The Work To Be Done: Characterizing the Problem of Tobacco Use Among Those With Fewer Resources

1
The Work To Be Done Characterizing the
Problem of Tobacco Use Among Those With Fewer
Resources
Michael Boysun, WA Evaluation Coordinator/
Epidemiologist
Stacey Schubert, OR HPCDP Surveillance Team Lead
2
Defining Low Socio-Economic Status in WA

• 200 of Federal Poverty Level
• Single person household making 20K
• 4 person household making 40K
• PROS
• Practical criteria for Medicaid eligibility
• Easy to communicate
• CONS
• Based only on income and household size
• Telephone survey data 10 missing

3
Defining Low Socio-Economic Status in OR

• TPEP-developed definition. Low SES if
• Did not graduate high school
• HH income is less than 25K
• On Oregon Health Plan
• Uninsured
• Not low SES if
• College graduate
• Income greater than 50K
• Excluded from consideration if
• Younger than 25 or older than 65
• PROS
• Can easily calculate over time not dependent on
  FPL guidance
• Missing income data (10) does not hamper
• CONS
• Difficult to communicate
• Skews low SES population in unusual ways

4
Disclaimer

• Challenges this morning
• Definitions evolving
• Understanding quirks and perks
• Comparability
• Different, but the same
• Teamwork
• 3 calls and counting, but practice time was not
  built into the budget

5
What We Will Cover Today

• Trends in smoking by SES status
• Maps depicting low SES by county
• Demographics of smokers by SES status
• Other tobacco use by SES status
• Trends in SHS
• Conclusions

6
By SES What Percent Smoke?
44
Low SES
34
19
Not Low SES
13
Oregon BRFSS
7
Exposure to Smoking in the Womb
Births paid by Medicaid
All births
Oregon Birth Files
8
By SES What Percent Have Ever Smoked?
Low SES
Not Low SES
Oregon BRFSS
9
By Low-SES, Who Smokes?
Gender lt200 FPL gt200FPL
smoking
Men Women
Washington BRFSS 2007
10
Gender among people who smoke
lt200 FPL gt200FPL
Men Women
Washington BRFSS 2007
11
By Low-SES, Who Smokes?
Age lt200 FPL gt200FPL
smoking
18-34 35-54 55
Washington BRFSS 2007
12
Age among people who smoke
lt200 FPL gt200FPL
18-34 35-54 55
Washington BRFSS 2007
13
By Low-SES Who Smokes?
Employment Status lt200 FPL
gt200FPL
smoking
Employed Unemployed Homemaker
Retired Unable to
/Student
Washington BRFSS 2007
14
Employment Status among people who smoke
lt200 FPL gt200FPL
Employed Unemployed Homemaker
Retired Unable to
/Student
Washington BRFSS 2007
15
By Low-SES Who Smokes?
Race and Ethnicity lt200 FPL
gt200FPL
smoking
White Bl/AfAm Asian
Pac/Is Nat Am Hisp/Lat
Washington BRFSS 2003-2007
16
Race/Ethnicity among people who smoke
lt200 FPL gt200FPL
White Bl/AfAm Asian
Pac/Is Nat Am Hisp/Lat
Washington BRFSS 2003-2007
17
By Low-SES Who Smokes?
Marital Status lt200 FPL
gt200FPL
smoking
Married /
Divorced Widowed Never married
Unmarried couple
Washington BRFSS 2007
18
Marital Status among people who smoke
lt200 FPL gt200FPL
Married /
Divorced Widowed Never married
Unmarried couple
Washington BRFSS 2007
19
By Low-SES Who Smokes?
Disability lt200 FPL gt200FPL
smoking
No disability Disability
Washington BRFSS 2007
20
Disability Status among people who smoke
lt200 FPL gt200FPL
No disability Disability
Washington BRFSS 2007
21
By Low-SES Who Smokes?
Children at home lt200 FPL
gt200FPL
smoking
No Children Children
Washington BRFSS 2007
22
Children at Home among people who smoke
lt200 FPL gt200FPL
No Children Children
Washington BRFSS 2007
23
By SES Planning to Quit?
Do not want to quit
Plan to quit in 6 months
Plan to quit in 30 days
Oregon BRFSS 2007
24
By Low-SES What About Quitting?
Percent of former smokers out of ever smokers
Not Low SES
Low SES
Oregon BRFSS
25
Where is low SES?
Geography
Ferry
Okanogan
Stevens
Kitsap
Grant
Adams
Franklin
Garfield
of pop lt200 FPL
Yakima
17.9 26.5
Clark
27.0 34.1
34.9 39.2
39.6 48.3
Age standardized Washington BRFSS (2004-2007) lt
200 FPL
26
Where is low SES?
Geography
Oregon BRFSS
27
By Low-SES Other tobacco use
Trends in Spit tobacco use
Washington BRFSS
28
By Low-SES Other tobacco use
Trends in Cigar smoking
Washington BRFSS
29
By Low-SES Other tobacco use
Trends in Cigar smoking By Gender
Men
Women
Washington BRFSS
30
By Low-SES What about Secondhand Smoke?
Smoking Ban In the Home
Not Low SES
Low SES
Oregon BRFSS
31
By Low-SES What about Secondhand Smoke?
In the Home
Washington BRFSS
32
By Low-SES What about Secondhand Smoke?
Smoking In Homes with Kids
Low SES
Not Low SES
Oregon BRFSS
33
By Low-SES What about Secondhand Smoke?
At work
Washington BRFSS
34
By Low-SES Other Tobacco Related Measures
35
Group Exercise
36
Our Conclusions

• Cigarette smoking rates, persistently high
  about double
• Similar pattern by demographics
• Desire and attempts to quit are high
• Success is low
• Cigar use concerning
• SHS strong trends attitudes exposure
• Awareness of tobacco cessation resources
  encouraging/ challenging