Biennial evaluation report / Arizona Department of Health Services, Tobacco Education & Prevention Program

              A REPORT ON TOBACCO CONTROL PROGRAMS AND SERVICES
ARIZONA DEPARTMENT OF HEALTH SERVICES
TOBACCO EDUCATION AND PREVENTION PROGRAM
2004 Biennial Evaluation Report
Janet Napolitano, Governor
State of Arizona
Catherine R. Eden, Ph.D., Director
Arizona Department of Health Services
150 North 18th Avenue
Phoenix, Arizona 85007-3228
Division of Public Health Services
Office of Tobacco Education and Prevention Program
Permission to quote or reproduce materials from this publication is granted when acknowledgment is made.
THIS REPORT WAS PREPARED BY
ARIZONA DEPARTMENT OF HEALTH SERVICES
DIVISION OF PUBLIC HEALTH SERVICES
Office of Tobacco Education and Prevention Program
SPECIAL THANKS AND APPRECIATION ARE EXTENDED TO
THE PROGRAM STAFF
OF THE OFFICE OF TOBACCO EDUCATION
AND PREVENTION PROGRAM
and
THE OFFICE OF TOBACCO EDUCATION
AND PREVENTION PROGRAM
EVALUATION UNIT
THANKS AND APPRECIATION
FOR THEIR CONTRIBUTIONS ARE ALSO EXTENDED TO
Rosemary Conner, Assistant Director
Division of Public Health Services
and
Raul Muoz, Deputy Assistant Director
Public Health Prevention Services
4
 Youth smoking prevalence continues to
decrease. The prevalence of current cigarette
use (i.e., any use of cigarettes in last 30 days)
for middle school students was 9% in 2003
compared to 11% in 2000. For high school
students this rate dropped from nearly 25%
in 2000 to 19% in 2003.
 In 2003, 42% of students who live with a
smoker were repeatedly exposed to second
hand smoke compared to 8% of students who
did not live with a smoker.
 In Fiscal Year 2004 nearly one third (32%) of all
Arizona schools with grades 4-8 received intensive
school-based tobacco prevention education (i.e.,
structured multi-lesson curricula).
 For Arizona adults, the smoking rate remains
below the national average, is steady, and
adults are smoking fewer cigarettes. The 2002
adult prevalence was 20%. In the same year,
the average number of self-reported packs
smoked per month was at 22, down from
30 packs per month in 1999.
 During the 12 months prior to the 2002
Arizona Adult Tobacco Survey, 43% of current
smokers said they tried to quit.
 There was an increase in reported household
smoking restrictions among non-smoking
households, from 89% of households in 1999
to 96% in 2002.
 Data from Fiscal Year 2003 show that three
months after completing services, nearly 25%
of clients who went through multi-session
in-person counseling, and nearly 30% of
clients who went through multi-session phone
counseling, reported that they had not used
tobacco at all in the preceding 30 days.
 The Arizona HealthLinks program, which
helps worksites create smoke-free environments
and provides or refers for a variety of tobacco
control and wellness services, has potentially
reached over 88,000 employees in Fiscal Year
2003-2004 alone.
 Marketing efforts are targeted to the overall
general market, and supplemented with specific
efforts in the key ethnic communities in
Arizona: Hispanic, African-American, Native
American and Asian-American. These efforts
are executed through an integrated advertising
campaign including media, public relations,
event sponsorships, sports sponsorships,
distribution of promotional items, and
community outreach.
EXECUTIVE SUMMARY
5
TABLE OF CONTENTS
PAGE
EXECUTIVE SUMMARY 4
INTRODUCTION 6
ADHS TEPP Organization 7
ADHS TEPP Contracts 8
EXPENDITURES 9
ACTIVITY AND SERVICES PROVIDED 10
Preventing Initiation Through School-Based Education 10
Preventing Initiation by Limiting Access to Tobacco Products 10
Helping Tobacco Users Quit 11
Reducing Exposure to Second Hand Smoke 14
Creating Awareness and Educating Through Social Marketing 17
ADHS TEPP Evaluation and Surveillance 22
RESULTS 24
Youth Behavior and Attitudes 24
Adult Behavior and Attitudes 29
6
ADHS TEPP was the third statewide
comprehensive tobacco control program in
the United States, following California and
Massachusetts. The majority of program funds
come from the 1994 Arizona tobacco tax
initiative. A description of the program
expenditures can be found in the next section.
