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2011ClearWayMinnesotaSM2011MinnesotaDepartmentofHealthSuggestedcitation: TobaccoUseinMinnesota:2010Update.Minneapolis,MN:ClearWayMinnesota
SMandMinnesotaDepartmentofHealth;February2011.The2010MATSwaspartiallyfundedbyacontributionfromBlueCrossandBlueShieldofMinnesota.
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TableofContents
Chapter
Page
1 TheMinnesotaAdultTobaccoSurvey2010:
Methodology................................................................................... 11
1.1 StudyDesign....................................................................... 11
1.2 AnalysisMethodology....................................................... 16
1.3 HowThisReportIsOrganized......................................... 111
2
Smoking
among
Minnesota
Adults
.............................................
2
1
2.1 Introduction......................................................................... 21
2.2 CigaretteUseinMinnesota............................................... 21
2.2.1 UseofCigarettes.................................................. 21
2.2.2 CigaretteUseinMinnesota,1999to
2010......................................................................... 211
2.3 CharacteristicsofSmokers................................................ 219
2.3.1
IndividualDemographic
CharacteristicsofSmokers.................................. 220
2.3.2 IndividualHealthandBehavioral
CharacteristicsofSmokers.................................. 221
2.4 IndividuallevelInfluencesonSmoking
Behavior............................................................................... 235
2.4.1 PerceptionsofHarm............................................ 235
2.4.2
Economic
Influences
on
Smoking
Behavior:SavingMoneyonCigarettes............. 239
2.4.3 LivingwithSmokers............................................ 242
2.4.4 CharacteristicsofSmokers,1999to
2010......................................................................... 244
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TableofContents(continued)
Chapter
Page
2.5 KeyFindings....................................................................... 245
3 UseofNonCigaretteTobaccoProducts..................................... 31
3.1 Introduction......................................................................... 31
3.2 MinnesotansUseofTobaccoProducts(All
Forms).................................................................................. 31
3.3
Useof
Non
Cigarette
Tobacco
Products
and
OtherProductsamongallMinnesotans......................... 33
3.4 UseofNonCigaretteTobaccoProductsand
OtherProductsamongCurrentCigarette
Smokers................................................................................ 38
3.5 TobaccoUse,2007to2010................................................. 39
3.6 UseofNonCigaretteTobaccoProducts,2007
to2010.................................................................................. 39
3.7 KeyFindings....................................................................... 311
4
QuittingBehaviors
among
Minnesota
Smokers
........................
41
4.1 Introduction......................................................................... 41
4.2 QuittingSmokingandUseofAssistanceto
Quit....................................................................................... 41
4.2.1 PastyearSmokingandSuccessful
Quitting................................................................. 42
4.2.2 AwarenessandUseofQuitting
Programsand
Medications
.................................
47
4.2.3 PastyearSmoking,QuitAttempts
andSuccessfulQuitting, 2007to2010.............. 415
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TableofContents(continued)
Chapter
Page
4.3 AssistancefromHealthCareProviders.......................... 419
4.3.1 VisitstoProviders................................................ 420
4.3.2 InterventionswithSmokers:TheAsk,
AdviseandReferModel..................................... 423
4.3.3 FormsofReferralReceivedby
SmokersfromProviders..................................... 425
4.3.4
Assistancefrom
Health
Care
Providers,2007to2010........................................ 426
4.4 SmokefreePoliciesandQuitting..................................... 428
4.4.1 WorkplaceSmokefreePoliciesand
Quitting................................................................. 428
4.4.2 HomeSmokefreeRulesandQuitting.............. 430
4.4.3 PerceivedEffectofSmokefree
PoliciesonQuittingAttitudesand
Behaviors...............................................................
432
4.5 RaisingtheCostofTobaccoProductsand
Quitting................................................................................ 434
4.6 KeyFindings....................................................................... 436
5 SecondhandSmokeExposureamongMinnesota
Adults............................................................................................... 51
5.1
Introduction.........................................................................
51
5.2 PerceptionsthatSecondhandSmokeIs
Harmful................................................................................ 51
5.2.1 PerceptionsthatSecondhandSmokeis
Harmful, 2007to2010......................................... 53
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TableofContents(continued)
Chapter
Page
5.6 SupportforSmokefreePoliciesinCars,
OutdoorAreas,andCasinos............................................. 526
5.7 KeyFindings....................................................................... 529
ListofTables
Table
21 SmokingstatusofMinnesotaadults,byselected
demographiccharacteristics......................................................... 23
22 Agedistributionof30dayestablishedand
unrecognizedsmokers................................................................... 26
23 Quitratiosofeversmokers,byselecteddemographic
characteristics.................................................................................. 210
24 CurrentsmokersamongallMinnesotaadultsfrom
1999to2010,byselecteddemographiccharacteristics............ 214
25 FormersmokersamongallMinnesotaadultsfrom
1999to2010,byselecteddemographiccharacteristics............ 215
26 Quitratiosfrom1999to2010amongeversmokers,
byselecteddemographiccharacteristics..................................... 216
27 NeversmokersamongallMinnesotaadultsfrom
1999to2010,byselecteddemographiccharacteristics............. 217
28 Selecteddemographiccharacteristics,bysmoking
status................................................................................................ 220
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TableofContents(continued)
Listof
Tables
(continued)
Table Page
43 Numberofquitattemptsinthepast12months
amongcurrentsmokerswithatleastonequit
attempt,byselecteddemographiccharacteristics..................... 45
44 StagesofChangeamongcurrentsmokers,by
selecteddemographic
characteristics
..........................................
47
45 Perceivedabilitytoquitsmokingwithoutstop
smoking medicationsamongcurrentsmokerswho
havetriedtoquit inthepast12months,byselected
demographiccharacteristics......................................................... 49
46 Useofanystopsmokingmedicationamongcurrent
smokerswhotriedtoquitinthepast12months,by
selecteddemographiccharacteristics.......................................... 412
47 Useofvariousstopsmokingmedicationsamong
currentsmokerswhohavetriedtoquitinthepast12
months.............................................................................................. 413
48 Useofvariousformsofbehavioralcounselingtoaid
quitting,amongcurrentsmokerswhohavetriedto
quitinthepast12months............................................................. 413
49
Willingnessto
use
aprogram,
product
or
medication
tohelpquitsmokingifcostwerenotanissue,among
currentsmokers,byselecteddemographic
characteristics.................................................................................. 414
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TableofContents(continued)
Listof
Tables
(continued)
Table Page
410 Perceptionsofstopsmokingmedications,among
currentsmokerswhohavetriedtoquitinthepast12
months,from2007to2010............................................................ 417
411 Healthcareprovidervisitsinthelast12months
amongcurrent
smokers,
by
selected
demographic
characteristics.................................................................................. 422
412 Ask,AdviseandRefermodelservicesreceivedfrom
healthcareprovidersamongsmokerswhovisited
anyproviderinthelast12months,byselected
demographiccharacteristics......................................................... 425
413 Stopsmokingreferralsreceivedbysmokerswho
visiteda providerinlast12months,amongall
smokerswho
visited
aprovider
...................................................
426
414 Smokingrelatedreactionstorestrictionsonsmoking
(athome, atwork,inrestaurantsandbarsor
elsewhere)amongcurrentsmokersandformer
smokers(whoquitwithinthepastfiveyears)........................... 433
415 Smokingrelatedreactionstothe2009nationwide62
centtobaccotaxincreaseamongcurrentandformer
smokers(who
quit
within
the
last
two
years),
by
selecteddemographiccharacteristicsandsmoking
status................................................................................................ 435
51 Agreementthatsecondhandsmokeisharmful,by
selecteddemographiccharacteristicsandsmoking
status................................................................................................ 52
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TableofContents(continued)
Listof
Tables
(continued)
Table Page
59 Opinionsaboutwhethersmokingshouldbeallowed
inMinnesotacasinos,amongallMinnesotans,by
selecteddemographiccharacteristicsandsmoking
status................................................................................................ 529
ListofFigures
Figure
21 SmokingstatusofMinnesotaadults,2010.................................. 23
22 Thirtydaysmokingstatusofyoungadults,2010..................... 26
23 SmokingprevalenceratesinU.S.andMinnesota
surveillancestudies,
from
1999
to
2010
.......................................
212
24 Prevalenceofyoungadult30daysmoking,by
selecteddemographiccharacteristics,from2003to
2010................................................................................................... 219
25 Ageofsmokinginitiationforcurrentsmokers,by
currentage group.......................................................................... 227
41
Pastyear
smokers,
from
2003
to
2010..........................................
