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Lee JS, Lowe Beasley K, Schooley MW, Luo F. Trends and Costs of US Telehealth Use Among Patients With Cardiovascular Disease Before and During the COVID-19 Pandemic. J Am Heart Assoc 2023; 12:e028713. [PMID: 36789857 PMCID: PMC10111470 DOI: 10.1161/jaha.122.028713] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Background The COVID-19 pandemic affected outpatient care delivery and patients' access to health care. However, no prior studies have documented telehealth use among patients with cardiovascular disease. Methods and Results We documented the number of telehealth and in-person outpatient encounters per 100 patients with cardiovascular disease and the percentage of telehealth encounters from January 2019 to June 2021, and the average payments per telehealth and in-person encounters across a 12-month period (July 2020-June 2021) using the MarketScan commercial database. From February 2020 to April 2020, the number of in-person encounters per 100 patients with cardiovascular disease decreased from 304.2 to 147.7, whereas that of telehealth encounters increased from 0.29 to 25.3. The number of in-person outpatient encounters then increased to 280.7 in June 2020, fluctuated between 268.1 and 346.4 afterward, and ended at 268.1 in June 2021, lower than the prepandemic levels. The number of telehealth encounters dropped to 16.8 in June 2020, fluctuated between 8.8 and 16.6 afterward, and ended at 8.8 in June 2021, higher than the prepandemic levels. Patients who were aged 18 to 35 years, women, and living in urban areas had higher percentages of telehealth encounters than those who were aged 35 to 64 years, men, and living in rural areas, respectively. The mean (95% CI) telehealth and in-person outpatient encounter costs per visit were $112.8 (95% CI, $112.4-$113.2) and $161.4 (95% CI, $160.4- $162.4), respectively. Conclusions There were large fluctuations in telehealth and in-person outpatient encounters during the pandemic. Our results provide insight into increased telehealth use among patients with cardiovascular disease after telehealth policy changes were implemented during the pandemic.
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Affiliation(s)
- Jun Soo Lee
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA
| | - Kincaid Lowe Beasley
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA
| | - Michael W Schooley
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA
| | - Feijun Luo
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA
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Wang G, Grosse SD, Schooley MW. Conducting Research on the Economics of Hypertension to Improve Cardiovascular Health. Am J Prev Med 2017; 53:S115-S117. [PMID: 29153111 PMCID: PMC5808538 DOI: 10.1016/j.amepre.2017.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/12/2017] [Accepted: 08/01/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Guijing Wang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael W Schooley
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Barbero C, Gilchrist S, Shantharam S, Fulmer E, Schooley MW. Doing More with More: How "Early" Evidence Can Inform Public Policies. Public Adm Rev 2017; 77:646-649. [PMID: 32684642 PMCID: PMC7367649 DOI: 10.1111/puar.12831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Colleen Barbero
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Siobhan Gilchrist
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, Georgia, since 2009
| | | | - Erika Fulmer
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, Georgia
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Barbero C, Gilchrist S, Schooley MW, Chriqui JF, Luke DA, Eyler AA. Appraising the evidence for public health policy components using the quality and impact of component evidence assessment. Glob Heart 2015; 10:3-11. [PMID: 25754561 DOI: 10.1016/j.gheart.2014.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
An essential strategy expected to reduce the global burden of chronic and cardiovascular disease is evidence-based policy. However, it is often unknown what specific components should constitute an evidence-based policy intervention. We have developed an expedient method to appraise and compare the strengths of the evidence bases suggesting that individual components of a policy intervention will contribute to the positive public health impact of that intervention. Using a new definition of "best available evidence," the Quality and Impact of Component (QuIC) Evidence Assessment analyzes dimensions of evidence quality and evidence of public health impact to categorize multiple policy component evidence bases along a continuum of "emerging," "promising impact," "promising quality," and "best." QuIC was recently applied to components from 2 policy interventions to prevent and improve the outcomes of cardiovascular disease: public-access defibrillation and community health workers. Results illustrate QuIC's utility in international policy practice and research.
