Tobacco Use in CO Who are the current smokers? Moving the Mark Revisited May 1, 2017 Amy Anderson, MPH Renee Calanan, PhD
Behavioral Risk Factor S urveillance S ystem (BRFS S ) ● Random-digit dialed landline and cell phone survey ● English or S panish ● Adults aged 18+ living in Colorado ● S ample: 11,500-13,500 weighted to be representative of the adult population in Colorado Healthy Kids Colorado S urvey (HKCS ) ● Paper survey voluntarily completed by high school students ● Random sample of schools and classrooms ● S ample: 15,000-25,000 weighted to be representative of all high school students (grades 9-12) in Colorado Pregnancy Risk Assessment Monitoring S ystem (PRAMS ) ● Mailed paper survey with telephone follow-up if no response ● Random sample of women who had a recent live birth ● S ample: 1,700-2,000 weighted to be representative of all women who had a recent live birth in Colorado 2
Current cigarette smoking among adults Colorado and U.S., 1998-2015 As of 2015, t here were approximat ely 600,000 adult Coloradans who current ly smoke cigaret t es. Dat a S ource: Behavioral Risk Fact or S urveillance S yst em 3
Current t obacco use among adults 4 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Current t obacco use among high school st udent s Dat a on current elect ronic vapor product use is not available in 2013. 5 Dat a S ource: Healt hy Kids Colorado S urvey, 2013 and 2015
Source: Rate per capita calculated by the CO Department of Public Health using tax revenue data from the CO Department of Revenue and population estimates from the 6 State Demographer's Office
Perceived risk of* and access t o ✝ cigaret t es among high school st udent s Dat a S ource: * among all high school students ✝ among underage high school students 7 Healt hy Kids Colorado S urvey, 2015
Current t arget populat ion: Adult s aged 18-24 wit hout a college educat ion 8 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2013-2015
Current t arget populat ion: Pregnant women * * Among t hose who smoked 3 mont hs before pregnancy 9 Dat a S ource: Pregnancy Risk Assessment Monit oring S yst em, 2014
Successes ● Overall decrease in cigarette smoking among youth and adults ● CO has lower prevalence than U.S . Challenges ● Decreasing trend in sales but small increase 2015-2016 ● Rise of e-vapor products ● Among high school students: ○ 30% use tobacco products ○ 1/ 6 report no or slight risk of smoking 1+ pack/ day ○ More than half report easy access to cigarettes ● High prevalence of smoking among priority populations: ○ Adults aged 18-24 without college education ○ Pregnant women 10
Who are the current smokers? 11
Prevalence by demographics and demographics of current smokers Disparit ies Who is more likely to smoke? Burden Who are the current smokers? 12
S t at ement on st ruct ural inequit y The Colorado Depart ment of Public Healt h and Environment acknowledges t hat social, economic and environment al inequit ies result in adverse healt h out comes and have a great er impact t han individual choices. Reducing healt h disparit ies t hrough syst ems change can help improve opport unit ies for all Coloradans. 13
Current smoking among adult s by sex S ex of current smokers 14 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Current smoking among adult s by age Age of current smokers 15 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Current smoking among adult s by race/ et hnicit y Race/ et hnicit y of current smokers 16 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Current smoking among Hispanic adult s by pref erred language* Pref erred language* of Hispanic current smokers *Language survey was completed in 17 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Current smoking among adult s by sexual orient at ion S exual orient at ion of current smokers 18 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Current smoking among adult s by socioeconomic st at us (S ES ) S ES of current smokers *Low S ES : uninsured, income below 200% FPL, no HS diploma/ GED, or unable t o work 19 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Current smoking among adult s by povert y level Povert y level of current smokers 20 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Current smoking among adult s by educat ion level Educat ion level of current smokers 21 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Current smoking among adult s by insurance t ype Insurance t ype of current smokers 22 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Current smoking among adult s by employment st at us Employment st at us of current smokers 23 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Current smoking among adult s by indust ry Indust ry of current smokers 24 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Current smoking among adult s by occupat ion Occupat ion of current smokers 25 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Current smoking among adult s by housing t ype Housing t ype of current smokers 26 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
S ummary - Who are t he smokers? Disparities Burden ● Adults <65 years ● Adults 25-64 ● Males ● Males ● Native American & Black ● White & Hispanic ● English-speaking Hispanic ● English-speaking Hispanic ● LGB ● Heterosexual ● Low S ● Low S ES ES ● <College degree ● High school grads & some ● <200% FPL college ● Uninsured & Medicaid ● Private insurance & ● Unemployed & unable to Medicaid ● Employed work ● Renters ○ Construction workers ● Homeowners 27 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em
Current smoking among adult s by region 28 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Where do current smokers live? 29 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
What else do we know about smokers? 30
Healt h care access and ut ilizat ion 31 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, (year)
Healt h behaviors 32 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Chronic healt h condit ions Age-adj ust ed t o t he 2000 st andard US populat ion 33 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Ment al Healt h * S core of 13-24 on 6-it em Kessler scale quest ions **S core of 20-24 on 8-it em Pat ient Healt h Quest ionnaire 34 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, (year)
Co-Occurring S ubst ance Use 35 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
S ummary: What else do we know about current smokers? Health care access and utilization ● Less likely to have a regular provider ● Less likely to have annual wellness visit and be up-to-date on preventive services Health behaviors ● Less likely to consume fruits and vegetables ● More likely to consume sugary drinks ● Less likely to meet physical activity recommendations Chronic health conditions ● More likely to be diagnosed with COPD, arthritis, cancer, cardiovascular disease, and depression ● More likely to have multiple chronic conditions 36 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em
S ummary: What else do we know about current smokers? Mental health ● More likely to have psychological distress or depression ● More likely to have 4+ adverse childhood experiences Co-occurring substance use ● More likely to use marij uana ● More likely to be a heavy drinker or binge drink ● More likely to use chewing tobacco 37 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em
Who are the current smokers: 1.Working in construction 2.18-24 without any college education 3.Low SES 38
Who are t he current smokers who are working in const ruct ion*? ✝ * Includes t hose who are employed or out of work for <1 year ✝ Unemployed means t hey have been out of work for <1 year and indicat ed const ruct ion as most recent indust ry of employment 39 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2014 & 2015
Who are t he current smokers who are 18-24 wit hout any college educat ion? 40 Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015
Who are t he current smokers who are low S ES *? * Low S ES : uninsured, income below 200% FPL, no HS diploma/ GED, or unable t o work Dat a S ource: Behavioral Risk Fact or S urveillance S yst em, 2015 41
Questions? renee.calanan@state.co.us amy.anderson@state.co.us 42
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