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Kentucky Tobacco Use Prevention and Cessation

Report Card

Prepared by

Ellen J. Hahn, DNS, RN

Mary Kay Rayens, PhD

Lisa Greathouse, BSN, RN

Erin King, BS

Chizimuzo T.C. Okoli, MSN, RN

Lou Ann Hartley, MSN, CNAA-BC, PAHM

Amy Yoder, MSN, RN

University of Kentucky College of Nursing

September 30, 2002

Kentucky Tobacco Use Prevention and Cessation

Report Card

Cabinet for Health Services Department for Public Health

Division of Adult and Child Health Chronic Disease Prevention and Control Branch

Tobacco Prevention and Cessation Program

This report was produced through a contract between

The Kentucky Cabinet for Health Services and

The University of Kentucky College of Nursing

“Treating tobacco dependence is like treating malaria in a mosquito infested swamp or cocaine addiction in a crack infested neighborhood. Smokers and former smokers live in a world infested with professional promoters of smoking” -Jack Henningfield Tobacco Control, 2000

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Acknowledgements

The authors give special thanks to the Tobacco Use Prevention and Cessation Coordinators from local health departments who assisted in collecting much of the data reported here. It is

through the vast array of evidence-based, community efforts that we will eventually see reductions in tobacco use and changes in tobacco control policies in Kentucky.

Special thanks to the following contributors:

Curt Rowe, Manager

Chronic Disease Prevention and Control Branch Kentucky Department for Public Health

Sam Burnette, Director

Division of Public Health Protection and Safety Kentucky Department for Public Health

George Robertson, Manager

Surveillance and Health Data Branch Kentucky Department for Public Health

Robert T. Rasnake

Data Management Coordinator UK College of Nursing Tobacco Policy Research Program

Katie Matthews

Matt Koger Christie Fann

Allison Frederick Seongkum Keo

Research Assistants UK College of Nursing Tobacco Policy Research Program

Funding for this project was provided in part through a Cooperative Agreement with the

Centers for Disease Control and Prevention—National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health.

Please direct requests for additional information to:

Ellen J. Hahn, DNS, RN Associate Professor University of Kentucky College of Nursing 760 Rose Street Lexington, Kentucky 40536-0232 (859) 257-2358 (859) 323-1057 (FAX) [email protected]

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Table of Contents Page

Acknowledgements ii

Table of Contents iii

Executive Summary iv

Methodology Overview Objectives Design Data Sources

5 6 7 7

Kentucky Report Card State Highlights 12

Centers for Disease Control funded Health Department Report Cards

Highlights (CDC) Cumberland Valley District Green River District Jefferson County Lexington-Fayette County Lincoln Trail District Madison County North Central District Northern Kentucky District Purchase District WEDCO District

19 20 23 28 33 38 43 48 53 58 63 68

CDC funded versus Non-CDC funded Health Department Service Areas

Highlights Report Card

73 74

References 78 Appendix

Healthy Kentuckians 2010 Tobacco Use Objectives

79

iii

Executive Summary

The purpose of the Kentucky Tobacco Use Prevention and Cessation Report Card is to describe tobacco use and policy patterns in the Commonwealth and selected local health department service areas from 1997 to 2001. Tobacco use is the single most preventable cause of death in Kentucky and the U.S. Kentucky leads the nation in adult cigarette smoking prevalence and spends over $1 billion dollars each year treating sick smokers. Although the Commonwealth of Kentucky is not making progress in reducing the percent of adults and pregnant women who smoke, the state is moving forward in reducing youth tobacco use, reducing youth access to tobacco products, adopting local voluntary smoke-free policies, and providing cessation programs. Public support for raising the tobacco tax and local option to pass laws related to tobacco prevention has remained the same over time, and very few manufacturing facilities ban smoking or offer resources to promote tobacco cessation for their employees. While almost all middle and high, public and private schools in the state ban smoking on school grounds for students, less than half have tobacco-free campuses banning tobacco use for employees. The Kentucky Department for Public Health (KDPH) Tobacco Prevention and Cessation Program supports local health departments in implementing comprehensive community-based programs that address the four Centers for Disease Control and Prevention (CDC) goals to reduce tobacco use and the associated health risks. The CDC goals are to (a) prevent initiation of tobacco use by youth and young adults; (b) promote cessation; (c) reduce exposure to secondhand smoke; and (d) identify and eliminate disparities among population groups that are disproportionately affected by tobacco use. The Kentucky Tobacco Prevention and Cessation Program has developed an Annual Plan that is based on the Healthy Kentuckians 2010 goals to reduce tobacco use. This Report Card illustrates the extent of progress toward meeting these goals at both the state and local level in selected health department service areas. For fiscal years 2000-2002, the Kentucky General Assembly allocated $5.5 million of the Master Settlement Agreement (MSA) monies to the Kentucky Department for Public Health for tobacco control (an average of $.60 per capita). The CDC recommends that Kentucky spend at least $6.42 per capita for comprehensive, evidence-based tobacco control. Prior to state MSA funding, ten local health departments received $60,000 per year from KDPH through a cooperative agreement with the CDC for comprehensive tobacco control. Seven of the 10 CDC funded health departments have been funded by the CDC since FY 1997-1998. The remaining three CDC funded health departments have been funded for tobacco control since FY 1998-1999. As a group, the 10 CDC funded health departments are significantly different than the non-CDC funded health departments in three areas: (1) the percent of smoking during pregnancy has remained significantly lower over time; (2) participation rates in tobacco cessation programs have steadily increased over time; and (3) the percent of smoke-free eating establishments has been significantly higher over time, compared to non-CDC funded health departments.

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Methodology Overview

Tobacco use is the leading cause of preventable death in Kentucky (Stapleton, 1998). The purpose of this report is to describe tobacco use and policy patterns in Kentucky and selected local health departments from 1997 to 2001. The use of tobacco creates a significant impact on Kentucky’s economy. In 1999, the cost of treating smoking-related illnesses in Kentucky exceeded one billion dollars (CDC Kentucky State Highlights, 2002). Kentucky spent $298 per capita on smoking-attributable direct medical costs. In 1998, tobacco cost Kentucky’s Medicaid system alone about $380 million. Kentucky employers bear the burden in higher premiums and taxpayers pay the price in increased public health spending. Kentucky’s high rate of tobacco use among adults hurts the state economy in other ways. Smoking cigarettes drives up employers’ disability costs and property insurance premiums and drains workforce productivity through time lost to cigarette breaks and sick days. In 1999 smoking attributable productivity costs were $465 per capita in Kentucky (CDC State Highlights, 2001). Smokers are absent from work 50% more often than non-smokers (CDC Fact Sheet, 2002). These economic realities place the state in a competitive disadvantage for attracting new employers and keeping existing ones.

The mission of the Kentucky Tobacco Prevention and Cessation Program is to reduce

preventable and premature deaths attributed to tobacco by implementing programs to diminish tobacco use and exposure to secondhand tobacco smoke. The program includes local and statewide initiatives aimed at preventing initiation of smoking in youth and helping those who wish to quit to do so. The Kentucky Department for Public Health Tobacco Use and Prevention and Cessation program supports local health departments that use existing infrastructure and strong linkages among community groups concerned about reducing the health risks and illness associated with tobacco use (Kentucky Department for Public Health, Tobacco Cessation and Prevention Program Annual Plan, 1999-2004).

The program is supported by funding from the Tobacco Master Settlement Agreement (MSA) and by a grant from the Centers for Disease Control and Prevention (CDC). In 1993, Kentucky was one of 13 states awarded funding from CDC for planning efforts. Funding for planning efforts were awarded to states that lacked the basic infrastructure needed to implement comprehensive tobacco prevention and cessation programs. The MSA funding was added at the request of Governor Patton to the Kentucky Legislature in the 2000 session. As a result of this request, an allocation of $5.5 million was added to the program for 2000-2002. The majority of the funding is allocated to local health departments to support comprehensive community based programs addressing the following four goals established by the Centers for Disease Control and Prevention:

• Preventing initiation of tobacco use by youth and young adults • Promoting cessation • Reducing exposure to secondhand smoke • Identifying and eliminating disparities among population groups that are

disproportionately affected by tobacco use

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Health departments and their community partners play a direct and vital role in educating leaders, decision-makers, the public and others in understanding the need for economic, social, and environmental changes that impact tobacco use (Healthy Kentuckians, 2010). Local health departments have a full or part-time tobacco coordinator who is responsible for forming a local partnership and preparing an annual plan that indicates how community partners will work with others to address the four CDC goals and local needs. Staff in the Department for Public Health provide technical support and training for local health departments to help them achieve their goals. The Department for Public Health provides workshops related to best practices, community mobilizations, policy development, surveillance, and evaluation. Objectives

The Kentucky Tobacco Cessation and Prevention Program (KTCP) Annual Plan (1999-2004) actualizes the mission of the program by identifying goals and objectives with targeted outcomes. The annual plan is linked with Healthy Kentuckians 2010 in terms of goals, objectives, and data sources (see Appendix). Figure 1 illustrates the connection between the Kentucky Annual Plan and Healthy Kentuckians 2010.

Figure 1. Sample Objectives, Kentucky Annual Plan and Healthy Kentuckians 2010

Objectives KY Tobacco Annual Plan 2004 Goal

Healthy Kentuckians 2010 Goal

Reduce cigarette use among adults. 28% 25% Reduce cigarette smoking among pregnant women.

22% 17%

Increase proportion of adult smokers who quit for a day or more.

60% 58%

Increase percent of food service establishments that prohibit smoking or limit it to separately ventilated areas.

40% 51%

Increase the number of workplaces that prohibit smoking.

43% 48%

Increase the proportion of schools with tobacco-free environments.

100% 100%

Reduce the proportion of young people who have smoked cigarettes in the past 30 days.

29% males 27% females

29% males 27% females

Increase compliance with youth access laws.

95% 95%

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Design

The purpose of this section is to describe the design and data sources used for the development and analysis of the Report Card. The primary goal of the Report Card is to monitor change over time in tobacco prevention and cessation related outcomes in Kentucky.

A time series design was used to analyze and compare changes in adult cigarette use, smoking during pregnancy, adult quit attempts, participation in tobacco cessation programs, smoking policy in food service establishments, tobacco policy in manufacturing facilities, public opinion, youth tobacco use, school tobacco policies, and illegal sales to minors using county and state level data over a five year time frame (1997-2001). Data Sources

Nine data sources were used to evaluate outcomes: The Behavioral Risk Factor Surveillance System (BRFSS), Kentucky Vital Statistics Birth File, Local Health Department (LHD) Tobacco Cessation Survey, Smoking Policy in Food Service Establishments, Workplace Tobacco Policy Survey, University of Kentucky Survey Public Opinion Poll, Kentucky Youth Tobacco Survey (KYTS), School Tobacco Policy Survey, and Illegal Tobacco Sales to Minors Data Base. Figure 2 displays the data sources in regard to the four CDC goals. Data analysis consisted of examining differences in percents and rates over time. Confidence intervals were used to determine the range of values (interval) that the true score (+ 3) would be 95% of the time.

Figure 2. KDPH Tobacco Cessation and Prevention Program Surveillance and Evaluation Data Sources

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Level of Data Prevent Youth Initiation

Promote Cessation

Eliminate ETS

County Illegal Tobacco

Sales

KY Birth Record

Food Service

Establishment

Funded Service Areas

School Policy Survey

BRFSS

LHD Tobacco Cessation

Workplace Policy Survey

State KYTS UK Public Opinion

Poll

Health Disparities

The Behavioral Risk Factor Surveillance System (BRFSS)

The BRFSS was used to determine change in adult cigarette use (past 30 days) and change in attempts to quit smoking within the past 12 months from 1997 to 2000. The BRFSS is a collaborative effort between the Kentucky Department of Health Services and the Centers for Disease Control and Prevention (CDC) to monitor state-level prevalence of the major behavioral risks associated with premature morbidity and mortality in adults. The Department for Public Health compiles these data and makes the electronic file available annually to the authors.

The purpose of the BRFSS is to examine trends over time, monitor program progress,

formulate policy for health initiatives, and measure progress toward state health objectives. Because it would be impossible to phone every household in Kentucky each year, the BRFSS relies on a sample of the population. The sampling method used assures comparability of data across the state and over time. A Disproportionate Stratified Sample (DSS) method is used to select phone numbers randomly throughout the state. Business and nonworking numbers are omitted for adults 18 years or older. To ensure data quality, interviewers are specially trained to ask questions exactly the same way for each call. Interviewers use the Computer Assisted Telephone Interview (CATI) software to manage dialing and data collection. The CATI standardized interviews takes 10 to 20 minutes and responses are entered directly into the computer by interviewers.

Data about adult cigarette use and attempts to quit smoking were analyzed from core

questions on the BRFSS regarding tobacco use. For example, smoking prevalence included the question, “Do you now smoke cigarettes everyday, some days, or not at all?” If the response was everyday or some days, the person was identified as a smoker. Quit attempts included the question, “During the past 12 months, have you quit smoking for one day or longer?” If the answer was yes, the smoker was considered to have made a quit attempt.

The BRFSS was designed to produce accuracy in prevalence data at the 95% confidence level. However, small sample sizes and the ability to segregate data by geographic region and demographic variables decrease statistical power. Since some of the health department service areas were not adequately represented in the annual BRFSS samples (sample sizes < 50), data were aggregated over three years (1997-1999 and 1998-2000) to ensure adequate sample sizes. Thus, moving rates are reported to show change over time in those health departments. The aggregated data reflect the unweighted estimates for the health department service area compared to Kentucky. Kentucky Vital Statistics Birth File

The Kentucky Vital Statistics Birth File was used to track smoking during pregnancy from 1997 to 2000. On every birth record, the mother was asked whether or not she smoked during pregnancy (yes/no). The Kentucky Vital Statistics Birth File represents a census of all babies born to mothers who reside in Kentucky by county. The Department of Public Health compiles these data and makes the electronic file available annually to the authors.

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Local Health Department Tobacco Cessation Survey

The Local Health Department Tobacco Cessation Survey (LHDTCS) was used to determine the rate of participation in tobacco cessation programs per 10,000 adult smokers from 1999 to 2001.

The LHDTCS was created by Hahn et al. to monitor the amount and type of tobacco

cessation services offered by the health departments in Kentucky. All 55 health departments voluntarily participate in the annual telephone survey. Participants include local health department tobacco prevention coordinators, health educators, and clinic managers. The number of tobacco cessation programs offered per year was measured by the question, “How many tobacco cessation programs were offered within the past year?” Every summer, the University of Kentucky College of Nursing staff conducts telephone interviews with Tobacco Coordinators and local Health Department Staff to assess services provided during the past fiscal year. Thus, the 2001 LHDTCS reflects services provided during fiscal year 2000-2001.

Rate of participation versus absolute numbers of cessation program participants was

used to determine the program’s reach in relation to the estimated population of adult smokers in the service area. The U.S. census data were used to determine the number of adults in a health department service area. The BRFSS was used to determine the proportion of adult smokers for the same area. The actual number of annual participants in the health department service area cessation programs was divided by the number of adult smokers in any given year. This number was multiplied by 10,000 to obtain the rate per 10,000. The use of a rate per 10,000 smokers allows for comparison to the state rate. Figure 3 illustrates this calculation using data for Fayette County in 2000.

Figure 3. Calculation Method Used to Determine Health Department Service Area Rate of Participation in Tobacco Cessation Programs

9

Rate Calculation Example Adult Population Proportion of Smokers Number of Smokers 205,023 x .241 = 49,411 Number of Participants Number of Smokers Raw Rate 45 divided by 49,411 = .00091 Raw Rate Multiplier Rate per 10,000 Smokers .00091 x 10,000 = 9.1

Smoke-free Food Service Establishment Survey The Kentucky Department for Public Health, Division of Environmental Health and

Community Safety, tracks smoking policies in food service establishments as part of the regular semi-annual food service inspections in every health department service area. The Smoke-Free Food Service Establishment Survey (SFFSES) was created to form a statewide database to track policies in all food service establishments in Kentucky. The existing Food Service Inspection Survey form was modified to include questions about smoking policies. The question used for this report is: “Is smoking allowed in the establishment?” If the response was no, the food service establishment was considered a smoke-free restaurant. The population from which the sample for the SFFSES was drawn includes all food establishments inspected by environmentalists in Kentucky.

Food establishments are defined as any facility that serves prepared food including gas

station convenience stores, and food markets. Schools, daycare centers, and churches were excluded from the database used for the analysis. Environmentalists assess smoking policy during routine food inspections conducted every six months. Data are entered into field computers by local health department staff. For 2001, data were collected on 85% of the Health Department Service Areas resulting in 6,373 food establishments surveyed.

The electronic data file is provided by the Kentucky Department for Public Health, and

the Division of Environmental Health, to the College of Nursing on an annual basis. In October of every year, the Kentucky Department of Public Health queries the database for the percent of eating establishments that were smoke-free at that point in time. The database is continually updated as six-month inspections are completed and entered into the system by local health department staff.

Workplace Tobacco Policy Survey

The Workplace Tobacco Policy Survey was used to assess smoking policies and

cessation resources in manufacturing facilities in Kentucky. The Workplace Tobacco Policy Survey is a bi-annual project that was piloted in 1999 with selected CDC-funded health departments. Tobacco coordinators were trained to conduct telephone interviews with human resource managers to assess a variety of tobacco policy issues. The 42-item interview guide includes questions about the company's written indoor and outdoor smoking policies, health care reimbursement for smoking cessation, sale of cigarettes on company property, provision of cessation and prevention programs, existence of community outreach and/or funding programs, and interest in changing company smoking policy. Currently in 2002, the Workplace Tobacco Policy Survey is underway with all 55 health department service areas.