Since its inception in 1995, the program and its
contractors have used a variety of strategies and
implemented simultaneous interventions that
address prevention (i.e., reducing initiation,
especially among youth), cessation
(i.e., increasing quitting) and second hand
smoke (i.e. reducing exposure to second hand
smoke), the three core areas of tobacco control.
Because tobacco use is a serious public health
problem, with a significant impact on morbidity
and mortality, state statute (i.e., ARS 36-772)
directed the Arizona Department of Health
Services to administer the states tobacco
control efforts.
An organization chart for the Tobacco Education
and Prevention Program and its location within
the Arizona Department of Health Services is
presented on the next page. Currently 12 fulltime
Arizona Department of Health Services
staff manage 16 community-based contracts, a
statewide media contract, six statewide program
contracts, one evaluation contract, and two
surveillance contracts.
INTRODUCTION
This report contains a brief description of the
Arizona Department of Health Services Tobacco
Education and Prevention Program (ADHS
TEPP) for Fiscal Years 2002, 2003 and 2004, as
well as expenditures. A description of program
activity and services provided along with key
results for youth and adult tobacco-related
behavior and attitudes are presented.
The report is complemented by detailed
information found in the 2002 Adult Tobacco
Survey Report, the 2003 Youth Tobacco Survey
Report, and the Tobacco Education and
Prevention Program Strategic Plan for Fiscal
Year 2004-2005. These documents are available
from the Tobacco Education and Prevention
Program. In addition, Program staff and contractors
are available to answer any questions and provide
additional information.
DESCRIPTION OF ADHS TEPP
7
ARIZONA DEPARTMENT OF HEALTH SERVICES
OFFICE OF TOBACCO EDUCATION AND PREVENTION SERVICES
8
The 16 community-based contracts include
all 15 Arizona counties:
 Apache  Mohave
 Cochise  Navajo
 Coconino  Pima
 Gila  Pinal
 Graham  Santa Cruz
 Greenlee  Yavapai
 La Paz  Yuma
 Maricopa
Most of these contracts are with county health
departments. These contracts include the
provision of services in school and communitybased
prevention, in adult cessation and in the
creation of smoke-free worksites and homes.
The sixteenth contract is with the Inter-Tribal
Council of Arizona, who in turn contracts with
seven American Indian tribes:
 Colorado River Indian Tribes
 Kaibab-Paiute
 Hopi
 Hualapai
 Pascua Yaqui
 Salt River Pima-Maricopa
 White Mountain Apache
and three urban Native American centers:
 Native Americans for Community Action
(Flagstaff)
 Native American Community Health Center
(Phoenix)
 Tucson Indian Center (Tucson)
Currently the Native American programs focus
on both school and community-based prevention
education.
In addition to their in-house media and public
relations efforts, the statewide media contractor
has a variety of sub-contracts, including
professional sports teams marketing contracts
with the Diamondbacks, Suns, Mercury, Coyotes,
and Cardinals; and ethnic marketing contracts
with agencies serving Hispanic/Latinos,
American Indians, African-Americans, and
Asian Pacific Islanders.
The six statewide program contracts include:
 The Arizona Smokers Helpline (i.e., phonebased
information, referral and cessation
services);
 Arizona HealthLinks (i.e., statewide smoke-free
worksite policy and healthy lifestyle education);
 Health Care Partnership (i.e., health care
provider training and education);
 Arizona Attorney General (i.e., tobacco
merchant compliance checks);
 US Script (i.e., cessation pharmacotherapy
(e.g., nicotine patch, gum, etc.) coordination);
 Arizona Interscholastic Association (i.e., healthy
lifestyle and character education for coaches,
school athletic directors, parents, and children).
The Department contracts with the University of
Arizona for evaluation services and the contract
is briefly described in the Activity and Services
Provided Section of the report. The two
surveillance contracts are with Northern Arizona
University (i.e., Adult Tobacco Survey) and the
Arizona Department of Education (Youth
Tobacco Survey).
