Cigarette smoking prevalence in US counties: 1996-2012

Area of Science:

• Public Health
• Epidemiology
• Biostatistics

Background:

• Cigarette smoking remains a primary cause of preventable death in the U.S.
• Lack of granular data below the state level hinders localized public health interventions.
• Understanding local smoking trends is crucial for effective public health strategies.

Purpose of the Study:

• To estimate current cigarette smoking prevalence at the county level in the U.S.
• To analyze trends in smoking prevalence from 1996 to 2012 across U.S. counties.
• To identify geographic and demographic factors associated with smoking prevalence and changes.

Main Methods:

• Utilized data from 4.7 million adults via the Behavioral Risk Factor Surveillance System (BRFSS) (1996-2012).
• Applied validated small area estimation techniques to derive county-level smoking prevalence.
• Incorporated a novel bias correction for the wireless-only population exclusion in BRFSS data prior to 2011.

Main Results:

• Observed dramatic county-level variations in smoking prevalence (males: 9.9%-41.5%; females: 5.8%-40.8% in 2012).
• Highest prevalence noted in Southern counties and those with large Native American populations; lowest in Western states like Utah.
• Overall prevalence declined (median 0.9%/year males, 0.6%/year females), but declines were uneven, with faster reductions in higher-income counties.

Conclusions:

• County-level smoking prevalence data offers critical insights into high-prevalence areas and slow-progress regions.
• These granular estimates are essential for developing and implementing targeted, effective local and state-level smoking reduction strategies.
• Addressing disparities in smoking prevalence and decline is key to reducing the national burden of smoking-related diseases.