Public Opinion Poll

Twice per year (spring and fall), public opinion about tobacco policy data are collected

by the University of Kentucky Survey Research Center as part of the Kentucky Survey, a statewide telephone survey of randomly selected non-institutionalized Kentucky adults. The purpose of the survey is to learn about public views on social, political, health, and economic

10

issues affecting Kentucky residents. Households are selected using random-digit dialing, a procedure giving every residential telephone line in Kentucky an equal probability of being called. The Kentucky Survey is designed to produce accuracy at the 95% confidence level.

For this report, public opinion poll respondents were asked whether they would favor an

increase in the cigarette tax as a deterrent to smoking (yes/no), and whether they would support giving communities the option of enacting local laws aimed at curbing teen tobacco use (yes/no). These issues were assessed biannually in 1999 and 2001. Because these data are available only at the state level, public opinion data are only reported in the Kentucky Report Card. The University of Kentucky Survey Research Center collects and compiles these data and makes the electronic file available to the authors.

School Tobacco Policy Survey

The School Tobacco Policy Survey was used to assess smoking policies and cessation

resources in public and private, middle and high schools in Kentucky. The School Tobacco Policy Survey is a bi-annual project that was piloted in 1999 with the CDC-funded health departments and extended to a random sample of health department service areas in 2001 Kentucky Department for Public Health, 1999-2001b. In 2001, health department service areas were randomly selected within each of the 15 Area Development Districts. Tobacco coordinators were trained to conduct telephone interviews with principals or assistant principals to assess a variety of tobacco policy issues. The 34-item interview guide includes questions about indoor and outdoor smoking policies, actions taken with violators, cessation services provided to students and employees, and research-based curricula. In 2003, the School Tobacco Policy Survey will be conducted in all 55 health department service areas.

Kentucky Youth Tobacco Survey

Kentucky Youth Tobacco Survey (KYTS) was used to track tobacco use among youth using a common methodology and core questionnaire. The biannual survey is intended to enhance the capacity of health departments to design, implement, and evaluate tobacco control and prevention programs. The survey is composed of seven core topics: prevalence of cigarette smoking and other tobacco use, knowledge and attitudes toward cigarette smoking, role of the media and advertising on use of cigarettes, access to cigarettes, tobacco-related school curricula environmental tobacco smoke (ETS), and cessation of cigarette smoking. A multistage sampling design with schools selected proportional to enrollment size was used to survey students from 13 to 15 years of age. Classrooms were chosen randomly within selected schools using an anonymous and confidential self-administered questionnaire. Completed survey answer sheets were sent to CDC for data entry and analysis.

Illegal Tobacco Sales to Minors Data Base

The data on illegal tobacco sales to minors is obtained by open records request annually from Kentucky Alcoholic Beverage Control (ABC). Data are gathered from June 1 to May 31 of every year. The percent of illegal tobacco sales to minors was assessed from 1997 to 2000. Illegal sales rates were based on the % of attempts to purchase tobacco products by underage youth (17 and younger).

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Kentucky Report Card

State Highlights

Kentucky has made progress in four of the ten areas over the past five years, made no

progress in five areas, and is losing ground in one tobacco prevention and cessation area. The State highlights that follow provide charts describing the outcomes over time. The following provides a narrative summary of the data.

Making Progress

The proportion of health departments providing tobacco cessation programs has increased from 1999 to 2001 by nearly 10%. Health departments are providing research-based cessation programs and have increased numbers of requests for tobacco use cessation programs, reflecting better marketing of services and an increase in consumer demand.

The percent of smoke-free food establishments significantly increased by 20% from 1999 to 2001. The 20% increase in smoke-free food service establishments reflects voluntary policy change since there are no local or state laws restricting smoking in public places.

There was a decrease in youth smoking and an increase in the retail price of cigarettes

from 1997 to 2000. Prevention of tobacco use among children and adolescents can lead to substantial reductions in death and disease from tobacco products among adults.

Tobacco sales to minors have decreased significantly from 1999 to 2000. No Progress

There was no significant change in the percent of adults who use cigarettes from 1997 to 2000. The age-adjusted death rate from heart disease and the age-adjusted incidence rate from lung cancer increased from 1997 to 1999. Kentucky leads the nation in adult smoking prevalence. Tobacco use is directly linked to heart disease and lung cancer.

There was no significant change in the percent of women who smoke during

pregnancy from 1997 to 2000. Pregnant women in Kentucky are two times more likely to smoke during pregnancy than women in the U.S. Women who smoke have increased risks for miscarriage, preterm labor, and low birth weight.

12

There was no significant change in the percent of adult smokers attempting to quit from 1997 to 2000. Although Kentucky smoking rates are higher than the U.S., adult smokers in Kentucky are just as likely to attempt to quit as smokers in the U.S.

There was no significant change in smoking policies in manufacturing facilities from

1999 to 2000. In 2000, about one in four manufacturing facilities offered resources for smoking cessation and reimbursed employees for cessation.

Support for raising the cigarette tax and local option remained fairly constant from

1999 to 2001. Nearly half of Kentuckians support raising the cigarette tax. Three-fourths of Kentuckians support local governments’ ability to pass laws related to tobacco prevention. Raising the real price of tobacco products by increasing cigarette excise tax is the single most effective approach to reducing tobacco use, especially among youth. Losing Ground

Only 15% of middle and high schools provide smoking cessation services to students and employees. While almost all middle and high schools ban smoking on school grounds for students, only 44.7% ban smoking on school grounds for employees. To change pro-tobacco norms, CDC recommends that the entire school environment be tobacco-free including students, faculty, staff, and visitors.

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30.529.730.830.723.222.622.923.2

01020304050

1997 1998 1999 2000

Perc

ent Kentucky

US

√ There was no significant change in the percent of adults who smoked cigarettes in Kentucky from 1997 to 2000.1 √ The age-adjusted death ratea from heart disease increased from 159.5 in 1997 to 313.4 in 1999.2 √ The age-adjusted incidence ratea from lung cancer increased from 79.37 in 1997 to 81.57 in 1999.3 a Age-adjusted rate per 100,000 total population Kentucky leads the nation in adult smoking prevalence. Tobacco use is directly linked to heart disease, lung and other cancers, and emphysema. One goal of Healthy Kentuckians 2010 is to reduce cigarette use among adults to 25%.

√ While there was a statistically significant drop in the percent of women who smoked during pregnancy from 1997 to 1998, there was no significant change in the percent of women who smoked during pregnancy in Kentucky from 1998 to 2000.4 √ Pregnant women in Kentucky are two times more likely to smoke during pregnancy than women in the US.4 Women who smoke have increased risks for miscarriage, preterm birth, and low birth weight. About 70% of mothers who stop smoking during pregnancy start again after the baby is born.5

One objective of Healthy Kentuckians 2010 is to reduce cigarette smoking among pregnant women to no more than 17%.

Smoking During Pregnancy, 1997-2000

12.6

23.723.723.724.7

13.2 12.9 12.3

0

10

20

30

1997 1998 1999 2000

Perc

ent

KentuckyUS

15

√ The percent of adult smokers attempting to quit in Kentucky was similar over time.1 √ The percent of adult smokers attempting to quit in Kentucky remained similar to national estimates from 1997 to 2000. 1 Given that nearly half of Kentucky smokers report at least one quit attempt, research-based tobacco dependence treatment and cessation services are needed. Healthy Kentuckians 2010 recommends increasing the proportion of adult smokers who stop smoking for a day or more to 58%.

Adult Quit Attempts, 1997-200050.5 48 49.9 48.249.2 47.8 51.3 49.4

0

10

20

30

40

50

60

1997 1998 1999 2000

Perc

ent KY

US

Tobacco Cessation Services in Local Health Departments (LHD), 1999-2001

√ The proportion of health departments providing tobacco cessation programs increased from 1999 to 2001 by nearly

10% .6 √ There was a nearly 70% increase in the number of health departments that provided Cooper Clayton group programs

from 1999 to 2001.6 √ The percent of health departments reporting requests for tobacco cessation services increased by 160% from 1999 to 2001.6 Health departments are providing research-based cessation programs and have increasing numbers of requests for tobacco use cessation programs, reflecting better marketing of services and an increase in consumer demand. Healthy Kentuckians 2010 recommends that all health departments provide research-based smoking cessation services.

Percent o f LHD 's Pro vid ing T o b acco C essat ion Pro grams, 19 9 9 - 2 0 0 1

72.753

68

0

20

40

60

80

1999 2000 2001

Perc

ent

Percent o f LHD 's R ep o rt ing C o o p er- C layt o n Pro g rams Pro vid ed in t heir Service A rea,

19 9 9 - 2 0 0 1

53.742.6

32

0

20

40

60

80

1999 2000 2001

Perc

ent

Percent o f LHD 's R eport ing R equest s f o r C essat ion Services,* 19 9 9 - 2 0 0 1

53

37

20

010

203040

5060

1999 2000 2001

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* Data from CDC-funded areas only √ There was no significant change in the percent of manufacturing facilities that had smoking policies from 1999 to

2000.8 √ The percent of manufactures that banned smoking remained similar from 1999 to 2000.8 √ There was a decline in the percent of manufacturing facilities that offered resources for smoking cessation from 1999 to 2000.8 √ There was a decline in the percent of manufacturing facilities that reimbursed employees for smoking cessation from

1999 to 2000.8 Four in ten manufacturing facilities in Kentucky banned indoor smoking in 1999 and 2000. Smoking at worksites presents an important source of environmental tobacco smoke that has been shown to have ill health effects on employees and contributes to lost productivity. In 2000, very few manufacturing facilities made smoking cessation resources available to their employees. Healthy Kentuckians 2010 recommends increasing the percentage of manufacturing facilities that reimburse for smoking cessation services to 48%.

Tobacco Policy in Manufacturing Facilities, 1999-2000*

324039

67

2624

43

69

0

20

40

60

80

Have smokingpolicies

Ban indoor smoking Offer cessationresources

Reimburse forcessation

Perc

ent

1999 (N=160)

2000 (N=437)

Smoking Policy in Food Service Establishments, 1999-2001

√ The percent of smoke-free food establishments increased by 20% from 1999 to 2001. 7

The 20% increase in smoke-free food service establishments reflects voluntary policy change since there are no local or state laws restricting smoking in public places. Healthy Kentuckians 2010 recommends increasing the percent of food service establishments that prohibit smoking or limit it to separately ventilated areas to 51%.

Percent of Smoke-free Eating Establishments

32 34.738.6

0

10

2030

40

50

1999 2000 2001

Perc

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Kentucky

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Adults Who Support Local Option, 1999-2001

71.5 75.9

0

20

40

60

80

100

1999 2001

Public Opinion Survey, 1999-2001

√ Nearly half of Kentuckians supported raising the cigarette tax in 2001.9 √ Three-fourths of Kentuckians support local governments’ ability to pass laws related to tobacco prevention.9 Raising the real price of tobacco products by increasing cigarette excise tax is the single most effective approach to reducing tobacco use, especially among youth. Of those who favor a tax hike, nearly two-thirds support a tax increase of 25 cents or more. Nearly 8 in 10 Kentuckians continue to support local government’s ability to pass laws related to tobacco prevention. One goal of Healthy Kentuckians 2010 is to increase the proportion of localities that adopt ordinances and policies to restrict tobacco use.

Adults Who Support Local Option, 1999-2001

71.5 75.9

0

20

40

60

80

100

1999 2001

Perc

ent

School Smoking Policy, 1999-2001

√ While almost all middle and high schools ban smoking on schoolgrounds for students, only 44.7% banned smoking on school grounds for employees in 2001. 10 √ Only 15% of middle and high schools provided smoking cessation services to students and employees in 2001.10

The CDC recommends that the entire school environment be tobacco-free for all students, faculty, staff, and visitors. Nearly 6 in 10 middle and high school smokers report trying to quit in the last 12 months,11 yet only 15% of schools in Kentucky provide directed smoking cessation services for students and employees. One Healthy Kentuckians 2010 goal is to increase to 100% the proportion of school with tobacco-free environments including all school property, vehicles, and at all school events.

Direct Smoking Cessation Services in Middle and High Schools, 2001

15%

85%

Yes

No

Smoking Banned on School Grounds, Middle and High Schools

65

97

44.7

96.8

020406080

100120

Students Employees

Perc

ent

1999

2001

Adults who Support Cigarette Tax Increase 1999-2001

44.4 46.7

0

20

40

60

1999 2001

Perc

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Current Youth Tobacco Use*, 1997-2000

* Note. Current use is defined by the CDC as smoking cigarettes on one or more of the past 30 days √ There was a steady increase in tobacco use fom 6th to 12th grade.11

√ Smokeless tobacco use among male middle and high school students is higher than for female students.11

√ There was an increase in the retail price of cigarettes and a decrease in youth smoking from 1997 to 2000.11

√ Kentucky middle school students were nearly two times more likely to be current smokers than those in the U.S. √ High school smoking in Kentucky is over 30% higher than the U.S. 11

Smoking among high school students in Kentucky has decreased from 1997 to 2000. Prevention of tobacco use among children and adolescents can lead to substantial reductions in death and disease from tobacco products among adults. One goal of the Healthy Kentuckians 2010 is to reduce the proportion of young people who have smoked cigarettes in the past 30 days to 29% for males and 27% for females.

Current Youth Smoking and the Average Retail Price of Cigarettes,

1997-2000.

3 74 7

$ 2 . 5 0

$ 1 . 4 6

020406080

100

1997 2000$0.00

$1.00

$2.00

$3.00

Current yout hsmokers

Average priceof pack ofcigaret t es

%

Current Use of Tobacco Products by Grade, 2000

020406080

100

6th 7th 8th 9th 10th 11th 12th

Any tobaccoCigar etteSLTCigar s

Perc

ent

Gr ade

Current Smokeless Tobacco use Among Middle and High School Students by

Gender, 2000

16 2 3

2 20

20

40

60

80

100

M iddle School High School

Perc

ent

M ale Female

Current Smoking among Middle and High School Students, 2000

22

37

12

29.2

0102030405060

M iddle School High SchoolPe

rcen

t

KY

US

Youth Access to Tobacco Products

√ The percent of tobacco sales to minors declined significantly from 1999 to 2000. 12

Healthy Kentuckians 2010 aims to strengthen minors’ access laws by increasing compliance to 95% or higher. Although the illegal sale rate has declined over time, only one in three youth smokers report being refused purchase of tobacco products statewide.11

Illegal Tobacco Sales, 1997-2000

1415.4

13.18.7

0

10

20

1997 1998 1999 2000

Perc

ent

Current Youth Smokers Refused Purchase of Cigarettes due to age

3431 3029

0

20

40

Middle School High School

Perc

ent Male

Female

19

Centers for Disease Control (CDC) funded Health Department Report Cards

The purpose of this section is to summarize the status of the ten health departments in regard to the primary outcomes for tobacco prevention and cessation over time. These 10 health departments serve a total of over 2.1 million people.

Prior to the MSA funding for tobacco prevention and cessation, 10 local health

departments in Kentucky received a small amount of funding ($60,000 per health department) through a cooperative agreement between the CDC and the Kentucky Department for Public Health. Seven of the health departments (Cohorts I and II) have been funded by CDC for approximately five years (since FY 1997-1998). Three health departments (Cohort III) have had approximately four years of CDC funding (since FY 1998-1999). Although all of these health departments are relatively new to tobacco prevention and cessation, Cohort I has had the most experience with tobacco control, followed by Cohorts II and III. In FY 2000-2001, all health departments received MSA funds for tobacco prevention and cessation. These funds were added to the CDC monies to comprise their total tobacco prevention and cessation budget. The CDC funded health departments by Cohort are:

Cohort I: Green River District, Madison County, North Central District, Northern Kentucky District Cohort II: Cumberland Valley, Purchase, WEDCO Districts Cohort III: Jefferson County, Lexington-Fayette County, Lincoln Trail District

Figure 4. CDC Funded Health Department Service Areas by Cohort

BALLARD

CARLISLE

GRAVES

McCRACKEN

FULTON

HICKMAN

CRITTENDEN

CALDWELL

TRIGG

LYON

LIVINGSTON

MARSHALL

MCLEAN

HENDERSON

UNION

WEBSTER

HOPKINS

CHRISTIAN

WOODFORD

BOONE

ROBERT

‘ SON

GALLATIN

CARROLLTRIMBLE

MASON

BRACKENPENDLETON

OWEN

KENTON

GRANT

CAMPBELL

BOYLE

FAYETTE

JESSA MINEMERCER

WASHINGTON

ANDERSON

GARRARD

SPENCER

SHELBY

HENRYOLDHAM

HARRISON

SCOTTFRANKLIN

NELSON

BULLITT

JEFFERSON

GRAYSON

HARDIN

BRECKINRIDGE

MEADE

MARION

HART

EDMONSON

BARREN

LARUE

CALLOWAY

SIMPSON

TODD

BUTLERMUHLENBERG

LOGAN

ALLEN

WARREN

HANCOCK

DAVIESS

OHIO

METCALFRUSSELL

ADAIR

CLINTON

CUMBERLAND

MONROE

CASEY

PULASKI

WAYNE

McCREARY

TAYLOR

GREEN

NICHOLAS

BOURBON

BELL

JACKSON

LAUREL

ROCKCASTLE

KNOX

LINCOLN

CLAY

WHITLEY

OWSLEY

ESTILLMADISON

KNOTTPERRY

LETCHERLESLIE

HARLAN

LEE FLOYDBREATHITT PIKE

POWELL

BOYD

MORGANJOHNSON MARTIN

WOLFE MAGOFFIN

MONTGOMERYCLARK MENIFEE

GREENUP

ROWAN

CARTER

ELLIOTT LAWRENCE

LEWIS

FLEMING

BATH

LAH 9/11/02

Cohort I

Cohort II

Cohort III

CDC Funded Health Department Highlights

Current Adult Cigarette Use There was no significant change in the percent of adults who smoked cigarettes in any of the CDC funded health departments from 1997 to 2000. However, the percent of adults who smoked cigarettes in the Purchase District decreased significantly from 1997 to 1999. In one CDC-funded health department, WEDCO District, the percent of adults who smoked cigarettes was significantly higher than the state rate in 1998-2000. Two CDC-funded health departments met the Healthy Kentuckian 2010 Objective to reduce cigarette use among adults to 25% in 2000: Lexington-Fayette County and Purchase District Health Departments. Smoking During Pregnancy Five of the CDC-funded health departments showed no significant change in the percent of women who smoked during pregnancy from 1997 to 2000. However, there was a significant decline in the percent of women who smoked during pregnancy in three CDC funded health departments over time: Jefferson County, Lexington-Fayette County, and Northern Kentucky Independent District Health Departments. Two health departments showed significant declines in the years preceding 2000, but the percent of women in these districts who smoked during pregnancy remained stable in more recent years (Lincoln Trail and WEDCO). The rates of smoking during pregnancy in seven of the health departments were similar to the state in 2000. The percent of women who smoked during pregnancy in two health departments remained significantly lower than the state rate from 1997 to 2000: Jefferson and Lexington-Fayette County. The Cumberland Valley District Health Department smoking during pregnancy rate remained significantly higher than the state from 1997 to 2000. One CDC funded health department met the Healthy Kentuckian 2010 Objective to reduce cigarette smoking among pregnant women to no more than 17%: Lexington-Fayette County Health Department. Adult Quit Attempts The percent of adult smokers attempting to quit remained similar over time in all 10 CDC-funded health departments. In all but one health department, the percent of adult smokers attempting to quit remained similar to the state rate from 1997 to 2000. The percent of adult smokers attempting to quit in Lexington-Fayette County was significantly higher than the state in 1998-2000.

