minnesota adult tobacco survey

8/7/2019 Minnesota Adult Tobacco Survey

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2011ClearWayMinnesotaSM2011MinnesotaDepartmentofHealthSuggestedcitation: TobaccoUseinMinnesota:2010Update.Minneapolis,MN:ClearWayMinnesota

SMandMinnesotaDepartmentofHealth;February2011.The2010MATSwaspartiallyfundedbyacontributionfromBlueCrossandBlueShieldofMinnesota.


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iiiFebruary2011

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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ivFebruary2011

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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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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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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xFebruary2011


Listof

Tables

(continued)

Table Page

43 Numberofquitattemptsinthepast12months

amongcurrentsmokerswithatleastonequit

attempt,byselecteddemographiccharacteristics..................... 45

44 StagesofChangeamongcurrentsmokers,by

selecteddemographic

characteristics

..........................................

47

45 Perceivedabilitytoquitsmokingwithoutstop

smoking medicationsamongcurrentsmokerswho

havetriedtoquit inthepast12months,byselected


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



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xiFebruary2011


Listof

Tables

(continued)

Table Page

410 Perceptionsofstopsmokingmedications,among

currentsmokerswhohavetriedtoquitinthepast12

months,from2007to2010............................................................ 417

411 Healthcareprovidervisitsinthelast12months

amongcurrent

smokers,

by

selected

demographic


412 Ask,AdviseandRefermodelservicesreceivedfrom

healthcareprovidersamongsmokerswhovisited

anyproviderinthelast12months,byselected


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


status................................................................................................ 52


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xiiiFebruary2011


Listof

Tables

(continued)

Table Page

59 Opinionsaboutwhethersmokingshouldbeallowed

inMinnesotacasinos,amongallMinnesotans,by


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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xivFebruary2011


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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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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13February2011

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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14February2011

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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16February2011

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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18February2011

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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19February2011

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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111February2011

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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27February2011

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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28February2011

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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211February2011

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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212February2011

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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213February2011

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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219February2011

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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220February2011

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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222February2011

Table 2-9. Selected health status indicators, by smoking status



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223February2011

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


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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226February2011

Table 2-11. Age of smoking initiation among current smokers, by selected

demographic characteristics


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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229February2011

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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232February2011

Table 2-13. Smoking intensity (averaged across past 30 days) and time to

first cigarette after wak ing, for current smokers


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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238February2011

Table 2-16. Perception of other tobacco and nicotine products as less harmful

than cigarettes, by selected demographic characteristics and

smoking status


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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239February2011

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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240February2011

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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243February2011

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



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244February2011

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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245February2011

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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249February2011

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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32February2011

Table 3-1. Current use of any tobacco product , by selected demographic

characteristics


Thedemographicpatternsforuseofanytobaccoproductaresimilartothose

alreadypresentedforcurrentcigarettesmokingbecausecigarettesmokers

constitutethelargestpercentageofalltobaccousers.Sinceonlymenusenon

cigarettetobaccotoanydegree,thesmalldifferenceinthepercentagesofwomen

andmenwhoarecigarettesmokers(14.5percentand17.7percent,asreportedin

Chapter2)becomesmuchwiderandstatisticallysignificantfortheuseofany

tobaccoproduct(15.31.6percentand26.92.0percent).


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35February2011

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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310February2011

Table 3-4. Tobacco use among Minnesota adults and current smokers from

1999 to 2010, by tobacco product


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



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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


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


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


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


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.


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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514February2011

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.



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518February2011

Figure 5-7. Most recent exposure of Minnesotans to secondhand smoke in

community settings, by type of setting



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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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532February2011

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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minnesota adult tobacco survey

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