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Affiliation(s)
- Colleen Barbero
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA.
| | | | - Michael W Schooley
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Douglas A Luke
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Amy A Eyler
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
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Spencer LM, Schooley MW, Anderson LA, Kochtitzky CS, DeGroff AS, Devlin HM, Mercer SL. Seeking best practices: a conceptual framework for planning and improving evidence-based practices. Prev Chronic Dis 2013; 10:E207. [PMID: 24331280 PMCID: PMC3864707 DOI: 10.5888/pcd10.130186] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How can we encourage ongoing development, refinement, and evaluation of practices to identify and build an evidence base for best practices? On the basis of a review of the literature and expert input, we worked iteratively to create a framework with 2 interrelated components. The first — public health impact — consists of 5 elements: effectiveness, reach, feasibility, sustainability, and transferability. The second — quality of evidence — consists of 4 levels, ranging from weak to rigorous. At the intersection of public health impact and quality of evidence, a continuum of evidence-based practice emerges, representing the ongoing development of knowledge across 4 stages: emerging, promising, leading, and best. This conceptual framework brings together important aspects of impact and quality to provide a common lexicon and criteria for assessing and strengthening public health practice. We hope this work will invite and advance dialogue among public health practitioners and decision makers to build and strengthen a diverse evidence base for public health programs and strategies.
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Affiliation(s)
- Lorine M Spencer
- Applied Systems Research and Evaluation Branch, Division of Public Health Performance Improvement, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop E70, Atlanta, GA 30341-3717. E-mail:
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Schell SF, Luke DA, Schooley MW, Elliott MB, Herbers SH, Mueller NB, Bunger AC. Public health program capacity for sustainability: a new framework. Implement Sci 2013; 8:15. [PMID: 23375082 PMCID: PMC3599102 DOI: 10.1186/1748-5908-8-15] [Citation(s) in RCA: 297] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 01/22/2013] [Indexed: 11/18/2022] Open
Abstract
Background Public health programs can only deliver benefits if they are able to sustain activities over time. There is a broad literature on program sustainability in public health, but it is fragmented and there is a lack of consensus on core constructs. The purpose of this paper is to present a new conceptual framework for program sustainability in public health. Methods This developmental study uses a comprehensive literature review, input from an expert panel, and the results of concept-mapping to identify the core domains of a conceptual framework for public health program capacity for sustainability. The concept-mapping process included three types of participants (scientists, funders, and practitioners) from several public health areas (e.g., tobacco control, heart disease and stroke, physical activity and nutrition, and injury prevention). Results The literature review identified 85 relevant studies focusing on program sustainability in public health. Most of the papers described empirical studies of prevention-oriented programs aimed at the community level. The concept-mapping process identified nine core domains that affect a program’s capacity for sustainability: Political Support, Funding Stability, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communications, Public Health Impacts, and Strategic Planning. Concept-mapping participants further identified 93 items across these domains that have strong face validity—89% of the individual items composing the framework had specific support in the sustainability literature. Conclusions The sustainability framework presented here suggests that a number of selected factors may be related to a program’s ability to sustain its activities and benefits over time. These factors have been discussed in the literature, but this framework synthesizes and combines the factors and suggests how they may be interrelated with one another. The framework presents domains for public health decision makers to consider when developing and implementing prevention and intervention programs. The sustainability framework will be useful for public health decision makers, program managers, program evaluators, and dissemination and implementation researchers.
