TM

Use of NHIS and CPS to AssessChildren’s Exposure to Secondhand Smoke

Angela Trosclair, MSOffice on Smoking and Health

National Conference On Tobacco or HealthBoston, MA

December 10 2003

TM

0

10

20

30

40

50

60

1955 1957 1959 1961 1963 1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001

Year

Pe

rce

nt

Trends in Cigarette Smoking* Among Adults (18+) by Gender—United States, 1955-2001

Source: 1955 Current Population Survey; 1965-2001 NHIS*Estimates since 1992 include some-day smoking

Males

Females

TM

Health Information in NHIS

• Access to health care

• Health care utilization

• Health conditions

• Immunizations

• AIDS knowledge

• Health behaviors

—Cigarette smoking

— Physical activity

— Alcohol use

• Limitation of activity

• Injuries

• Health insurance

TM

Ever Smokers: Adults aged 18 and older who reported lifetime smoking of 100 or more cigarettes

Current Smokers: Among ever smokers, persons smoked cigarettes every day or some days

Case Definitions - NHIS

TM

• Used by Office on Smoking and Health (CDC), the lead federal agency in tobacco control, to measure national prevalence on smoking among adults and trends over time

• Guides intervention activities at a variety of settings

• Demographic/socio-economic information available

• Used in numerous research & other publications

• Issue: information on other tobacco products available only periodically

Usefulness

TM

• Self-reports by respondents

• Limited call-backs to respondents

• Centralized administration of data collection and dissemination (Census Bureau, NCHS)

• Issue: Complex sampling & data management process

Simplicity

TM

• Systematic redesign and content update every 10-15 years to accommodate changing data needs

• 2 modules (Basic, Supplements) enable timely response to new data needs

• Issue: extensive redesign in 1997 – difficult for continuous data trending from earlier years

Flexibility

TM

• Nationally representative large sample

• Weighting of data to produce nationally representative estimates

• Blacks and Hispanics over sampled since 1995

• Issues– Multiple years’ data are combined for

racial/ethnic sub-groups– Excludes persons in military, institutionalized,

homeless, or living abroad

Representativeness

TM

• Early release of data highlights: 6 months after data collection

• Public data sets available 11 months after data collection

• Re-engineering project underway to shorten it to 6 months (to be completed by 2004)

• Issue: Detailed report (Advance Data) on cigarette smoking for 1997-1998 published in 2003

Timeliness

TM

• On-going contracts with U.S. Census Bureau for data collection

• Annual on-going surveillance system for cigarette smoking

• Public data sets available for each year

• Responsiveness to new data needs: supplemental modules

Stability

TM

During the past week, has anyone smoked cigarettes, cigars, or pipes anywhere inside your home?

0 days (< 1day/week/rarely) or 1-7 days/week

This question does not allow the capture of information on resident vs. visitor smokers. The original battery of questions will be asked in the 2005 Cancer Control Supplement

11,442 children were able to be matched to a corresponding adult, with only 1934 children with no matching adult (83.1% of the sample of adults with children was available for analysis)

.

Summary of Findings —NHIS 2000Cancer Control Supplement

Children’s Exposure based on 1 question

TM

In regression analyses—

• residents in the West and Northeast were less likely to expose their children to SHS in the home

• Hispanics, NH-Blacks, and NH-Other Races were less likely to expose their children NH-Whites

• Odds of exposure increase with decreasing level of educational attainment of the mother

• Single-mother households more likely to expose their children

Summary of Findings — 2000 NHIS, Children <= 6 yrscontinued

TM

• Monthly employment survey of about 50,000 (1998/1999) to 57,000 (1992/1993) households representative of the non-institutional population of the United States living in households. Armed forces members are also interviewed.

• All household members 15+ years are interviewed. As this is a workforce survey younger adult respondents are eligible.

• Periodically, tobacco-related measures are collected including 3 months each in 1992/1993, 1995/1996, 1998/1999, 2001/2002, and 2003. Proxy responses allowed for basic tobacco use.