415
42 Currentsmokerswhohavetriedtoquitinthepast12
months, from1999to2010........................................................... 416
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TableofContents(continued)
Listof
Figures
(continued)
Figure Page
43 UseofanystopsmokingmedicationandofNRT
amongcurrentsmokerswhohavetriedtoquitinthe
past12months,from1999to2010............................................... 418
44 Useofbehavioraltherapybycurrentsmokerswho
havetried
to
quit
in
the
past
12
months,
from
2003
to
2010................................................................................................... 419
45 Minnesotanswhovisitedahealthcareproviderin
thelast12months,bysmokingstatus......................................... 421
46 Currentsmokerswhowereasked,advised,and
referredbyhealth careprovidersinthelast12
months,from2003to2010............................................................ 427
47
Currentsmokers
with
one
or
more
quit
attempts
in
thepast12months,byvariousworkplacesmoking
policies............................................................................................. 430
48 Currentsmokerswithoneormorequitattemptsin
thepast12months,bysmokingpolicyinsidethe
home................................................................................................. 431
51 Agreementthatsecondhandsmokeisharmful,from
2003to
2010
.....................................................................................
53
52 Minnesotansworkinginindoorworksettingswho
arecoveredbysmokefreepoliciesinworkareas,
overallandforselectedcommonindoorwork
settings............................................................................................. 58
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TableofContents(continued)
Listof
Figures
(continued)
Figure Page
53 Minnesotansworkinginoutdoorworksettingswho
arecoveredbysmokefreepoliciesinworkareas,
overallandforselectedcommonoutdoorwork
settings............................................................................................. 59
54
Minnesotanscovered
by
asmoke
free
policy
at
workandat home,from1999to2010...................................... 512
55 Minnesotanscoveredbyasmokefreepolicyinwork
areas,byindoor/outdoorworksetting,from2003to
2010................................................................................................... 513
56 ExposureofMinnesotanstosecondhandsmokein
thepast7days,inselectedsettings............................................. 515
57
Mostrecent
exposure
of
Minnesotans
to
secondhand
smokeincommunitysettings,bytypeofsetting...................... 518
58 ExposureofMinnesotanstosecondhandsmokein
thepast7daysinselectedsettings,from2003to2010............. 523
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DataCollection
Datacollectiontookplacein2010,betweenFebruary19andMay30.The
questionnairewasadministeredusingacomputerassistedtelephoneinterviewing
(CATI)system.
The
sample
was
identified
and
selected
using
standard
RDD
survey
procedures,whichincludeconductingascreenerinterviewtoidentifyresidential
phonenumbersandthenselectingonepersonfortheMATSinterview.Operational
procedurestosupporttheadministrationofthequestionnaireincludedtelephone
contactingrulesandproceduresthatmetorexceededthestandardrequirementsfor
theCDCBehavioralRiskFactorSurveillanceSystemsurveys(BRFSS).Atleast15
callattemptsweremadetocontacthouseholdsandindividualsidentifiedand
selectedthroughtheRDDsurvey(unlesseachsampledcaseresultedinacompleted
interviewor
reached
another
final
resolution
in
fewer
attempts).
Supporting
measuresincludedaninformationalwebsite,advancenotificationlettersandletters
senttothosewhoinitiallydeclinedtorespondtothesurveytoencouragethemto
participate.AccordingtoBRFSSprotocol,telephoneinterviewersrecontacted
anyonewhoinitiallydeclinedparticipation,tomakeasecondattempttosecure
theircooperation.
Thefinalsamplesizeof7,057interviewsslightlyexceededthesampleplanof7,000.
The5,555landlineinterviewswerelessthanthe5,950originallyplannedandthe
1,502cellphoneinterviewsweremorethanthe1,050originallyplanned.As
describedintheMinnesotaAdultTobaccoSurvey2010MethodologyReport,thislargerproportionofcellphoneinterviewsinthecombinedlandlinecellsampleusedfor
theanalysespresentedinthisreportoffersanimprovementinreducingthe
samplingvarianceinthefinalsample.
TheAmericanAssociationforPublicOpinionResearch(AAPOR)methodologywas
usedtocalculatetheweightedlandlinesampleandcellphonesampleresponse
ratesof
45.0
and
44.5%
percent,
respectively,
which
reflect
net
response
rates
across
boththescreenerquestionnaireandtheMATSquestionnaire.
Everyeffortwasmadetoensuretheconfidentialityofrespondentsandtoinform
themofthefeaturesofthesurvey,itsvoluntarynatureandtheconfidentialityof
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theirresponses.RDDphonenumberswerenotretainedintheanalyticaldatafiles.
Reportsciteonlyaggregatedata.
The
MATS
2010
questionnaire,
data
collection
and
data
security
plan
were
reviewedandapprovedbytheMinnesotaDepartmentofHealthInstitutional
ReviewBoardandbytheWestatInstitutionalReviewBoard.Aninstitutional
reviewboard(IRB)isaspeciallyconstitutedreviewbodyestablishedtoprotectthe
welfareofhumansubjectsrecruitedtoparticipateinbiomedicalandbehavioral
research.WestatsIRBsresponsibilitiesaredetailedintheregulationsconcerning
humansubjectprotectionandtheMultipleProjectAssurancegrantedtoWestatby
theU.S.DepartmentofHealthandHumanServices,OfficeforProtectionfrom
ResearchRisks,DivisionofHumanSubjectProtection.
SampleWeighting
Sampleweightsarecreatedsothatunbiasedpopulationestimatescanbecalculated
usingtheresultsofasurveyfromasampleofafinitepopulation.Thesample
weightingprocessincludedfourmajorsteps:1)adjustfortheprobabilityof
selectionduetothesamplingplan,2)applyscreenerandextendednonresponse
adjustments,3)computedualframecompositeweightingadjustmentstocombine
theoverlappingcellmostlylandline*andcellphonesamples,and4)poststratifyto
estimatedpopulation
totals
through
acalibration
process
to
adjust
for
remaining
nonresponseandcoverageerror.MATS2010incorporatedthedemographic
characteristicsofgender,age,race,location,andeducationfromthe2008American
CommunitySurvey(ACS)intothecalibrationcharacteristicsdimensions.
Thismerged,weighteddatasetisusedinproducingthestatewideestimates
presentedinthisreportfortheentireadultMinnesotapopulationandsubgroupsof
thatpopulation.
*Thereisapossibilitythatmembersofthelandlinesamplewerecellmostlyphoneuserswhodidhappentoanswertheir
landlinephonewhentheMATSinterviewerscalledthatphonenumber.Thus,itwaspossiblethatagivencellmostlyphone
usercouldhavebeensampledthrougheitherthecellphoneorthelandlinesample.Becauseofthis,combiningthetwo
samplesintoasingleweightedfileforanalysisrequiredweightingadjustmentsforthisoverlapgroup,toadjustforthe
dualprobabilityofselection.
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whenpeoplewhoaremissedinthesurveydifferfromthoseinterviewedinways
otherthanthecategoriesusedinweighting.Aswithmostsurveysthatrelyon
telephoneinterviewing,somesubgroups,suchasspecificracialorethnicminority
communities,are
likely
to
be
under
represented.
Othernonsamplingerrorsmayresultfromthesurveydesign,howrespondents
interpretedquestions,howableandwillingrespondentsweretoprovideaccurate
answers,andhowaccuratelytheanswerswererecordedandprocessed.TheMATS
AdvisoryPanelandWestattookseveralstepstominimizethesetypesoferrors,
includingcarefulquestionnairedesign,useofexistingvalidatedquestions,and
havingmultipleindividualsreviewnewquestions;useofaCATIsystemto
administerthequestionnaireandrecordresponses;internaltestingoftheCATI
questionnaire;pilottestingoftheinstrumentandsurveyprocedures;monitoringof
thesampleandofthecollecteddatathroughoutdatacollection;andthorough
reviewofthedatafiletofinalizeitforanalysis.
1.2 AnalysisMethodology
Therearetwomaingoalsoftheanalysis:first,todescribeMinnesotain2010,based
ontheMATS2010data;second,todescribetobaccorelatedtrendsinMinnesota
from1999
to
2010,
with
the
main
focus
on
changes
from
2007
to
2010.
Thetabulationshavethefollowingfeatures.
MATS2010Analysis
Theanalysisgeneratedfrequenciesofallkeystudyoutcomes,principallyinthe
formofpercentagedistributions.Inafewinstances,meanshavebeencalculatedfor
continuousvariables,suchasthenumberofcigarettessmokedinthepast30days.
Bivariate
analyses
generated
tables
displaying
the
major
outcomes
by
demographic
subgroups.Subgroupestimatesarepresentedforagegroups,gender,education,
incomeandsmokingstatus(whenappropriate).Additionalsubgroupestimates
weregeneratedfortheyoungadultanalysisfor30daysmokingstatus,smoking
frequencyandcollegestatus.Allestimatesarealsopresentedwith95percent
confidenceintervalhalfwidths.
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particularlysalient.Allsuchsubgroupestimatesincludeestimatesofchange
between2007and2010.
