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