T
H
E
F
A
C
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Cigarette smoking among upstate New York adults
20.9%
16.2%
18.1%
Upstate New York
New York State
United States
22.1%
18.1%
18.8%
22.7%
Central New York/
Southern Tier
Region
Finger Lakes
Region
Utica/Rome/North
Country Region
Western New York
Region
Sources: New York State Department of Health.” Behavioral Risk Factor Surveillance System.” 2012.
To request access: http://www.health.state.ny.us/nysdoh/brfss/
Centers for Disease Control and Prevention. “Adult Cigarette Smoking in the United States: Current Estimates.”
http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm
Upstate New York is home to more than 810,000 adult smokers. From 2004 to 2012, upstate New
York has seen a 5.4 percentage point decrease in smoking prevalence, while the state as a whole
has seen a 4.9 point decrease and the nation has seen a 3.7 point decrease. Despite the decline in
smoking prevalence, upstate New York’s smoking prevalence (20.9 percent) is still higher than the
national prevalence (18.1 percent) as well as New York state (16.2 percent).
8963-14CC
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Smoking: Fifty Years of Progress and Failure
Fifty years ago, the Surgeon General’s Advisory Committee released the first report on smoking and
health. Since then, the prevalence of cigarette smoking in the U.S. has declined from 42 percent in
1965 to 18.1 percent in 2012, but more than 42 million people still smoke.1 Smoking remains the
leading cause of preventable death in the U.S.2 Despite efforts to reduce smoking prevalence the
nation fell short of achieving its Healthy People 2010 objective of reducing smoking prevalence to
less than 12 percent of adults.3 Therefore, Healthy People 2020 retained the goal of reducing adult
smoking prevalence to 12 percent.4
The burden of disease caused by cigarette smoking is extensive. It is estimated that in 2009, Americans
were living with 14 million serious medical conditions that are directly attributed to smoking.5 Welldocumented health consequences of smoking include:
• 480,000 premature deaths among American adults age 35 and older between 2005 and 2009.6
• Lung cancer and colorectal cancer.7
• Cancers of the oropharynx, larynx, esophagus, trachea, bronchus, stomach, pancreas, kidney
and ureter, bladder and cervix.8
• Acute myeloid leukemia.9
• Increased risk of breast cancer.10
• Major, non-cancer causes of death, including cardiovascular disease and stroke, and chronic
obstructive pulmonary disease (emphysema and chronic bronchitis).11
Annual smoking-attributable economic costs in the United States estimated by the U.S. Surgeon
General for the years 2009 to 2012 were between $289 billion and $332.5 billion including:12
• $132.5 billion to $175.9 billion for direct medical care of adults (from 2009-2012) and more than
$151 billion in lost productivity (from 2005 to 2012).
• $5.6 billion (in 2006) for lost productivity due to exposure to secondhand smoke.
In 2013, New York state had the 11th lowest adult smoking prevalence (16.6 percent) among U.S.
states. West Virginia had the highest rate of adult smokers (27.3 percent), while Utah had the lowest
adult smoking rate (10.3 percent).13 New York state has strong legislative protections that restrict
smoking in public places, such as restaurants and bars,14 and the highest cigarette excise tax in the
nation.15 In spite of this, smoking costs New York state more than $15.6 billion (2014 dollars) each
year in direct medical costs and economic productivity losses.16 In 2011, New York ranked 18th for
state funding of tobacco prevention efforts by spending 23 percent of what the Centers for Disease
Control and Prevention recommends for adequate prevention of tobacco use among youth.17 New
York state residents’ federal and state tax burden from smoking-caused government expenditures
was estimated to be $889 per household in 2011.18 While the average pack of cigarettes costs $7.89,
the real price to society and the state’s economy is about $36 per pack.19
Close to 24,000 New Yorkers die each year from diseases caused by smoking cigarettes, and an
additional 3,000 lives are claimed by exposure to secondhand smoke. The New York State
Department of Health projects that 280,000 of the state’s youth younger than age 18 will die early
from smoking-related illnesses.20
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New health care law covers programs to help quit
The Affordable Care Act requires most private health plans to cover tobacco-cessation interventions,
including up to two quit attempts per year at no cost to the member.21 Each quit attempt can vary
for individuals and can be composed of a combination of individual, group and telephone counseling
along with medications approved by the Food and Drug Administration for tobacco cessation.22 To
date, the FDA has approved seven smoking-cessation medications: five nicotine medications (patch,
gum, lozenge, nasal spray, and inhaler) and two non-nicotine pills (bupropion and varenicline).23
About this report
The purpose of this report is to document the prevalence of smoking, examine current scientific
literature on the health and economic effects of smoking and analyze progress in decreasing
smoking rates in upstate New York, New York state and the U.S.
