforcements

and fines on youth smoking Critical Public Health, 13(1), 33-46• Levy, D.T. & Friend, K.B. (2002). Strategies for reducing youth access to tobacco: A

framework for understanding empirical findings on youth access

policies.Drugs:duc.Prev. Policy; 9:285-301

References• Maseeh, A. & Kwatra, G. (2005). A review of smoking cessation interventions.

Medscape General Medicine 7(4), 24.• McCracken, M., Jiles, R., & Blanck, H. M. (2007). Health behaviors of the young

adult US population : behavior risk factor surveillance system. Center for Disease Control and Prevention and Chronic Disease, 4 (2)

• Miller, W.R. and Sanchez, VC. (1993). Motivating young adults for treatment and lifestyle change. Notre Dame (IN): University of Notre Dame.

• Northridge, M.E. (2004). Building coalitions for tobacco control and prevention in the 21st Century American Journal of Public Health, 94 (2), 178-180.

• Potomac Center for Medical Education. (2006). Smoking cessation working group best practices exchange and dissemination. Retrieved from: http://smokingcessationexchange.org/

• Ransom, P. & Shelley, D. (2006). What can community organizations do for tobacco Control? Journal of Health and Human Services Administration, 29 (1),

51-85.