Interpretation
of
Trend
Results
MATSisaseriesofrepeatedcrosssectionalsurveys.ThismeansthateveryMATS
surveydrawsanewsampleoftheMinnesotapopulation.Repeatedcrosssectional
surveysareanefficientandusefulwaytodescribecharacteristicsofapopulation
overtime,especiallyforplanningpopulationlevelprogramsandpolicies.Careis
needed,however,wheninterpretingtheresultsofsuchsurveys.Forexample,
peoplecanandwillmoveinoroutofthestate,willdieandwillbeborn.A
repeatedcrosssectionalsurveydoesnotaccountforthepossibilitythatthechanges
observedovertimecouldbeduetodifferencesinthecompositionofthepopulation
betweenthesurveyadministrations.
TestingofDifferences
Akeyfeatureofthisreportisthatstatisticallysignificantdifferencesareclearly
indicatedinfigures,tablesandtext.Adifferencebetweentwogroupsortwotime
pointsisstatisticallysignificantwhenitisunlikelytohaveoccurredbychance.The
differencesarealwaysbetweentwogroups,forexample,menandwomen,or
peoplewithahighschooldegreeandpeoplewithacollegedegree.
Asignificancetestprovidesathresholdofconfidence,alevelatwhichresearchers
commonlyagreethatthepopulationvaluesrepresentedbythesurveyestimatesare
reliablydifferentfromoneanother.Inthisreport,thatthresholdisalwaysthe95
percentconfidencelevel.
Thisreportusestwodifferentsignificancetests.Thefirsttestisforexamining
differencesbetweendifferentsubgroups(forexample,betweenmenandwomen).
Thesecondtestisforexaminingdifferencesbetweendifferentsurveyyears;for
example,between
MATS
2007
and
MATS
2010.
MATS2010SignificanceTesting.Intheanalysis,estimatesarecomparedfrom
independentsubgroupswithinthesample.Asdescribedabove,onegroupis
alwayscomparedwithoneothergroup(forexample,mencomparedwithwomen)
ormultipleseriesofgroups(forexample,lessthanhighschooleducationwithhigh
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schooleducation;lessthanhighschooleducationwithsomecollege;lessthanhigh
schooleducationwithcollegegraduates).Iftheconfidenceintervalsaroundthetwo
estimatesdonotoverlap,thenthedifferencebetweenthetwoisstatistically
significantat
the
95
percent
level.
Significance
is
not
indicated
on
the
table,
because
therearetoomanypossiblecomparisonsinanygiventable(asintheeducation
exampleabove).Itwouldbedifficulttonoteallsignificantdifferencesamongall
possiblepairsinastraightforwardway.Significantdifferencesthereforeare
mentionedinthetextonly.Thisisaconservativetest,whichmaymissafew
statisticallysignificantresultsthatcouldbedetectedbyteststhatfocusonspecific
predictedrelationships,suchaspairwisettests.
Resultsthatmeetthe95percentconfidencelevelarethefocusofthisreport.
MATSTrendSignificanceTesting.Inthetrendanalysis,MATScomparestheresults
fromtwoyears(mainly2007and2010).Toassesswhetherthedifferencebetween
yearsissignificant,anestimateoftheamountofchangebetweenthetwoyearsis
calculatedandisexpressedinthesameunitsasthetwoestimates(e.g.,percentage
pointsinmostinstances;countsoftheanalyticalunit,suchasmeandayssmoked,
inafewinstances).
To
test
the
statistical
significance
of
the
amount
of
change
between
two
years,
this
reportusesaonetailedttest.Aonetailedttestisastandardstatisticaltestthatis
appropriatelyusedwhenthereisonlyonedirectionofinterest(eitherpositiveor
negative)forthetest.ForalltheMATStrendanalyses,itispossibletohypothesize
adirectionofchangebetween2007and2010(forexample,thatcigarettesmoking
willdeclineorthatquittingattemptswillincrease).Thesehypothesesweremade
beforethedatawasanalyzed,topreventanybias,andwerebasedontheknown
trendsinMinnesotatobaccouseaspublishedintheMATS2007report.The
individualhypothesisforeachcomparisonpositiveornegativeisexplicitly
statedoneachtableinthisreportthatpresentstrenddata.
Aonetailedtestcanbeusedonlytotestinthehypothesizeddirection.Changing
thedirectionofthetestafterthedataisanalyzedviolatesthekeyassumptionthat
thetestisbasedonthatthedirectionofthechangeisknown.However,thereis
nothingtoprecludeconductingatwotailedtestafteraonetailedtest.MATS2010
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Minnesotaadults,andperceptionsoftobaccouseandthesocialenvironmentof
smoking.Chapter3examinestheuseofvariousformsoftobaccootherthan
cigarettes.Chapter4addressesquittingsmoking,assistancefromhealthcare
providersin
quitting,
and
the
effects
that
the
price
of
cigarettes
and
smoke
free
policieshaveontobaccouseandquitting.Chapter5focusesonMinnesotans
exposuretosecondhandsmoke,describingwheretheseexposuresoccur,how
awarenessofsecondhandsmokeriskhaschanged,therelationshipbetweensmoke
freepoliciesandtheseexposures,andattitudestowardsvarioussmokefree
policies.
Website
This
technical
report
and
a
briefing
are
available
at:
www.mnadulttobaccosurvey.org
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FormerSmokers
Duetotheaddictivenatureoftobaccoandmanyfactorsinthesocialenvironment,
thoseattemptingtoquitsmokinghavevaryingdegreesofsuccess.Surveillance
studiessuch
as
MATS
use
the
term
former
smokertodescribesomeonewhohas
smokedatleast100cigarettesinhisorherlifetimebutwhoisnotcurrently
smoking.Thisdefinitiondoesnotconsiderthelengthoftimethatthepersonhas
gonewithoutsmokingacigarette.Thetermalsoignoresthepsychological,
physical,behavioralandenvironmentalfactorsthatmayweakenorsupport
maintenanceofthequitstatus,whichwillbediscussedinchapter3.Thepresent
sectionfocusesonthedemographiccharacteristicsofformersmokers.
Overall,
27.31.3
percent
of
adult
Minnesotans
(about
1,062,000
people)
are
former
smokers(Table21).Thisrepresentsanincreaseofapproximately126,000former
smokersinthethreeyearssinceMATS2007,whichreported936,000former
smokers.Thereisastatisticallysignificantdifferenceinthepercentagesofmenand
womenwhoareformersmokers:29.71.9percentofmenareformersmokers,
comparedto25.01.7percentofwomen.Asinthecaseofcurrentsmokers,thereisa
markedpatternacrosstheagegroups:6.32.3percentof1824yearoldsareformer
smokers,rangingupto44.02.8percentofthose65orolderasformersmokers.All
differencesbetweenagegroupsarestatisticallysignificant.Therearenolarge
differencesamongthosewithlessthanacollegedegree,rangingbetween27.9and
29.9percent;the23.51.9percentofcollegegraduateswhoareformersmokersis
statisticallydifferentfromtheotherthreeeducationalstatusgroups.Acrossthe
incomegroups,thelowestpercentageofformersmokersoccursamongthelowest
incomegroup,at24.82.5percent.Thisisstatisticallysignificantfromthemiddle
twoincomegroups,inwhichapproximately31percentareformersmokers.
InterpretingtheDataaboutFormerSmokers:theQuitRatio.Drawingconclusions
aboutquitting
behaviors
within
demographics
based
on
the
prevalence
of
former
smokersposeschallenges.Tobeaformersmoker,itisnecessarytohaveoncebeen
asmoker.Thus,thepercentageofformersmokersinanygroupispartlyafunction
ofthenumberofpeopleinthegroupwhohaveeverbeensmokers.Viewedin
isolation,relativepercentagesofformersmokersacrossgroupscanbemisleading.
Asmallerpercentageinonegroupcomparedwithanothermaybeduetoasmaller
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percentageofindividualswhohaveeverbeensmokersandnottoalowerquitrate.
Forexample,thosewiththehighestincomehavethelowestsmokingratesand
highestratesofneversmoking,yettherateofformersmokersamongthisgroupis
lowerthan
those
with
incomes
between
$35,000
and
$75,000.
These
findings
alone
cannotbeinterpretedtomeanthatthosewithhigherincomesquitsmokingata
lowerratethantheothergroups.Sincefewersmokersexistamongthehighest
incomegroup,fewercanbecomeformersmokers.
Unlessthelifetimeincidenceofeversmokingisconsistentacrossthegroupsbeing
compared,thebettercomparisonisthequitratio.
Ever Smoker and Quit Ratio
Ever smokers are defined as the sum total of current smokers and
former smokers.
Quit ratio is defined as the proportion (expressed as a percentage)
of ever smokers who are former smokers at a given time. This ratiocan be calculated for the entire population or for any subgroup.
The quit ratio is calculated as:
The total number of former smokers, divided by the sum of the totalnumber of current smokers plus the total number of former smokers.