This report includes an analysis of current available data on smoking and describes:
• Current smoking prevalence among upstate New York adults by region.
• Trends in smoking prevalence.
• Current smoking status.
• Smoking prevalence among socio-demographic groups.
Key Findings
Despite progress made in reducing the prevalence of smoking in New York state as whole as of
2012, the upstate New York regions still have had higher smoking rates compared to the state and
the nation. If upstate New York were its own state, it would have the 17th highest adult smoking
prevalence (20.9 percent) and the rest of the state would improve to have the 3rd lowest smoking
rate behind only California and Utah.24
• Upstate New York is home to more than 810,000 adult smokers.
–While only 25.5 percent of New York adults live in upstate New York, 32.9 percent of New
York adult smokers reside in upstate New York (data not shown).
• Adult smoking prevalence varies across upstate New York.
–The lowest smoking prevalence rate in any upstate New York region in 2012 (18.1 percent in
the Finger Lakes region) exceeds the state prevalence rate (16.2 percent).
– The highest smoking prevalence rate in 2012 in any upstate New York region is in Western
New York (22.7 percent) where 23.1 percent of males smoke and 20.8 percent of females
smoke (combined 2011 and 2012 for gender).
• Adult smoking rates have been decreasing in upstate New York. –Upstate New York has experienced a 5.4 point decrease in smoking prevalence since 2004.
This is compared to a 4.9 point decrease in New York state and a 3.7 point decrease in the U.S.
• Upstate New York has a larger proportion of males who smoke than females who smoke. –In upstate New York, adult males have a higher smoking prevalence rate (22.8 percent) than
adult females (19.4 percent) (data not shown).
• The percentage of upstate New York adults who smoke every day is decreasing. –The percentage of adults who smoke every day has decreased by 12.1 points in upstate New
York since 1996 (data not shown).
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Percent of adult population
Smoking prevalence among upstate New York regions and New York state
Healthy People 2020 Goal: 12%
Source: New York State Department of Health.” Behavioral Risk Factor Surveillance System .” 2011 and 2012.
To request access: http://www.health.state.ny.us/nysdoh/brfss/
About one-fifth of upstate New York adults reported being current smokers during 2011 and 2012.
• Regionally, the highest smoking rate is among males in the combined Central New York/
Southern Tier region (24.8 percent), and the lowest rate is among females in the Finger Lakes region (17.3 percent).
• The difference in smoking rates between males and females is 3.4 points for upstate New York (data not shown), compared to 4.5 points in New York state.
• Variations in adult smoking prevalence among upstate New York regions are modest, with average rates ranging from 18.1 percent in the Finger Lakes region to 22.7 percent in the Western New York region (shown on page 1).
• Smoking prevalence in the upstate New York region (20.9 percent) exceeds the national prevalence of 18.1 percent (shown on page 1).
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Trends in age-adjusted smoking prevalence among adults
Age-adjusted data provided by the Institute of Health Metrics and Evaluation
30%
Percent of adult population
25%
26.2%
26.5%
24.5%
24.5%
23.9%
24.0%
25.6%
23.7%
24.4%
22.8%
22.8%
23.6%
21.7%
21.5%
20%
22.2%
20.9%
20.1%
19.2%
20.2%
20.0%
17.9%
15%
10%
5%
0%
2000
2002
2004
Upstate New York
2006
2008
New York State
2010
2012
United States
Source: Dwyer-Lindgren, L.; et al. “Cigarette smoking prevalence in US counties: 1996-2012. “Population Health Metrics 2014. Additional file 3: Age-Standardized total
cigarette smoking prevalence, all counties, 1996-2012.
Note: Current smoking is defined as having smoked at least 100 cigarettes during one’s lifetime and currently smoking every day or on some days.
• Since 1996 (1996-1999 data not shown), adult smoking rates in upstate New York have been consistently above state and national rates.
• From 1996 through 2005, more than one-quarter of upstate New York adults reported being current smokers.