ADHS TEPP CONTRACTS
9
EXPENDITURES
ADHS TEPP EXPENDITURES
10
ACTIVITY AND SERVICES PROVIDED
PREVENTING INITIATION THROUGH SCHOOLBASED
EDUCATION
In Fiscal Year 2003/2004, the ADHS TEPP
Evaluation Unit developed and implemented
a new approach to collecting school-based
program activity data. The following information
is from this new database.
During Fiscal Year 2004 (i.e., 2003/2004
academic year) ADHS TEPP provided some
form of tobacco prevention education to 38%
of all public schools in Arizona with 4-8 grade
students. More specifically, 32% of all schools
with 4-8 grade students received intensive
school-based tobacco prevention education.
Among the states two most population dense
counties, Maricopa and Pima, 29% and 53%
of schools with grades 4-8, respectively, received
intensive tobacco prevention education in the
2003/2004 academic year.
Intensive school-based tobacco prevention
education (i.e., structured multi-lesson curricula)
is only taught in grades 4-8. These grades include
children who are predominantly between the
ages of 10 and 14 and are entering, or in, a
developmental phase where experimentation
with tobacco begins. School-based prevention
efforts, complemented by adult cessation and
individual and societal (e.g., policy) changes
that reduce exposure to second hand smoke,
are intended to provide refusal skills, establish
negative attitudes toward tobacco use, and
ultimately delay or eliminate initiation.
A pilot evaluation of the intensive curriculumbased
prevention education programs was
conducted in schools on a voluntary basis in
Fiscal Year 2004. More than 2,000 4th and 5th
graders in 40 schools and 3300 6th, 7th and 8th
graders in 52 schools participated.
Over 91% of the students from all grades reported
that the classes gave them good reasons not to
smoke or use tobacco and that what they learned
from the classes would help keep them from using
tobacco. Over 93% reported that they believe it is
important to be tobacco free. Regarding program
content, over 94% of the students said they
learned about how smoking and smokeless
tobacco harms their body, about what happens
when people get addicted to tobacco, about how
other peoples smoke harms their body, and why
its hard to quit using tobacco.
Only 12% of the 6th, 7th, and 8th graders said
they thought they might try tobacco sometime
soon and 13% said they would try smoking if
one of their best friends wanted them to. Results
from the statewide evaluation of all intensive
school-based prevention education programs in
the current fiscal year (i.e., 2004/2005), coupled
with other youth surveillance data, will help
ADHS TEPP identify schools at which there is
the highest risk for taking up tobacco and direct
intensive prevention education resources and
programming to those schools.
PREVENTING INITIATION BY LIMITING ACCESS
TO TOBACCO PRODUCTS
THE ARIZONA YOUTH TOBACCO PROGRAM
The Arizona Youth Tobacco Program
(Program) was created in September of 2001
through an Interagency Service Agreement
between the Arizona Attorney Generals Office
(AGO) and the ADHS TEPP.
The goals of the Program are
to reduce youth access to
tobacco products and facilitate
the enforcement of Arizonas
youth tobacco statutes.
11
In Fiscal Year 2002, almost all compliance
inspections were performed by local law
enforcement agencies under contract with the
AGO. During Fiscal Years 2003 and 2004, until
December 31, 2003, the Program served as
a pilot for the Department of Healths
CounterActs Program. Compliance inspections
for 2003 are not included for FY 2003, because
these were only done in Maricopa County,
and not statewide.
NUMBER OF COMPLIANCE
INSPECTIONS BY FISCAL YEAR
A reduction in services occurred from Fiscal Year
2002 to 2004. The number of clients served by both
the Arizona Smokers Helpline (i.e., phone-based
counseling and information, known as AshLine)
and the local projects (i.e., in-person cessation
counseling) dropped from Fiscal Year 2002 to 2004.
The Smokers Helpline was most impacted by the
reduction in television and radio promotion. Local
project cessation was most affected by a reduction
in funds for cessation services, including
pharmacotherapy (e.g., patch, Zyban, etc.).
The number of cessation clients served by the
Arizona Smokers Helpline fell from 3,351 clients
in Fiscal Year 2002, to 2,301 in 2003, and 1,858
clients in 2004. The number of cessation clients
receiving in-person counseling by the ADHS
TEPP local projects dropped from 5,649 in Fiscal
Year 2002, to 4,274 in 2003, and 2,575 in 2004.
