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Government Surveys &Government Surveys &
Healthy People 2020
Presented by: Chris Moll, TMA

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Monitoring the Futureg
Youth Risk Behavior Surveillance Survey
Behavioral Risk Factor Surveillance System
National Health Interview Survey
National Survey on Drug Use and HealthNational Survey on Drug Use and Health
Tobacco Use Supplement - CPS
National Youth Tobacco Survey

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Survey Sample Size Sample Pop MethodSurvey Sample Size Sample Pop. Method
MTF 40,000 Grades 8, 10, 12
YRBSS 15,000 Grades 9‐12
BRFSS 400,000 Adults (18+)
NHIS 35,000 Adults (18+)
NSDUH 70 000 People 12+NSDUH 70,000 People 12+
TUS‐CPS 240,000 Adults (18+)
NYTS 25,000 Grades 6‐12

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Survey Definitiony
MTF None. (30‐day, Daily, ½ Pack+ Daily)
YRBSS Smoked on at least 1 day in the 30 days prior to
the survey. (20/30 days = “Current Frequent”)
BRFSS Have smoked at least 100 cigarettes in their
lifetime and now smoke every daylifetime and now smoke every day.
NHIS Have smoked at least 100 cigarettes in their
lifetime and now smoke daily or some days.y y
NSDUH None. (Lifetime, Past Year, Past Month)
TUS‐CPS Smoke every day or “some days”
NYTS Smoked cigarettes on at least 1 day in the 30
days prior to the survey.

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25
Smoking Prevalence, 1999‐2013
15
20 MTF‐8 (Daily)
MTF‐10 (Daily)
MTF 12 (Daily)
10
5 MTF‐12 (Daily)
YRBS (Curr. Freq.)
BRFSS (Daily)
NHIS (Daily)
0
5
NHIS (Daily)
NYTS (Daily)
TUS‐CPS (Daily)
SourcesSources:: MonitoringMonitoring thethe Future,Future, BehavioralBehavioral RiskRisk FactorFactor SurveillanceSurveillance System,System, YouthYouth RiskRisk BehaviorBehavior SurveillanceSurveillance System,System,
NationalNational HealthHealth InterviewInterview System,System, NationalNational YouthYouth TobaccoTobacco Survey,Survey, &Tobacco&Tobacco UseUse SurveySurvey –– CurrentCurrent PopulationPopulation SupplementSupplement

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25
Daily Smokers, Youth
MTF12: -62%
5
10
15
20
YRBS: -62%
0
NYTS: -62%
20
25
Daily Smokers, Adults
BRFSS: -26%
5
10
15
20
NHIS: -26%
0
5
TUS: -27%

7. conference.tma.org
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2500
Per Capita Cigarette Consumption
2000
1000
1500
500
1000
0
998
999
000
001
002
003
004
005
006
007
008
009
010
011
012
013
55%
Source: TMA’s World Cigarette GuideSource: TMA’s World Cigarette Guide
19
19
20
20
20
20
20
20
20
20
20
20
20
20
20
20

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None
1 Location1 Location
2 Locations
3 Locations
Source: CDCSource: CDC

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$7
Price per pack, 1999‐2013
$4
$5
$6
$2
$3
$4
$‐
$1
Source: TMA EstimateSource: TMA Estimate
Weighted Avg. Price Per Price PointWeighted Avg. Price Per Price Point

10. conference.tma.org
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< $.50
$.50 ‐ $.99$.50 $.99
$1 ‐ $1.49
$1.49 ‐ $1.99
Source: CDCSource: CDC
$2+

11. conference.tma.org
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9‐12.9%
13‐15.9%
16‐18.9%
19‐21.9%
22‐24.9%
Source: BRFSSSource: BRFSS
25%+

12. conference.tma.org
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13. conference.tma.org
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Google Search “Interest”Google Search Interest
Source: google.com/trendsSource: google.com/trends

14. conference.tma.org
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2500
Per Capita Cigarette Consumption
2000
1000
1500
500
1000
0
998
999
000
001
002
003
004
005
006
007
008
009
010
011
012
013
Source: TMA’s World Cigarette GuideSource: TMA’s World Cigarette Guide
19
19
20
20
20
20
20
20
20
20
20
20
20
20
20
20

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2011
Ever Heard
Ever Tried 3 1%Ever Tried 3.1%
30‐Day Use 1%
Source: NYTSSource: NYTS

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2011 2012
Ever Heard 48%
Ever Tried 3 1% 6 6%Ever Tried 3.1% 6.6%
30‐Day Use 1% 2%
Source: NYTSSource: NYTS

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GOAL
Reduce illness disability and
GOAL
Reduce illness, disability, and
death related to tobacco use and
secondhand smoke exposure.

