HIGHLIGHTS FROM THE CALIFORNIA TOBACCO SURVEYS Elizabeth A. Gilpin, MS Principal Investigator 1999 California Tobacco Surveys Cancer Prevention and Control Program University of California, San Diego, Cancer Center http://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 CALIFORNIA TOBACCO 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 tax 1990: Media campaign begins By 1993, over 120 new local clean air ordinances were adopted 1994: State law: indoor workplaces smokefree 1994: STAKE Act (youth access enforcement) 1998: Smokefree workplace law extended to bars and game rooms 1999: Proposition 10 passed, new $0.50/pack tax Expenditures of the California Tobacco Control Program 140 Competitive Grants (22.3%) School Programs (31.4%) Local Agencies (26.3%) Media (20.1%) Expenditures in Millions ($) 120 100 80 60 40 20 0 90 91 92 93 Source: Balbach et al., 1998 and 2000 94 Year 95 96 98 99 00 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 IMPORTANT OUTCOME MEASURES • Cigarette price • Per capita cigarette consumption • Adult smoking prevalence • Adult cessation • Adolescent smoking • Adolescent perceptions of ease of obtaining cigarettes SURVEILLANCE OF IMPORTANT OUTCOME 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 Average Real Price/Pack of Cigarettes in California (1999 dollars) Real Price/Pack (1999 $) $4.00 $3.50 $3.00 $2.50 $2.00 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Source: Tax Burden on Tobacco, 2000 Seasonally Adjusted Trend of Per Capita Consumption for Cigarettes, California vs. U.S. 16 California Packs per Month 14 California Trend US-California 12 US Trend 22% lower 10 8 6 4 1983 54% lower Program Starts 1985 1987 1989 1991 1993 1995 Year Source: Tobacco Institute; Orzechow ski & Walker; U.S. Bureau of Census 1997 1999 2001 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? Smoking Prevalence Among California Adults, Aged 18 or Older 35 NHIS CATS/BRFS CPS 30 CTS % Predicted 25 95% CI 20 15 1975 1980 1985 1990 1995 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 2000 Smoking Prevalence Among Adults in the Rest of the United States, Aged 18 and Older 40 35 % 30 25 NHIS CPS 20 15 1975 Predicted 95% CI 1980 1985 1990 1995 Source: NHIS 1978, 1979, 1980, 1983, 1985, 1987, 1988, 1990, 1991, 1993, 1994; CPS 1992-1993, 1995-1996, 1998-1999 2000 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. 22 Adult Daily Smoking, Standardized and Unstandardized Unstandardized 20 17.5 16.4 % 18 Standardized 16 15.9 14.1 14 14.7 13.9 13.0 13.0 12 1988 1990 Source: CTS 1990, 1992, 1996, 1999 1992 1994 1996 1998 2000 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? Light Smoking (<15 Cigarettes/Day) Among Current Smokers % Current Smokers 80 Occasional Smokers All Light Smokers 60 30.4 40 30.5 26.8 26.4 20 16.8 17.7 1990 1992 24.6 29 0 Source: CTS 1990, 1992, 1996, 1999 1996 1999 Daily Cigarette Consumption and Smoking Bans 16 14 13.9 Cigarettes/Day 12 11.2 10 8.2 7.3 8 6 4 2 0 None Source: CTS 1999 Work ban only Home ban only Both 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 Quit Attempts Among Smokers in the Last Year 70 61.5 56.0 60 48.9 50 38.1 % 40 30 20 10 0 1990 Source: CTS 1990, 1992, 1996, 1999 1992 1996 1999 Relapse Following Most Recent Quit Attempt for Smokers in Last Year 100 90 1990 1996 1999 90 120 80 % Abstinent 70 60 50 40 30 20 10 0 0 30 Source: CTS 1990, 1996, 1999 60 Time (days) 150 180 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? The Effect of Removing Population Distribution Changes from Adolescent (12-17 years) Smoking Prevalence in the Last 30 Days 14 Unstandardized Standardized % 12 12 11.6 10 9.2 9.2 9.0 9.0 8 7.7 7.8 6 1988 1990 Source: CTS 1990, 1993, 1996, 1999 1992 1994 1996 1998 2000 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? 