Three months after completing services, nearly
1/4 of clients who went through multi-session
in-person counseling, and 1/3 of clients who
went through multi-session phone counseling,
reported that they had not used tobacco at all
in the preceding 30 days.
These results are based on FY 2002  2003 data,
the most recent data for which full follow-up is
currently available. When followed up a year after
completing services, about 15% of all counseling
clients report not having used tobacco in the past
30 days. These results are based on an intent-totreat
model of analysis, whereby clients who were
not able to be contacted at a follow-up point are
assumed to be using tobacco again. It is a
conservative estimate of the quit rate for ADHS
TEPP cessation clients.
HELPING TOBACCO USERS QUIT
12
ASHLINE CESSATION QUIT RATES: 30-DAY ABSTINENCE
(NOT EVEN A PUFF IN THE PAST 30 DAYS) FY 2001  2002
LOCAL PROJECT QUIT RATES: 30-DAY ABSTINENCE
(NOT EVEN A PUFF IN THE PAST 30 DAYS) FY 2001  2002
13
In addition to cessation services, ADHS TEPP
has a nationally recognized program for
continuing education for health care professionals.
From Fiscal Year 2002 to 2004, approximately
1,160 people in Arizona were certified to deliver
a Five A, Brief Tobacco Cessation Intervention
based on recommendations made by the Public
Health Service Clinical Practice Guideline.
Additionally, over 89 certified instructors
continued to build capacity within communities,
organizations, and health care facilities throughout
the state to teach others the information and skills
to deliver the Public Health Service recommended
Five A, Brief Tobacco Cessation Intervention.
Approximately 4,000 people have been certified
to deliver the Five A, Brief Intervention model
since December 1998.
At 2-month follow-up (FY 2002), 75% of health
care professional continuing education participants
identified new strategies, as recommended by the
Public Health Service Guideline, that they had
incorporated into their practice setting as a result
of attending a Health Care Partnership Continuing
Education Presentation.
INDIVIDUALS CERTIFIED TO DELIVER A BRIEF
TOBACCO CESSATION INTERVENTION IN ARIZONA FY 2000  2001 through 2003  2004
14
The Arizona HealthLinks program was launched
in Fiscal Year 2002-2003. The program helps
worksites create smoke-free environments and
provides or refers for a variety of tobacco control
(e.g., cessation) and wellness (e.g., exercise,
nutrition, etc.) services.
REDUCING EXPOSURE
TO SECOND HAND SMOKE
INTENDED AZHL OUTCOMES
ARIZONA HEALTHLINKS (WORKSITE INTERVENTIONS)
15
The following table illustrates the 2002-2003 program goal numbers as well as the program deliverables.
ARIZONA HEALTHLINKS
AZ HEALTHLINKS PROGRAMS / OUTCOMES FY 2002  2003
16
In the 2003-2004 contract year, objectives
and goal numbers were tailored based on the
results of the first year. In FY 2003-2004,
Az HealthLinks conducted 385 program pitches
to 375 worksites. In addition, 85 health fairs
and 33 specialized programs were delivered to
worksites. There were 212 wellness programs
implemented in 180 worksites, and 244 tobacco
programs implemented in 175 worksites.
Wellness programs included physical activity
and nutrition programs and presentations;
tobacco activities included providing cessation
information, onsite cessation classes and policy
trainings at worksites. Based on the number of
worksites involved with Az HealthLinks during
2003-2004, there was a potential to reach a total
of 88,040 employees.
AZ HEALTHLINKS PROGRAMS / OUTCOMES FY 2003  2004
17
HISTORY
From 1998-2001 the ADHS TEPP media
campaigns focused on three key initiatives that
included adult cessation, teen prevention, and
pregnant women. In late 2000, an RFP for a
new agency of record was distributed, and due
May 2001. The final determination of the agency
of record was completed in November 2001.
OVERVIEW
E.B. Lane was contracted by ADHS TEPP in
November of 2001 to support the ADHS TEPP
goals through a range of media (marketing and
public relations) efforts across a number of target
groups throughout the state of Arizona.