Thequitratioisasnapshotofwhetherthosewhohaveeversmokedarecurrently
smokingornot.Whencomparedoverdifferentpointsintime,thequitratio
characterizesthesmokingorformersmokingstatusofthetotaleversmoking
populationandprovidesbetterinformationtomonitorcessationtrends.
Thequitratioisasimpleconcept,butissomewhatconfoundedbysurvivorbiasin
thecaseofagegroups.Smokersdieatyoungeragesthannonsmokers,aneffect
realizedmainly
in
later
years.
Younger
people
are
less
likely
to
be
successful
quittersthanoldersmokers,inpartbecausesuccessfulquittingusuallyrequires
repeatedquitattempts.Consequently,thepoolofsmokers(andthereforeofever
smokers)willtendtodiminishfasterinolderagegroupsthaninyoungerage
groups.Therefore,formersmokerstendtodominateinthepoolofeversmokersas
anagecohortgrowsolder.
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smokers.Alldifferencesbetweenagegroupsforneversmokingarestatistically
significant,exceptbetweenthe4564yearoldgroupandthose65orolder.Both
currentsmokingandneversmokingratesdeclineasageincreases,whilethe
percentageof
former
smokers
increases,
as
discussed
previously.
Therearenolargedifferencesamongthosewithlessthanacollegedegree,ranging
between48.4and52.1percent;the71.72.0percentofcollegegraduateswhoare
neversmokersisstatisticallydifferentfromtheotherthreeeducationalstatus
groups.Theprevalenceofneversmokingincreasesasincomeincreases.Among
Minnesotanswithannualhouseholdincomesof$35,000orless,49.03.1percentare
neversmokers,and64.32.5percentofthosewithhouseholdincomesabove$75,000
areneversmokers.Onlythedifferencesbetweenthosewithincomesgreaterthan
$75,000andeachoftheotherincomelevelsarestatisticallysignificant.
2.2.2 CigaretteUseinMinnesota,1999to2010
TrendsinMinnesotaandtheUnitedStates
Thissectiondiscussesthechangesinsmokingprevalenceovertimeinthe
Minnesotaadultpopulation,usingtheMATSdata.Measurementsweretakenat
1999,2003,2007,and2010.Asnotedinchapter1,thesearefourrepeatedcross
sections,orsnapshots,ofthepopulationateachtimepoint,ratherthana
longitudinalcohort
following
the
same
people
over
time.
Comparisons
between
an
agesubgroup,forexample,willincludeadifferentgroupofrespondentsofthe
sameageduringeachyear.
Ingeneral,tablesandfiguresinthissectionwillpresentstatisticsfromallfourtime
points,butthediscussionsinthissectionwillfocusonlyonthechangesfrom2007
to2010.Consistentwiththisapproach,significancetestsareperformedonlyforthe
changesfrom2007and2010.Anexceptiontothisisthechangeintheoverall
smoking
prevalence
rate
from
1999
to
2010,
which
is
also
presented
and
tested
for
significance.Readersinterestedinintermediatechangesbetween1999,2003,and
2007canfindthempresentedanddiscussedinthe2007MATSreport.
AsillustratedinFigure23,bothnationalandMinnesotaprevalenceratesare
decliningovertime.TheNationalHealthInterviewSurveydatashowadownward
trendthatappearstohaveleveledoffatabout20percentfrom2004through2010.6
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Minnesotasrate,however,hasdeclinedsignificantlyfrom1999through2010from
22.11.7percentto16.11.2percent,achangeof6.0percentagepoints.This
significantdeclineinMinnesotahasoccurredevenasthenationalratehasstalled.
Minnesotatherefore
has
been
able
to
make
notable
progress
in
reducing
the
prevalenceoftobaccouseatatimewhenthenationhasshownonlyincremental
reductions.
Figure 2-3. Smoking prevalence rates in U.S. and Minnesota surveillance
studies, from 1999 to 2010
Source: National Health Interview Surveys 1999 to 2010; Minnesota Adult Tobacco Surveys, 1999, 2003,
2007, and 2010
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UseofCigarettes,2007to2010
Between2007and2010,thepercentageofadultsinMinnesotawhoarecurrent
smokersdeclinedfrom17.01.4percentto16.11.2percent(Table24);thetotal
numberof
current
smokers
fell
from
634,000
in
2007
to
625,000
in
2010.
However,
thisreductionof0.9percentagepoint/9,000smokersisnotstatisticallysignificant.
ThepercentageofMinnesotanswhohaveneversmokeddecreasedslightly,by1.3
percentagepoints,from57.91.6percentin2007to56.61.5percentin2010,butthis
changeisnotstatisticallysignificant.Therewasasomewhatlargerchangeinthe
percentageofMinnesotanswhoareformersmokers,risingbyastatistically
significant2.2percentagepointsfrom25.11.3percentto27.31.3percent.As
discussedpreviously,thisstatisticisbetterinterpretedbyuseofthequitratiointhe
overallpopulation,
rather
than
as
an
isolated
number.
Detailed
statistics
for
the
followingdiscussionsofthesethreegroupsappearinTables24,25,and27.
CurrentSmokers.Smokingratesformenandwomenshowedaboutthesame
declinebetween2007and2010asthegeneraladultpopulation(Table24),and,as
inthecaseoftheoverallpopulation,thesechangesarenotstatisticallysignificant.
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Figure 2-4. Prevalence of young adult 30-day smoking, by selected
demographic characteristics, from 2003 to 2010
Hypothesis: The 30-day smoking prevalence will decline from 2007 to 2010 for all groups
Source: Minnesota Adult Tobacco Surveys, 2003, 2007, and 2010
2.3 CharacteristicsofSmokers
Thissection
focuses
on
the
characteristics
of
smokers
in
terms
of
their
demographic
characteristics,healthstatus,andphysiologicalaspectssuchasaddictionleveland
smokingintensity,withsomecomparisonstoformersmokersandneversmokers.
Thetermnonsmokersreferstoformerandneversmokerscombined.Thissection
firstdescribesthecharacteristicsofsmokersin2010,andthenexploreschangesin
thecharacteristicsofsmokersfrom2007to2010.
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2.3.1 IndividualDemographicCharacteristicsofSmokers
Minnesotasmokerstendtohavelowereducationallevelsandlowerhousehold
incomesthanformersmokersorneversmokers(Table28).About9percent(8.81.8
percent)of
smokers
have
acollege
degree,
compared
with
25.32.1
percent
of
formersmokersand37.21.8percentofneversmokers.Thedifferencesincollege
graduationamongthesmokingstatusgroupsareallstatisticallysignificant.Atthe
otherextreme,10.12.7percentofsmokershavenotcompletedhighschool,
comparedwith8.31.7percentofformersmokersandonly6.71.2percentofnever
smokers,butnoneofthesedifferencesarestatisticallysignificant.Currentsmokers
aremorelikelytohaveahighschooldegreeastheirhighestlevelofeducationand
lesslikelytobecollegegraduatesthaneitherformersmokersorneversmokers;
thesedifferences
are
all
statistically
significant.
Minnesotasmokerstendtohavelowerhouseholdincomesthanformersmokersor
neversmokers.Allincomedifferencesbetweensmokersandeachoftheothertwo
smokingstatusgroupsarestatisticallysignificant.
Table 2-8. Selected demographic characteristics, by smoking status
Source: Minnesota Adult Tobacco Survey, 2010
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Table 2-9. Selected health status indicators, by smoking status
Source: Minnesota Adult Tobacco Survey, 2010
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ComparativeDrinkingBehaviorofSmokers
Awellestablishedbehavioralrelationshipexistsbetweensmokinganddrinking,
particularlyproblemdrinking.7
Drinking Indicators
MATS 2007 used several common measures of alcohol use, includingdaily frequency of alcohol use in past 30 days, quantity of drinks in
past 30 days, heavy drinking and binge drinking.
A heavy drinker has averaged more than two drinks per day
over the past 30 days (men) / more than one drink per dayover the past 30 days (women). The definition of heavy
drinking conforms to that used by CDCs Behavioral RiskFactor Surveillance Survey.
A binge drinker had one or more episodes of having five ormore drinks on a single occasion in the past 30 days (men)/
four or more drinks on a single occasion in the past 30 days(women).
Survey Questions
During the past 30 days, have you had at least one drink ofany alcoholic beverage such as beer, wine, wine coolers or
liquor?
During the past 30 days, how many days did you drink any
alcoholic beverages?
A drink is one can or bottle of beer, one glass of wine, one canor bottle of wine cooler, one cocktail or one shot of liquor.
During the past 30 days, on the days when you drank, abouthow many drinks did you drink on an average day?
Considering all types of alcoholic beverages, how many timesduring the past 30 days did you have 5/4 or more drinks on a
single occasion?