12-17 Year Old Committed Never Smokers 1993 1996 1999 80 70 60 65.7 62.2 55.8 50 % 49.0 43.9 40.9 40 38.0 41.3 35.5 30 20 10 0 12 to 13 14 to 15 Age Group Source: CTS 1993,1996,1999 16 to 17 15-17 Year Old Established Smokers 1993 1996 1999 25 17.3 20 13.8 % 12.8 15 10 10.2 10.7 9.9 7.0 5.8 3.8 5 0 15 16 Age (years) Source: CTS 1993,1996,1999 17 EASE OF ACCESS •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? 70 60 Never Smokers Who Think It Would Be Easy To Get Cigarettes 57.9 56.9 57.2 % of Never Smokers 48.0 50 40 30 20 10 0 1990 Source: CTS 1990, 1993, 1996, 1999 1993 1996 1999 Perception of Ease of Buying a Few Cigarettes (Age 12-14 years) 100 1996 80 54.7 60 % 1999 42.3 44.7 40 28.4 20 0 Committed Never Smoker Source: CTS 1996, 1999 Susceptible Never Smoker Perception of Ease of Buying a Pack of Cigarettes (Age 15-17 Years) 1996 100 80 1999 93.4 86.8 73.2 63.7 % 52.5 60 45.7 40 20 0 Experimenter Occasional Daily Established Smoking Source: CTS 1996, 1999 COMPLIANCE WITH SCHOOL SMOKING BANS •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? School Policy Against Smoking by Current Smoking Status and Year 100 1996 88.2 91.2 90 80 1999 68.1 64.4 70 57.0 56.9 % 60 50 55.8 46.1 41.7 37.5 40 33.3 24.7 30 20 10 0 Nonsmokers Current Smokers Most or all obey Source: CTS 1996, 1999 Nonsmokers Current Smokers Seen someone smoking (yes) Nonsmokers Current Smokers Preference for smokefree school 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? Students Who Recall Taking a Course on the Health Dangers of Smoking 80 73.2 75.7 76.1 77.8 1993 1996 1999 70 60 % 50 40 30 20 10 0 1990 Year Source: CTS 1990, 1993, 1996, 1999 Class on Health Dangers of Smoking Ineffective 80 69.2 70 60 1996 61.7 50.3 50 % 1999 42.4 40 30 20 10 0 Never Smokers Source: CTS 1990, 1993, 1996, 1999 Ever Smokers PROTECTION OF NONSMOKERS FROM SECONDHAND TOBACCO SMOKE •In the workplace •In the home SECONDHAND SMOKE 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? Indoor Workers Reporting Smokefree Workplaces 100 90.5 93.4 80 60 % 46.3 40 35 20 0 1990 Source: CTS 1990, 1992, 1996, 1999 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? Exposure of Nonsmoking Indoor Workers to Secondhand Smoke 35 29 30 22.4 25 20 % 15.6 11.8 15 10 5 0 1 1990 2 1993 Source: CTS 1990, 1993, 1996, 1999 3 1996 4 1999 80 Exposure of Nonsmoking Indoor Workers by Type of Workplace in 1999 50.2 70 60 % 50 31.9 40 24.5 30 17.7 20 10 11.7 7.1 7.9 Classroom Hospital 0 Source: CTS 1999 Office Plant/ Factory Restaurant/ Store/ Bar Warehouse Vehicle Exposure of Nonsmoking Indoor Workers by Size of Workplace in 1999 30 20.6 25 17.8 18.1 % 20 12.1 15 10 5 0 <5 5-24 25-50 Number of Employees at Workplace Source: CTS 1999 >50 Place of Exposure to Someone Smoking in Last 6 Months Other Than Own Home or Work in 1999 40 31.7 % Nonsmokers 35 30 25 20 15 13.2 12.5 8.2 10 4.1 5 2.1 5.3 3.8 3.2 0 Restaurant Source: CTS 1999 Bar/ Restaurant Bar/ Tavern Park/ Outdoors Shopping Community Gambling Sports Mall Venue Event Place Most Recently Exposed Others’ Homes Others’ Cars 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. Home Smoking Restrictions Among All Californians (Smokers and Nonsmokers) 80 73.2 70 60 1993 1996 1999 64.5 50.9 % 50 40 29.1 30 20.0 20 18.9 16.6 12.0 14.8 10 0 Smokefree Some Restrictions Home Smoking Policy Source: CTS 1993, 1996, 1999 No Restrictions Home Smoking Restrictions Reported by California Smokers 1993 60 1996 1999 53.9 47.2 50 38.1 40 35.6 % 31.0 30 26.1 26.3 20.1 21.8 20 10 0 Smokefree Some Restrictions Home Smoking Policy Source: CTS 1993, 1996, 1999 No Restrictions Protection of Young Children (0-5 Years) in Households Where Adults Smoke 100 All adults smoke At least 1 adult smokes 73.0 % Protected 80 62.4 56.7 60 44.8 41.6 40 19.3 20 0 1993 Source: CTS 1993, 1996, 1999 1996 1999 EXPOSURE TO SECONDHAND SMOKE IN VENUES BESIDES THE WORKPLACE OR HOME •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. 