The primary strategy of the media contract was
to target efforts and create efficiencies to ensure
a solid return on ADHS TEPPs financial
investment for the contractual fiscal years, in
both preventing and reducing the prevalence in
tobacco use.
At the onset of the engagement several
parameters existed, which included:
 The prior budget being reduced from
$16 million to $7.5 million
 A previous general awareness strategy
implemented with separate messages
The new strategy developed was to migrate from
multiple programs and sponsorships to a single
campaign that had a consistent brand message,
and was able to bridge the gap of the various
target markets.
CREATING AWARENESS AND
EDUCATING THROUGH SOCIAL MARKETING
THE SPECIFICS OF THE FOUR-YEAR
STRATEGY PLAN INCLUDED:
 Elevating and reducing the existing
programs to a cohesive campaign, while
adjusting message and delivery systems
for the ethnic markets
 Elevating the ADHS brands
 Focusing on fiscal responsibility
(return on investment)
 Focusing on fiscal accountability
(tying campaign efforts to specific and
measurable results)
18
 GEARHEADZ  ARS 36-772 mandates
that $550,000 per year be allocated for
the development of anti-tobacco
marketing programs for school buses.
A pilot program using an animated
series promoting an anti-tobacco
message has been developed and tested
in one school district and is scheduled
for statewide distribution.
 AZ HEALTHY KIDS FAIRS 
collaborative community outreach
program delivered through school
districts, and designed to provide a
variety of health services, including
prevention messages.
 COUNTERACTS  campaign to engage
retailers in a program to counter the
sale of tobacco items to minors.
The initial step was taken to categorize the various programs into two groups (or functions): cessation
or prevention, with cessation also speaking to second hand smoke.
CESSATION
 AZ HEALTHLINKS  helps worksites
create smoke-free environments and
provides or refers for a variety of
tobacco control and wellness services.
 GOCOLDTURKEY.COM  campaign and
website services (tied to ashline.com)
that reaches smokers who are already
in the quit zone, offering cessation hints.
 INHALE LIFE  campaign designed with
a positive and healthy message that
focuses on physical activities, run
through the sports sponsorships.
PREVENTION
19
1. AZ HEALTHLINKS: See previous section.
2. COUNTERACTS: See AZ Youth Tobacco
Program section, page 10.
3. GEARHEADZ: Within the one-month trial
period the program delivered the anticipated
results of driving the targeted population of
elementary kids to the website. The results
showed a 59% return (unique visitors) with
the average length of stay at under just
three minutes.
4. INHALE LIFE: Through several sports
sponsorships, a large population in the state
received a positive and healthy message,
encouraging active involvement in their
own lifestyle.
5. GO COLD TURKEY: People who saw the ads
feel positively about the state on two levels:
 Believe government is providing tobacco
users with resources to help them quit on
their own
 Believe government is trying to help
tobacco users.
Over 40,000 unique visitors went to the
GoColdTurkey.com website, and almost 20%
of them came back more than once. During the
six months of the media campaign, the number
of people who reached out via internet or
telephone for help from the state services was
up 13% in the counties where the campaign
ran, in comparison to the six months prior.
6. HEALTHY KIDS ARIZONA: Healthy Kids fairs
are held in high-risk use elementary school
districts. Over 2,500 children have received
free health screenings in a variety of areas
including vision, dental and respiratory,
with thousands more family members
taking advantage of the educational and
entertainment components of the events.
SOCIAL MARKETING RESULTS
With the strategy and approach underway,
media was reevaluated to aggregate the media
buys into a single inventory to maximize reach
and frequency. The current step is projecting
the Inhale Life single brand message brought
to you by ADHS.
The overall marketing efforts are targeting the
general market. However, distinct budget
allocations were designated and executed
through sub-contractors in the Hispanic, African-
American, Native American and Asian-American
markets. The ethnic population efforts will be
executed to carry the overarching brand
message, and will be supported by the general
population campaign, but have targeted media,
public relations, event sponsorships, and
community outreach.
20
ACTIVITY AND SERVICES PROVIDED
Continued on page 21
21
Under a unified campaign theme, Inhale Life/
Be Tobacco Free, new youth prevention, adult
cessation and second hand smoke communications
will be disseminated statewide. Additional
ethnic-specific efforts will continue to
supplement the general market efforts, tying
in to Inhale Life/Be Tobacco Free where
relevant and appropriate.