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Affiliation(s)
- Sarah F Schell
- Center for Public Health Systems Science, George Warren Brown School of Social Work, Washington University in St, Louis, 700 Rosedale Ave, Campus Box 1009, St, Louis, MO, 63112, USA
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Dunet DO, Gase LN, Oliver ML, Schooley MW. Evaluative Thinking: A Tool to Inform Policy Development and Policy Impact Evaluations. Am J Health Promot 2012; 26:201-3. [DOI: 10.4278/ajhp.110505-cit-186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Diane O. Dunet
- Diane O. Dunet, PhD, is Senior Evaluator and Health Scientist, and Michael W. Schooley, MPH, is Chief, Applied Research and Evaluation Branch, Division for Heart Disease and Stroke Prevention; and Lauren N. Gase, MPH, is Health Scientist, Office of the Associate Director for Policy, Centers for Disease Control and Prevention, Atlanta, Georgia. Monica L. Oliver, PhD, is Director, The Evaluation Group, Decatur, Georgia
| | - Lauren N. Gase
- Diane O. Dunet, PhD, is Senior Evaluator and Health Scientist, and Michael W. Schooley, MPH, is Chief, Applied Research and Evaluation Branch, Division for Heart Disease and Stroke Prevention; and Lauren N. Gase, MPH, is Health Scientist, Office of the Associate Director for Policy, Centers for Disease Control and Prevention, Atlanta, Georgia. Monica L. Oliver, PhD, is Director, The Evaluation Group, Decatur, Georgia
| | - Monica L. Oliver
- Diane O. Dunet, PhD, is Senior Evaluator and Health Scientist, and Michael W. Schooley, MPH, is Chief, Applied Research and Evaluation Branch, Division for Heart Disease and Stroke Prevention; and Lauren N. Gase, MPH, is Health Scientist, Office of the Associate Director for Policy, Centers for Disease Control and Prevention, Atlanta, Georgia. Monica L. Oliver, PhD, is Director, The Evaluation Group, Decatur, Georgia
| | - Michael W. Schooley
- Diane O. Dunet, PhD, is Senior Evaluator and Health Scientist, and Michael W. Schooley, MPH, is Chief, Applied Research and Evaluation Branch, Division for Heart Disease and Stroke Prevention; and Lauren N. Gase, MPH, is Health Scientist, Office of the Associate Director for Policy, Centers for Disease Control and Prevention, Atlanta, Georgia. Monica L. Oliver, PhD, is Director, The Evaluation Group, Decatur, Georgia
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Schmidt SM, Andrews T, Bibbins-Domingo K, Burt V, Cook NR, Ezzati M, Geleijnse JM, Homer J, Joffres M, Keenan NL, Labarthe DR, Law M, Loria CM, Orenstein D, Schooley MW, Sukumar S, Hong Y. Proceedings from the workshop on estimating the contributions of sodium reduction to preventable death. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.cvdpc.2011.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Giovino GA, Biener L, Hartman AM, Marcus SE, Schooley MW, Pechacek TF, Vallone D. Monitoring the tobacco use epidemic I. Overview: Optimizing measurement to facilitate change. Prev Med 2009; 48:S4-10. [PMID: 18809429 DOI: 10.1016/j.ypmed.2008.08.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 08/25/2008] [Accepted: 08/31/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This Overview paper (I of V) summarizes research work to date on monitoring the tobacco use epidemic, discusses the recommendations made at the November, 2002 National Tobacco Monitoring, Research and Evaluation Workshop sponsored by the U.S. National Cancer Institute (NCI), Centers for Disease Control and Prevention (CDC), the American Legacy Foundation, and the Robert Wood Johnson Foundation on the topic of tobacco surveillance and evaluation, and discusses the current state of affairs. METHODS A conceptual model based on the classical infectious diseases framework/paradigm focusing on the Agent, Host, Vector and Environment is used to integrate the work presented in the four other papers that appear in this supplemental issue of Preventive Medicine. RESULTS The Agent paper (II) describes surveillance on tobacco products and biomarkers; the Host paper (III) describes surveillance on the smoker/user, or potential smoker/user; the Vector paper (IV) describes monitoring of industry activity; and the Environment paper (V) describes several key strategies for monitoring influential environmental factors. Overall, some improvements to the nation's surveillance system have been made in recent years. However, additional steps are needed to optimize measurement of tobacco use and factors influencing use in the United States. CONCLUSIONS Tobacco monitoring efforts play a vital role in combating the epidemic of addiction and disease produced by various tobacco products. The knowledge and experience gained by the tobacco use prevention and control community through this commitment to linkages of data collected in the domains of Vector and Environment, in addition to Agent and Host, could inform monitoring of a wide range of other public health issues as well, including diet and nutrition, physical activity, overweight and obesity, and substance abuse.
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Affiliation(s)
- Gary A Giovino
- Department of Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, 312 Kimball Tower, Buffalo, New York 14214-8028, USA.