Intermsofanyuseofalcohol,thereislittledifferenceamongcurrent,formerand
neversmokers,
with
65.04.0
percent
of
current
smokers
and
59.62.0
percent
of
neversmokershavinghadadrinkinthepast30days(Table210).However,
smokersdrankmoreoftenandingreaterquantitiesthanneversmokers,averaging
5.3daysonwhichtheydrankand30.3drinksoverthepast30days,comparedwith
3.7daysand13.5drinksforneversmokers.Formersmokerspartiallydeviatefrom
thetypicalpatternoffittingbetweencurrentandneversmokersforthenumberof
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224February2011
daysonwhichtheydrank(5.8days);buttheymaintainthepatternforthenumber
ofdrinks(20.0).(ThesedataarenotshowninTable210.)
Table 2-10. Selected drinking behaviors, by smoking status
Source: Minnesota Adult Tobacco Survey, 2010
Theexpectedpatterniswelldefinedfortwomeasuresofproblemdrinking:heavy
drinkingandbingedrinking.Amongcurrentsmokers,19.04.1percentwereheavy
drinkersduringthepast30days,comparedwithonly3.51.0percentofnever
smokers.Currentsmokersengagedinbingedrinkingatmorethandoubletherate
ofneversmokersinthepast30days,38.74.1percentcomparedwith15.11.5
percent.Thedifferencesbetweensmokersandneversmokersarestatistically
significantforbothmeasures.AsseeninTable210,formersmokersaremorelike
neversmokersthancurrentsmokersinregardtothesetwomeasures.
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Table 2-11. Age of smoking initiation among current smokers, by selected
demographic characteristics
Source: Minnesota Adult Tobacco Survey, 2010
Comparedwith
the
oldest
cohort,
younger
cohorts
of
current
smokers
initiated
smokingatyoungerages.Theonlydistinctandstatisticallysignificantdifferencein
ageofinitiationoccursbetweensmokerswhoareunder65yearsoldandthosewho
are65orolder.Approximately29percentoftheseoldestsmokershadbegun
smokingbyage14,comparedwiththeapproximately49percentto53percentof
theotheragegroupswhodidso(Figure25).Conversely,16.49.1percentofthe
oldestgroupdidnottryacigaretteuntiltheageof21,andonly5percentto9
percentoftheotheragegroupsshowthislaterinitiation.Thislaststatementignores
therateoflaterinitiationforcurrent1824yearolds,whichiszero;the1820year
oldsinthisgroupwhohavenotyettriedacigarettemaystilldosoaftertheyreach
their21birthday.Whilegenerallyindicativeofhistoricaltrends,thedifferencesin
ageofsmokinginitiationamongthevariousagegroupsmaynotsupportfine
distinctions,especiallysincerecallofthepreciseagewhentheysmokedtheirfirst
cigarettemaydiminishastimepasses.
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Generally,individualsspendafewyearsadvancingfromtryingtheirfirstcigarette
toregularuse.Whiletheageatwhichindividualsbecameregularsmokersshows
thevariousdemographicpatternssimilartothosepresentwhentheyfirsttrieda
cigarette,these
patterns
manifest
themselves
later
for
the
age
of
becoming
aregular
smoker.ComparingTable211toTable212,thedistributionsacrossthevarious
demographicsubgroupsshifttotherightbyoneagegroup.
Lowereducationalattainmentisassociatedwithyoungerageofregularsmoking.
Thepercentageofthosewhobecameregularsmokersatearlieragesishigherfor
thelesseducatedanddecreasesaseducationallevelrises.
Therearenostatisticallysignificantdifferencesinageofbecomingaregularsmoker
forage,
gender
or
income,
except
for
the
18
24
year
olds
who
became
regular
smokersatage21orolder(3.33.3percent,whichissignificantlydifferentfromall
theotheragegroups).However,thisstatisticisconfoundedbythefactthatthe18
20yearoldsinthisagegroupbydefinitioncouldnothavebecomeregularsmokers
atage21orolder,butremaininthedenominatorforthepercentagecalculation.
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Table 2-13. Smoking intensity (averaged across past 30 days) and time to
first cigarette after wak ing, for current smokers
Source: Minnesota Adult Tobacco Survey, 2010
TimetoFirstCigaretteafterWaking
MATS
measures
the
typical
length
of
time
between
waking
and
smoking
the
first
cigarette,astrongindicatorofnicotineaddiction.
Level of Addiction
Among various measures, smoking within 30 minutes of waking is
indicative of strong addiction.
Survey Question
How soon after you wake up do you smoke your first
cigarette? Would you say within 5 minutes, 6-30 minutes,
31-60 minutes or after 60 minutes?
Slightlylessthanhalf(44.84.1percent)ofMinnesotasmokerssmoketheirfirst
cigaretteofthedaywithin30minutesofwaking(Table213).Asageincreases,this
addictionmeasuretendstoincrease.Thepercentageof4564yearoldswhosmoke
within30minutesofwaking(57.66.3percent)ishigherinastatisticallysignificant
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Table 2-16. Perception of other tobacco and nicotine products as less harmful
than cigarettes, by selected demographic characteristics and
smoking status
Source: Minnesota Adult Tobacco Survey, 2010
Forthetobaccoproducts,thereappearstobeaconsistenttrendacrosstheage
groups:theyoungertheperson,themorelikelytheyaretoagreethattheproductis
lessharmfulthancigarettes.Whilemanyofthedifferencesbyagegrouparenot
statisticallysignificant,the1824yearoldsshowsignificantlyhigherpercentages
whosubscribetothebeliefinlessharmforhookah(23.54.4percent),natural
cigarettes(18.33.9percent),androllyourowncigarettes(8.12.8percent),as
comparedtosomeoralloftheotheragegroups.
Menareconsistentlymorelikelytoviewtheproductsaslessharmful,at
approximatelyone
and
ahalf
to
three
times
the
rate
of
women
for
most
products.
Thesedifferencesarestatisticallysignificantforallbutrollyourowncigarettes.
Thereislittlevariationintheperceptionoflowerharmforthevarioustobacco
productsacrosstheeducationalandincomelevels.
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Fromtheperspectiveofspecificproducts,itisencouragingthatonly7.80.9percent
ofMinnesotansbelievethatlightorultralightcigarettesarelessharmful.MATS
2010addedsnustothelistofproductsinthisquestion,and8.60.9percentof
Minnesotansbelieve
snus
is
less
harmful,
with
men
nearly
three
times
as
likely
as
womentoconsideritso.
OveronethirdofMinnesotans(36.41.8)deemelectroniccigarettes(whichdonot
containtobaccobutdocontainnicotine)aslessharmfulthancigarettes.Smokersare
muchmorelikelytoconsiderthemlessharmfulthancigarettes,with58.05.1
percentofthemendorsingthisview,comparedto35.93.3percentofformer
smokersand30.82.2percentofneversmokers.
2.4.2
EconomicInfluences
on
Smoking
Behavior:
Saving
Money
onCigarettes
Inlightofthenationaleconomicdownturnandtherisingpriceoftobaccoproducts
aroundthetimeoffieldingMATS2010,aseriesofquestionsaboutthethings
smokersmayhavebeendoinginthepastyeartosavemoneyoncigaretteswere
added.
Methods Used by Smokers to Save Money on Cigarettes
Survey Question
In the past year have you done any of the following things to
try and save money on cigarettes?
Bought a cheaper brand of cigarettes?
Rolled your own cigarettes?
Used another form of tobacco other than cigarettes?
Used coupons, rebates, buy 1 get 1 free, or any otherspecial promotions?
Purchased cartons instead of individual packs? Found less expensive places to buy cigarettes?
Ofthevariousmethodsusedbysmokerstosavemoneyoncigarettes,fourofthem
relatetoshoppingbehavior(cheaperbrand,useofcoupons,buyingcartons,
cheaperoutlets)andtworelatetousingalternativeproducts(rollyourown,non
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cigarettetobacco).Foreachoftheshoppingoptions,fromonethirdtotwothirdsof
smokershadmadeuseofagivenoptioninthepastyear,rangingfrom33.83.9
percentwhoboughtacheaperbrandto65.83.8percentthatusedcouponsand
similarpromotions
(Table
217).
Fewer
smokers
resorted
to
alternative
products:
12.32.9percentusedanotherformoftobaccoand19.33.5percentrolledtheirown.
Sincethethrustofthesequestionsiseconomic,examiningthesecostsaving
measuresbyincomelevelistheanalysisofprimaryinterest.Predictably,acrossall
themeasures,thereappearstobeadistinctpatternofdecliningadoptionofthe
measuresasincomelevelincreases.Whilethedifferencesbetweeneachcontiguous
pairofincomelevelsarealmostneverstatisticallysignificant,thereareanumberof
significantdifferencesbetweensomeofthelowerandsomeofthehigherincome
levels.Forexample,the63.46.2percentofthelowestincomegroupwhofoundless
expensiveplacestobuycigarettesisapproximatelydoublethepercentageofthose
withincomesabove$50,000whodidso,andthisdifferenceissignificant.The
71.05.4percentofthelowestincomegroupwhousedcouponsissignificantly
differentfromthe52.79.2percentofthehighestincomegroupwhodidso.
