1. Regional Variation in Tobacco Use: A Community Health Survey of Urban, Suburban, and Rural Households
Rose Malinowski Weingartner, BA, Kayshin Chan, MPH, Maya Gutierrez, BA, Amanda Innes Dominguez, MSS, MLSP, Kris Minot, MS Research & Evaluation, Public Health Management Corporation, 260 S. Broad St., Philadelphia, PA 19102
Objectives
Compare survey results for urban, suburban, and rural areas in tobacco use, tobacco smoke exposure and tobacco cessation histories
Recognize the differences and similarities in patterns of tobacco use and tobacco use treatment between geographic areas
Understand the value of comprehensive local data for tobacco control program planning.
Background
PHMC’s Community Health Data Base
Household Health Surveys
Cover variety of health topics, including tobacco use and tobacco smoke pollution exposure
Align with national indicators from BRFSS, NHIS, Healthy People 2010, etc.
Large sample size for a geographically small region allows for county-level and smaller analysis
Southeastern Pennsylvania Household Health Survey
5-county survey with sample of about 10,000 households
Includes Philadelphia and four surrounding counties (Bucks, Chester, Delaware, and Montgomery). Per 2000 Census pop. density, range from 572 – 11,233 per sq mi.
Philadelphia county is more than three times as dense as the next highest density county.
Berks-Lancaster-Schuylkill Household Health Survey
Shorter version of the Southeastern Pennsylvania instrument, with the same core set of indicators
3-county survey with sample of about 3,000 households
Includes 3 counties adjacent to the northwest of the 5-county region. Per 2000 Census pop. Density, range from 194 – 495 per sq. mi.
Key Findings- Tobacco Use Prevalence
Smoking Prevalence by County, 2008
Percent (%)
Projected number
Philadelphia
27.3
292,800
Delaware
19.2
81,500
Montgomery
14.5
87,200
Bucks
17.1
79,800
Chester
15.7
58,300
Lancaster
16.2
59,800
Berks
24.8
77,000
Schuylkill
25.4
32,200
Smoking Prevalence by County, 2008
Demographic Characteristics of Smokers
The poor (<100% Federal Poverty Level) are more likely to be smokers than the non-poor, across the region. Education is also inversely related to smoking across all counties.
Smoking Prevalence Among Adults <12th Grade Education by County, 2008
Variation in smoking prevalence: County-level smoking rates ranged from 27.3% in Philadelphia to 13.7% in Montgomery County.
Non-cigarette tobacco use: County-level non-cigarette tobacco use rates ranged from 6.9% in Schuylkill County to 3.3% in Delaware County.
*Healthy People 2010 Objective is 12% or lower.
Key Findings – TSP Exposure
Key Findings – Cessation
Conclusions
With a comprehensive data source, geographic and demographic variation can be tracked and mapped across broad geography
Looking at discrete regions dispels myths about tobacco use and exposure among different groups of people:
Tobacco use: counties with the lowest and highest population density had the highest smoking prevalence
TSP Exposure: counties with the lowest and highest population density had the highest levels of TSP in the home.
Cessation: little difference in cessation methods was seen between counties
It is important to narrow down the geographic scope of the information when using data for local program planning
Detailed data can better improve service delivery through more targeted efforts based on location and demographics
Tracking data over time can also inform program evaluation efforts
Across the region: 54.3% tried to quit in past year
Across the region: 63.7% were advised to quit smoking by their healthcare provider in the past year
Of those who tried quitting:
“Cold turkey” was most popular across the region (61.3%)
NRT and TCP (excluding Chantix) were used by 19.7%
Chantix was used by 9.0%
TSP Exposure in Households by County, 2008
Cessation Methods: Cold Turkey and NRT Use by County, 2008
In one in seven households (14.7% or 277,000 homes) across the region, residents are exposed to tobacco smoke pollution inside the home.
Exposure by Poverty (<100% Federal Poverty Line):
Tobacco smoke exposure in poor households ranges from about one-fifth of households (20.8%) in Lancaster County to about one-third of households (32.0%) in Delaware County.
Graphs are ordered from highest population density (Philadelphia, orange) to least population density (Schuylkill, green)