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30‐day Use, Grades 9‐12
35
40
45
20
25
30
5
10
15
0
Tobacco Cigarettes Smokeless Cigars
Sources: NHIS, BRFSS, MTFSources: NHIS, BRFSS, MTF
Tobacco‐2020 Cigarettes‐2020 Smokeless‐2020 Cigars‐2020

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30
Adult Current Use, 1998‐2012
20
25
10
15
0
5
0
Cigarettes Smokeless Cigars
Sources: NHIS, BRFSS, MTFSources: NHIS, BRFSS, MTF
Cigarettes Smokeless Cigars
Cigarettes‐2020 Smokeless‐2020 Cigars‐2020

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30‐Day Cigarette Use
30
35
40
30 Day Cigarette Use
20
25
30
5
10
15
0
YRBS MTF8 MTF10 MTF12
Sources: NHIS, BRFSS, MTFSources: NHIS, BRFSS, MTF
NYTS NSDUH Goal (16)

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Adult Current Cigarette Use 1998 2012
25
30
Adult Current Cigarette Use, 1998‐2012
15
20
5
10
0
Sources: NHIS, BRFSS, TUSSources: NHIS, BRFSS, TUS‐‐CPS, NSDUHCPS, NSDUH
NHIS TUS‐CPS NSDUH BRFSS Goal (12)

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30‐Day Smokeless Use
7
8
9
10
4
5
6
0
1
2
3
0
YRBS MTF8 MTF10 MTF12
Sources: NHIS, BRFSS, MTFSources: NHIS, BRFSS, MTF
NYTS NSDUH(14‐17) Goal (6.9)

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Adult Current Smokeless Use, 1998‐2012
3
3.5
4
2
2.5
0.5
1
1.5
0
Sources: NHIS, BRFSS, MTFSources: NHIS, BRFSS, MTF
NHIS NSDUH TUS‐CPS Goal (0.3)

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Smoking Prevalence, 1999‐2013
15
20
25
0
5
10
0

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Per Capita Cigarette Consumption
1500
2000
2500
0
500
1000
1500
0
1998
2000
2002
2004
2006
2008
2010
2012

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30 D Ci tt U
25
30
35
40
30‐Day Cigarette Use
0
5
10
15
20
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020+

27. conference.tma.org
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28. @@

29. None. (30‐day, Daily, ½ Pack+ Daily)
@@
Sample MethodDefinition of Current Smoker 8th, 10th, and 12th GSurvey Population
40,000
15 000
Monitoring the
Future
Youth Riskd k d i l d
350 000
15,000Youth Risk
Behavior Survey
Behavioral Risk
F S ill
Have smo
i h i
Had smoked cigarettes on at least 1 day
during the 30 days before the survey.
(20 of 30 days for “Current Frequent”)
350,000
87 500
Factor Surveillance
System
National Health
in their Noninstitutionalized Adults
Adults (18 and older)87,500Interview Survey Have smoked
cigarettes in the
now smoke dail
Adults (18 and older)

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In the WorkplacePublic PlacesRestaurantsStores
10%
2 %
Allowed
59%
41%
25%29% Banned
59%
90%75%71%
Source: TMA’s Tobacco USASource: TMA’s Tobacco USA

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• $118.3 million
• 40,000 people
• 7,000 youths
Source: FDA.govSource: FDA.gov

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• Susceptibilityp y
• Frequency
• Effects of Regulation
• Attitudes
C ti & R l
Source: FDA.govSource: FDA.gov
• Cessation & Relapse

33. 800
900
500
600
700
of Pounds
200
300
400
Millions
0
100
2006 2007 2008 2009 2010 2011
Cigarettes Moist Snuff Other Smokelessg
Source: USDASource: USDA‐‐ERSERS

34. 500
600
2005 2011
376 372 364
345
323
304 296 288 281 274
400
2005‐2011:
2005‐2015:
288 281 274 267
200
300
0
100
2005 2010 2015
Cigarettes (bn pcs) TMA Estimates

35. 2002‐2010:
2002‐2010:
2001‐2009:
Sources: Monitoring the Future, Sources: Monitoring the Future,
TMA’s World Cigarette Guide, US CensusTMA’s World Cigarette Guide, US Census