One CDC-funded health department met the Healthy Kentuckian 2010 Objective to increase the proportion of adult smokers who stop smoking for a day or more to 58%: Lexington-Fayette County Health Department.

20

Participation in Tobacco Cessation Programs

Although the rate of participation in tobacco cessation programs in six of the CDC funded health departments increased over time, very few adult smokers are being reached by current programs. The health departments with the highest cessation program participation rates in 2001 were (in order from highest to lowest): Green River District, Cumberland Valley District, North Central District, and Purchase District Health Departments. Three health departments showed declines in 2001 in the cessation program participation rate: Lexington- Fayette County, Lincoln Trail, and Madison County. The Jefferson County tobacco cessation program participation rate remained unchanged from 1999 to 2001. The cessation program participation rates in two health departments were markedly lower than the state rate in 2001: Jefferson County and Lexington-Fayette County Health Departments. Smoking in Food Service Establishments

In five health departments, the percent of smoke-free food establishments increased significantly over time: Green River District, Jefferson County, Lexington-Fayette County, Madison County, and WEDCO District Health Departments. The percent of smoke-free food establishments did not change significantly in the other five CDC funded health departments. Compared to the state rate, five health departments had similar smoke-free food establishment rates. The percent of smoke-free food establishments was significantly higher than the state rate in 2001 in three health departments: Jefferson County, Lexington-Fayette County, and WEDCO District Health Departments. Two health departments were significantly lower than the state rate on percent of smoke-free food establishments: Cumberland Valley District and Green River District Health Departments. Tobacco Policy in Manufacturing Facilities

Change over time could be assessed in three Cohort I health departments (Green River did not participate in 2000). There was no significant change from 1999 to 2000 in the percent of manufacturing facilities that had smoking policies, those that banned indoor smoking, or those that offered cessation resources or reimbursed for cessation in Madison County, North Central District, or Northern Kentucky District Health Departments.

The percent of manufacturing facilities that banned smoking in 2000 was similar to the total sample for all CDC funded health departments that participated in the 2000 surveys. Only 4 in 10 manufacturing facilities banned indoor smoking. While almost all health departments were similar to the total sample on offering cessation resources and reimbursing for cessation in 2000, two health departments were significantly lower than the total sample. Manufacturers in Lexington-Fayette County were significantly less likely to offer cessation resources in 2000 than the total sample. Manufacturers in the Lincoln Trail District were significantly less likely to reimburse for smoking cessation in 2000 than the total sample.

21

School Smoking Policy

Eight of the 10 CDC-funded health departments participated in the School Tobacco Policy Survey in both 1999 and 2001. North Central participated only in 1999 and Jefferson County participated only in 2001. The percent of schools that banned smoking on school grounds for employees did not change significantly in any of the health department service areas that participated in 1999 and 2001. Similarly, the percent of schools offering smoking cessation services to students and/or employees did not change significantly from 1999 to 2001.

The percent of schools that banned smoking on school grounds for employees in 2001 was similar to the total sample in five health departments. Three health departments had a significantly higher proportion of schools reporting banning on school ground for employees than the total sample: Cumberland Valley District, Lexington-Fayette County, and Madison County Health Departments. The percent of schools banning smoking on school grounds for employees in 2001 was significantly lower in the Green River District compared with the total sample. Illegal Tobacco Sales to Minors

The percent of tobacco sales to minors did not change significantly over time in eight CDC funded health departments. Two health department service areas noted significant declines over time: Lexington-Fayette County and Lincoln Trail District Health Department. In six health departments, the percent of tobacco sales to minors was similar to the state rate from 1997 to 2000. The illegal tobacco sales rate remained significantly lower than the state rate in one health department service area: Lincoln Trail District Health Department. In one health department, the illegal tobacco sales rate was significantly higher than the state rate in 2000: Madison County.

22

Cumberland Valley District Highlights

There was no significant change in the percent of adults who smoked cigarettes in the Cumberland Valley District from 1997 to 2000. Similarly, there was no significant change in the percent of women who smoked during pregnancy for this same time period. The percent of adult smokers attempting to quit was similar over time. The rate of participation in tobacco cessation programs increased from 1999 to 2001, and the rate was higher in the Cumberland Valley District than in the rest of the state for 2001. The percent of smoke-free food establishments did not change significantly over time. Nearly 5 in 10 manufacturing facilities banned smoking. The percent of schools banning smoking on school grounds in 2002 was significantly higher in the Cumberland Valley District than the total Kentucky sample. The percent of schools providing cessation services did not change significantly from 1999 to 2001. The percent of sales to minors in the Cumberland Valley District did not change significantly from 1997 to 2000. Figure 5. Cumberland Valley District Health Department Service Area

BALLARD

CARLISLE

GRAVES

McCRACKEN

FULTON

HICKMAN

CRITTENDEN

CALDWELL

TRIGG

LYON

LIVINGSTON

MARSHALL

MCLEAN

HENDERSON

UNION

WEBSTER

HOPKINS

CHRISTIAN

WOODFORD

BOONE

ROBERT

‘ SON

GALLATIN

CARROLLTRIMBLE

MASON

BRACKENPENDLETON

OWEN

KENTON

GRANT

CAMPBELL

BOYLE

FAYETTE

JESSA MINE

MERCER

WASHINGTON

ANDERSON

GARRARD

SPENCER

SHELBY

HENRYOLDHAM

HARRISON

SCOTTFRANKLIN

NELSON

BULLITT

JEFFERSON

GRAYSON

HARDIN

BRECKINRIDGE

MEADE

MARION

HART

EDMONSON

BARREN

LARUE

CALLOWAY

SIMPSON

TODD

BUTLERMUHLENBERG

LOGAN

ALLEN

WARREN

HANCOCK

DAVIESS

OHIO

METCALFRUSSELL

ADAIR

CLINTON

CUMBERLAND

MONROE

CASEY

PULASKI

WAYNE

McCREARY

TAYLOR

GREEN

NICHOLAS

BOURBON

BELL

JACKSON

LAUREL

ROCKCASTLE

KNOX

LINCOLN

CLAY

WHITLEY

OWSLEY

ESTILLMADISON

KNOTTPERRY

LETCHERLESLIE

HARLAN


POWELL

BOYD


WOLFE MAGOFFIN


GREENUP

ROWAN

CARTER

ELLIOTT LAWRENCE

LEWIS

FLEMING

BATH

LAH 9/11/01

Cumberland Valley

23

Cumberland Valley

24

√ There was no significant change in the percent of adults who smoked cigarettes in the Cumberland Valley District from 1997 to 2000.1 √ The age-adjusted death ratea from heart disease increased from 332.1 in 1997 to 361.2 in 1999.2 √ The age-adjusted incidence ratea from lung cancer increased slightly from 108.02 in 1997 to 108.93 in 1999.3 aAge-adjusted rate per 100,000 total population. The percent of adults who smoke cigarettes in the Cumberland Valley District remained similar to the state from 1997 to 2000. Tobacco use is directly linked to heart disease, lung and other cancers, and emphysema. One goal of Healthy Kentuckians 2010 is to reduce cigarette use among adults to 25%.

√ There was no significant change in the percent of women who smoked during pregnancy in the Cumberland Valley District

from 1997 to 2000.4 √ The percent of women who smoke during pregnancy in the Cumberland Valley District was significantly higher than the state

from 1997 to 2000.4 Women who smoke have increased risks for miscarriage, preterm birth, and low birth weight. About 70% of Kentucky mothers who stop smoking during pregnancy start again after the baby is born.5 One objective of Healthy Kentuckians 2010 is to reduce cigarette smoking among pregnant women to no more than 17%.


34.232.430.333.7

23.423.723.724.7

12.612.312.913.2

05

10152025303540

1997 1998 1999 2000

Perc

ent Cumberland Valley

KentuckyU.S.

Current Adult Cigarette Use, 1997-2000

36.730.5 31.630.6

38.730.8 29.7 30.5

0

10

20

30

40

50

1997 1998 1999 2000

Perc

ent

Cumberland ValleyKentucky

* Weighted estimates

Cum

berla

nd V

alle

y To

bacc

o Pr

even

tion

and

Ces

satio

n R

epor

t Car

d

Cum

berla

nd V

alle

y To

bacc

o Pr

even

tion

and

Ces

satio

n R

epor

t Car

d

√ The percent of adult smokers attempting to quit in the Cumberland Valley District was similar over time.1 √ The percent of adult smokers attempting to quit in the Cumberland Valley District remained similar to the state

from 1997 to 2000.1 Given that nearly half of Kentucky smokers report at least one quit attempt, a variety of research-based tobacco dependence treatment and cessation services are needed. Healthy Kentuckians 2010 recommends increasing the proportion of adult smokers who stop smoking for a day or more to 58%.

Adult Quit Attempts, 1997-2000

45.041.8 46.947.3

0102030405060

1997-1999 1998-2000

Perc

ent


Participation in Tobacco Cessation Programs, 1999-2001

√ The rate of participation in tobacco cessation programs in the Cumberland Valley District increased from 1999 to

2001.6 √ The cessation program participation rate in the Cumberland Valley District was higher than the state in 2001.6 Health departments are providing research-based cessation programs and have increasing numbers of requests for tobacco use cessation programs, reflecting better marketing of services and an increase in consumer demand. Although the rate of participation in tobacco cessation programs in the Cumberland Valley District increased in 2001, very few adult smokers are being reached by current programs. Healthy Kentuckians 2010 recommends that all health departments provide research-based smoking cessation services.

0

36

3.89.59.4

20.5

0

10

20

30

40

50

1999 2000 2001

Rat

e pe

r 10,

000

adul

t sm

oker

s


25

Cum

berla

nd V

alle

y To

bacc

o Pr

even

tion

and

Ces

satio

n R

epor

t Car

d


√ The percent of smoke-free food establishments in the Cumberland Valley District did not change significantly from 1999 to 2001.7

√ The percent of smoke-free food establishments in the Cumberland Valley District did not was significantly lower than the state rate. 7

The increase in smoke-free Kentucky food service establishments over time reflects voluntary policy change since there are no local or state laws restricting smoking in public places. Healthy Kentuckians 2010 recommends increasing the percent of food service establishments that prohibit smoking or limit it to separately ventilated areas to 51%.


19.319.518

32 34.738.6

0102030405060

1999 2000 2001

Perc

ent

Cumberland Valley

Kentucky

√ Nearly 6 in 10 manufacturing facilities in the Cumberland Valley District have smoking policies.8 √ About 2 in 10 manufacturing facilities in the Cumberland Valley District offer resources for smoking cessation

and reimburse employees for cessation.8 Similar to the total sample, nearly half of the manufacturing facilities in the Cumberland Valley District banned smoking in 2000.7 Smoking in worksites presents an important source of environmental tobacco smoke that has have ill health effects on employees and contributes to lost productivity. Similar to the total sample in 2000, nearly 2 in 10 manufacturing facilities in the Cumberland Valley District made smoking cessation resources available to their employees. Healthy Kentuckians 2010 recommends increasing the percent of manufacturing facilities that reimburse for smoking cessation services to 48%.

Tobacco Policy in Manufacturing Facilities, 2000

19 21

43

24 26

4859

69

01020304050607080

Havesmokingpolicies

Ban indoorsmoking

Offercessationresources

Reimbursefor

cessation

Perc

ent

Cumberland Valley (n = 17)

Total Sample (N = 437)

26

Cum

berla

nd V

alle

y To

bacc

o Pr

even

tion

and

Ces

satio

n R

epor

t Car

d


√ While all middle and high schools in Cumberland Valley District banned smoking on school grounds for students from 1999 to 2001, only 6 in 10 schools banned smoking on school grounds for employees. 10

√ The percent of schools banning smoking on school grounds in the Cumberland Valley District in 2001 was significantly higher than the total Kentucky sample.10

√ The percent of schools providing cessation services in the Cumberland Valley District did not change significantly from 1999 to 2001.10

Smoking restrictions on school grounds in the Cumberland Valley District have not changed significantly since 1999. The CDC recommends that the entire school environment be tobacco-free for all students, faculty, staff, and visitors. Nearly 6 in 10 Kentucky middle and high school smokers report trying to quit in the last 12 months,11 yet only over 4% of schools in the Cumberland Valley District provided direct smoking cessation services for students and employees in 2001.

Direct Smoking Cessation Services in Middle and High Schools 1999-

2001

7 3.814.611

010203040

1999 2001

Perc

ent Cumberland

ValleyTotal Sample

Smoking Banned on School Grounds for Employees, Middle and High

Schools

61 62.365

44.7

020406080

100

1999 2001

Perc

ent

CumberlandValleyTotal Sample

√ The percent of sales to minors in the Cumberland Valley District did not change significantly from 1997 to 2000. 12

The percent of tobacco sales to minors in the Cumberland Valley District was similar to the state from 1997 to 2000. Healthy Kentuckians 2010 aims to strengthen minors’ access laws by increasing compliance to 95% or higher. Although the illegal sale rate has declined over time, only one in three youth smokers report being refused purchase of tobacco products statewide.11

Illegal Tobacco Sales to Minors, 1997-2000

17.4 15.917.4

9.3 8.713.1

1415.4

0

10

20

30

1997 1998 1999 2000

Perc

ent


27

Green River District Highlights

There was no significant change in the percent of adults who smoked cigarettes in the Green River District from 1997 to 2000. Similarly, there was no significant change in the percent of women who smoked during pregnancy for this same time period. The percent of adult smokers attempting to quit was similar over time. The rate of participation in tobacco cessation programs in the Green River District increased from 1999 to 2001, and the cessation program participation rate remained higher than the state rate. The percent of smoke-free establishments significantly increased from 2000 to 2001, but it remained significantly lower than the state. Only 3 in 10 manufacturing facilities banned smoking in 1999. While almost all middle and high schools banned smoking on school grounds for students in 2001, only 3 in 10 schools banned smoking on school grounds for employees, remaining significantly lower than the total Kentucky sample. The percent of illegal sales to minors in the Green River area did not change significantly from 1997 to 2000. Figure 6. Green River District Health Department Service Area

BALLARD

CARLISLE

GRAVES

McCRACKEN

FULTON

HICKMAN

CRITTENDEN

CALDWELL

TRIGG

LYON

LIVINGSTON

MARSHALL

MCLEAN

HENDERSON

UNION

WEBSTER

HOPKINS

CHRISTIAN

WOODFORD

BOONE

ROBERT

‘ SON

GALLATIN

CARROLLTRIMBLE

MASON

BRACKENPENDLETON

OWEN

KENTON

GRANT

CAMPBELL

BOYLE

FAYETTE

JESSA MINE

MERCER

WASHINGTON

ANDERSON

GARRARD

SPENCER

SHELBY

HENRYOLDHAM

HARRISON

SCOTTFRANKLIN

NELSON

BULLITT

JEFFERSON

GRAYSON

HARDIN

BRECKINRIDGE

MEADE

MARION

HART

EDMONSON

BARREN

LARUE

CALLOWAY

SIMPSON

TODD

BUTLERMUHLENBERG

LOGAN

ALLEN

WARREN

HANCOCK

DAVIESS

OHIO

METCALFRUSSELL

ADAIR

CLINTON

CUMBERLAND

MONROE

CASEY

PULASKI

WAYNE

McCREARY

TAYLOR

GREEN

NICHOLAS

BOURBON

BELL

JACKSON

LAUREL

ROCKCASTLE

KNOX

LINCOLN

CLAY

WHITLEY

OWSLEY

ESTILLMADISON

KNOTTPERRY

LETCHERLESLIE

HARLAN


POWELL

BOYD


WOLFE MAGOFFIN


GREENUP

ROWAN

CARTER

ELLIOTT LAWRENCE

LEWIS

FLEMING

BATH

LAH 9/11/02

Green River

28

Gre

en R

iver

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d

√ There was no significant change in the percent of women who smoked during pregnancy in the Green River Dis-trict from 1997 to 2000.4

√ The percent of women who smoke during pregnancy in the Green River District was similar to the state from 1997 to 2000.4

Women who smoke have increased risks for miscarriage, preterm birth, and low birth weight. About 70% of Kentucky mothers who stop smoking during pregnancy start again after the baby is born.5 One objective of Healthy Kentuckians 2010 is to reduce cigarette smoking among pregnant women to no more than 17%.