Purchasingcartonsisoneexceptionthatshowslittledifferenceacrosstheincome
groups.
Itis
also
informative
to
look
at
the
absolute
numbers
for
some
methods
and
income
groups.Forexample,almostnoneofthehighestincomegrouprolledtheirown
cigarettes(3.53.4percent),butoverhalfofthemusedcoupons(52.79.2percent).
Thehighestincomegroupswerealsohighlyresistanttogivinguptheirpreferred
cigarettes:only19.87.2percentboughtacheaperbrandand9.85.5percentused
anotherformoftobaccotosavemoney.Amongthelowestincomegroup,using
couponsandfindingcheaperplaceswerequitecommon:71.05.4percentand
63.46.2percent,respectively.
Educationtendstocorrelatewithincome,andthepatternsacrosseducationallevels
aresimilartothoseacrossincomelevels.Thereislittledifferencebetweenmenand
women,exceptforusingalternativeproducts:22.74.9percentofmenand15.34.9
percentofwomenrolledtheirown(differencenotsignificant),and16.84.4percent
ofmenand6.93.3percentofwomenusedanotherformoftobacco(difference
significant).
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Youngadults(31.34.7percent)arealsomorelikelytolivewithasmokerthan25
44yearolds(17.52.2percent),4564yearolds(17.01.9percent)andthose65or
older(8.91.9percent).Allofthesedifferencesbetweenyoungadultsandtheother
agegroups
are
statistically
significant.
Conversely,thosewithcollegedegreesarelesslikelytolivewithasmoker(8.51.3
percent)thanthosewithlessthanahighschooldegree(23.85.8),withonlyahigh
schooldegree(22.42.8percent),andthosewithsomecollege(20.72.2percent).All
ofthesedifferencesbetweencollegegraduatesandtheothereducationallevelsare
statisticallysignificant.
Table 2-19. Smoking environment, by selected demographic characteristicsand smoking status
Source: Minnesota Adult Tobacco Survey, 2010
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2.4.4 CharacteristicsofSmokers,1999to2010
ThissectionexaminesMinnesotasmokersintermsofthechangesovertimein
selectedsmokingrelatedbehaviorsandattitudes.
SmokingIntensity
Asnotedinsection2.3.2,smokersaregroupedbythenumberofcigarettesthey
smokeperday:lessthan15cigarettesperday,1624cigarettesperday,and25or
morecigarettesperday,referredtorespectivelyaslight,moderate,andheavy
smokers.Thesedescriptionsareforconvenienceonlyanddonotimplyreduced
harmfromsmokingatthelowerlevels. From2007to2010,therewas
approximatelya9percentagepointshiftinthepercentageofheavyandmoderate
smokersto
light
smokers,
from
54.14.7
percent
to
63.24.0
percent
(Table
220).
The
9.1percentagepointincreaseinlightsmokersiscomposedofa5.1percentagepoint
decreaseinmoderatesmokersanda4.0percentagepointdecreaseinheavy
smokers.Thechangesfrom2007to2010forallthreelevelsofsmokingintensityare
statisticallysignificant.
Table 2-20. Smoking intensity and time to first cigarette after waking, among
smokers from 1999 to 2010
aThese items are hypothesized to decline from 2007 to 2010
bThese items are hypothesized to increase from 2007 to 2010
* Statistically significant at the 95% confidence level
Source: Minnesota Adult Tobacco Surveys, 1999, 2003, 2007, and 2010
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TimetoFirstCigaretteafterWaking
Asmentionedearlier,timetofirstcigaretteafterwakingisarobustindicatorof
levelofnicotinedependence.Thechangebetween2007and2010inthepercentage
ofsmokers
who
smoke
their
first
cigarette
within
30
minutes
of
waking
is
not
statisticallysignificant.(Table220).Thissuggeststhattherehasbeennochangein
theoveralllevelofnicotinedependenceamongsmokersinMinnesotaduringthis
timeperiod.
Asdiscussedinsection2.4.1,perceptionofharmisanimportantindicatorof
potentialexperimentationwithtobaccouse,motivationtoquitandsupportfor
tobaccocontrolpolicies.Thissectionexaminesthetrendintheperceived
harmfulness
of
smoking
an
occasional
cigarette.
There
was
a
decrease
of
about
3
percentagepointsinthepercentofMinnesotanswhoregardsmokinganoccasional
cigaretteasharmful.In2007,78.31.5percentofMinnesotansthoughtsmokingan
occasionalcigarettewasharmful.In2010,thisnumberdecreasedby3.2percentage
pointsto75.11.4percent.Sincethehypothesisfortheonetailedtestforthischange
wasspecifiedaspositive,thisnegativechangedoesnottestasstatistically
significant.However,thisdecreaseisstatisticallysignificantifatwotailedtestis
applied.
Livingwith
a
Smoker
MATSalsoexaminedthetrendsfrom1999to2010inlivingwithasmoker.There
wasnosignificantchangefrom2007to2010,withthepercentageofadultswholive
withasmokerholdingvirtuallysteadyat17.81.3percentin2010,comparedto
17.51.5percentin2007.
2.5 KeyFindings
Some
of
the
most
important
findings
from
this
chapter
are
summarized
below.
All
differencespresentedinthissummaryarestatisticallysignificantatthe0.05
confidencelevelunlessotherwisenoted.
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Sources
1. CentersforDiseaseControlandPrevention.2009BehavioralRiskFactorSurveillanceSystem:CalculatedVariables(Version6RevisedMarch1,2010).Atlanta,GA:U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention,2010.
2. VitalandHealthStatistics,SummaryHealthStatisticsforU.S.Adults:NationalHealth
InterviewSurvey,2009.Series10:DataFromtheNationalHealthInterviewSurveyNo.249.
Hyattsville,MD:U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControland
Prevention,NationalCenterforHealthStatistics.August,2010.
3. CentersforDiseaseControlandPrevention.CigaretteSmokingAmongAdultsandTrends
inSmokingCessation UnitedStates,2008.MMWR.2009;58(44):12271232.
4. CentersforDiseaseControlandPrevention.2006BehavioralRiskFactorSurveillanceSystem:Calculated
Variables
and
Risk
Factors
(Version
7).
Atlanta,
GA:
U.S.
Department
of
Health
and
Human
Services,CentersforDiseaseControlandPrevention,2007.
5. U.S.DepartmentofHealthandHumanServices.PreventingTobaccoUseAmongYoungPeople:AReportoftheSurgeonGeneral.Atlanta,GA:U.S.DepartmentofHealthandHumanServices,PublicHealthService,CentersforDiseaseControlandPrevention,NationalCenterforChronicDisease
PreventionandHealthPromotion,OfficeonSmokingandHealth;1994.
6. EarlyReleaseofSelectedEstimatesBasedonDataFromtheJanuaryJune2010National
HealthInterviewSurvey. ReleasedDecember15,2010. U.S.DepartmentofHealthandHuman
Services,CentersforDiseaseControlandPrevention,NationalCenterforHealthStatistics.
Availableat:http://www.cdc.gov/nchs/nhis/released201012.htm#8. AccessedDecember2010.
7. BoboJK,HustenC.Socioculturalinfluencesonsmokinganddrinking.AlcoholResearchandHealth.2000;24(4):22532.
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Table 3-1. Current use of any tobacco product , by selected demographic
characteristics
Source: Minnesota Adult Tobacco Survey, 2010
Thedemographicpatternsforuseofanytobaccoproductaresimilartothose
alreadypresentedforcurrentcigarettesmokingbecausecigarettesmokers
constitutethelargestpercentageofalltobaccousers.Sinceonlymenusenon
cigarettetobaccotoanydegree,thesmalldifferenceinthepercentagesofwomen
andmenwhoarecigarettesmokers(14.5percentand17.7percent,asreportedin
Chapter2)becomesmuchwiderandstatisticallysignificantfortheuseofany
tobaccoproduct(15.31.6percentand26.92.0percent).
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Non-Cigarette Tobacco Use Status (continued)
Electronic cigarettes:
Electronic cigarettes are a new product. An electronic cigarette (or e-cigarette) is a battery-powered device that provides inhaled doses of
a vaporized nicotine solution. In addition to nicotine delivery, this
vapor may also provide a flavor and physical sensation similar to thatof inhaled tobacco smoke, although no smoke or combustion is
actually involved in its operation. An e-cigarette typically takes theform of an elongated tube, typically designed to resemble a real
smoking product, most often a cigarette.
E-cigarettes can be considered an alternative nicotine product.Because they do not contain tobacco, MATS does not count their use
when determining overall tobacco use, non-cigarette tobacco use, or
smokeless tobacco use.
A current user of the respective product has used a hookah,snus, dissolvable tobacco, or an e-cigarette at least one day in
the past 30 days.
Anyone else is not a current user.