Event marketing will continue, with participation
focused on those events that maximize outreach
to the various communities throughout Arizona.
The next Healthy Kids Arizona fair will take
place in the spring of 2005 and will target a
school district with a greater Native American
population.
Ongoing efforts will look to enhance the existing
evaluation systems in order maximize all social
marketing communications.
ACTIVITY AND SERVICES PROVIDED
22
The ADHS TEPP Evaluation Unit was
established in July 2002, and is located at the
University of Arizona. The mission of the
ADHS TEPP Evaluation Unit ... to foster the
development of sound and effective programs ...
through ... technical assistance to ADHS TEPP
and to local and statewide projects to assure
adequate information for program planning
and refinement, exemplifies that program
assessment is seen as an integral, on-going
program activity. The unit is responsible for
coordinating all ADHS TEPP evaluation
activities, developing and/or improving data
collection systems (e.g., process, prevention
outcome, cessation outcome, etc.), creating
usable reports, and training ADHS TEPP staff,
at all levels, on the best use of information. In
the near future, the unit will expand its in-depth
analysis of surveillance, process, outcome, and
impact data. This will be especially important
to ADHS TEPPs work in identifying and better
serving populations and communities with
tobacco control disparities.
In Fiscal Year 2005, the ADHS TEPP Evaluation
Administrator and ADHS TEPP Evaluation Unit
staff will oversee the fourth fielding of the Arizona
Adult Tobacco Survey (ATS) and the third
fielding of the Arizona Youth Tobacco Survey
(YTS). These two surveys, along with the Arizona
Youth Risk Behavior Survey (YRBSimplemented
by the Arizona Department of Education) and
the Arizona Youth Survey (AYSimplemented
by the Arizona Criminal Justice Commission),
represent the states primary adult and youth
tobacco behavior surveillance.
ADHS TEPP EVALUATION AND SURVEILLANCE
PERSPECTIVE ON PROGRAM EVALUATION
23
Since 2002, the Arizona Department of Health
Services, Arizona Department of Education, and
Arizona Criminal Justice Commission have
worked together to streamline youth surveillance
data collection (i.e., YTS, YRBS, AYS) and
coordinate analysis and reporting. Currently the
YTS and YRBS are fielded, in coordination,
within the same schools. The AYS has a much
larger sample with a focus on attitudes,
prevalence, and frequencies of substance use
among youth. It is fielded in opposite years to
the YTS/YRBS. In-depth analyses continue to
be conducted for each survey, and coordinated
across the surveys. The Arizona Department of
Health Services, Arizona Department of
Education, and the Arizona Criminal Justice
Commission are all working together to better
understand youth and young adult behavior, in
order to develop better prevention and
intervention programs, as well as an improved
surveillance system, using this new information.
Future directions in evaluation will expand on
current efforts to collect, analyze, distribute,
and apply the best possible information. The
appropriate use of valid and reliable information
for decision making continues to be the primary
goal for the ADHS TEPP Evaluation Unit. More
specifically, in the coming three years
the ADHS TEPP Evaluation Unit will focus on
establishing a standardized process evaluation
system; improving outcome data for the three
core services areas (i.e., prevention, cessation,
second hand smoke) and social marketing; and
conducting analyses that integrate process,
outcome and surveillance results into timely
information that can be used easily in program
planning and development.
There is also an emerging effort within the
Arizona Department of Health Services to better
integrate all chronic disease efforts (e.g., heart
disease, cancer, stroke, chronic obstructive
pulmonary disease (COPD), diabetes, etc.).
Through the use of the ADHS Chronic Disease
Fund, and with the support of the Tobacco
Revenue Use Spending and Tracking (TRUST)
Commission, the Arizona Department of Health
Services is aligning all chronic disease plans.
It is anticipated that staff from the Tobacco
Education and Prevention Program will be
actively involved in these efforts.
24
YOUTH BEHAVIOR AND ATTITUDES
YOUTH SMOKING PREVALENCE CONTINUES TO DECREASE
Current use of cigarettes, defined as any use of cigarettes, even a puff, during the past 30 days, was reported
by 9% of middle school students and 19% for high school students. Both of these rates are below the
national average and show a steady downward trend since 1997.