• Smoking rates remained relatively flat among adults in upstate New York from 1996 until 2004. Upstate New York’s smoking prevalence rate dropped 5.4 points, from 25.6 percent in 2004 to 20.2 percent in 2012. During the same time period the smoking prevalence rate among U.S. adults dropped 3.7 points, from 23.7 percent in 2004 to 20.0 percent in 2012.
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Smoking status among upstate New York adults
48.3%
Western
New York
Region
29.0%
22.7%
30.0%
Finger Lakes
Region
17.7%
51.3%
30.5%
18.1%
48.3%
Utica/Rome/
North Country
Region
32.9%
18.8%
51.3%
Central
New York/
Southern Tier
26.6%
22.1%
58.6%
New York
State
25.2%
16.2%
0%
10%
Never Smoked
20%
30%
40%
Former Smoker
50%
60%
70%
Current Smoker
Source: The New York State Department of Health. “Behavioral Risk Factor Surveillance System.” 2012. To request access:
http://www.health.state.ny.us/nysdoh/brfss/
Note: Current smoking is defined as having smoked at least 100 cigarettes during one’s lifetime and currently smoking every day or on some days.
Compared to the upstate New York regions observed, New York state has the highest percentage
of adults who never smoked (58.6 percent). New York state also has the lowest rate of current
adult smokers (16.2 percent).
• The Finger Lakes region and the combined Central New York/Southern Tier region have the
highest percentage of adults who never smoked (51.3 percent). The upstate New York regions
with the lowest percentage of adults who never smoked are Western New York and Utica/
Rome/North Country (48.3 percent each).
• Regionally, the highest rate of former smokers is in the Utica/Rome/North Country region at
32.9 percent.
• In upstate New York, the percentage of females who never smoked is 52.3 percent compared
to 47.7 percent of males (2011 and 2012 combined) (data not shown).
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Smoking among New York state’s youth
Experts say that preventing youth from starting to smoke is critical to curtailing adult smoking. The
vast majority of smokers start when they’re young. Nearly all first tobacco use takes place before
high school graduation. Almost 90 percent of adults who regularly smoke started at or before the
age of 18.
The younger one is when he/she starts smoking, the more likely it is that the habit will continue into
adulthood. Young people who smoke regularly are addicted to nicotine, just as adults are. While
many teen smokers report wanting to quit, an estimated 60 percent of them continue smoking into
adulthood.
The Youth Risk Behavior Surveillance System biennially administers a school-based survey to monitor
priority health-risk behaviors, including tobacco use, among youth and young adults.
New York state high school students who reported smoking cigarettes
on at least one of the previous 30 days
35%
32.9%
31.8%
30%
Percent of students
25%
20.2%
20%
16.2%
15%
13.8%
14.8%
12.5%
10.6%
10%
5%
0%
1997
1999
2003
2005
2007
2009
2011
2013
Source: Centers for Disease Control and Prevention: “Youth Online: High School YRBS New York 1997-2013 Results.”
http://nccd.cdc.gov/YouthOnline/App/Results.aspx?LID=NY archived at http://www.webcitation.org/6TrT0JinX on Nov. 5, 2014.
• In 2013, 10.6 percent of high school students had smoked cigarettes on at least one of the 30 days prior to the survey.
• Among high school students who said they smoked cigarettes on at least one of the 30 days
prior to the survey, 15.7 percent reported smoking more than 10 cigarettes per day when
they did smoke (data not shown).
• In 2013, 4.5 percent of New York’s high school students were considered “current frequent smokers” (smoked cigarettes on 20 or more of the previous 30 days). Much of the decline in this measure occurred between 1997 (16.3 percent) and 2005 (6.3 percent) (data not shown).
Sources: American Cancer Society. “Child and Teen Tobacco Use.” Nov. 15, 2013. http://www.cancer.org/Cancer/CancerCauses/TobaccoCancer/ChildandTeenTobaccoUse/
child-and-teen-tobacco-use-toc, archived at http://www.webcitation.org/6TulNvW0M on Nov. 7, 2014.
Centers for Disease Control and Prevention. “Youth Risk Behavior Surveillance – United States, 2009.” Surveillance Summaries, Morbidity and Mortality Weekly Report,
Vol.59, No. SS-5. June 4, 2010, pages 1, 66, 68. http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf archived at http://www.webcitation.org/6Tukyw3Pt on Nov. 7, 2014.