21.822.5

24.925.4

23.7

23.7 23.4

24.7

13.2 12.9 12.3 12.60

10

20

30

40

1997 1998 1999 2000

Perc

ent Green River

KentuckyU.S.

29


32.9 34.930.4 30.430.6 30.8 29.7 30.5

0

10

20

30

40

50

1997 1998 1999 2000

Per

cent

Green RiverKentucky

√ There was no significant change in the percent of adults who smoked cigarettes in the Green River District from 1997 to 2000.1

√ The age-adjusted death ratea from heart disease decreased from 325.8 in 1997 to 302.9 in 1999.2 √ The age-adjusted incidence ratea from lung cancer decreased from 103.9 in 1997 to 83.25 in 1999.3 aAge-adjusted rate per 100,000 total population The percent of adults who smoke cigarettes in the Green River District remained similar to the state from 1997 to 2000. Tobacco use is directly linked to heart disease, lung and other cancers, and emphysema. One goal of Healthy Kentuckians 2010 is to reduce cigarette use among adults to 25%.

*Weighted estimates

√ The percent of adult smokers attempting to quit in the Green River District was similar over time.1 √ The percent of adult smokers attempting to quit in the Green River District was similar to the state from 1997 to

2000.1 Given that nearly half of Kentucky smokers report at least one quit attempt, a variety of research-based tobacco dependence treatment and cessation services are needed. Healthy Kentuckians 2010 recommends increasing the proportion of adult smokers who stop smoking for a day or more to 58%.


40.744.6 46.947.3

0102030405060

1997-1999 1998-2000

Perc

ent

Green RiverKentucky


√ The rate of participation in tobacco cessation programs in the Green River District increased from 1999 to 2001.6 √ The cessation program participation rate in the Green River District remained higher than the state from 1999 to

2001.6 Health departments are providing research-based cessation programs and have increasing numbers of requests for tobacco use cessation programs, reflecting better marketing of services and an increase in consumer demand. Although the rate of participation in tobacco cessation programs in the Green River District increased in 2000, very few adult smokers are being reached by current programs. Healthy Kentuckians 2010 recommends that all health departments provide research-based smoking cessation services.

43

50.3

14.820.5

9.59.4

0

10

20

30

40

50

60

1999 2000 2001

Rat

e pe

r 10,

000

adul

t sm

oker

s

Green RiverKentucky

Gre

en R

iver

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d

30

√ Nearly 7 in 10 manufacturing facilities in the Green River District had smoking policies in 1999.8 √ In 1999, about one-third of the manufacturing facilities in the Green River District offer resources for smoking

cessation and reimburse employees for cessation.8 Similar to the total sample in 2000, over one-third of manufacturing facilities in the Green River District banned indoor smoking in 1999. Smoking in worksites presents an important source of environmental tobacco smoke that has ill health effects on employees and contributes to lost productivity. Similar to the total sample in 2000, over one-third of the manufacturing facilities in the Green River District made smoking cessation resources available to their employees. Healthy Kentuckians 2010 recommends increasing the percent of manufacturing facilities that reimburse for smoking cessation services to 48%.

65

35 36 33

69

43

24 26

01020304050607080


Ban indoorsmoking



Perc

ent 1999 Green River (n = 48)

2000 Total Sample (N = 437)Tob


√ The percent of smoke-free food establishments in the Green River District significantly increased from 2000 to 2001.7

√ The percent of smoke-free food establishments in the Green River District has remained significantly lower than the state.7



1012.5

31.6

38.634.732

0

10

20

30

40

50

1999 2000 2001

Perc

ent Green River

Kentucky

* Green River did not participate in the 2000 survey. G

reen

Riv

er T

obac

co P

reve

ntio

n an

d C

essa

tion

Rep

ort C

ard

31

Tobacco Policy in Manufacturing Facilities, 1999-2000

√ The percent of tobacco sales to minors in the Green River District did not change significantly from 1997 to 2000.12

The percent of tobacco sales to minors in the Green River District was similar to the state from 1997 to 2000. Healthy Kentuckians 2010 aims to strengthen minors’ access laws by increasing compliance to 95% or higher. Although the illegal sale rate has declined over time, only one in three youth smokers report being refused purchase of tobacco products statewide.11


13.615.4

8.97.4 8.713.1

15.4 14

0

10

20

30

1997 1998 1999 2000

Perc

ent

Green River

Kentucky


*Includes students and employees. √ While almost all middle and high schools in the Green River District banned smoking on school grounds for students in 2001, only 3 in 10 schools banned smoking on school grounds for employees. 10 √ The percent of schools banning smoking on school grounds in the Green River District in both 1999 and 2001 was

significantly lower than the total Kentucky sample.10 √ The percent of middle and high schools providing cessation services in the Green River District did not change

significantly from 1999 to 2001.10

Smoking restrictions on school grounds in the Green River District have not changed significantly since 1999. The CDC recommends that the entire school environment be tobacco-free for all students, faculty, staff, and visitors. Nearly 6 in 10 Kentucky middle and high school smokers report trying to quit in the last 12 months,11 yet only 19% of schools in the Green River District provided direct smoking cessation services for students and employees in 2001.

Direct Smoking Cessation Services in Middle and High Schools

15 18.614.611

010

2030

40

1999 2001

Perc

ent

Green RiverTotal Sample


Schools

2944.742

65

0

50

100

1999* 2001

Perc

ent

Green RiverTotal Sample

Gre

en R

iver

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d

32

Jefferson County Highlights

There was no change in the percent of adults who smoke cigarettes in Jefferson County from 1997 to 2000. While there was a significant decline in the percent of women who smoked during pregnancy from 1997 to 2000, the rate of smoking during pregnancy remains higher than the U.S. The percent of adult smokers attempting to quit was similar over time. The rate of participation in tobacco cessation programs in Jefferson County remained unchanged from 1999 to 2001. The percent of smoke-free food establishments in Jefferson County increased significantly from 2000 to 2001, remaining significantly higher than the state. Four in 10 manufacturing facilities ban smoking. While all middle and high school banned smoking on school grounds for students, only 30% banned smoking on school grounds for employees. The percent of schools providing cessation services for employees and students was significantly lower than the total Kentucky sample. The percent of illegal tobacco sales to minors in Jefferson County did not change significantly from 1997 to 2000. Figure 7. Jefferson County Health Department Service Area

BALLARD

CARLISLE

GRAVES

McCRACKEN

FULTON

HICKMAN

CRITTENDEN

CALDWELL

TRIGG

LYON

LIVINGSTON

MARSHALL

MCLEAN

HENDERSON

UNION

WEBSTER

HOPKINS

CHRISTIAN

WOODFORD

BOONE

ROBERT

‘ SON

GALLATIN

CARROLLTRIMBLE

MASON

BRACKENPENDLETON

OWEN

KENTON

GRANT

CAMPBELL

BOYLE

FAYETTE

JESSA MINE

MERCER

WASHINGTON

ANDERSON

GARRARD

SPENCER

SHELBY

HENRYOLDHAM

HARRISON

SCOTTFRANKLIN

NELSON

BULLITT

JEFFERSON

GRAYSON

HARDIN

BRECKINRIDGE

MEADE

MARION

HART

EDMONSON

BARREN

LARUE

CALLOWAY

SIMPSON

TODD

BUTLERMUHLENBERG

LOGAN

ALLEN

WARREN

HANCOCK

DAVIESS

OHIO

METCALFRUSSELL

ADAIR

CLINTON

CUMBERLAND

MONROE

CASEY

PULASKI

WAYNE

McCREARY

TAYLOR

GREEN

NICHOLAS

BOURBON

BELL

JACKSON

LAUREL

ROCKCASTLE

KNOX

LINCOLN

CLAY

WHITLEY

OWSLEY

ESTILLMADISON

KNOTTPERRY

LETCHERLESLIE

HARLAN


POWELL

BOYD


WOLFE MAGOFFIN


GREENUP

ROWAN

CARTER

ELLIOTTLAWRENCE

LEWIS

FLEMING

BATH

LAH 9/11/02

Jefferson County

33

Jeffe

rson

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d √ While there was a significant decline in the percent of women who smoked during pregnancy in Jefferson County

from 1997 to 2000, the rate of smoking during pregnancy is still higher than in the U. S. 4 √ The percent of women who smoke during pregnancy in Jefferson County was significantly lower than the state

from 1997 to 2000.4 Women who smoke have increased risks for miscarriage, preterm birth, and low birth weight. About 70% of Kentucky mothers who stop smoking during pregnancy start again after the baby is born.5 One objective of Healthy Kentuckians 2010 is to reduce cigarette smoking among pregnant women to no more than 17%.


18.420.7 19.8 19.1

23.423.723.724.7

12.613.2 12.9 12.30

10

20

30

40

1997 1998 1999 2000

Perc

ent Jefferson

Kentucky

U.S.

34

√ There was no change in the percent of adults who smoked cigarettes in Jefferson County from 1997 to 2000.1 √ The age-adjusted death ratea from heart disease decreased from 333.7 in 1997 to 307.1 in 1999.2 √ The age-adjusted incidence ratea from lung cancer decreased from 106.52 in 1997 to 103.42 in 1999.3 aAge-adjusted rate per 100,000 total population The percent of adults who smoke cigarettes in Jefferson County remained similar to the state from 1997 to 2000. Tobacco use is directly linked to heart disease, lung and other cancers, and emphysema. One goal of Healthy Kentuckians 2010 is to reduce cigarette use among adults to 25%.

*Weighted estimates

Current Adult Cigarette Use, 1997-200029.2 27.5 28.7 28.430.6 30.8 29.7 30.5

0

10

20

30

40

1997 1998 1999 2000

Perc

ent

JeffersonKentucky

Jeffe

rson

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d


√ The rate of participation in tobacco cessation programs in Jefferson County remained unchanged from 1999 to

2001.6 √ The cessation program participation rate in Jefferson County remained markedly lower than the state from 1999 to

2001.6 Health departments are providing research-based cessation programs and have increasing numbers of requests for tobacco use cessation programs, reflecting better marketing of services and an increase in consumer demand. Very few adult smokers are being reached by current Programs in Jefferson County. Healthy Kentuckians 2010 recommends that all health departments provide research-based smoking cessation services.

0.8 1.9 0.7

20.5

9.59.4

010

203040

5060

1999 2000 2001

Rat

e pe

r 10,

000

adul

t sm

oker

s

Jefferson

Kentucky

35

√ The percent of adult smokers attempting to quit in Jefferson County was similar over time.1

√ The percent of adult smokers attempting to quit in Jefferson County was similar to the state from 1997 to 2000.1

Given that nearly half of Kentucky smokers report at least one quit attempt, a variety of research-based tobacco dependence treatment and cessation services are needed. Healthy Kentuckians 2010 recommends increasing the proportion of adult smokers who stop smoking for a day or more to 58%.


49.15046.7

53.748.5 48.24850.4

010203040506070

1997 1998 1999 2000

Perc

ent

JeffersonKentucky

Jeffe

rson

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d

√ Nearly 7 in 10 manufacturing facilities in Jefferson County have smoking policies.8 √ Nearly 3 in 10 manufacturing facilities offer resources for smoking cessation and reimburse employees for cessation.8 Similar to the total sample, 4 in 10 manufacturing facilities in Jefferson County banned indoor smoking in 2000. Smoking at worksites presents an important source of environmental tobacco smoke that has ill health effects on employees and contributes to lost productivity. Similar to the total sample, nearly 3 in 10 manufacturing facilities made smoking cessation resources available to their employees. Healthy Kentuckians 2010 recommends increasing the percent of manufacturing facilities that reimburse for smoking cessation services to 48%.


√ The percent of smoke-free food establishments in Jefferson County increased significantly from 2000 to 2001.7 √ The percent of smoke-free food establishments in Jefferson County in 2001 was significantly higher than the state

rate.7

The increase in smoke-free Kentucky food service establishments over time reflects voluntary policy change since there are no local or state laws restricting smoking in public places. Healthy Kentuckians 2010 recommends increasing the percentage of food service establishments that prohibit smoking or limit it to separately ventilated areas to 51%.

Percent of Smoke-free Eating Establishements

47 47.557.7

38.634.732

0

20

40

60

1999 2000 2001

Perc

ent

JeffersonKentucky


42

27 27

43

24 26

67 69

01020304050607080

Havesmokingpolicies

Ban indoorsmoking


Reimbursefor cessation

Perc

ent

Jefferson (n = 85)Total Sample (N = 437)

36

√ The percent of tobacco sales to minors in Jefferson County did not change significantly from 1997 to 2000. 12

The percent of tobacco sales to minors in Jefferson County was similar to the state from 1997 to 2000. Healthy Kentuckians 2010 aims to strengthen minors’ access laws by increasing compliance to 95% or higher. Although the illegal sale rate has declined over time, only one in three youth smokers report being refused purchase of tobacco products statewide.11


8.311.511.5 13.68.7

13.11415.4

0

10

20

30

1997 1998 1999 2000

Perc

ent Jefferson

Kentucky

School Smoking Policy, 2001

√ While all middle and high schools banned smoking on school grounds for students in Jefferson County, only 30% banned smoking on school grounds for employees. 10 √ The percent of schools in Jefferson County that banned smoking on school grounds was similar to the total

Kentucky sample.10 √ The percent of schools in Jefferson County providing cessation services was significantly lower than the total

Kentucky sample.10 The CDC recommends that the entire school environment be tobacco-free for all students, faculty, staff, and visitors. Nearly 6 in 10 Kentucky middle and high school smokers report trying to quit in the last 12 months, 11 yet only 5% of schools in Jefferson County provided direct smoking cessation services for students and employees in 2001.

Direct Smoking Cessation Services in Middle and High Schools, 2001*

4.6

14.6

0

10

20

30

40

Jefferson Total Sample

Perc

ent

Smoking Banned on School Grounds for Employees, Middle and

High Schools, 2001*

3044.7

020406080

100

Jefferson Total Sample

Perc

ent

Jeffe

rson

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d

* Represents a random sample in Jefferson County.

37

Lexington-Fayette County Highlights

There was no significant change in the percent of adults who smoked cigarettes in Lexington-Fayette County from 1997 to 2000. While there was a significant decline in the percent of women who smoked during pregnancy from 1998 to 1999, the rate of smoking during pregnancy remains higher than in the U.S. While the percent of adult smokers attempting to quit was similar over time, it was significantly higher than the state. The rate of participation in tobacco cessation programs in Lexington-Fayette County increased in 2000 but dropped in 2001. The percent of smoke-free food establishments significantly increased from 1999 to 2001 and was significantly higher than the state rate. Six in 10 manufacturing facilities in Lexington-Fayette Count ban smoking. While almost all middle schools and high school banned smoking on school grounds for students from 1999 to 2001, two-thirds banned smoking on school grounds for employees. The percent of illegal tobacco sales to minors dropped significantly in 2000.

Figure 8. Lexington-Fayette County Health Department Service Area

BA LLA R D

C AR LIS LE

G R AV ES

McCRACKEN

FU LTO N

H IC K M AN

C R ITTE ND E N

C A LD W E LL

TR IG G

LYO N

LIVINGSTON

M AR SH A LL

MCLEAN

H E N D ER SO N

U N IO N

W EB STER

H O PKIN S

C H R IS TIA N

WOODFORD

BO O N E

ROBERT

‘ SON

GALLATIN

C A R R O LLTRIMBLE

M AS O N

BR AC K ENPENDLETON

O W E N

KENTON

G R AN T

CAMPBELL

BO YLE

FA YE TTE

JES SA M IN E

M ER C E R

W ASH IN G TO N

A ND E R SO N

GARRARD

SPE N C ER

S HE LB Y

H EN R YO LD H A M

H A R R IS O N

SC O TTFR A NK LIN

N ELS O N

B ULLITT

JEFFE RS O N

G R AY SO N

H A RD IN

BR EC K IN R ID G E

M E AD E

M AR IO N

H AR T

ED M O NS O N

B AR R EN

LAR U E

C ALLO W A Y

S IM P SO N

TO D D

BU TLE RM U H LE N BE R G

LO G A N

ALLEN

W A R RE N

HANCOCK

D A VIESS

O H IO

M E TC A LFRUSSELL

AD AIR

C LIN TO N

C U M BER LAN D

M O NR O E

C A SE Y

P ULAS KI

W AY N E

M cC R EA RY

TA YLO R

G R EE N

N IC H O LAS

BO U R BO N

B ELL

JA CK SO N

LA U RE L

R O C KC AS TLE

KN O X

LIN C O LN

C LA Y

W H ITLEY

O W SLEY

E STILLM AD ISO N

K NO TTPER R Y

LETC H ERLE SLIE

H A R LAN

LEE FLO YDB R EATH ITT P IK E

P O W ELL

B O YD

M O R G A NJO H N SO N M AR TIN

W O LFE M AG O FFIN

MONTGOMERYC LAR K M EN IFEE

G R E EN U P

R O W AN

C AR TER

E LLIO TTLAW R E N C E

LEW IS

FLE M IN G

BATH

L AH 9/11 /02

L exington-F ayette C ounty

38

Lexi

ngto

n-Fa

yette

Tob

acco

Pre

vent

ion

and

Ces

satio

n √ While there was a significant decline in the percent of women who smoked during pregnancy in Lexington- Fayette County from 1998 to 1999, the rate of smoking during pregnancy is still higher than in the U. S.4

√ The percent of women who smoke during pregnancy in Lexington-Fayette County was significantly lower than the state from 1997 to 2000.4

Women who smoke have increased risks for miscarriage, preterm birth, and low birth weight. About 70% of Kentucky mothers who stop smoking during pregnancy start again after the baby is born.5 One objective of Healthy Kentuckians 2010 is to reduce cigarette smoking among pregnant women to no more than 17%. Lexington-Fayette County met the 2010 objective in 1999.