RESULTS
MIDDLE SCHOOL STUDENTS  30-DAY CIGARETTE USE PREVALENCE
Arizona Data:
 2000 = AZ Youth Tobacco Survey
 2001 = mean of AZ Youth Tobacco Surveys
2000 & 2002
 2002 = AZ Youth Survey
 2003= AZ Youth Tobacco Survey
National Prevalence Estimate = National Youth Tobacco
Survey (Legacy Foundation/CDC)
25
Although cigarettes were the most commonly
used form of tobacco by both ever and current
users in middle and high school, cigar and
cigarillo use also accounts for a fairly large
proportion of tobacco use, with other tobacco
products accounting for smaller proportions.
A comparison of the prevalence rates for middle
school students from the 2000 and 2003 Youth
Tobacco Surveys (YTS) shows that both the
percent of students who report having ever tried
tobacco and the percent who report current
tobacco use has declined slightly for all types
of tobacco. The rate for ever using tobacco
decreased by 10%, while current use rates have
declined by approximately 15%.
Overall, Arizona cigarette smoking and smokeless
tobacco prevalence rates for both middle and
high school students fall below those reported on
national surveys. However, the percent of
Arizona middle school students who report
currently using any form of tobacco is slightly
higher than national rates, and the percent of
Arizona middle schoolers who have ever tried
cigars or cigarillos is also slightly higher.
Levels of tobacco use increase, for the most part,
by grade, and therefore by age. There is,
however, a noticeable drop in the percentage of
ever and current users between the 9th and 10th
grades. Adolescents typically reach the age of
16, the age at which they can choose to drop out
of high school, when they are in 10th grade.
Therefore, the dip in prevalence between 9th
and 10th grades may be a result of 10th graders
dropping out of school. This suggests that youth
who are not captured in school-based surveys
are likely to have a higher tobacco use rate than
students. By the 12th grade, 31% of the students
surveyed reported using tobacco during the
past 30 days. This sets the stage for the high
prevalence rate (29%) for the 18-24 age group
reported in the 2002 Adult Tobacco Survey (ATS).
HIGH SCHOOL STUDENTS  30-DAY CIGARETTE USE PREVALENCE
Arizona Data:
 2000: mean (99 & 01)
 2001: mean (00 & 02)
 2002: Arizona Youth Survey
 2003: AZ Youth Tobacco Survey
 National Data: National Youth Risk Behavior Survey
(CDC trend data, 1991-2003)
26
STUDENTS SELF-REPORTED TOBACCO USE BY GRADE 2003
 Ever (ever used in lifetime)  Current (use during last 30 days)  Frequent (use on 20 or more of past 30 days)
Male students in middle and high school
reported consistently higher tobacco use rates
than did female students. Although only 1.4%
more males than females reported current use of
tobacco in middle school, the difference widened
to 8.1% in high school. Thus, the gender
difference in current tobacco use rates among
high school students is quite pronounced.
STUDENTS REPORTING EVER AND CURRENT TOBACCO USE BY GENDER 2003
27
American Indian/Alaskan Native youth reported
the highest rate of tobacco use during the past 30
days, and African-American youth reported the
second highest rates in both high school and
middle school youth. Hispanic and Asian youth
reported the lowest use during the past 30 days
among high school students. The current use rate
for Hispanic middle school students (17.5%),
however, was higher than White and Asian youth.
STUDENTS REPORTING USING
ANY TYPE OF TOBACCO DURING PAST 30 DAYS BY ETHNIC GROUP 2003
28
In 2003, students were asked on how many
of the past 7 days they had been in the same
room or the same car with someone who was
smoking cigarettes. Among all students, 58%
reported exposure to cigarette smoke in a room
at least once during the past week, and 40%
reported exposure at least once in a car.
If we compare the exposure to second hand
smoke of students who live with a smoker to
those who do not, we find important differences.
Seventy-seven percent of students who live with
a smoker reported exposure in a room at least
once during the past week, compared to 43% who
do not live with a smoker. Exposure on three or
more occasions was 58% for those living with a
smoker compared to 17% for those who did not.