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Percentage of adult smokers who smoke every day
Age-adjusted data provided by the Institute of Health Metrics and Evaluation
Percentage of smokers
90%
85%
80%
83.7%
82.0%
81.6%
80.5%
79.8%
78.6%
78.0%
77.7%
75%
77.4%
75.9%
74.6%
72.7%
77.4%
76.3%
75.1%
73.3%
74.9%
72.5%
70%
71.6%
73.4%
72.8%
71.3%
70.6%
69.9%
70.3%
67.7%
65%
64.9%
60%
1996
1998
2000
Upstate New York
2002
2004
United States
2006
2008
2010
2012
New York State
Sources: Dwyer-Lindgren , L.; et al. “Cigarette smoking prevalence in US counties: 1996-2012. “Population Health Metrics 2014. Additional file 4: Age-Standardized daily
cigarette smoking prevalence, all counties, 1996-2012.
As adult smoking prevalence decreases overall, the percentage of smokers who smoke on a daily basis
also decreases.
• Compared to New York state and the nation, upstate New York has a higher proportion of
smokers who smoke every day.
• Since 1996, the percentage of adult smokers that smokes every day has decreased by about
12 points in upstate New York and 16 points in New York state.
• In 1996, about 84 percent of upstate New York adults smoked every day. In 2012, 64.9 percent
of adult smokers in New York state smoked every day and 71.6 percent of smokers in upstate
New York smoked every day.
Region
Percentage of smokers who smoke everyday
1996
2012
Western New York
83.4%
70.1%
Utica/Rome/North Country
84.2%
73.6%
Southern Tier
84.7%
73.7%
Finger Lakes
82.4%
70.6%
Central New York
83.8%
69.8%
Upstate New York
83.7%
71.6%
New York state
80.5%
64.9%
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Prevalence of smoking by age, income and
education
AGE
17.4%
18-24
21.0%
25-34
15.6%
35-44
19.3%
45-54
AGE
Socio-demographic variations in smoking prevalence have been
well-documented.
The percentages
16.4%
17.4%
55-64
reported below represent the smoking rates within each sub-group
18-24 (e.g. Age 18-24).
65+
25-34
35-44AGE
15.6%
17.4%
19.3%
18-24
45-54
25-34
55-64
• Smoking rates vary by age, peaking in the
25-34 age group (21.0 percent) and then declining to 8.1 percent among those
ages 65 and older.
21.0%
8.1%
35-44
65+
8.1%
21.0%
16.4%
15.6%
19.3%
45-54
16.4%
55-64
EDUCATION
Less than
65+
8.1%
24.0%
high school
High school
21.8%
graduate or GED
• Among adults who do not have a high
school diploma or GED, 24.0 percent
smokes compared to 7.3 percent of
college graduates.
Attended college
EDUCATION
or technical school
Less than
College graduate
7.3%
high school
High school
graduate or EDUCATION
GED
Less
than
Attended
college
high school
or technical
High
school
College
graduate
7.3%
graduate or GED
Attended college
or technical school
24.0%
21.8%
16.4%24.0%
21.8%
16.4%
College graduate
• Of those with a household income of
$50,000 or more, 11.7 percent smokes,
compared to 25.2 percent of those who
have incomes below $15,000.
16.4%
7.3%
INCOME
Less than $15,000
25.2%
$15,000-$24,999
22.1%
17.9%
$25,000-$34,999
$35,000-$49,999
INCOME
Less than$50,000
$15,000+
0
5
$15,000-$24,999
INCOME
$25,000-$34,999
Less
than $15,000
$35,000-$49,999
$15,000-$24,999 0
$50,000 +
$25,000-$34,999
$50,000 +
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11.7%
25.2%
22.1%
17.9%
16.1% 25.2%
5
10 15 20 25
30 35 40 45 50 55
22.1%
5
10 15 20 25 30 35 40 45 50 55
$35,000-$49,999
Source: New York State Department of Health. “Behavioral Risk Factor Surveillance System.” 2012.
To request access: http://www.health.state.ny.us/nysdoh/brfss/
16.1%
10 15 20 25 30 35 40 45 50 55
11.7%
17.9%
16.1%
0
11.7%
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50 Years of Smoking in the U.S.
Release of the first Surgeon
General’s smoking and health
report on the link between
smoking and lung cancer.
1964
42% of Americans smoked
1965
Arizona becomes the first state to
restrict smoking in a number of
public places.
Passage of the original Federal Cigarette Labeling and
Advertising Act to inform the public about the adverse
health effects of smoking.
1973
1987
Congress bans smoking on all
domestic airlines.
