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
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
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%.
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.
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.
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 Massachusetts $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 Pennsylvania $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.Hampshire $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 11.7 Massachusetts 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 6.8 Pennsylvania 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 7.9 N.Hampshire - N. Carolina 11.9 Wisconsin 9.3 Florida 8.6 Maine 7.9 New Jersey 7.1 N. Dakota 5.8 Wyoming -
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
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.
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 (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
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 Results States 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 Results States 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.
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
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.
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