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Clark PI, Schooley MW, Pierce B, Schulman J, Hartman AM, Schmitt CL. Impact of home smoking rules on smoking patterns among adolescents and young adults. Prev Chronic Dis 2006; 3:A41. [PMID: 16539782 PMCID: PMC1563982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Smoking restrictions in public places have been shown to reduce cigarette consumption and may reduce smoking prevalence. Evidence is emerging that smoke-free policies in nonpublic places may have a similar effect. The purpose of this study was to determine whether an association exists between household smoking rules and smoking patterns among adolescents (aged 15 to 18 years) and young adults (aged 19 to 24 years) living in parental homes (i.e., the homes of their parents, grandparents, or foster parents). METHODS Cross-sectional data from the 1998-1999 Tobacco Use Supplement to the Current Population Survey were analyzed for the association between household smoking rules and smoking behaviors among adolescents and young adults. We used a probability sample of noninstitutionalized adolescents (aged 15 to 18 years) and young adults (aged 19 to 24 years) living in the United States and assessed smoking status, attempts to quit, and smoking intensity. RESULTS After controlling for smoking status of others in the household, the odds of ever having smoked, being a current smoker, and smoking more than five cigarettes per day were significantly smaller in households with strict no-smoking policies than in households where smoking was permitted anywhere. These results were relevant for adolescents and young adults. CONCLUSION Household smoking rules are a type of antitobacco socialization that help deter adolescents from smoking. The influence of household smoking rules seems to extend beyond adolescence into the young adult years among people who continue to live at home with their parents, grandparents, or foster parents.
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Affiliation(s)
- Pamela I Clark
- Battelle Centers for Public Health Research and Evaluation, 6115 Falls Rd, Suite 200, Baltimore, MD 21209, USA.
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Siegel M, Mowery PD, Pechacek TP, Strauss WJ, Schooley MW, Merritt RK, Novotny TE, Giovino GA, Eriksen MP. Trends in adult cigarette smoking in California compared with the rest of the United States, 1978-1994. Am J Public Health 2000; 90:372-9. [PMID: 10705854 PMCID: PMC1446161 DOI: 10.2105/ajph.90.3.372] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study compared trends in adult cigarette smoking prevalence in California and the remainder of the United States between 1978 and 1994. METHODS We used data from National Health Interview Surveys and Behavioral Risk Factor Surveillance System surveys to compare trends in smoking prevalence among persons 18 years and older. RESULTS In both California and the remainder of the United States, the estimated annual rate of decline in adult smoking prevalence accelerated significantly from 1985 to 1990: to -1.22 percentage points per year (95% confidence interval [CI] = -1.51, -0.93) in California and to -0.93 percentage points per year (95% CI = -1.13, -0.73) in the remainder of the nation. The rate of decline slowed significantly from 1990 to 1994: to -0.39 percentage points per year (95% CI = -0.76, -0.03) in California and to -0.05 percentage points per year (95% CI = -0.34, 0.24) in the remainder of the United States. CONCLUSIONS The presence of an aggressive tobacco control intervention has supported a significant decline in adult smoking prevalence in California from 1985 to 1990 and a slower but still significant decline from 1990 to 1994, a period in which there was no significant decline in the remainder of the nation. To restore nationwide progress in reducing smoking prevalence, other states should consider similar interventions.
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Affiliation(s)
- M Siegel
- Social and Behavioral Sciences Department, Boston University School of Public Health, MA 02118, USA.
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Arday DR, Tomar SL, Nelson DE, Merritt RK, Schooley MW, Mowery P. State smoking prevalence estimates: a comparison of the Behavioral Risk Factor Surveillance System and current population surveys. Am J Public Health 1997; 87:1665-9. [PMID: 9357350 PMCID: PMC1381131 DOI: 10.2105/ajph.87.10.1665] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study examined whether there are systematic differences between the Behavioral Risk Factor Surveillance System (BRFSS) and the Current Population Survey (CPS) for state cigarette smoking prevalence estimates. METHODS BRFSS telephone survey estimates were compared with estimates from the US Census CPS tobacco-use supplements (the CPS sample frame includes persons in households without telephones). Weighted overall and sex- and race-specific BRFSS and CPS state estimates of adults smoking were analyzed for 1985, 1989, and 1992/1993. RESULTS Overall estimates of smoking prevalence from the BRFSS were slightly lower than estimates from CPS (median difference: -2.0 percentage points in 1985, -0.7 in 1989, and -1.9 in 1992/1993; P < .05 for all comparisons), but there was variation among states. Differences between BRFSS and CPS estimates were larger among men than among women and larger among Blacks than among Hispanics or Whites; for most states, these differences were not significant. CONCLUSIONS The BRFSS generally provides state estimates of smoking prevalence similar to those obtained from CPS, and these are appropriate for ongoing state surveillance of smoking prevalence.