1989
1992
Beginning of New York state’s
Tobacco Control Program.
Aspen, Colorado, is the first U.S. city to
require that restaurants be smoke-free.
Secondhand smoke is classified as a Group
A carcinogen, the most dangerous group
of cancer-causing carcinogens.
2000
NASCAR ended its longstanding
sponsorship deal with R.J. Reynolds
Tobacco Co., cited to be a result of
“changing business dynamics.”
2004
FDA is granted regulatory
authority over tobacco products.
2009
19% of Americans still smoke
2003
New York state’s comprehensive Clean
Indoor Air Act prohibited smoking in
most public and private indoor work
areas, including bars, restaurants and
bowling facilities.
2006
The tobacco industry is found guilty of
knowingly and intentionally deceiving
the American public by making false and
fraudulent statements.
2014
The 50th anniversary of the first Surgeon General’s
smoking and health report, which cites smoking as
the cause of cancer and diseases that affect almost all
organs of the body, including the eyes, pancreas, liver
and reproductive organs.
Sources: U.S. Department of Health and Human Services.
“The Health Consequences of Smoking-50 Years of Progress:
A Report of the Surgeon General. Executive Summary.” 2014.
http://www.surgeongeneral.gov/library/reports/50-years-of-progress/exec-summary.pdf
Archived at http://www.webcitation.org/6TrQXcpAj on November 5, 2014.
American Cancer Society. “50 Years of Fighting Tobacco.”
http://www.acscan.org/content/wp-content/uploads/2014/01/SGR-infographic.jpg
Archived at http://www.webcitation.org/6TrizMep4 On November 5, 2014
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Recent federal actions
Tips From Former Smokers Campaign: The
Centers for Disease Control and Prevention
started a national, three-month antismoking
campaign in March 2012. It featured hardhitting, emotionally evocative television
1.577 pt
advertising that depicted the smoking-related
suffering and serious, long-term health effects
of smoking. The campaign also featured
nonsmokers who have experienced diseases
as a result of secondhand smoke. According
to a CDC study, the Tips media campaign
motivated 1.6 million smokers to make a
quit attempt. Because the campaign was
so widespread, the agency estimated that
6 million nonsmokers had conversations with
their family and friends about the dangers
of smoking.
U.S. Food and Drug Administration Deeming
Regulations: The Family Smoking Prevention
and Tobacco Control Act of 2009 gave the
Food and Drug Administration oversight of
the manufacture, distribution and marketing
of tobacco products. The FDA now regulates cigarettes, cigarette tobacco, roll-yourown tobacco and smokeless tobacco. With
the increasing popularity of non-cigarette
tobacco products, the agency has proposed
extending its authority to cover additional
products, such as electronic cigarettes, cigars,
pipe tobacco, nicotine gels and dissolvables,
and tobacco product components and parts
used to consume tobacco. Once the proposed
rule becomes final, the FDA will be able to
use powerful regulatory tools, such as age
restrictions and rigorous scientific review of
new tobacco products. The proposed rule also
will allow the FDA to explore whether different products pose different levels of risk.
IF YOU SMOKE WITH
DIABETES, PLAN
FOR AMPUTATION,
KIDNEY FAILURE,
HEART SURGERY ...
OR ALL THREE.
Bill, Age 40
Michigan
Smoking makes diabetes much worse.You can quit.
For free help, call 1-800-QUIT-NOW.
www.cdc.gov/tips
#CDCTips
Source: McAfee, T., et al. “Effect of first federally funded US antismoking national media campaign.” The Lancet. Vol. 382, Issue 9909. Dec 14, 2013, pages 2001-2011. Source: U.S. Food and Drug Administration. Center for Tobacco Products. “Issue Snapshot on Deeming: Regulating Additional Tobacco Products.
http://www.fda.gov/downloads/TobaccoProducts/NewsEvents/UCM397724.pdf archived at http://www.webcitation.org/6TrlB5zTa on Nov. 5, 2014.
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Quitting smoking: Resources and tips for success
Excerpts from the Centers for Disease Control and Prevention “Quit Tips:”
1. Don’t smoke any cigarettes. Each cigarette you smoke damages your lungs, your blood vessels,
and cells throughout your body.
2. Write down why you want to quit. Really wanting to quit smoking is very important to how
much success you will have in quitting.
3. Know that it will take commitment and effort to quit smoking. Nearly all smokers have some
feelings of nicotine withdrawal when they try to quit. Nicotine is addictive.