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? 80 Cumulative Percentage Favoring Additional Cigarette Excise Tax 1996 70 1999 Cumulative % 60 50 40 30 20 10 0 $3.00 $2.00 $1.50 $1.00 $0.75 Additional Excise Tax Source: CTS 1996, 1999 $0.50 $0.25 Percent of Buyers and Cigarettes Purchased by Store Type 50 Buyers Cigarettes 40 % 30 20 10 0 Liquor/drug stores ($3.52/pack) Source: CTS 1999 Convenience stores/gas stations ($3.47/pack) Supermarkets ($3.28/pack) Discount stores Non/lower-taxed ($2.91/pack) sources ($2.33/pack) Other ($3.32/pack) 10.0% Expected and Actual Percentage Changes in Cigarette Consumption Due to Price Changes in California, 1989-1999 5.0% 3.79% 0.81% 0.00% 0.0% 1.05% 0.18% 0.73% -1.86% -1.86% -2.90% -5.0% -4.24% -3.85% -4.22% -5.45% -1.07% -4.00% -5.58% -6.96% -10.0% -8.94% -9.51% -12.64% -15.0% Annual % Change in Trended Demand -20.0% Expected Change in Demand Due to Price Changes -19.97% -20.78% -25.0% 1989 1990 1991 1992 1993 1994 Source: CA BOE, 1999; Tax Burden on Tobacco, 1999 1995 1996 1997 1998 1999 Actual and Expected Changes in Adolescent Prevalence 40.0% 28.8% 30.0% 20.0% 10.0% 4.3% 1.4% 0.0% 0.0% -10.0% -20.0% -30.0% Actual % Change in Prevalence Expected % Change in Prevalence Due to Price Changes -33.0% -32.8% -40.0% 1990-1993 Source: CTS 1993, 1996, 1999; Tax Burden on Tobacco, 1999 1993-1996 1996-1999 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 increases http://ssdc.ucsd.edu Back-up slides ADOLESCENT USE OF OTHER TOBACCO 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? Experimentation with Smokeless Tobacco by Cigarette Smoking Experience in Adolescent Boys 70 60 1996 1999 % Ever Used 50 40 30 20 10 0 Committed Never Smokers Susceptible Never Smokers Noncurrent Users Current Experimenters Adolescent Smoking Experience Source: CTS 1996, 1999 Current Established Smokers 100 Experimentation with Cigars by Cigarette Smoking Experience % Ever Used 80 1996 1999 60 40 20 0 Committed Never Smokers Susceptible Never Smokers Noncurrent Users Current Current Experimenters Established Smokers Adolescent Smoking Status Source: CTS 1996, 1999 Bidi Use by Traditional Cigarette Smoking Status % 100 90 Bidi Use Ever In Last 30 Days 80 70 60 50 40 30 20 10 0 Committed Susceptible Never Never Smokers Smokers Noncurrent Users Current Current Experimenters Established Smokers Adolescent Smoking Experience Source: CTS 1996, 1999 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? Current Cigar Use by Gender and Age 16 12.3 1990 % Current Cigar Smokers 14 10.5 1996 1999 11.0 12 9.2 10 7.0 6.2 8 5.4 6 4.0 4.8 3.8 3.1 2.7 4 1.8 1.5 2 0.3 1.3 1.1 0.3 0 18-24 25-44 Men Source: CTS 1990, 1996, 1999 45-64 65+ Age 18-24 25-44 0.2 0.3 0.3 0.1 0 0 45-64 Women 65+ Current Cigar Use by Gender and Cigarette Smoking Status % Current Cigar Smokers 20 15.4 14.8 1990 1996 1999 15 10.9 10 7.8 7.5 6.5 5.0 5 3.9 2.9 2.6 2.2 0.8 0.3 0.1 0.5 0.6 Never Smoker Former Smoker 0.1 0.9 0 Never Smoker Former Smoker Men Source: CTS 1990, 1996,1999 Current Smoker Women Current Smoker Cigar Use Patterns Among Current Cigar Smokers by Cigarette Smoking Status, 1999 Never % Days in Last Month None Every Day Cigars on Days When Smoked 1 2 3+ Monthly Cigar Consumption >5 >10 >30 Usually Inhale Former Current % % 48.3 1.5 36.1 10.4 44.4 3.6 96.2 2.1 1.4 80.4 12.9 6.4 82.4 9.8 5.3 10.3 6.3 1.9 10.8 26.4 19.0 14.5 20.5 15.3 11.6 4.7 45.7