15.616.118.61823.423.723.724.7

12.612.312.913.2

0

10

20

30

40

1997 1998 1999 2000

Perc

ent Fayette

Kentucky

U.S.

39

√ There was no significant change in the percent of adults who smoked cigarettes in Lexington-Fayette County from 1997 to 2000.1

√ The age-adjusted death ratea from heart disease decreased slightly from 293.8 in 1997 to 289.7 in 1999.2 √ The age-adjusted incidence ratea from lung cancer increased slightly from 88.84 in 1997 to 89.08 in 1999.3 aAge-adjusted rate per 100,000 total population The percent of adults who smoke cigarettes in Lexington-Fayette County remained similar to the state in 1997, 1999, and 2000. Tobacco use is directly linked to heart disease, lung and other cancers, and emphysema. One goal of Healthy Kentuckians 2010 is to reduce cigarette use among adults to 25%. Lexington-Fayette County met the 2010 objective in 2000.

* Weighted estimates


24.1 2327.7

24.630.6 30.8 29.7 30.5

0

10

20

30

40

1997 1998 1999 2000

Perc

ent

Fayette Kentucky

Lexi

ngto

n-Fa

yette

Tob

acco

Pre

vent

ion

and

Ces

satio

n

√ The percent of adult smokers attempting to quit in Lexington-Fayette County was similar over time.1 √ The percent of adult smokers attempting to quit in Lexington-Fayette County was significantly higher than the

state in 1998-2000.1 Given that nearly half of Kentucky smokers report at least one quit attempt, a variety of research-based tobacco dependence treatment and cessation services are needed. Healthy Kentuckians 2010 recommends increasing the proportion of adult smokers who stop smoking for a day or more to 58%. Lexington-Fayette County met the 2010 objective in 1998-2000.


58.151.6 46.947.3

010203040506070

1997-1999 1998-2000

Perc

ent

Fayette Kentucky


√ The rate of participation in tobacco cessation programs in Lexington-Fayette County increased in 2000 but

dropped again in 2001.6 √ The cessation program participation rate in Lexington-Fayette County was similar to the state in 2000 but lower in

2001.6 Health departments are providing research-based cessation programs and have increasing numbers of requests for tobacco use cessation programs, reflecting better marketing of services and an increase in consumer demand. Although the rate of participation in tobacco cessation programs in Lexington-Fayette County increased in 2000, very few adult smokers are being reached by current programs. Healthy Kentuckians 2010 recommends that all health departments provide research-based smoking cessation services.

29.1

1.7

20.5

9.59.4

0

10

20

30

40

50

1999 2000 2001Rat

e pe

r 10,

000

adul

t sm

oker

s

Fayette

Kentucky

40

Lexi

ngto

n-Fa

yette

Tob

acco

Pre

vent

ion

and

Ces

satio

n


√ The percent of smoke-free food establishments in Lexington-Fayette County significantly increased from 1999 to 2001.7

√ The percent of smoke-free food establishments in Lexington-Fayette County in 2001 was significantly higher than the state rate.7



38 43.8 45.8

32 34.7 38.6

0102030405060

1999 2000 2001

Perc

ent

FayetteKentucky

√ Nearly half of the manufacturing facilities in Lexington-Fayette County have smoking policies.8 √ Only 1 in 10 manufacturing facilities offer resources for smoking cessation and 3 in 10 reimburse employees for

cessation.8 Similar to the total sample, nearly 6 in 10 manufacturing facilities in Lexington-Fayette County banned indoor smoking in 2000. Smoking in worksites presents an important source of environmental tobacco smoke that has ill health effects on employees and contributes to lost productivity. The percent of manufacturing facilities in Lexington-Fayette County that had smoking policies and made smoking cessation resources available to their employees was significantly lower than the total sample. Healthy Kentuckians 2010 recommends increasing the percent of manufacturing facilities that reimburse for smoking cessation services to 48%.


4957

10

3143

24 26

69

01020304050607080

Havesmokingpolicies

Ban indoorsmoking



Perc

ent

Fayette (n = 51)Total Sample (N = 437)

41

Lexi

ngto

n-Fa

yette

Tob

acco

Pre

vent

ion

and

Ces

satio

n


√ While almost all middle and high schools in Lexington-Fayette County banned smoking on school grounds for students from 1999 to 2001, two-thirds banned smoking on school grounds for employees in 2001. 10 √ The percent of schools banning smoking on school grounds in Lexington-Fayette County in 2001 was significantly

higher than the total Kentucky sample.10 √ The percent of schools providing cessation services in Lexington-Fayette County did not change significantly from

1999 to 2001.10

Smoking restrictions on school grounds in Lexington-Fayette County have not changed significantly since 1999. The CDC recommends that the entire school environment be tobacco-free for all students, faculty, staff, and visitors. Nearly 6 in 10 Kentucky middle and high school smokers report trying to quit in the last 12 months,11 yet only 12% of schools in Lexington-Fayette County provided direct smoking cessation services for students and employees in 2001.


1912.2

14.611

0

10

20

30

40

1999 2001

Perc

ent

Fayette

Total Sample


High Schools

68.384

44.7

65

020406080

100

1999 2001

Perc

ent

Fayette

Total Sample

√ The percent of tobacco sales to minors in Lexington-Fayette County dropped significantly in 2000.12

The percent of tobacco sales to minors in Lexington-Fayette County was similar to the state from 1997 to 2000. Healthy Kentuckians 2010 aims to strengthen minors’ access laws by increasing compliance to 95% or higher. Although the illegal sale rate has declined over time, only one in three youth smokers report being refused purchase of tobacco products statewide.11


6.1

14.518.916.1

8.713.1

15.4 14

0

10

20

30

1997 1998 1999 2000

Perc

ent

FayetteKentucky

42

Lincoln Trail District Highlights

There was no significant change in the percent of adults who smoked cigarettes in the Lincoln Trail District from 1997 to 2000. While there was a significant decline in the percent of women who smoked during pregnancy from 1997 to 1998, the percent remained stable from 1998 to 2000. The percent of adult smokers attempting to quit was similar over time. The rate of participation in tobacco cessation programs in the Lincoln Trail District decreased from 1999 to 2001. The percent of smoke-free establishments did not increase significantly from 1999 to 2001. Only 3 in 10 manufacturing facilities ban smoking. While all middle and high schools in the area banned smoking on school grounds for students, only 3 in 10 banned smoking on school ground for employees. The percent of sales to minors in this area dropped significantly from 1999 to 2000. Figure 9. Lincoln Trail District Health Department Service Area

BALLARD

CARLISLE

GRAVES

McCRACKEN

FULTON

HICKMAN

CRITTENDEN

CALDWELL

TRIGG

LYON

LIVINGSTON

MARSHALL

MCLEAN

HENDERSON

UNION

WEBSTER

HOPKINS

CHRISTIAN

WOODFORD

BOONE

ROBERT

‘ SON

GALLATIN

CARROLLTRIMBLE

MASON

BRACKENPENDLETON

OWEN

KENTON

GRANT

CAMPBELL

BOYLE

FAYETTE

JESSA MINE

MERCER

WASHINGTON

ANDERSON

GARRARD

SPENCER

SHELBY

HENRYOLDHAM

HARRISON

SCOTTFRANKLIN

NELSON

BULLITT

JEFFERSON

GRAYSON

HARDIN

BRECKINRIDGE

MEADE

MARION

HART

EDMONSON

BARREN

LARUE

CALLOWAY

SIMPSON

TODD

BUTLERMUHLENBERG

LOGAN

ALLEN

WARREN

HANCOCK

DAVIESS

OHIO

METCALFRUSSELL

ADAIR

CLINTON

CUMBERLAND

MONROE

CASEY

PULASKI

WAYNE

McCREARY

TAYLOR

GREEN

NICHOLAS

BOURBON

BELL

JACKSON

LAUREL

ROCKCASTLE

KNOX

LINCOLN

CLAY

WHITLEY

OWSLEY

ESTILLMADISON

KNOTTPERRY

LETCHERLESLIE

HARLAN


POWELL

BOYD


WOLFE MAGOFFIN


GREENUP

ROWAN

CARTER

ELLIOTT LAWRENCE

LEWIS

FLEMING

BATH

LAH 9/11/02

Lincoln Trail

43

Linc

oln

Trai

l Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t √ While there was a significant decline in the percent of women who smoked during pregnancy in the Lincoln Trail District from 1997 to 1998, the percent remained stable from 1998 to 2000.4 √ While the percent of women who smoke during pregnancy in the Lincoln Trail District was significantly higher

than the state in 1997, the percent has been similar to the state since 1998.4 Women who smoke have increased risks for miscarriage, preterm birth, and low birth weight. About 70% of Kentucky mothers who stop smoking during pregnancy start again after the baby is born.5 One objective of Healthy Kentuckians 2010 is to reduce cigarette smoking among pregnant women to no more than 17%.


28.2

22.6

24.1

23.2

23.4

23.7

23.7

24.7

12.612.312.913.2

0

10

20

30

40

1997 1998 1999 2000

Perc

ent Lincoln Trail

Kentucky

U.S.

44

√ There was no significant change in the percent of adults who smoked cigarettes in the Lincoln Trail District from

1997 to 2000.1 √ The age-adjusted death ratea from heart disease decreased from 318.5 in 1997 to 277.1 in 1999.2 √ The age-adjusted incidence ratea from lung cancer increased slightly from 109.72 in 1997 to 110.16 in 1999.3 aAge-adjusted rate per 100,000 total population The percent of adults who smoke cigarettes in the Lincoln Trail District remained similar to the state from 1997 to 2000. Tobacco use is directly linked to heart disease, lung and other cancers, and emphysema. One goal of Healthy Kentuckians 2010 is to reduce cigarette use among adults to 25%.

*Weighted Estimates


30.6 3229.132.430.6 30.529.730.8

0

10

20

30

40

1997 1998 1999 2000

Perc

ent

Lincoln TrailKentucky

Linc

oln

Trai

l Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t

√ The percent of adult smokers attempting to quit in the Lincoln Trail District was similar over time.1 √ The percent of adult smokers attempting to quit in the Lincoln Trail District was similar to the state from 1997 to



48.050.6 46.947.3

010203040506070

1997-1999 1998-2000

Perc

ent



√ The rate of participation in tobacco cessation programs in the Lincoln Trail District decreased from 1999 to 2001.6 √ The cessation program participation rate in the Lincoln Trail District was higher than the state in 1999 but lower in

2000 and 2001.6 Health departments are providing research-based cessation programs and have increasing numbers of requests for tobacco use cessation programs, reflecting better marketing of services and an increase in consumer demand. Very few adult smokers are being reached by current Programs in the Lincoln Trail District. Healthy Kentuckians 2010 recommends that all health departments provide research-based smoking cessation services.

2.66.1

21 20.5

9.59.4

01020304050

1999 2000 2001

Rat

e pe

r 10,

000

adul

t sm

oker

s Lincoln TrailKentucky

45

Linc

oln

Trai

l Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t

√ Nearly 8 in 10 manufacturing facilities in the Lincoln Trail District have smoking policies.8 √ Nearly 2 in 10 manufacturing facilities offer resources for smoking cessation and about 1 in 10 reimburse employees for cessation.8 Similar to the total sample, one-third of manufacturing facilities in the Lincoln Trail District banned indoor smoking in 2000. Smoking in worksites presents an important source of environmental tobacco smoke that has ill health effects on employees and contributes to lost productivity. The percent of manufacturing facilities in the Lincoln Trail District that reimbursed for smoking cessation was significantly lower than the total sample. Healthy Kentuckians 2010 recommends increasing the percent of manufacturing facilities that reimburse for smoking cessation services to 48%.


√ The percent of smoke-free food establishments in the Lincoln Trail District did not increase significantly from 1999 to 2001.7

√ The percent of smoke-free food establishments in the Lincoln Trail District in 2001 was similar to the state rate.7



31 31.537

38.634.732

0102030405060

1999 2000 2001

Perc

ent



3319

43

2411

77

26

69

0102030405060708090

Havesmokingpolicies

Ban indoorsmoking



Perc

ent

Lincoln Trail (n = 65)Total Sample (N = 437)

46

√ The percent of sales to minors in the Lincoln Trail District dropped significantly from 1999 to 2000.12

The percent of tobacco sales to minors in the Lincoln Trail District was significantly lower than the state from 1997 to 2000. Healthy Kentuckians 2010 aims to strengthen minors’ access laws by increasing compliance to 95% or higher. Although the illegal sale rate has declined over time, only one in three youth smokers report being refused purchase of tobacco products statewide.11


1.1

7.22.8

5.28.7

13.11415.4

0

10

20

30

1997 1998 1999 2000

Perc

ent



√ While all middle and high schools in the Lincoln Trail District banned smoking on school grounds for students, only

3 in 10 banned smoking on school grounds for employees in 2001.10 √ The percent of schools banning smoking on school grounds in the Lincoln Trail District in 2001 was similar to the

total Kentucky sample.10 √ The percent of schools in the Lincoln Trail District providing cessation services did not change significanatly from

1999 to 2001.10

Smoking restrictions on school grounds in the Lincoln Trail District have not changed significantly since 1999. The CDC recommends that the entire school environment be tobacco-free including all students, faculty, staff, and visitors. Nearly 6 in 10 middle and high school smokers report trying to quit in the last 12 months,11 yet only 18% of schools in the Lincoln Trail District provided direct smoking cessation services for students and employees in 2001.

D irect Smo king C essat io n Services in M idd le and High Schoo ls

22 18.2 14.611

010203040

1999 2001

Perc

ent

Lincoln Trail

Total Sample

Smoking Banned on School Grounds, Middle and High Schools for Employees

5065

44.729.6

020406080

100

1999 2001

Perc

ent

Lincoln TrailTotal Sample

Linc

oln

Trai

l Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t

47

Madison County Highlights

There was no significant change in the percent of adults who smoked cigarettes in Madison County from 1997 to 2000. Similarly, there was no significant change in the percent of women who smoked during pregnancy for the same time period. The percent of adult smokers attempting to quit remained the same over time. The rate of participation in tobacco cessation program increased from 2000 but declined in 2001. The percent of smoke-free food establishments in Madison County increased significantly from 1999 to 2001. There was no significant increase in the percent of manufacturing facilities that banned smoking from 1999 to 2000. All middle and high schools banned smoking on school grounds for students in Madison County in 2001, while almost all banned smoking on school grounds for employees, representing a significantly higher proportion compared to the total Kentucky sample. The percent of illegal tobacco sales to minors in Madison county did not decline significantly from 1997 to 2000, and was higher than the state in 2000. Figure 10. Madison County Health Department Service Area

BALLARD

CARLISLE

GRAVES

McCRACKEN

FULTON

HICKMAN

CRITTENDEN

CALDWELL

TRIGG

LYON

LIVINGSTON

MARSHALL

MCLEAN

HENDERSON

UNION

WEBSTER

HOPKINS

CHRISTIAN

WOODFORD

BOONE

ROBERT

‘ SON

GALLATIN

CARROLLTRIMBLE

MASON

BRACKENPENDLETON

OWEN

KENTON

GRANT

CAMPBELL

BOYLE

FAYETTE

JESSA MINE

MERCER

WASHINGTON

ANDERSON

GARRARD

SPENCER

SHELBY

HENRYOLDHAM

HARRISON

SCOTTFRANKLIN

NELSON

BULLITT

JEFFERSON

GRAYSON

HARDIN

BRECKINRIDGE

MEADE

MARION

HART

EDMONSON

BARREN

LARUE

CALLOWAY

SIMPSON

TODD

BUTLERMUHLENBERG

LOGAN

ALLEN

WARREN

HANCOCK

DAVIESS

OHIO

METCALFRUSSELL

ADAIR

CLINTON

CUMBERLAND

MONROE

CASEY

PULASKI

WAYNE

McCREARY

TAYLOR

GREEN

NICHOLAS

BOURBON

BELL

JACKSON

LAUREL

ROCKCASTLE

KNOX

LINCOLN

CLAY

WHITLEY

OWSLEY

ESTILLMADISON

KNOTTPERRY

LETCHERLESLIE

HARLAN


POWELL

BOYD


WOLFE MAGOFFIN


GREENUP

ROWAN

CARTER

ELLIOTT LAWRENCE

LEWIS

FLEMING

BATH

LAH 9/11/02

Madison County

48

Mad

ison

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d Current Adult Cigarette Use,* 1997-2000

30.328.8 29.829.7

0

10

20

30

40

1997-1999 1998-2000

Perc

ent

MadisonKentucky

√ There was no significant change in the percent of adults who smoked cigarettes in Madison County from 1997 to 2000.1 √ The age-adjusted death ratea from heart disease increased from 260.9 in 1997 to 325.6 in 1999.2 √ The age-adjusted incidence ratea from lung cancer increased from 93.77 in 1997 to 98.49 in 1999.3 aAge-adjusted rate per 100,000 total population The percent of adults who smoke cigarettes in Madison County remained similar to the state from 1997 to 2000. Tobacco use is directly linked to heart disease, lung and other cancers, and emphysema. One goal of Healthy Kentuckians 2010 is to reduce cigarette use among adults to 25%.