Survey Questions
Have you ever used any of the following tobacco products?
A hookah water pipe?
Electronic cigarettes, such as Smoking Everywhere or
Njoy?
Snus, such as Camel Snus or Tourney Snus?
Any tobacco product that dissolves in the mouth, such astobacco tablets, sticks, or strips?
During the past 30 days, how many days did you use
A hookah water pipe?
Electronic cigarettes, such as Smoking Everywhere orNjoy?
Snus, such as Camel Snus or Tourney Snus?
Any tobacco product that dissolves in the mouth, such as
tobacco tablets, sticks, or strips?
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Table 3-4. Tobacco use among Minnesota adults and current smokers from
1999 to 2010, by tobacco product
* Statistically significant at the 95% confidence level
a Hypothesis: the percentages for these items will decline from 2007 to 2010
b Hypothesis: the percentages for these items will increase from 2007 to 2010
Source: Minnesota Adult Tobacco Surveys, 1999, 2003, 2007, and 2010
Useof
Non
Cigarette
Tobacco
Products
among
Current
Cigarette
Smokers.
For
ease
ofcomparison,thestatisticsforthechangesincigarettesmokersuseofnon
cigarettetobaccoproductsappearinTable34immediatelybelowtheresultsforall
Minnesotans.Therewasastatisticallysignificantincreaseincurrentuseofnon
cigarettetobaccoproductsamongsmokersfrom2007to2010.In2007,11.92.8
percentofsmokerswerecurrentusersofsomeformofnoncigarettetobacco,
increasingby5.8percentagepointsto17.63.2percentin2010.Thisisafunctionof
increasesincurrentpipe,cigar,andsmokelesstobaccouseamongsmokers,with
theincrease
in
smokeless
tobacco
use
by
itself
accounting
for
most
of
the
increase.
Theincreasesincurrentpipeandcigaruseareapproximately1and2percentage
pointsrespectively,neitherchangebeingsignificant.The5.2percentagepoint
increaseincurrentuseofsmokelesstobaccobysmokersisrelativelylarge(4.41.6
percentto9.62.7percent)andisstatisticallysignificant.
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41February2011
4.QuittingBehaviorsamongMinnesotaSmokers
4.1
Introduction
ThischapterdescribesquittingbehaviorsamongMinnesotassmokers.Theresults
presentedhereexaminequitattempts,successfulquitting,useofquittingprograms
andmedications,assistanceforquittingfromhealthcareproviders,andimpactof
smokefreepoliciesonquitting.
4.2 QuittingSmokingandUseofAssistancetoQuit
Thissectionexaminestheprevalenceofquittingattemptsandsuccessfulquitting,
andtheuseofquittingprogramsandmedicationsinquitattempts.
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48February2011
formersmokerswhohavequitinthepastfiveyears.Nostatisticallysignificant
differencesexistinawarenessbyage,gender,educationorincome.
Perceptionsof
Quitting
Assistance
Perceptionsofquittingassistancemayaffectsmokersinterestinorwillingnessto
useassistance.Sincesuccessfulquittershaveusuallymademultiplequitattempts
beforebeingsuccessful,thissectionandthefollowingsection,aboutuseof
assistance,focusoncurrentsmokerswhohavetriedtoquitinthepastyear.
Stop-smoking Medications
Survey Questions
Next Im going to read a list of statements about stop-
smoking medications. Please tell me if you agree or disagreewith each statement.
If you decided you wanted to quit, you would be able to quitwithout stop-smoking medications.
Stop-smoking medications are too expensive.
You dont know enough about how to use stop-smoking
medications properly.
Stop-smoking medications are too hard to get.
Stop-smoking medications might harm your health.
Overhalf(56.15.8percent)ofcurrentsmokerswhohavetriedtoquitsmokingin
thepastyearbelievethattheycouldquitsmokingwithoutstopsmoking
medications(Table45).Thereisalargeandsignificantdifferencebyage.Among
currentsmokers,81.99.5percentof1824yearoldsbelievetheycanquitsmoking
withoutstopsmokingmedications,comparedwith51.59.3percentof2544year
olds,45.59.6percentof4564yearolds,and49.217.5percentofthe65orolder
group.The
difference
between
the
18
24
year
olds
and
all
the
other
age
groups
is
statisticallysignificant.Therearenosignificantdifferencesbygender,educationor
income.
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412February2011
Table 4-6. Use of any stop-smoking medication among current smokers who
tried to quit in the past 12 months, by selected demographic
characteristics
Source: Minnesota Adult Tobacco Survey, 2010
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419February2011
In2010,20.14.6percentofcurrentsmokerswithaquitattemptinthepastyear
usedsomekindofbehavioralsmokingcessationcounseling(suchasaclassor
program)intheirlastattempt(Figure44).Thisincreaseof5.2percentagepoints
from2007
is
statistically
significant.
Figure 4-4. Use of behavioral therapy by current smokers who have tried
to quit in the past 12 months, from 2003 to 2010
* Statistically significant at the 95% confidence level
Hypothesis: The percentage who used behavioral therapy will increase from 2007 to 2010
Source: Minnesota Adult Tobacco Surveys, 2003, 2007 and 2010
4.3 AssistancefromHealthCareProviders
Thissectionexaminesthesmokerspathtoquittingthroughtreatmentreceived
fromahealthcareprovider,specificallywhetherpatientsrecallbeingaskedifthey
smoke,advisedtoquit,andreferredtoanappropriatecessationcounseling
program.Section4.3.1examinestheMinnesotasmokerswhoseehealthcare
providersandtheirdemographiccharacteristics.Section4.3.2describeshowwell
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421February2011
Figure 4-5. Minnesotans who visited a health care provider in the last 12
months, by smoking status
Source: Minnesota Adult Tobacco Survey, 2010
Table411presentsthepercentageofeachdemographicgroupofsmokerswhosaw
aprovider.
Thelikelihoodthatasmokervisitedanyhealthcareproviderinthepastyear
increasessteadilywiththeageofthesmoker,rangingfrom57.610.5percentofthe
youngestagegroupto87.76.3percentoftheoldest.Therearenostatistically
significantdifferencesbetweeneachsuccessivepairofagegroups,butotherwiseall
differencesaresignificant.
Femalesmokerssawahealthcareproviderataconsiderablyhigherratethanmale
smokers,80.84.8percentascomparedto61.05.6percent,astatisticallysignificant
difference.
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422February2011
Table 4-11. Health care provider visits in the last 12 months among current
smokers, by selected demographic characteristics
Source: Minnesota Adult Tobacco Survey, 2010
Smokerswithatleastsomecollegeeducationaremorelikelytohaveseena
healthcareproviderthanthosewithahighschooldegreeorless,atarateof7778
percentcomparedto6165percent.Thepercentagesforthetwohighereducational
levelsaresignificantlydifferentfromsmokerswithonlyahighschooldegree.
Therearenosignificantdifferencesbyhouseholdincomelevel.
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424February2011
ImplementationofAsk,AdviseandReferModelinMinnesota
ThenextsectionslookattheextenttowhichMinnesotasmokersexperiencedeach
ofthestepsintheAsk,AdviseandRefermodel.
Ideally,allpatientswouldreportthattheirhealthcareprovidersimplementthe
clinicalpracticeguideline.In2010,80.21.2percentofMinnesotanswhosawa
healthcareproviderreportedbeingaskediftheysmoke.Theanalysisofsmokers
experiencewiththeAsk,AdviseandRefermodelislimitedtothosesmokerswho
actuallysawahealthcareprovider.TheresultsappearinTable412.The
percentagesaresmokerswhoreceivedtheactivity(indicatedineachtablecolumn)
fromatleastoneprovidertheysawinthelast12months,asapercentageofthose
smokerswho
saw
any
provider
in
the
last
12
months.
GettingtheAsk,AdviseandReferModelfromAnyProvider.Amongsmokerswho
sawanyproviderinthelast12months,94.42.1percentofthemreportedbeing
askediftheysmokeand71.84.3percentwereadvisednottosmoke.Fewerthan
half(43.94.8percent)ofcurrentsmokers,however,receivedareferralfor
assistancetoquitsmoking.
In2010,nearlyallsmokersreportedbeingaskedbyaprovideriftheysmoke.The
percentage
of
patients
who
report
that
providers
advise
could
still
be
improved.
Thelowerrateforrefersuggeststhatmoreprovidersneedtoimplementthis
portionoftheguidelinemoreconsistently.
Intermsofbeingaskedbyprovidersiftheysmokeorbeingadvisednottosmoke,
therearenostatisticallysignificantdifferencesbyage,gender,educationorincome.
Intermsofreceivingreferralsforassistance,thereisnoapparentdemographic
trendandfewapparentdifferences.Youngadults1824seemtohavereceived
referralsthe
least
of
all
the
age
groups
(32.712.3
percent),
and
the
45
64
year
olds
seemtohavereceivedreferralsatthehighestrate(50.47.2percent);whiletheseare
significantlydifferentfromeachother,neitherissignificantlydifferentfromthe
othertwoagegroups.Therearenostatisticallysignificantdifferencesbygender,
educationorincome.