YOUTH EXPOSURE TO SECOND HAND SMOKE
YOUTH EXPOSURE TO SECOND HAND SMOKE
29
The estimated smoking prevalence rate is 20% for
adult Arizona residents and this rate has been a
stable trend over time. This consistent trend is
supported by the results for the last three Adult
Tobacco Surveys (ATS), as well as the last twelve
Arizona Behavioral Risk Factor Surveys (AZ
BRFS  another statewide phone-based survey
that includes tobacco questions). The current
national estimate of smoking prevalence for
adults, based on the 2003 National Behavioral
Risk Factor Surveillance Survey, is 22%.
Although smoking prevalence has remained
steady, there is evidence that Arizonans have
decreased the number of cigarettes they are
smoking. The percentage of current smokers
reporting smoking every day declined from 83%
in 1999 to 77% in 2002. In addition, current
smokers in 2002 reported smoking fewer
cigarettes per day on average (15/day) than they
reported in 1999 (20/day). Taken together, the
average number of packs smoked monthly by
current smokers in 2002 is estimated to be about
22, down from 30 packs/month, reported in 1999.
ADULT BEHAVIOR AND ATTITUDES
ARIZONA ADULT SMOKING RATE REMAINS BELOW THE NATIONAL AVERAGE,
IS STEADY, AND ADULTS ARE SMOKING FEWER CIGARETTES
AVERAGE NUMBER OF SELF-REPORTED PACKS SMOKED PER MONTH ATS
30
2002 ARIZONA SMOKING PREVALENCE COMPARED TO NATIONAL DATA
ESTIMATED NUMBER OF PACKS SMOKED PER MONTH BY AGE GROUP
The decrease in the number of packs smoked
per month can be seen across most age groups.
This is the case even among 1824-year-olds
who have the highest prevalence of any age
group (i.e., 29%), but the lowest reported use
(i.e., 12 packs/month).
Overall, there is not a large difference in
smoking prevalence between men and women.
The estimated rate for men in Arizona is 21%,
and for women it is 19%. This gap is smaller
than that reported nationally, primarily because
the overall reported smoking rate for men
appears to be somewhat lower in Arizona.
31
However, when looked at by age, the gender
gap seen in the youth prevalence numbers
persists into young adulthood, and the high
prevalence rates among 1824-year-olds appears
to be driven by high rates among males in that
age group.
Overall, the 2002 ATS data show a continuing
trend of higher smoking rates among Whites and
African-Americans, and lower prevalence rates
for Hispanics and American Indians. Prevalence
rates by race and ethnicity were essentially stable
between 1999 and 2002 with the exception
of a notable decline in prevalence among
respondents who identify as Black or African-
American (from 24.1% in 1999 to 20.8% in
2002). This finding should be interpreted
cautiously, however, because of the small
number of African-Americans surveyed (n=183).
2002 PREVALENCE OF CURRENT SMOKERS BY AGE AND GENDER
32
Forty-three percent of current smokers reported
trying to quit in the 12 months prior to
responding to the ATS. Of those attempting to
quit, 23% used a pharmaceutical quit aid, and
7% used classes, counseling, or some other type
of non-medicinal quit aid. Most smokers said
that the most important reason for making their
last quit attempt was for my own health.
CESSATION
MOST IMPORTANT REASONS WHY SMOKERS DECIDED TO QUIT ATS 2002 (n=1028)
33
Among non-smoking households, the percentage
restricting smoking inside the home increased
from 89% in 1999 to 96% in 2002. For smokers
households, smoking restrictions stayed about
the same, from 72% in 1999 to 71% in 2002.
ADULT EXPOSURE TO SECOND HAND SMOKE
HOUSEHOLD SMOKING RULES
FOR NON-SMOKERS 1999 & 2002
HOUSEHOLD SMOKING RULES
FOR SMOKERS 1999 & 2002
The increase in home smoking restrictions
among non-smoking households is consistent
with the increasing support for clean indoor air
in restaurants, public and private buildings and
other indoor venues. Since 1999, Arizona has
seen several key community ordinances for clean
indoor air (i.e., Tempe, Guadalupe, Tucson,
Pima County, among others). It is understandable
that such municipal support would translate
to support for smoke free homes. The increasing
public support for clean indoor air does not seem
to have an effect on smokers household bans as
indicated by the lack of change in the rates from
1999 to 2002.