√ There was no significant change in the percent of women who smoked during pregnancy in Madison County from 1997 to 2000.4

√ While the percent of women who smoked during pregnancy in Madison County was significantly lower than the state in 1997, the percent has been similar to the state since 1998.4

Women who smoke have increased risks for miscarriage, preterm birth, and low birth weight. About 70% of Kentucky mothers who stop smoking during pregnancy start again after the baby is born.5 One objective of Healthy Kentuckians 2010 is to reduce cigarette smoking among pregnant women to no more than 17%.


23.920.8 21.6

25.423.7 23.4

23.7

24.7

12.612.312.913.2

0

10

20

30

40

1997 1998 1999 2000

Perc

ent Madison

Kentucky

U.S.

*Unweighted Data

49

Mad

ison

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d

√ The percent of adult smokers attempting to quit in Madison County remained the same over time.1 √ The percent of adult smokers attempting to quit in Madison County remained similar to the state from 1997 to



50.050.0 46.947.3

010203040506070

1997-1999 1998-2000

Perc

ent

MadisonKentucky


√ The rate of participation in tobacco cessation programs in Madison County increased in 2000 but declined in 2001.6 √ The cessation program participation rate in Madison County was higher than the state in 1999 and 2000 but was

similar to the state rate in 2001.6 Health departments are providing research-based cessation programs and have increasing numbers of requests for tobacco use cessation programs, reflecting better marketing of services and an increase in consumer demand. Very few adult smokers are being reached by current programs in Madison County. Healthy Kentuckians 2010 recommends that all health departments provide research-based smoking cessation services.

23.3

59.6

39.2

20.5

9.59.4

010203040506070

1999 2000 2001

Rat

e pe

r 10,

000

adul

t sm

oker

s

MadisonKentucky

50

Mad

ison

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d

√ There was no significant increase in the percent of manufacturing facilities that had smoking policies in Madison

County from 1999 to 2000.8 √ There was no significant increase in the percent of manufacturing facilities that banned indoor smoking in Madison County from 1999 to 2000.8 √ There was no significant change in the percent of manufacturing facilities that offered resources for smoking cessation and reimbursed employees for cessation in Madison County from 1999 to 2000.8 Similar to the total sample, nearly 3 in 10 manufacturing facilities in Madison County banned indoor smoking in 2000. Smoking in worksites presents and important source of environmental tobacco smoke that has ill health effects on employees and contributes to lost productivity.

Similar to the total sample, only 4 in 10 manufacturing facilities in Madison County made smoking cessation resources available to their employees in 2000. Healthy Kentuckians 2010 recommends increasing the percent of manufacturing facilities that reimburse for smoking cessation services to 48%.


11

54

212839

3043

24 26

68 76 69

020406080

100

Havesmokingpolicies

Ban indoorsmoking


Reimbursefor

cessation

Perc

ent 1999 (n = 28)

2000 (n = 29)2000 Total Sample (N = 437)


√ The percent of smoke-free food establishments in Madison County increased significantly from 1999 to 2001.7 √ The percent of smoke-free food establishments in Madison County in 2001 was similar to the state rate.7



32 35.546.4

38.634.732

0102030405060

1999 2000 2001

Perc

ent

MadisonKentucky

51

√ The percent of tobacco sales to minors in Madison County did not decline significantly from 1997 to 2000. 12

The percent of tobacco sales to minors in Madison County was significantly higher than the state in 2000. Healthy Kentuckians 2010 aims to strengthen minors’ access laws by increasing compliance to 95% or higher. Although the illegal sale rate has declined over time, only one in three youth smokers report being refused purchase of tobacco products statewide.11


24.130.6

24.720.2

8.713.11415.4

0

10

20

30

40

1997 1998 1999 2000

Perc

ent

Madison

Kentucky


*Includes students and employees √ All middle and high schools banned smoking on school grounds for students in Madison County in 2001, while

almost all banned smoking on school grounds for employees.10

√ The percent of schools banning smoking on school grounds in Madison County in 2001 was significantly higher than the total Kentucky sample.10

√ While the percent of middle and high schools providing cessation services in Madison County increased from 1999 to 2001, the change was not statistically significant. 10

Smoking restrictions on school grounds in Madison County have not changed significantly since 1999. The CDC recommends that the entire school environment be tobacco-free for all students, faculty, staff, and visitors. Nearly 6 in 10 Kentucky middle and high school smokers report trying to quit in the last 12 months,11 yet only over one-third of schools in Madison County provided direct smoking cessation services for students and employees in 2001.


36.4

10 11 14.6

01020304050

1999 2001

Perc

ent

Madison

Total Sample

Smoking Banned on School Grounds for Employees, Middle Schools and

High Schools

10090

44.7

65

0

2040

6080

100

1999* 2001

Perc

ent

MadisonTotal Sample

Mad

ison

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d

52

North Central District Highlights

There was no significant change in the percent of adults who smoked cigarettes in the North Central District from 1997 to 2000. Similarly, there was no significant change in the percent of women who smoked during pregnancy for the same time period. The percent of adult smokers attempting to quit in this area was similar over time. The rate of participation in tobacco cessation programs dropped in 2000 but increased in 2001. The percent of smoke-free food establishments did not increase significantly from 1999 to 2001. There was no significant change in the percent of manufacturing facilities that banned smoking in the North Central service area from 1999 to 2000. All middle and high schools banned smoking on school grounds and for employees, representing a significantly higher percent compared to the total Kentucky sample. The percent of illegal tobacco sales to minors did not decline significantly from 1997 to 2000. Figure 11. North Central District Health Department Service Area

BALLARD

CARLISLE

GRAVES

McCRACKEN

FULTON

HICKMAN

CRITTENDEN

CALDWELL

TRIGG

LYON

LIVINGSTON

MARSHALL

MCLEAN

HENDERSON

UNION

WEBSTER

HOPKINS

CHRISTIAN

WOODFORD

BOONE

ROBERT

‘ SON

GALLATIN

CARROLLTRIMBLE

MASON

BRACKENPENDLETON

OWEN

KENTON

GRANT

CAMPBELL

BOYLE

FAYETTE

JESSA MINE

MERCER

WASHINGTON

ANDERSON

GARRARD

SPENCER

SHELBY

HENRYOLDHAM

HARRISON

SCOTTFRANKLIN

NELSON

BULLITT

JEFFERSON

GRAYSON

HARDIN

BRECKINRIDGE

MEADE

MARION

HART

EDMONSON

BARREN

LARUE

CALLOWAY

SIMPSON

TODD

BUTLERMUHLENBERG

LOGAN

ALLEN

WARREN

HANCOCK

DAVIESS

OHIO

METCALFRUSSELL

ADAIR

CLINTON

CUMBERLAND

MONROE

CASEY

PULASKI

WAYNE

McCREARY

TAYLOR

GREEN

NICHOLAS

BOURBON

BELL

JACKSON

LAUREL

ROCKCASTLE

KNOX

LINCOLN

CLAY

WHITLEY

OWSLEY

ESTILLMADISON

KNOTTPERRY

LETCHERLESLIE

HARLAN


POWELL

BOYD


WOLFE MAGOFFIN


GREENUP

ROWAN

CARTER

ELLIOTT LAWRENCE

LEWIS

FLEMING

BATH

LAH 9/11/01

North Central

53

Nor

th C

entra

l Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car


32.635.329.829.7

0

10

20

30

40

50

1997-1999 1998-2000

Perc

ent

North CentralKentucky

√ There was no significant change in the percent of adults who smoked cigarettes in the North Central District from 1997 to 2000.1 √ The age-adjusted death ratea from heart disease increased from 287.2 in 1997 to 341.9 in 1999.2 √ The age-adjusted incidence ratea from lung cancer increased from 88.11 in 1997 to 99.92 in 1999.3 aAge-adjusted rate per 100,000 total population The percent of adults who smoke cigarettes in the North Central District remained similar to the state from 1997 to 2000. Tobacco use is directly linked to heart disease, lung and other cancers, and emphysema. One goal of Healthy Kentuckians 2010 is to reduce cigarette use among adults to 25%.

√ There was no significant change in the percent of women who smoked during pregnancy in the North Central District from 1997 to 2000.4 √ The percent of women who smoke during pregnancy in the North Central District was similar to the state from

1997 to 2000.4 Women who smoke have increased risks for miscarriage, preterm birth, and low birth weight. About 70% of Kentucky mothers who stop smoking during pregnancy start again after the baby is born.5 One objective of Healthy Kentuckians 2010 is to reduce cigarette smoking among pregnant women to no more than 17%.


24.425.8

23.124.5 23.423.7

23.724.7

12.612.312.913.2

0

10

20

30

40

1997 1998 1999 2000

Perc

ent North Central

KentuckyU.S.

*Unweighted Data

54

√ The percent of adult smokers attempting to quit in the North Central District was similar over time.1 √ The percent of adult smokers attempting to quit in the North Central District remained similar to the state from

1997 to 2000.1 Given that nearly half of Kentucky smokers report at least one quit attempt, a variety of research-based tobacco dependence treatment and cessation services are needed. Healthy Kentuckians 2010 recommends increasing the proportion of adult smokers who stop smoking for a day or more to 58%.


41.7 43.2 46.947.3

010203040506070

1997-1999 1998-2000

Perc

ent


Participation in Tobacco Cessation Programs, 1999- 2001

√ The rate of participation in tobacco cessation programs in the North Central District dropped in 2000 but increased

in 2001.6 √ The cessation program participation rate in the North Central District was higher than the state in 1999 and 2001.6 Health departments are providing research-based cessation programs and have increasing numbers of requests for tobacco use cessation programs, reflecting better marketing of services and an increase in consumer demand. Although the rate of participation in tobacco cessation programs in the North Central District increased in 2001, very few adult smokers are being reached by current programs. Healthy Kentuckians 2010 recommends that all health departments provide research-based smoking cessation services.

0

34.931.6

20.59.59.4

01020

304050

1999 2000 2001

Rat

e pe

r 10,

000

adul

t sm

oker

s

North Central

Kentucky

Nor

th C

entra

l Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t

55

√ There was no significant change in the percent of manufacturing facilities that had smoking policies in the North Central District from 1999 to 2000.8

√ There was no significant change in the percent of manufacturing facilities that banned indoor smoking in the North Central District from 1999 to 2000.8 √ There was no significant change in the percent of manufacturing facilities that offered resources for smoking cessation and reimbursed employees for cessation in the North Central District from 1999 to 2000.8 Similar to the total sample, nearly 4 in 10 manufacturing facilities in the North Central District banned indoor smoking in 2000. Smoking in worksites presents an important source of environ-mental tobacco smoke that has ill health effects on employees and contributes to lost productivity. Similar to the total sample, nearly 3 in 10 manufacturing facilities in the North Central District made smoking cessation resources available to their employees in 2000. Healthy Kentuckians 2010 recommends increasing the percent of manufacturing facilities that reimburse for smoking cessation services to 48%.


47

22 17

3927 26

43

24 26

7465 69

0

20

40

60

80

Havesmokingpolicies

Ban indoorsmoking


Reimbursefor

cessation

Perc

ent

1999 (n = 19)2000 (n = 23)2000 Total Sample (N = 437)


√ The percent of smoke-free food establishments in the North Central District did not increase significantly from 1999 to 2001.7

√ The percent of smoke-free food establishments in the North Central District in 2001 was similar to the state rate.7



29 31.639.2

38.634.732

0102030405060

1999 2000 2001

Perc

ent


Nor

th C

entra

l Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t

56

√ The percent of tobacco sales to minors in the North Central District did not decline significantly from 1997 to 2000. 12

The percent of tobacco sales to minors in the North Central District was similar to the state from 1997 to 2000. Healthy Kentuckians 2010 aims to strengthen minors’ access laws by increasing compliance to 95% or higher. Although the illegal sale rate has declined over time, only one in three youth smokers report being refused purchase of tobacco products statewide.11


8

18.3

13.913.78.7

13.1

15.4 14

0

10

20

30

1997 1998 1999 2000

Perc

ent

North Central

Kentucky


√ All middle and high schools in the North Central District banned smoking on school grounds for students and employees.10

√ The percent of schools banning smoking on school grounds in the North Central District was significantly higher than the total Kentucky sample.10

√ The percent of schools in the North Central District providing cessation services was similar to the total Kentukcy sample.10

The CDC recommends that the entire school environment be tobacco-free for all students, faculty, staff, and visitors. Nearly 6 in 10 middle and high school smokers report trying to quit in the last 12 months,11 yet only 2 in 10 schools in the North Central District provided direct smoking cessation services for students and employees in 1999.

Direct Smoking Cessation Services in Middle and High Schools, 1999

22

11

0

10

20

30

40

North Central Total Sample

Perc

ent

Smoking Banned on School Grounds for Students and Employees, Middle and

High Schools, 1999

65100

020406080

100

North Central Total Sample

Perc

ent

Nor

th C

entra

l Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d

57

Northern Kentucky District Highlights

There was no significant change in the percent of adults who smoked cigarettes in the Northern Kentucky District from 1997 to 2000. However, there was a significant decline in the percent of women who smoked during pregnancy from 1999 to 2000. The percent of adults smokers attempting to quite in this area remained similar over time. The rate of participants in tobacco cessation programs increased from 2000 to 2001. The percent of smoke-free food establishments in the Northern Kentucky District did not change significantly from 1999 to 2001. There was no significant change in the percent of manufacturing facilities that banned smoking in the Northern Kentucky District from 1999 to 2000. While almost all middle and high schools banned smoking on school grounds for students in 2001, only one-third banned smoking on school grounds for employees. The present of illegal tobacco sales to minors did not decline significantly from 1997 to 2000. Figure 12. Northern Kentucky District Health Department Service Area

BALLARD

CARLISLE

GRAVES

McCRACKEN

FULTON

HICKMAN

CRITTENDEN

CALDWELL

TRIGG

LYON

LIVINGSTON

MARSHALL

MCLEAN

HENDERSON

UNION

WEBSTER

HOPKINS

CHRISTIAN

WOODFORD

BOONE

ROBERT

‘ SON

GALLATIN

CARROLLTRIMBLE

MASON

BRACKENPENDLETON

OWEN

KENTON

GRANT

CAMPBELL

BOYLE

FAYETTE

JESSA MINE

MERCER

WASHINGTON

ANDERSON

GARRARD

SPENCER

SHELBY

HENRYOLDHAM

HARRISON

SCOTTFRANKLIN

NELSON

BULLITT

JEFFERSON

GRAYSON

HARDIN

BRECKINRIDGE

MEADE

MARION

HART

EDMONSON

BARREN

LARUE

CALLOWAY

SIMPSON

TODD

BUTLERMUHLENBERG

LOGAN

ALLEN

WARREN

HANCOCK

DAVIESS

OHIO

METCALFRUSSELL

ADAIR

CLINTON

CUMBERLAND

MONROE

CASEY

PULASKI

WAYNE

McCREARY

TAYLOR

GREEN

NICHOLAS

BOURBON

BELL

JACKSON

LAUREL

ROCKCASTLE

KNOX

LINCOLN

CLAY

WHITLEY

OWSLEY

ESTILLMADISON

KNOTTPERRY

LETCHERLESLIE

HARLAN


POWELL

BOYD


WOLFE MAGOFFIN


GREENUP

ROWAN

CARTER

ELLIOTT LAWRENCE

LEWIS

FLEMING

BATH

LAH 9/11/011

Northern Kentucky

58

Nor

ther

n K

entu

cky

Toba

cco

Prev

entio

n an

d C

essa

tion

√ There was a significant decline in the percent of women who smoked during pregnancy in the Northern Kentucky District from 1999 to 2000.4 √ The percent of women who smoke during pregnancy in the Northern Kentucky District was similar to the state from

1997 to 2000.4 Women who smoke have increased risks for miscarriage, preterm birth, and low birth weight. About 70% of mothers who stop smoking during pregnancy start again after the baby is born.5 One objective of Healthy Kentuckians 2010 is to reduce cigarette smoking among pregnant women to no more than 17%.


25.6

22.723.722.8

24.7 23.4

23.7

23.7

12.612.312.913.2

0

10

20

30

40

1997 1998 1999 2000

Perc

ent Northern Kentucky

KentuckyU.S.

59


27.130.8

26.5 25.931.230.6 29.7 30.5

0

10

20

30

40

1997 1998 1999 2000

Perc

ent

Northern Kentucky

Kentucky

√ There was no significant change in the percent of adults who smoked cigarettes in the Northern Kentucky District from 1997 to 2000.1 √ The age-adjusted death ratea from heart disease decreased from 280.1 in 1997 to 277.2 in 1999.2 √ The age-adjusted incidence ratea from lung cancer increased from 86.65 in 1997 to 94.52 in 1999.3 aAge-adjusted rate per 100,000 total population The percent of adults who smoke cigarettes in the Northern Kentucky District remained similar to the state from 1997 to 2000. Tobacco use is directly linked to heart disease, lung and other cancers, and emphysema. One goal of Healthy Kentuckians 2010 is to reduce cigarette use among adults to 25%.