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Affiliation(s)
- D R Arday
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Ga. 30341-3724, USA
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Giovino GA, Schooley MW, Zhu BP, Chrismon JH, Tomar SL, Peddicord JP, Merritt RK, Husten CG, Eriksen MP. Surveillance for selected tobacco-use behaviors--United States, 1900-1994. MMWR CDC Surveill Summ 1994; 43:1-43. [PMID: 7969014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PROBLEM/CONDITION Surveillance of tobacco use is an essential component of any tobacco-control program. The information gathered can be used to guide research initiatives, intervention programs, and policy decisions. REPORTING PERIODS: This report covers the period 1900-1994 for per capita cigarette consumption; 1965-1991 for trends in cigarette smoking prevalence and cessation; 1974-1991 for trends in the number of cigarettes smoked daily by current smokers; 1987-1991 for recent patterns of tobacco use; 1970, 1987, and 1991 for trends in cigar/pipe smoking and snuff/chewing tobacco use; 1984-1992 for trends in state-specific prevalences of regular cigarette smoking; 1987-1992 for state-specific estimates of smokeless-tobacco use; and 1976-1993 for trends in cigarette smoking among U.S. high school seniors. DESCRIPTION OF SYSTEMS Estimates of cigarette consumption are reported by the U.S. Department of Agriculture, which uses data from the U.S. Department of the Treasury, the U.S. Department of Commerce, the Tobacco Institute, and other sources. The National Health Interview Survey uses household interviews to provide nationally representative estimates (for the civilian, noninstitutionalized population) of cigarette smoking and other behaviors related to tobacco use. The Behavioral Risk Factor surveillance System uses telephone surveys of civilian, noninstitutionalized adults (> or = 18 years of age) to provide state-specific estimates of current cigarette smoking and use of smokeless tobacco. The University of Michigan's Institute for Social Research uses school-based, self-administered questionnaires to gather data on cigarette smoking from a representative sample of U.S. high school seniors. RESULTS During the period 1900-1963, per capita cigarette consumption increased; after 1964, consumption declined. During the years 1965-1991, current cigarette smoking prevalence among persons ages > or = 18 years declined overall and in every sociodemographic category examined. Decrease in current smoking prevalence was slow in some groups (e.g., among persons with fewer years of formal education). Both the prevalence of never smoking and the prevalence of cessation increased from 1965 through 1991. The prevalence of current cigarette smoking, any tobacco smoking, and any tobacco use was highest among American Indians/Alaska Natives and non-Hispanic blacks and lowest among Asians/Pacific Islanders. The prevalence of cigar smoking and pipe smoking has declined substantially since 1970. The prevalence of smokeless-tobacco use among white males ages 18-34 years was higher in 1987 and 1991 than in 1970; among persons > or = 45 years of age, the use of smokeless tobacco was more common among blacks than whites in 1970 and 1987. Cigarette smoking prevalence has decreased in most states. The prevalence of smokeless tobacco use was especially high among men in West Virginia, Montana, and several southern states. From 1984-1993, prevalence of cigarette smoking remained constant among U.S. high school seniors. However, prevalence increased slightly for male seniors and white seniors, decreased slightly for female high school seniors, and decreased sharply for black high school seniors. INTERPRETATION With the exceptions of increases in cigarette smoking among white and male high school seniors and in the use of smokeless tobacco among white males ages 18-34 years, reductions in tobacco use occurred in every subgroup examined. This decrease must continue if the national health objectives for the year 2000 are to be reached. ACTIONS TAKEN Surveillance of tobacco use is ongoing. Effective interventions that discourage initiation and encourage cessation are being disseminated throughout the United States.
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Affiliation(s)
- G A Giovino
- Office on Smoking and Health, CDC, Atlanta, GA
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