There are many ways smokers quit, including using nicotine replacement products (gum and
patches) or FDA-approved, non-nicotine cessation medications.
4. Get help if you want it. Smokers can receive free resources and assistance to help them quit
by calling the 1-800-QUIT-NOW quitline (1-800-784-8669). Your health care provider also is a
good source of help and support.
5. Remember this good news! More than half of all adult smokers have quit, and you can, too.
Millions of people have learned to face life without a cigarette. Quitting smoking is the single
most important step you can take to protect your health and the health of your family.
Source: Centers for Disease Control and Prevention. “Smoking & Tobacco Use: Quit Tips”. July 10. 2012.
http://www.cdc.gov/Tobacco/quit_smoking/how_to_quit/quit_tips/index.htm archived at http://www.webcitation.org/6U4zrmRin on Nov. 14, 2014.
Additional resources for quitting:
American Cancer Society. “Guide to Quitting Smoking.”
http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/index
American Heart Association. ”Resources for Quitting Smoking.”
http://www.heart.org/HEARTORG/GettingHealthy/QuitSmoking/QuittingResources/Resources-forQuitting-Smoking_UCM_307934_Article.jsp
American Lung Association. “Stop Smoking.” http://www.lung.org/stop-smoking/
American Lung Association. “Freedom From Smoking® Online” http://www.ffsonline.org/
Centers for Disease Control and Prevention. “Smoking & Tobacco Use: Quit Smoking Resources.”
http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/resources/
The National Cancer Institute. http://www.smokefree.gov/
New York State Smokers’ Quitline. 1-866-NY-QUITS (1-866-697-8487).
http://www.nysmokefree.com/
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Methods
Cost of smoking in New York state: Pennsylvania State University
Researchers at Pennsylvania State University calculated direct medical expenditures and the cost of
lost productivity due to smoking. Medical costs for adults include ambulatory care, hospital care,
drugs, nursing home care, home health care, nonprescription drugs and nondurable medical costs.
The data presented uses the medical care line of the U.S. Consumer Price Index to adjust the medical
costs in the Pennsylvania State University study (2009 dollars) to 2014 dollars. The general inflation
(all items) adjustment is used to change lost productivity costs from 2009 dollars to 2014 dollars.25
Smoking trends and prevalence rates: New York State Department of Health’s Behavioral Risk
Factor Surveillance System and the Institute of Health Metrics and Evaluation
Data were obtained from the annual Behavioral Risk Factor Surveillance System survey, a national,
cross-sectional telephone survey of the non-institutionalized civilian adult population. The BRFSS
randomly selects phone numbers to call for the survey, resulting in a representative sample of U.S.
residents from which prevalence estimates of common health behaviors are derived. Point prevalence estimates of current adult cigarette smoking were derived from the most recently available
BRFSS survey results (2012) which were obtained from the New York State Department of Health.26
Estimates were obtained using Enterprise Guide data management and statistical software from
the SAS Institute Inc., in accordance with BRFSS weighting procedures published by the Centers for
Disease Control and Prevention.27 Subset analysis where the raw sample count within any data cell
is less than 50 or the half width of the confidence interval is greater than 10 has been excluded. To
obtain current (2012) prevalence estimates, two regions of upstate New York (Central New York and
the Southern Tier) were combined for a larger sample size. To estimate regional smoking prevalence
by gender the most recent BRFSS data (2012) were combined with the prior year’s data (2011) for
sufficient sample sizes.
Prior to 2011, the BRFSS survey called only landline telephone numbers to reach respondents.
Beginning in 2011, cellular telephone numbers were also called. Because of this change in data
collection methodology, data collected from 2011 on is not comparable to data collected in prior
years.28 To overcome this discrepancy, the Institute of Health Metrics and Evaluation applied a novel
methodology to BRFSS survey results from 1996 to 2012 in order to correct for bias that may have
resulted from the addition of cellphones.29 The Institute’s completed dataset is available to the
public and includes age-adjusted county level smoking prevalence estimates for each year. Ageadjusting standardizes the population to a normal age distribution so that prevalence numbers
can be compared from year to year. This report utilized the IHME’s dataset to provide estimates of
trends in smoking prevalence and trends in daily smoking behaviors over time. Because the IHME
applied small area estimation models to account for small sample sizes in rural counties, combining
Central New York and the Southern Tier was unnecessary when analyzing these data. County level
prevalence estimates were aggregated to form the regions of upstate New York using population
denominators from the Census Bureau.30
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Methods (continued)
Smoking module of the Behavioral Risk Factor Surveillance System survey:
In the BRFSS, cigarette smoking status is assessed by asking:
1) Have you smoked at least 100 cigarettes in your entire life? (Note: 5 packs= 100 cigarettes)
a. Yes c. Not sure/Don’t know
b.No
d. Refused
If the respondent answers ‘Yes’ to this question, he/she is considered a smoker and is asked the next
question in the series:
2) Do you now smoke cigarettes every day, some days, or not at all?