*Weighted Estimates

Nor

ther

n K

entu

cky

Toba

cco

Prev

entio

n an

d C

essa

tion


√ The rate of participation in tobacco cessation programs in the Northern Kentucky District increased from 2000 to 2001.6

√ The cessation program participation rate in the Northern Kentucky District remained similar to the state from 1999 to 2001.6

Health departments are providing research-based cessation programs and have increasing numbers of requests for tobacco use cessation programs, reflecting better marketing of services and an increase in consumer demand. Although the rate of participation in tobacco cessation programs in the Northern Kentucky District increased in 2001, very few adult smokers are being reached by current programs. Healthy Kentuckians 2010 recommends that all health departments provide research-based smoking cessation services.

21.9

11.111.9

20.5

9.59.4

0

10

20

30

40

50

1999 2000 2001

Rat

e pe

r 10,

000

adul

tsm

oker

s Northern KentuckyKentucky

60

√ The percent of adult smokers attempting to quit in the Northern Kentucky District remained similar over time.1

√ The percent of adult smokers attempting to quit in the Northern Kentucky District remained similar to the state from 1997 to 2000.1

Given that nearly half of Kentucky smokers report at least one quit attempt, research-based tobacco dependence treatment and cessation services are needed. Healthy Kentuckians 2010 recommends increasing the proportion of adult smokers who stop smoking for a day or more to 58%.


44.646.1 46.947.3

010203040506070

1997-1999 1998-2000

Perc

ent

Northern KentuckyKentucky

Nor

ther

n K

entu

cky

Toba

cco

Prev

entio

n an

d C

essa

tion

√ There was no significant change in the percent of manufacturing facilities that had smoking policies in the Northern Kentucky District from 1999 to 2000.8 √ There was no significant change in the percent of manufacturing facilities that banned indoor smoking in the

Northern Kentucky District from 1999 to 2000.8 √ There was no significant change in the percent of manufacturing facilities that offered resources for smoking cessation and reimbursed employees for cessation in the Northern Kentucky District from 1999 to 2000.8 Similar to the total sample, nearly half of the manufacturing facilities in the Northern Kentucky District banned indoor smoking in 2000. Smoking at worksites presents an important source of environmental tobacco smoke that has ill health effects on employees and contributes to lost productivity. Similar to the total sample, only 3 in 10 manufacturing facilities in the Northern Kentucky District made smoking cessation resources available to their employees in 2000. Healthy Kentuckians 2010 recommends increasing the percent of manufacturing facilities that reimburse for smoking cessation services to 48%.


5241 4249

30 2843

24 26

71 73 69

020406080

100

Havesmokingpolicies

Ban indoorsmoking


Reimbursefor

cessation

Perc

ent

1999 (n = 65)

2000 (n = 79)

2000 Total Sample (N = 437)

Smoking Policy in Food Service Establishment , 1999-2001

√ The percent of smoke-free food establishments in the Northern Kentucky District did not change significantly from 1999 to 2001.7

√ The percent of smoke-free food establishments in the Northern Kentucky District in 2001 was similar to the state rate.7

The increase in smoke-free food service establishments over time reflects voluntary policy change since there are no local or state laws restricting smoking in public places. Healthy Kentuckians 2010 recommends increasing the percent of food service establishments that prohibit smoking or limit it to separately ventilated areas to 51%.


36.3

42.237

32 34.7

38.6

0102030405060

1999 2000 2001

Perc

ent

Northern KentuckyKentucky

61

√ The percent of tobacco sales to minors in the Northern Kentucky District did not decline significantly from 1997 to 2000. 12

The percent of tobacco sales to minors in the Northern Kentucky District was similar to the state from 1997 to 2000. Healthy Kentuckians 2010 aims to strengthen minors’ access laws by increasing compliance to 95% or higher. Although the illegal sale rate has declined over time, only one in three youth smokers report being refused purchase of tobacco products.11


13.4

18.9

12.2

22.8

8.713.1

15.4 14

0

10

20

30

1997 1998 1999 2000

Perc

ent

Northern Kentucky

Kentucky


*Includes students and employees √ While almost all middle and high schools in the Northern Kentucky District banned smoking on school grounds for students in 2001, only about one-third banned smoking on school grounds for employees. 10 √ The percent of schools banning smoking on school grounds in the Northern Kentucky District in 2001 was similar to

the total Kentucky sample.10 √ While the percent of middle and high schools providing cessation services in the Northern Kentucky District

increased from 1999 to 2001, the change was not statistically significant.10

Smoking restrictions on school grounds in the Northern Kentucky District have not changed significantly since 1999. The CDC recommends that the entire school environment be tobacco-free for all students, faculty, staff, and visitors. Nearly 6 in 10 Kentucky middle and high school smokers report trying to quit in the last 12 months,11 yet only about one-fourth of schools in the Northern Kentucky District provided direct smoking cessation services for students and employees in 2001.

Direct Smoking Cessation Services in Middle and High

Schools

10

25.814.611

010203040

1999* 2001

Perc

ent Northern

KentuckyTotalSample

Smoking Banned on School Grounds for Employees, Middle and High Schools

36.9 44.7

8865

020406080

100

1999* 2001

Perc

ent

NorthernKentuckyTotalSample

Nor

ther

n K

entu

cky

Toba

cco

Prev

entio

n an

d C

essa

tion

Rep

ort

62

Purchase District Highlights

There was no significant change in the percent of adults who smoked cigarettes in the Purchase District from 1997 to 2000. Similarly, there was no significant change in the percent of women who smoked during pregnancy over the same time period. The percent of adults smokers attempting to quit remained similar over time. The rate of participation in tobacco cessation programs increased from 1999 to 2001. The percent of smoke-free food establishments in the Purchase District did not change significantly from 1999 to 2001. Nearly four in 10 manufacturing facilities banned smoking. While almost all middle and high schools banned smoking on school grounds for students from 1999 to 2000, about 6 in 10 schools banned smoking on school grounds for employees. Schools in the Purchase District did not provide direct cessation services for employees or students in 1999 or 2001. Although the percent of illegal tobacco sales to minors dropped significantly from 1997 to 1998, the percent has not changed since 1998. Figure 13. Purchase District Health Department Service Area

BALLARD

CARLISLE

GRAVES

McCRACKEN

FULTON

HICKMAN

CRITTENDEN

CALDWELL

TRIGG

LYON

LIVINGSTON

MARSHALL

MCLEAN

HENDERSON

UNION

WEBSTER

HOPKINS

CHRISTIAN

WOODFORD

BOONE

ROBERT

‘ SON

GALLATIN

CARROLLTRIMBLE

MASON

BRACKENPENDLETON

OWEN

KENTON

GRANT

CAMPBELL

BOYLE

FAYETTE

JESSA MINE

MERCER

WASHINGTON

ANDERSON

GARRARD

SPENCER

SHELBY

HENRYOLDHAM

HARRISON

SCOTTFRANKLIN

NELSON

BULLITT

JEFFERSON

GRAYSON

HARDIN

BRECKINRIDGE

MEADE

MARION

HART

EDMONSON

BARREN

LARUE

CALLOWAY

SIMPSON

TODD

BUTLERMUHLENBERG

LOGAN

ALLEN

WARREN

HANCOCK

DAVIESS

OHIO

METCALFRUSSELL

ADAIR

CLINTON

CUMBERLAND

MONROE

CASEY

PULASKI

WAYNE

McCREARY

TAYLOR

GREEN

NICHOLAS

BOURBON

BELL

JACKSON

LAUREL

ROCKCASTLE

KNOX

LINCOLN

CLAY

WHITLEY

OWSLEY

ESTILLMADISON

KNOTTPERRY

LETCHERLESLIE

HARLAN


POWELL

BOYD


WOLFE MAGOFFIN


GREENUP

ROWAN

CARTER

ELLIOTT LAWRENCE

LEWIS

FLEMING

BATH

LAH 9/11/02

Purchase Valley

63

Purc

hase

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d √ There was no significant change in the percent of women who smoked during pregnancy in the Purchase District from 1997 to 2000.4

√ The percent of women who smoked during pregnancy in the Purchase District was similar to the state from 1997 to 2000.4

Women who smoke have increased risks for miscarriage, preterm birth, and low birth weight. About 70% of mothers who stop smoking during pregnancy start again after the baby is born.5 One objective of Healthy Kentuckians 2010 is to reduce cigarette smoking among pregnant women to no more than 17%.


26.1

22.122.723

23.723.724.7

23.4

12.612.312.913.20

10

20

30

40

1997 1998 1999 2000

Perc

ent Purchase

Kentucky

U.S.

64


21.925.1

29.7 30.534.129.630.6 30.8

05

10152025303540

1997 1998 1999 2000

Perc

ent

PurchaseKentucky

√ The percent of adults who smoked cigarettes in the Purchase District significantly decreased from 1997 to 1999.1 √ The age-adjusted death ratea from heart disease increased from 320.0 in 1997 to 334.8 in 1999.2 √ The age-adjusted incidence ratea from lung cancer decreased from 95.49 in 1997 to 87.48 in 1999.3 aAge-adjusted rate per 100,000 total population The percent of adults who smoke cigarettes in the Purchase District remained similar to the state in 1997, 1998, and 2000. Tobacco use is directly linked to heart disease, lung and other cancers, and emphysema. One goal of Healthy Kentuckians 2010 is to reduce cigarette use among adults to 25%. The Purchase District Health Department met the 2010 objective in 2000.

*Weighted Estimates

√ The percent of adult smokers attempting to quit in the Purchase District remained similar over time.1

√ The percent of adult smokers attempting to quit in the Purchase District remained similar to the state from 1997 to 2000.1



45.544.8 46.947.3

0102030405060

1997-1999 1998-2000

Perc

ent

PurchaseKentucky


√ The rate of participation in tobacco cessation programs in the Purchase District increased from 1999 to 2001.6

√ The cessation program participation rate in the Purchase District was higher than the state in 2000 and 2001.6

Health departments are providing research-based cessation programs and have increasing numbers of requests for tobacco use cessation programs, reflecting better marketing of services and an increase in consumer demand. Although the rate of participation in tobacco cessation programs in the Purchase District increased in 2001, very few adult smokers are being reached by current programs. Healthy Kentuckians 2010 recommends that all health departments provide research-based smoking cessation services.

0

26.623.1

20.5

9.59.4

0

10

20

30

40

50

1999 2000 2001Rat

e pe

r 10,

000

adul

t sm

oker

s

PurchaseKentucky

Purc

hase

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d

65

√ Nearly 7 in 10 manufacturing facilities in the Purchase District have smoking policies.8 √ Nearly 2 in 10 manufacturing facilities offer resources for smoking cessation and nearly 3 in 10 reimburse employees for cessation.8 Similar to the total sample, 4 in 10 manufacturing facilities in the Purchase District banned indoor smoking in 2000. Smoking at worksites presents an important source of environmental tobacco smoke that has ill health effects on employees and contributes to lost productivity. Similar to the total sample, nearly 2 in 10 manufacturing facilities in the Purchase District made smoking cessation resources available to their employees. Healthy Kentuckians 2010 recommends increasing the percent of manufacturing facilities that reimburse for smoking cessation services to 48%.


43

1628

43

24 26

69 69

01020304050607080

Havesmokingpolicies

Ban indoorsmoking


Reimbursefor

cessation

Perc

ent

Purchase (n = 49)Total Sample (N = 437)


√ The percent of smoke-free food establishments in the Purchase District did not change significantly from 1999 to 2001.7

√ The percent of smoke-free food establishments in the Purchase District in 2001 was similar to the state rate.7 The increase in smoke-free food service establishments over time reflects voluntary policy change since there are no local or state laws restricting smoking in public places. Healthy Kentuckians 2010 recommends increasing the percent of food service establishments that prohibit smoking or limit it to separately ventilated areas to 51%.


31.726

33.2

38.634.732

01020304050

1999 2000 2001

Perc

ent

PurchaseKentucky

Purc

hase

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d

66

√ Although the percent of tobacco sales to minors in the Purchase District dropped significantly from 1997 to 1998, the percent has not changed significantly since 1998.12

The percent of tobacco sales to minors in the Purchase District was significantly higher than the state in 1997 and significantly lower than the state in 1999. Healthy Kentuckians 2010 aims to strengthen minors’ access laws by increasing compliance to 95% or higher. Although the illegal sale rate has declined over time, only one in three youth smokers report being refused purchase of tobacco products statewide.11

IIlegal Tobacco Sales to Minors, 1997-2000

34.7

13.2

6.510.4 8.7

13.115.4 14

0

10

20

30

40

1997 1998 1999 2000

Perc

ent

PurchaseKentucky


√ While almost all middle and high schools in the Purchase District banned smoking on school grounds for students from 1999 to 2001, about 6 in 10 schools banned smoking on school grounds for employees.10

√ The percent of schools banning smoking on school grounds in the Purchase District in 2001 was similar to the total Kentucky sample.10

√ Schools did not provide cessation services in the Purchase District in 1999 or 2001.10

Smoking restrictions on school grounds in the Purchase District have not changed significantly since 1999. The CDC recommends that the entire school environment be tobacco-free including all students, faculty, staff, and visitors. Nearly 6 in 10 middle and high school smokers report trying to quit in the last 12 months,11 yet none of schools in the Purchase District provided direct smoking cessation services for students and employees in 1999 or 2001.


0 0

14.611

01020

3040

1999 2001

Perc

ent

Purchase

Total Sample


High Schools

58.16944.7

65

0

50

100

1999 2001

Perc

ent Purchase

Total Sample

Purc

hase

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d

67

WEDCO District Highlights

There was no significant change in the percent of adults who smoked cigarettes in the WEDCO District from 1997 to 2000. While there was a significant decline in the percent of women who smoked during pregnancy from 1998 to 2000, the percent in 2000 was similar to 1997 and 1998. The percent of adult smokers attempting to quit remained the same over time. The rate of participation in tobacco cessation programs increased from 1999 to 2001. The percent of smoke-free food establishments in the WEDCO District increased significantly from 2000 to 2001. Four in 10 manufacturing facilities banned smoking. While all middle and high school in this area banned smoking on school grounds for students from 1999 to 2000, nearly two-thirds banned smoking on school grounds for employees in 2001. The percent of illegal tobacco sales to minors did not decline significantly from 1997 to 2000. Figure 14. WEDCO District Health Department Service Area

BALLARD

CARLISLE

GRAVES

McCRACKEN

FULTON

HICKMAN

CRITTENDEN

CALDWELL

TRIGG

LYON

LIVINGSTON

MARSHALL

MCLEAN

HENDERSON

UNION

WEBSTER

HOPKINS

CHRISTIAN

WOODFORD

BOONE

ROBERT

‘ SON

GALLATIN

CARROLLTRIMBLE

MASON

BRACKENPENDLETON

OWEN

KENTON

GRANT

CAMPBELL

BOYLE

FAYETTE

JESSA MINE

MERCER

WASHINGTON

ANDERSON

GARRARD

SPENCER

SHELBY

HENRYOLDHAM

HARRISON

SCOTTFRANKLIN

NELSON

BULLITT

JEFFERSON

GRAYSON

HARDIN

BRECKINRIDGE

MEADE

MARION

HART

EDMONSON

BARREN

LARUE

CALLOWAY

SIMPSON

TODD

BUTLERMUHLENBERG

LOGAN

ALLEN

WARREN

HANCOCK

DAVIESS

OHIO

METCALFRUSSELL

ADAIR

CLINTON

CUMBERLAND

MONROE

CASEY

PULASKI

WAYNE

McCREARY

TAYLOR

GREEN

NICHOLAS

BOURBON

BELL

JACKSON

LAUREL

ROCKCASTLE

KNOX

LINCOLN

CLAY

WHITLEY

OWSLEY

ESTILLMADISON

KNOTTPERRY

LETCHERLESLIE

HARLAN


POWELL

BOYD


WOLFE MAGOFFIN


GREENUP

ROWAN

CARTER

ELLIOTTLAWRENCE

LEWIS

FLEMING

BATH

LAH 9/11/02

WEDCO

68

WED

CO

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car


4033.9

29.829.7

0

10

20

30

40

50

1997-1999 1998-2000

Perc

ent

WEDCO

Kentucky

√ There was no significant change in the percent of adults who smoked cigarettes in the WEDCO District from 1997 to 2000.1

√ The age-adjusted death ratea from heart disease increased from 264.2 in 1997 to 355 in 1999.2 √ The age-adjusted incidence ratea from lung cancer decreased from 92.44 in 1997 to 84.12 in 1999.3 aAge-adjusted rate per 100,000 total population The percent of adults who smoke cigarettes in the WEDCO District was significantly higher than the state in 1998 to 2000. Tobacco use is directly linked to heart disease, lung and other cancers, and emphysema. One goal of Healthy Kentuckians 2010 is to reduce cigarette use among adults to 25%.

√ While there was a significant decline in the percent of women who smoked during pregnancy in the WEDCO

District from 1998 to 2000, the percent in 2000 was similar to 1997 and 1998.4 √ While the percent of women who smoked during pregnancy in the WEDCO District was significantly different

than the state in 1998 and 1999, the percent was similar to the state rate in 2000.4 Women who smoke have increased risks for miscarriage, preterm birth, and low birth weight. About 70% of mothers who stop smoking during pregnancy start again after the baby is born.5 One objective of Healthy Kentuckians 2010 is to reduce cigarette smoking among pregnant women to no more than 17%.


27.2 28.1

2320.1

23.7 23.4

23.724.7

12.612.312.913.20

10

20

30

40

1997 1998 1999 2000

Perc

ent WEDCO

Kentucky

U.S.