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427February2011
MATS2007,thepercentagesofsmokersarebasedonsmokerswhosawahealth
careproviderin2010.Theresultsshow:
Astatisticallysignificant7.8percentagepointincreaseinthepercentageof
currentsmokerswhoreportedbeingaskediftheysmoke,from86.53.3
percentin2007to94.42.1percentin2010.
Essentiallynochangeinthepercentageofcurrentsmokerswhowere
advisednottosmoke,whichwas74.04.3percentin2007and71.84.3
percentin2010.
Nostatisticallysignificantchangeinthepercentageofcurrentsmokerswho
receivedanyformofreferraltostopsmokingmedicationsorprograms,
whichwas40.35.1in2007and43.94.8percentin2010.
Figure 4-6. Current smokers who were asked, advised, and referred by health
care providers in the last 12 months, from 2003 to 2010
Referred was not determined in 2003
* Statistically significant at the 95% confidence level
Hypothesis: The percentages who were asked, advised, and referred will each increase from 2007 to 2010
Source: Minnesota Adult Tobacco Surveys, 2003, 2007, and 2010
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431February2011
Over85percent(87.21.0percent)ofMinnesotansliveinhomeswheresmokingis
notallowedanywhere.Notunexpectedly,neversmokers(93.91.1percent)arethe
mostlikelytoliveinhomeswithsmokefreepolicies,followedbyformersmokers
(90.91.5percent)
and
current
smokers
(58.14.0
percent).
These
differences
among
smokingstatusgroupsarestatisticallysignificant.Notably,halfofallsmokerslive
inhomeswheresmokingisnotallowed.
About60percent(59.45.4percent)ofsmokerswithsmokefreepoliciesintheir
hometriedtoquitsmokinginthepastyear,comparedwith47.96.2percentof
thosewhodonothavesmokefreepoliciesathome(Figure48).Thisassociationis
statisticallysignificant(p
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53February2011
(95.00.9percent).Thegroupwiththelowestlevelofeducationalattainment
(83.45.0percent)islesslikelythaneveryothereducationalgroup(whichvaryfrom
90.8percentto95.1percent)toagreethatsecondhandsmokeisharmful.While
someof
the
differences
among
education
and
income
groups
are
statistically
significant,theactualdifferencesaresmall.
5.2.1 PerceptionsthatSecondhandSmokeisHarmful,
2007to2010
Between2007and2010,thepercentageofMinnesotanswhobelievethat
secondhandsmokeisveryorsomewhatharmfuldecreasedslightlyfrom93.00.8to
92.30.8,butthisdifferenceisnotstatisticallysignificantandthusrepresentsa
stablefinding
(Figure
51).
This
stability
is
noteworthy
because
the
overall
percentageisveryhigh,asdesired.
Figure 5-1. Agreement that secondhand smoke is harmful, from 2003 to 2010
Hypothesis: The percentage who agree that secondhand smoke is harmful will increase from 2007 to 2010
Source: Minnesota Adult Tobacco Survey, 2003, 2007, and 2010
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58February2011
Figure 5-2. Minnesotans working in indoor* work settings who are covered
by smoke-free policies in work areas, overall and for selected
common indoor w ork settings
* Indoor setting based on respondents characterization of their primary work setting as indoors or not.
Source: Minnesota Adult Tobacco Survey, 2010
OutdoorWorkSettings
Amongthosewhodonotworkprimarilyindoors,workareasmokingprohibitions
arelesscommonoverall,covering44.25.1percentofsuchworkers(Figure53).
Workarea
smoking
prohibitions
are
most
common
for
those
outdoor
workers
who
workinavehicle(62.510.0percent).Onlyaboutaquarterofoutdoorworkerswho
workinfarming(27.911.0percent)andconstruction(25.58.9percent)arecovered.
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5.4 SecondhandSmokeExposure
Thissectionfocusesonexposuretosecondhandsmokeinanysetting,andthen
examinesexposure
in
the
community,
at
work,
in
acar
and
at
home.
5.4.1 AnyExposuretoSecondhandSmoke
Exposure to Secondhand Smoke in Any Setting
Exposure to secondhand smoke in any setting is exposure in any one
or more of the following settings: in the community at large, at work,
in a car or at home. For work, it encompasses any type of worksetting, including indoor and outdoor settings.
Questions and definitions for each individual exposure setting
(community, work, car and home) can be found in the sectionsbelow.
Almosthalf(45.61.5percent)ofMinnesotanshavebeenexposedtosecondhand
smokeinsomelocationinthepastsevendays(Figure56).Therearestatistically
significantdifferencesingeneralexposuretosecondhandsmokebyage,gender,
educationandsmokingstatus(Table54).Youngadultsaged1824(73.84.2
percent)are
more
likely
to
be
exposed
to
secondhand
smoke
in
any
location
than
anyotheragegroup.Thereisaconsistent,statisticallysignificanttrendforage:as
ageincreases,exposuretosecondhandsmokeinanylocationdecreases.Similarly,
men(50.52.2percent)aremorelikelytobeexposedthanwomen(40.82.0percent),
andpeoplewhodonothaveacollegedegreearesignificantlymorelikelytobe
exposedthanpeoplewhodo.Exposuretosecondhandsmokevariesbysetting.
Minnesotansaremorelikelytobeexposedtosecondhandsmokeinthecommunity
atlarge(34.11.4percent)thaninacar(17.61.2percentandlesslikelytobe
exposed
at
home
(9.51.0
percent)
or
at
work
(9.41.2
percent)
than
in
either
of
the
firsttwolocations.Thesedifferencesarestatisticallysignificant.
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516February2011
Table 5-4. Minnesotans exposed to secondhand smoke in the past seven
days in various settings, by selected demographic characteristics and
smoking status
Note: Smoking reported at home or in work areas could refer to smokers own smoking, as well as that of others. If
report referred only to smoker, this does not represent the persons exposure to secondhand smoke. True
secondhand smoke exposure may be somewhat lower than presented for home and work areas.
Source: Minnesota Adult Tobacco Survey, 2010
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Figure 5-7. Most recent exposure of Minnesotans to secondhand smoke in
community settings, by type of setting
Source: Minnesota Adult Tobacco Survey, 2010
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525February2011
5.5.1 SmokefreePoliciesintheWorkplaceandTheirAssociation
withWorkplaceExposure
Minnesotanswithpoliciesthatdonotallowsmokingatworkfacelessexposureto
secondhandsmokeintheirworkareathanthosewithoutsuchpolicies.Among
Minnesotanswhoreportthatsmokingisnotallowedinworkareas,only3.30.8
percenthadsomeonesmokeintheirworkareainthepastsevendays(Table56).
Bycomparison,thosewhoreportthatsmokingisallowedinworkareashad
someonesmokeintheirworkareaatovertwelvetimesthatrate(41.35.1percent,
p
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AmongallMinnesotans,43.81.5percentthinkthatsmokingshouldnotbe
allowedatallinMinnesotacasinos.Slightlymore(47.11.5percent)believeit
shouldbeallowedinspecialsmokingareas.Only9.20.9percentsayit
should
be
allowed
throughout
the
building.
Few
current
smokers
believe
smokingshouldnotbeallowedatall(14.62.9percent)inMinnesotacasinos.
KeySecondhandSmokeFindingsfor2007to2010
In2010,80.71.6percentofMinnesotanssaidtheirworkplacehadapolicy
thatdidnotpermitsmokingineitherworkareasorindoorcommonareas.
Thisisanincreaseof4.6percentagepointsover2007(76.11.9percent).
Amongthosewhoworkindoors,90.81.3percentsaidsmokingwasnot
allowedintheirworkareain2010,astatisticallysignificantincreaseof5.0
percentagepoints
over
2007.
ThepercentageofMinnesotanslivinginhomeswheresmokingisnot
permittedshowedasimilarsignificantincreasefrom2007to2010,risingby
4.1percentagepointsfrom83.21.3percentto87.21.0percent.
Between2007and2010,therewasalargeandsignificantdecreaseinthe
percentageofMinnesotansexposedtosecondhandsmokeinanylocationin
thepastsevendays,decliningby11.1percentagepoints,from56.71.7
percentto45.61.5percentin2010.
Therewerestatisticallysignificantdeclinesinsevendayexposureto
secondhandsmokeinallofthetypesofsettingstrackedbyMATS.The
largestdeclineinexposuretosecondhandsmokeinaspecificsettingwasin
communityexposure,whichdecreasedfrom46.01.6percentofMinnesotans
in2007to34.11.4in2010.Exposuretosecondhandsmokedeclinedby5.1
percentagepointsatwork,3.0percentagepointsinacarand2.5percentage
pointsathome.
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