a. Every day
c. Not at all
b.Some days
e. Refused
d. Don’t know/not sure
If the respondent answers ‘Every day’ or ‘Some days’ he/she is asked about quit attempts (question
3). If the respondent answers ‘Not at all’, he/she is considered a former smoker and is asked about
the last time he/she smoked (question 4).
3) During the past 12 months, have you stopped smoking for one day or longer because you
were trying to quit smoking?
a. Yes
c. Don’t know/not sure
b.No
d. Refused
4) How long has it been since you last smoked a cigarette, even one or two puffs?
a. Within the past month (less than 1 month ago)
b.Within the past 3 months (1 month but less than three months ago)
c. Within the past 6 months (3 months but less than 6 months ago)
d.Within the past year (6 months but less than 1 year ago)
e. Within the past 5 years (1 year but less than 5 years ago)
f. Within the past 10 years (5 years but less than 10 years ago)
g.10 years or more
h.Don’t know/not sure
i. Refused
Other measures of smoking prevalence: In addition to the Behavioral Risk Factor Surveillance System, the National Health Interview Survey
also assesses smoking prevalence, but was not used for this report, because it lacks state and county
level data. The NHIS conducts in-person interviews rather than phone interviews. In a recent study
comparing the NHIS with the BRFSS, researchers found that NHIS estimates of national smoking
prevalence among adults were one to three percentage points higher than BRFSS estimates.31
The authors believe this reflects higher smoking rates among persons residing in households without telephones. The Surgeon General’s report on smoking and health cites estimates from the
National Health Interview Survey, which began collecting data on smoking in 1965.32 Healthy People
objectives referred to in this report are also informed by the National Health Interview Survey.33
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Endnotes
1 U.S. Department of Health and Human Services. “The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Executive Summary.”
2014, page i. http://www.surgeongeneral.gov/library/reports/50-years-of-progress/exec-summary.pdf
Archived at http://www.webcitation.org/6TrQXcpAj on Nov. 5, 2014.
2Ibid., page 17.
3 HealthyPeople.gov. “2020 Topics & Objectives, Tobacco Use.” http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=41 archived at http://www.webcitation.org/6TrQhyIv6 on Nov. 5, 2014.
4 Ibid.
5Rostron B., Chang C., and Pechacek T. “Estimation of Cigarette Smoking–Attributable Morbidity in the United States.” JAMA Internal Med. Oct. 13, 2014. Web. 6 Nov. 2014. doi:10.1001/jamainternmed.2014.5219
6 U.S. Department of Health and Human Services. Page 2.
7 Ibid.
8Warren et al. “The 2014 Surgeon General’s Report: The Health Consequences of Smoking- 50 Years of Progress- A Paradigm Shift in Cancer Care.” Wiley Online Library.
March 28,2014. Web. Nov. 7, 2014. DOI: 10.1002/cncr.28695,
9 Ibid.
10 Simon, S. “Study Links Smoking to Breast Cancer Risk.” Feb. 28, 2013. http://www.cancer.org/cancer/news/study-links-smoking-to-breast-cancer-risk
archived at http://www.webcitation.org/6TuqfY3x6 on Nov. 7, 2014.
11 U.S. Department of Health and Human Services. Page 2.
12 Ibid., page 17.
13 Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. “Prevalence and Trends Data, Tobacco Use- 2013.”
http://apps.nccd.cdc.gov/BRFSS/list.asp?cat=TU&yr=2013&qkey=8161&state=All
archived at http://www.webcitation.org/6TrQ6Hfsb on Nov. 5, 2014
14 American Lung Association, State of Tobacco Control 2014. “Highlights: New York”. http://www.stateoftobaccocontrol.org/state-grades/new-york/highlights.html
archived at http://www.webcitation.org/6TUa12r7l on Oct. 21, 2014.