*Unweighted estimates

69

√ The percent of adult smokers attempting to quit in the WEDCO District remained similar over time.1

√ The percent of adult smokers attempting to quit in the WEDCO District was similar to the state rate from 1997 to 2000.1



48.6 44.7 46.947.3

010203040506070

1997-1999 1998-2000

Perc

ent

WEDCOKentucky


√ The rate of participation in tobacco cessation programs in the WEDCO District increased from 1999 to 2001.6 √ The cessation program participation rate in the WEDCO District was similar to the state in 2001.6 Health departments are providing research-based cessation programs and have increasing numbers of requests for tobacco use cessation programs, reflecting better marketing of services and an increase in consumer demand. Although the rate of participation in tobacco cessation programs in the WEDCO District increased in 2001, very few adult smokers are being reached by current programs. Healthy Kentuckians 2010 recommends that all health departments provide research-based smoking cessation services.

0

18.4

3.5

20.5

9.59.4

0

10

20

30

40

50

1999 2000 2001

Rat

e pe

r 10,

000

adul

t sm

oker

s

WEDCOKentucky

WED

CO

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d

70

√ Eight in 10 manufacturing facilities in the WEDCO District have smoking policies.8 √ Three in 10 manufacturing facilities offer resources for smoking cessation and 4 in 10 reimburse employees for

cessation.8 Similar to the total sample, nearly 4 in 10 manufacturing facilities in the WEDCO District banned indoor smoking in 2000. Smoking at worksites presents an important source of environmental tobacco smoke that has ill health effects on employees and contributes to lost productivity. Similar to the total sample, 3 in 10 manufacturing facilities in the WEDCO District made smoking cessation resources available to their employees. Healthy Kentuckians 2010 recommends increasing the percent of manufacturing facilities that reimburse for smoking cessation services to 48%.


√ The percent of smoke-free food establishments in the WEDCO District increased significantly from 2000 to 2001.7 √ The percent of smoke-free food establishments in the WEDCO District in 2001 was significantly higher than the

state rate.7 The increase in smoke-free food service establishments over time reflects voluntary policy change since there are no local or state laws restricting smoking in public places. Healthy Kentuckians 2010 recommends increasing the percent of food service establishments that prohibit smoking or limit it to separately ventilated areas to 51%.


51.1

25 25.938.6

32 34.7

010203040506070

1999 2000 2001

Perc

ent

WEDCOKentucky


3930

42

83

43

24 26

69

0102030405060708090


Ban indoorsmoking

Offer cessationresources


Perc

ent WEDCO (n = 23)

Total (N = 437)

WED

CO

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d

71

√ The percent of tobacco sales to minors in the WEDCO District did not decline significantly from 1997 to 2000. 12

The percent of tobacco sales to minors in the WEDCO District was significantly lower than the state in 1999, but similar to the state in 2000. Healthy Kentuckians 2010 aims to strengthen minors’ access laws by increasing compliance to 95% or higher. Although the illegal sale rate has declined over time, only one in three youth smokers report being refused purchase of tobacco products statewide.11


6.1

9.812

23.3

8.7

13.115.4 14

0

10

20

30

1997 1998 1999 2000

Perc

ent

WEDCOKentucky


√ While all middle and high schools in the WEDCO District banned smoking on school grounds for students from

1999 to 2000, nearly two-thirds banned smoking on school grounds for employees in 2001.10 √ The percent of schools banning smoking on school grounds in the WEDCO District in 2001 was similar to the total

Kentucky sample.10 √ The percent of schools in the WEDCO District providing cessation services increased from 1999 to 2001, although

the change was not stasticially significant.10

Smoking restrictions on school grounds in the WEDCO District have not changed significantly since 1999. The CDC recommends that the entire school environment be tobacco-free including all students, faculty, staff, and visitors. Nearly 6 in 10 middle and high school smokers report trying to quit in the last 12 months,11 yet only 18% of schools in the WEDCO District provided direct smoking cessation services for students and employees in 2001.


18.2

0

1114.6

0

10

20

30

40

1999 2001

Perc

ent

WEDCO

Total Sample


High Schools

44

63.644.7

65

02040

6080

100

1999 2001

Perc

ent

WEDCOTotal Sample

WED

CO

Tob

acco

Pre

vent

ion

and

Ces

satio

n R

epor

t Car

d

72

Centers for Disease Control funded versus non-CDC funded Health Department Service Areas

The percent of adult smokers in the CDC funded health departments remained the same

over time and did not differ from those without CDC funding. Likewise, the percent of adult smokers attempting to quit in the CDC funded areas remained the same over time and did not differ from the non-CDC funded health departments. However, the percent of women who smoked during pregnancy was significantly lower over time in the CDC funded service areas compared to the non-CDC funded health departments. There was a steady increase in the rate of participation in tobacco cessation programs among the CDC funded service areas from 1999 to 2001; whereas, participation rates in the non–CDC funded service areas remained unchanged during the same time period. CDC funded service areas showed a 20% increase in smoke-free food service establishments from 1999 to 2001, significantly higher than the non-CDC funded areas. CDC funded and non-funded health departments did not differ on school smoking policies or the provision of cessation services to students and employees. Similarly, the CDC funded and non-funded health departments were similar over time in the percent of illegal tobacco sales to minors. Figure 15. CDC versus Non-CDC Funded Health Department Service Areas

BALLARD

CARLISLE

GRAVES

McCRACKEN

FULTON

HICKMAN

CRITTENDEN

CALDWELL

TRIGG

LYON

LIVINGSTON

MARSHALL

MCLEAN

HENDERSON

UNION

WEBSTER

HOPKINS

CHRISTIAN

WOODFORD

BOONE

ROBERT

‘ SON

GALLATIN

CARROLLTRIMBLE

MASON

BRACKENPENDLETON

OWEN

KENTON

GRANT

CAMPBELL

BOYLE

FAYETTE

JESSA MINE

MERCER

WASHINGTON

ANDERSON

GARRARD

SPENCER

SHELBY

HENRYOLDHAM

HARRISON

SCOTTFRANKLIN

NELSON

BULLITT

JEFFERSON

GRAYSON

HARDIN

BRECKINRIDGE

MEADE

MARION

HART

EDMONSON

BARREN

LARUE

CALLOWAY

SIMPSON

TODD

BUTLERMUHLENBERG

LOGAN

ALLEN

WARREN

HANCOCK

DAVIESS

OHIO

METCALFRUSSELL

ADAIR

CLINTON

CUMBERLAND

MONROE

CASEY

PULASKI

WAYNE

McCREARY

TAYLOR

GREEN

NICHOLAS

BOURBON

BELL

JACKSON

LAUREL

ROCKCASTLE

KNOX

LINCOLN

CLAY

WHITLEY

OWSLEY

ESTILLMADISON

KNOTTPERRY

LETCHERLESLIE

HARLAN


POWELL

BOYD


WOLFE MAGOFFIN


GREENUP

ROWAN

CARTER

ELLIOTT LAWRENCE

LEWIS

FLEMING

BATH

LAH 9/11/02

CDC and Non CCD Funded

BATH

73

CDC and Non-CDC Funded

CD

C T

obac

co P

reve

ntio

n an

d C

essa

tion

Rep

ort C

ard

CD

C T

obac

co P

reve

ntio

n an

d C

essa

tion

Rep

ort C

ard

74

√ The percent of women who smoked during pregnancy was significantly lower in CDC funded service areas than non-CDC funded areas from 1997 to 2000.4 Women who smoke have increased risks for miscarriage, preterm birth, and low birth weight. About 70% of mothers who stop smoking during pregnancy start again after the baby is born. One objective of Healthy Kentuckians 2010 is to reduce cigarette smoking among pregnant women to no more than 17%.


29.128.62930 32.23132.931.5

01020304050

1997 1998 1999 2000

Perc

ent

CDCFundedNon-CDCFunded

√ The percent of adults who smoke cigarettes in CDC funded service areas remained similar to non-CDC areas from 1997 to 2000.1 The percent of adults who smoke in the CDC funded service areas remained the same from 1997 to 2000. Tobacco use is directly linked to heart disease, lung and other cancers, and emphysema. One goal of Healthy Kentuckians 2010 is to reduce cigarette use among adults to 25%.


21.223 22.1 21.9

26.32625.826.8

12.612.312.913.2

0

10

20

30

40

1997 1998 1999 2000

Perc

ent

CDC Funded

Non-CDC Funded

U.S.

CD

C T

obac

co P

reve

ntio

n an

d C

essa

tion

Rep

ort C

ard

75

√ The percent of adult smokers attempting to quit in the CDC funded service areas was similar over time.1 √ The percent of adult smokers in CDC funded service areas attempting to quit remained similar to non-CDC funded service areas from 1997 to 2000.1 Given that nearly half of Kentucky smokers report at least one quit attempt, research-based tobacco dependence treatment and cessation services are needed. Healthy Kentuckians 2010 recommends increasing the proportion of adult smokers who stop smoking for a day or more to 58%.

Adult Quit Attempts, 1997-200050 46.4 50.5 47.950.9 49.6 49.4 48.6

0102030

405060

1997 1998 1999 2000

Perc

ent CDC

FundedNon-CDCFunded

Participation in Tobacco Cessation, 1999-2001

√ The rate of participation in tobacco cessation programs in CDC funded service areas steadily increased from 1999 to

2001.6 √ The cessation program participation rate in CDC funded service areas was similar to non-CDC funded areas in 1999

and 2000, and slightly higher in 2001.6 Health departments are providing research-based cessation programs and have increasing numbers of requests for tobacco use cessation programs, reflecting better marketing of services and an increase in consumer demand. Very few adult smokers are being reached by current programs in both CDC funded and non-CDC funded service areas. Healthy Kentuckians 2010 recommends that all health departments provide research-based smoking cessation services.

8.711.8 14.2

10.3 11.1 10.4

0

10

20

30

40

50

1999 2000 2001Rat

e pe

r 10,

000

adul

t sm

oker

s

CDC FundedNon-CDC Funded

CD

C T

obac

co P

reve

ntio

n an

d C

essa

tion

Rep

ort C

ard

76

School Smoking Policy, 2001 √ The percent of schools banning smoking on school grounds for employees in CDC funded service areas was similar to non- CDC funded areas in 2001. 7

√ The percent of schools providing smoking cessation services to students and employees in CDC funded service areas was similar to non-CDC funded areas in 2001.7

The CDC recommends that the entire school environment be tobacco-free including all students, faculty, staff, and visitors. Nearly 6 in 10 middle and high school smokers report trying to quit in the last 12 months,8 yet only 14% of schools in the CDC funded service areas provided direct smoking cessation services for students and employees in 2001. One Healthy Kentuckians 2010 goal is to increase to 100% the proportion of schools with tobacco-free environments including all school property, vehicles, and at all school events.


Schools

44.6 45

0

20

40

60

CDC Non CDC

Perc

ent

Direct Cessation Services in Middle and

High Schools

14.1 14.9

0

5

10

15

20

CDC Non CDC


√ The percent of smoke-free food establishments in CDC funded service areas was significantly higher than non-CDC funded areas from 1999 to 2001.7

The 20% increase in smoke-free food service establishments in CDC funded service areas reflects voluntary policy change since there are no local or state laws restricting smoking in public places. Healthy Kentuckians 2010 recommends increasing the percentage of food service establishments that prohibit smoking or limit it to separately ventilated areas to 51%.


35.9 38.4 43.9

25.5 27.5 28.6

0

20

40

60

1999 2000 2001

Perc

ent CDC

FundedNon-CDCFunded


√ The percent of schools banning smoking on school grounds for employees in CDC funded service areas was similar to non- CDC funded areas in 2001. 9

√ The percent of schools providing smoking cessation services to students and employees in CDC funded service areas was similar to non-CDC funded areas in 2001. 9

The CDC recommends that the entire school environment be tobacco-free including all students, faculty, staff, and visitors. Nearly 6 in 10 middle and high school smokers report trying to quit in the last 12 months,10 yet only 14% of schools in the CDC funded service areas provided direct smoking cessation services for students and employees in 2001. One Healthy Kentuckians 2010 goal is to increase to 100% the proportion of schools with tobacco-free environments including all school property, vehicles, and at all school events.

Smoking Banned on School Grounds for Employees, Middle

and High Schools

44.6 45

0

20

40

60

CDC Non CDC

Perc

ent

Direct Cessation Services in Middle and High Schools

14.1 14.9

0

5

10

15

20

CDC Non CDC

Perc

ent

CD

C T

obac

co P

reve

ntio

n an

d C

essa

tion

Rep

ort C

ard

77


139.5

13.115.1

7.9

15.4 13.315.6

05

101520

1997 1998 1999 2000

Perc

ent

CDCFunded

Non-CDCFunded

√ The percent of tobacco sales to minors significantly decreased in both CDC funded service areas and non-CDC funded areas from 1999 to 2000.9 √ The percent of tobacco sales to minors in CDC funded service areas was similar to non-CDC funded areas from 1997 to 2000. Healthy Kentukians 2010 aims to strenghen minors’ access to laws by increasing compliance to 95% or higher. Although the illegal sale rate has declined over time, only one in three youth smokers report being refused purchase of tobacco products statewide.8


139.5

13.115.1

7.9

15.413.3

15.6

0

5

10

15

20

1997 1998 1999 2000

Perc

ent CDC

Funded

Non-CDCFunded

√ The percent of tobacco sales to minors significantly decreased in both CDC funded service areas and non-CDC funded areas from 1999 to 2000. 12 √ The percent of tobacco sales to minors in CDC funded service areas was similar to non-CDC funded areas from 1997 to 2000. 12 Healthy Kentukians 2010 aims to strenghen minors’ access to laws by increasing compliance to 95% or higher. Although the illegal sale rate has declined over time, only one in three youth smokers report being refused purchase of tobacco products statewide.11

78

References

1. BRFSS, 2000 http://apps.nccd.cdc.gov/brfss/trends. 2. Kentucky Annual Vital Statistics Report, Kentucky Cabinet for Health Services Depart-

ment for Public Health, Division of Epidemiology and Health Planning. Frankfort, KY: KDPH, 1999.

3. Kentucky Cancer Registry, 2001. http://web.kcr.uky.edu. 4. Kentucky Vital Statistics Birth File, Kentucky Department for Public Health, Surveillance

and Health Data Branch. Frankfort, KY: KDPH, 1997-2000. 5. McBride CM, Pirie PL, Currie SJ. Post-partum relapse to smoking: a prospective study.

Health Education Research 1999;7:381-390. 6. Local Health Department Tobacco Cessation Survey, University of Kentucky College of

Nursing. Lexington, KY: UKCON, 1999-2001. 7. Kentucky Department for Public Health, Division of Public Health Protection and Safety.

Frankfort, KY: KDPH, 1999-2001. 8. Kentucky Workplace Tobacco Policy Survey, University of Kentucky College of Nursing.

Lexington, KY: UKCON, 1999-2000. 9. University of Kentucky Survey Public Opinion Poll, Survey Research Center. Lexington,

KY: UK, 1999-2001. 10. Kentucky School Tobacco Policy Survey, University of Kentucky College of Nursing.

Lexington, KY: UKCON, 1999-2001. 11. Hahn, EJ, Plymale, MA, Rayens, MK. Kentucky Youth Tobacco Survey 2000. Kentucky

Cabinet for Health Services. Frankfort, KY: KDPH, March 2001. 12. Illegal Tobacco Sales to Minors Data Base, Alcoholic Beverage Control. Frankfort, KY:

ABC, 1997-2000.

79

Appendix

Healthy Kentuckians 2010 Selected Tobacco Use Objectives Healthy Kentuckians 2010 is our state’s commitment to the national prevention initiative, Healthy

People 2010. The Healthy Kentuckians 2010 Prevention Objectives fall into four major categories: (1) promoting healthy behaviors; (2) promoting healthy and safe communities; (3) improving systems for personal and public health; and (4) preventing and reducing disease and disorders. The outcomes assessed in this report are consistent with the following selected Healthy Kentuckians 2010 Tobacco Use Objectives

Current Adult Cigarette Use Objective 3.1 Reduce the proportion of adults (18 and older) who use tobacco products (1998 Baseline: 30.8%). Smoking During Pregnancy Objective 3.4 Reduce cigarette smoking among pregnant women to a prevalence of no more than 17 percent (1997 Baseline: 25%). Adult Quit Attempts Objective 3.2 Increase to 58 percent the proportion of cigarette smokers aged 18 and older who stop

smoking cigarettes for a day or more. Tobacco Cessation Services in Local Health Departments Objective 3.20d Increase to 100 percent the proportion of health departments that provide a variety of

research-based smoking cessation treatment interventions. Smoking Policy in Food Service Establishments Objective 3.17 Increase to 51 percent the proportion of food service establishments that prohibit

smoking or limit it to separately ventilated areas (1999 Baseline: 32%). Tobacco Policy in Manufacturing Facilities Objective 3.16 Increase to 100 percent the proportion of worksites that prohibit smoking or limit it to

separately ventilated areas. Objective 3.19 Increase the proportion of health plans that reimburse for nicotine addiction treatment. Objective 3.20e Increase to 48 percent manufacturing facilities that reimburse for smoking cessation

services. Public Opinion Objective 3.22 Increase the proportion of localities that adopt ordinances and/or policies to restrict

tobacco use. School Tobacco Policy Objective 3.15 Increase to 100 percent the proportion of schools with tobacco-free environments

including all school property, vehicles, and at all school events. Youth Tobacco Use Objective 3.6 Reduce the proportion of young people who have smoked cigarettes within the past 30

days (1997 Baseline: 47.0%, males 48.4% and females 45.3%). Objective 3.6a Reduce the proportion of young people who have used smokeless tobacco in the past

30 days (1997 Baseline: males 28.6% and females 2.3%). Illegal Tobacco Sales to Minors Objective 3.13 Enforce minors’ access laws to increase compliance to 95 percent or higher (1998 Baseline: 86%).

10/15/02

tobacco prevention and cessation report card final...centers for disease control and...

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