• Non-response rates for supplement self respondents ranged from 35% to 39% in 1998/1999 and 32% to 34%in 1995/1996

Current Population Survey Sample DesignTobacco Use Supplement

TM

Ever Smokers: Adults aged 18 and older who reported lifetime smoking of 100 or more cigarettes

Current Smokers: Among ever smokers, persons who smoked cigarettes every day or some days

Case Definitions - CPS

TM

Home Smoking Bans

Not allowed if all adult (15+ yrs) household members agree that “no one is allowed to smoke anywhere”

Allowed if all adult (15+ yrs) household members agree that “smoking is allowed in some places or at some times” OR “smoking is permitted anywhere”

Discrepancy/Unknown if there is disagreement between adult household members or if member(s) fail to respond to the question

CPS-TUS Data Definitions

TM

9.9%

5.7%

2,151 (92/93)

1,282 (98/99)

Discrepancy/

Uncertain/

Disagreement

45.0%

29.8%

9,751 (92/93)

6,695 (98/99)

Smoking

Allowed

45.0%

64.5%

9,750 (92/93)

14,497 (98/99)

No Smoking

Allowed

Unweighted Frequencies of Home Smoking Rules for Households With at Least 1 Child <= 6 Years

1992/1993 vs. 1998/1999

TM

Summary of Findings Smoking Rules in Households With at Least 1 Child <= 6 Years

CPS-TUS 1992/1993 vs. 1998/1999

• Overall (among HHs with smokers and those without), 34% reduction in prevalence of HHs where smoking allowed

• Among HHs with at least one smoker, 16% reduction in prevalence of smoking being allowed in the home

• Among HHs where no adult residents smoke, 41.2% decrease in prevalence of smoking being allowed in the home

TM

Summary of Findings Smoking Rules in Households With at Least 1 Child <= 6 Years

and at Least 1 Smoker -- CPS-TUS 1998/1999

• HHs where the mother had at least a college education were less likely to report that smoking was allowed in the home

• HHs where the mother was Hispanic or NH-Asian were less likely to report that smoking was allowed in the home

• Middle and high-income HHs were less likely to report that smoking was allowed in the home

• Among Census Regions, HHs in the Pacific, Mountain, South West and South Atlantic were less likely to report smoking being allowed in the home than HHs in the North East and South East

TM

Limitations CPS-TUS Analysis of Home Smoking Rules in

Households With Children <= 6 Years

• CPS-TUS home smoking rule question does not capture extent to which visitors smoke in the home

• Translation of proportion of households with children <= 6 years allowing smoking anywhere or in some places at some times to number of children in that age group exposed is methodologically difficult

• CPS-TUS has considerable undercoverage for non-White households (e.g. completion of the TUS is very low for Hispanic households overall)

• Smoking being allowed in HHs with young children may be increasingly underreported as mass media campaigns make this a sensitive topic

TM

Introduction of CDC's Web-Based Tobacco Survey Database

The Question Inventory on Tobacco (QIT)

Angela Trosclair, MSLinda Pederson, PhD

Pascale Wortley, MD, MPHMichael Schooley, MPH

TM

What is QIT?

• QIT includes data from 13 different health surveys (most from 1990 or later)

• QIT includes data from both national and state surveys

• QIT includes data collected from both youth and adults

TM

How can QIT be used?

• QIT can be used to locate survey questions and their response formats

• QIT can be used to locate data and documentation for secondary data analyses

• QIT can be used to gather ideas for future survey development

TM

Demonstration of Objectives

1) A review of QIT’s key features

2) A simple search by category and keyword

TM

A Simple Search by Category and Keyword

TM

Search of Category, Media/Advertising, and Keyword, Actors

TM

Results

TM

Question Details for 1st Result

TM

Survey Details for 1st Result

TM

Angela Trosclair, MSATrosclair@cdc.gov

The Question Inventory on Tobaccohttp://www.cdc.gov/tobacco/qit