15 Campaign for Tobacco-Free Kids. “State Cigarette Excise Tax Rates &Rankings.” June 20, 2014. http://www.tobaccofreekids.org/research/factsheets/pdf/0097.pdf
archived at http://www.webcitation.org/6UD3ozx55 on Nov. 19, 2014
16 Rumberger, J.; Hollenbeak C.; and Kline, D. “Potential Costs and Benefits of Smoking Cessation for New York.” April 30, 2010. http://www.lung.org/stop-smoking/tobacco-control-advocacy/reports-resources/cessation-economic-benefits/reports/NY.pdf
archived at http://www.webcitation.org/6U52LjTPD on Nov. 14, 2014.
17 Campaign for Tobacco-Free Kids. “A Broken Promise to Our Children: The 1998 State Tobacco Settlement 12 Years Later.” Nov. 17, 2010. Page vii.
http://www.tobaccofreekids.org/content/what_we_do/state_local_issues/settlement/FY2011/StateSettlementReport_FY2011_web.pdf
archive at http://www.webcitation.org/6U0f9vpvM on Nov. 11, 2014.
18 Ibid., page 66.
19 American Lung Association. “Smoking Cessation: The Economic Benefits, New York Facts.”
http://www.lungusa.org/stop-smoking/tobacco-control-advocacy/reports-resources/cessation-economic-benefits/states/new_york.html
archived at http://www.webcitation.org/6TrP66kQ7 on Nov. 5, 2014.
20 New York State Department of Health. “Smoking and Tobacco Use- Cigarettes and Other Tobacco Products.” April 2014.
http://www.health.state.ny.us/prevention/tobacco_control/ archived at http://www.webcitation.org/6TrPEEL9d on Nov. 5, 2014.
21 McAfee, T.; Babb, S.; McNabb, S. et al. “Helping Smokers Quit – Opportunities Created by the Affordable Care Act.” The New England Journal of Medicine.
Nov. 19, 2014. DOI: 10.1056/NEJMp1411437
22 Ibid.
23 Ibid.
24 Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. “Prevalence and Trends Data, Tobacco Use- 2013.”
http://apps.nccd.cdc.gov/brfss/list.asp?cat=TU&yr=2012&qkey=8161&state=All
archived at http://www.webcitation.org/6UfbwPliR on Dec. 8, 2014.
25 Malik M.; Church, J.; and Rippy D. “CPI Detailed Report: Data for December 2011.” Pages 80 and 84.
http://www.bls.gov/cpi/cpid1112.pdf archived at http://www.webcitation.org/6U52BJMxK on Nov. 14, 2014.
26 New York State Department of Health. “Behavioral Risk Factor Surveillance System.”
To request access: http://www.health.ny.gov/statistics/brfss/
27 Ibid.
28 Centers for Disease Control and Prevention. “Behavioral Risk Factor Surveillance System: Comparability of Data BRFSS 2012.” July 15, 2013.
http://www.cdc.gov/brfss/annual_data/2012/pdf/Compare_2012.pdf archived at http://www.webcitation.org/6UbP22nD7 on Dec. 5, 2014.
29 Dwyer-Lindgren L.; Mokdad A.H.; Srebotnjak T. et al. “Cigarette smoking prevalence in US counties: 1996-2012.” Population Health Metrics. March 24, 2014. http://www.pophealthmetrics.com/content/12/1/5 archived at http://www.webcitation.org/6U0jicrcs on Nov. 11, 2014.
30 United States Census Bureau. “American Fact Finder: American Community Survey 3-year Estimates.”
http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_3YR_S0101&prodType=table
archived at http://www.webcitation.org/6UFrkofMS on Nov. 21. 2014
31 Nelson, D. et al. “A Comparison of National Estimates From the National Health Interview Survey and the Behavioral Risk Factor Surveillance System.”
American Journal of Public Health. Vol. 93 No. 8. August 2003. 1335–1341.
32 Centers for Disease Control and Prevention. “NHIS-Adult Tobacco Use Information: Historical Context.” Dec. 9, 2011.
http://www.cdc.gov/nchs/nhis/tobacco/tobacco_history.htm archived at http://www.webcitation.org/6UYMSSO5h on Dec. 3 2014.
33 Nelson, D.E. et al. “A Comparison of National Estimates From the National Health Interview Survey and the Behavioral Risk Factor Surveillance System.”
August 2003. American Journal of Public Health. Page 1108.
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