36. 30 Day40%
Cigarette Use - 12th Grade
il
25%
30%
35%
Daily
5%
10%
15%
20%
½ Pack+ Daily
0%
30 Day Daily 1/2 Pack+

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Relative Risk Factor (RR)Relative Risk Factor (RR)
Population Attributable Risk (PAR)p ( )
Smoking Attributable Fraction (SAF)
Smoking Attributable Mortality (SAM)

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Rate of Death of Smokers_____________________________
Rate of Death in Nonsmokers
(Relative Risk) x (Smoking Prevalence)

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R l ti Ri kRelative Risk:
Current Smokers
Former Smokers
2.80
1 64
(RR1)
(RR2)Former Smokers 1.64
Prevalence:
Current Smokers 23 41%
( 2)
(p1)Current Smokers
Former Smokers
23.41%
28.62%
(p1)
(p2)
Never Smokers 47 97% (p )Never Smokers 47.97% (p0)
Total IHD Deaths: 57,220

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Prevalence(never) + PAR(current) + PAR(former) - 1__________________________________
Prevalence(never) + PAR(current) + PAR(former)Prevalence(never) + PAR(current) + PAR(former)
[p + p (RR ) + p (RR )] 1[p0 + p1(RR1) + p2(RR2)] - 1____________________________
[p0 + p1(RR1) + p2(RR2)][p0 + p1(RR1) + p2(RR2)]

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( 4 9 2341(2 ) 2 62(1 64)) 1(.4797 + .2341(2.8) + .2862(1.64)) - 1________________________________
( 4797 + 2341(2 8) + 2862(1 64))(.4797 + .2341(2.8) + .2862(1.64))
SAF = 38%

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SAF x Total Deaths from IHD = SAM
.38 x 57,220 =
21,744

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Cancers
C i iCardiovascular Diseases
Respiratory Diseasesp y
Prenatal Conditions
and more…and more

45. @@
40
45
Current Cigarette Use
30
35
40
9th Grade
15
20
25
%
9th Grade
10th Grade
11th Grade
12th Grade
0
5
10
1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011
Source: YRBS 2011Source: YRBS 2011

46. @@

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US Smoking PrevalenceSmoking Prevalence (%)
30%
35%
40%
45%
35
40
45
15%
20%
25%
30%
20
25
30
0%
5%
10%
1965 1969 1973 1977 1981 1985 1989 1993 1997 2001 2005 2009
5
10
15
1965 1969 1973 1977 1981 1985 1989 1993 1997 2001 2005 2009
% of Adults
Source: US Division of Health Interview Statistics
0

48. conference.tma.org
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35%
90‐97:
25%
30%
04‐09:
15%
20%
10%
97‐04:
Adult Prevalence
Source: US Division of Health Interview Statistics

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18%
Every Day Smoking Prevalence
10%
12%
14%
16%
4%
6%
8%
10%
0%
2%
2006 2007 2008 2009 2010 2011 2012
NHIS MTF‐12th BRFSS
Sources: Monitoring the Future, National Health Interview Survey, Behavior Risk
Factor Surveillance System

50. @@
20 00%
25.00%
30.00%
35.00%
T t l
30.00%
40.00%
50.00%
Total
0.00%
5.00%
10.00%
15.00%
20.00% Total
Male
Female
0.00%
10.00%
20.00%
Total
Male
Female
30.00% 60.00%
5.00%
10.00%
15.00%
20.00%
25.00%
Total
Male
Female 10.00%
20.00%
30.00%
40.00%
50.00%
Total
Male
Female
0.00% 0.00%
Source: TMA’s World Cigarette GuideSource: TMA’s World Cigarette Guide

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16
18
10
12
14
MTF‐8 (Daily)
MTF‐10 (Daily)
6
8
MTF‐12 (Daily)
YRBS (Curr. Freq.)
BRFSS (Daily)
NHIS (Daily)
0
2
4
2007 2008 2009 2010 2011 2012
Sources: NHIS, BRFSS, MTF, YRBSSources: NHIS, BRFSS, MTF, YRBS

52. conference.tma.org
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Pieces per CapitaUS Smoking PrevalenceEvery Day Smoking Prevalence
1,000
1,500
2,000
Pieces per Capita
20%
30%
40%
50%
US Smoking Prevalence
10%
15%
20%
y y g
0
500
,
2002 2006 2010
0%
10%
20%
0%
5%
10%
2006 2007 2008 2009 2010 2011
Cigarette Consumption per Capita% of AdultsNHIS MTF‐12th BRFSS