Partnership For A Tobacco Free Maine Maine Adult Tobacco

Partnership For A Tobacco-Free Maine Maine Adult Tobacco Survey 2004: A Summary of Findings Submitted to: Partnership For A Tobacco-Free Maine Bureau of Health Department of Health and Human Services Funded by Maine's Share of the Tobacco Settlement Submitted by: THE GALLUP ORGANIZATION 283 Water Street, Third Floor P.O. Box 2389 Augusta, Maine 04338-2389 Phone: (207) 623-3796 Fax: (207) 623-0265 85 E Street P.O. Box 2890 South Portland, Maine 04116-2890 Phone: (207) 767-6440 Fax: (207) 767-8158 Approved for Release May 25, 2005 A list of key statewide partners includes but is not limited to the following: American Cancer Society, New England Division American Heart Association, Maine Chapter American Lung Association of Maine Center for Tobacco Independence Maine Cardiovascular Health Council Medical Care Development Maine Center for Public Health Maine Coalition on Smoking or Health Maine Department of Education Maine Office of Substance Abuse Programs of the Healthy Maine Partnerships TABLE OF CONTENTS SURVEY METHODOLOGY...............................................................................................................................1 2004 MAINE ADULT TOBACCO SURVEY HIGHLIGHTS ............................................................................7 TOBACCO USE BY MAINE ADULTS.............................................................................................................13 TOBACCO USE OVERVIEW.................................................................................................................................13 LIFETIME CIGARETTE USE .................................................................................................................................13 CURRENT CIGARETTE USE ................................................................................................................................15 DAILY CIGARETTE USE .....................................................................................................................................18 INITIATION OF TOBACCO USE ............................................................................................................................19 SOURCES OF CIGARETTES..................................................................................................................................20 SMOKELESS TOBACCO, CIGAR AND PIPE USE .....................................................................................................22 ADULT PERCEPTIONS OF YOUTH TOBACCO USE/ACCESS ....................................................................................24 PERCEIVED TOBACCO USE ................................................................................................................................28 TOBACCO IN THE MEDIA ...................................................................................................................................29 MOTIVATION AND ASSISTANCE TO QUIT................................................................................................33 INTENTIONS TO QUIT SMOKING .........................................................................................................................35 QUIT ATTEMPTS AMONG SMOKERS....................................................................................................................39 TOBACCO TREATMENT SERVICES ......................................................................................................................43 QUITTING ADVICE AND ASSISTANCE FROM HEALTHCARE PROFESSIONALS .........................................................46 AWARENESS OF COMMUNITY TOBACCO PREVENTION AND CONTROL ORGANIZATIONS .......................................48 INVOLUNTARY EXPOSURE TO SECONDHAND SMOKE.........................................................................53 OPINIONS AND CONCERN ABOUT SECONDHAND SMOKE .....................................................................................53 SECONDHAND SMOKE IN HOUSEHOLDS .............................................................................................................56 SECONDHAND SMOKE IN VEHICLES ...................................................................................................................61 SECONDHAND SMOKE AT THE WORKPLACE .......................................................................................................63 SUMMARY OF PROGRESS AND CHALLENGES ........................................................................................69 DEMOGRAPHIC CHARACTERISTICS .........................................................................................................73 APPENDIX: 2004 MATS SURVEY INSTRUMENT ........................................................................................75 Survey Methodology Introduction The Maine Adult Tobacco Use Survey (MATS) is a survey of knowledge, attitudes, beliefs, behaviors, social and personal experiences related to tobacco use and other risk factors for tobacco-related chronic diseases. The purpose of the survey is to provide more detailed information regarding these behaviors in Maine adults than is available from other surveys. The survey is conducted to provide data to be used in assessment, planning, and evaluation of the Maine Bureau of Health’s efforts to prevent tobacco use and tobacco-related chronic disease. The survey has several different domains. These are tobacco prevalence and consumption, quitting smoking, exposure to secondhand smoke, social norms and community influences on tobacco use, law enforcement and policy, self-management of tobacco-related chronic diseases, penetration of counter-marketing media messages, public opinion on some specific tobacco issues and information on demographics and sub-populations. Within these various domains, there are three main objectives: (1) to examine progress and trends in outcomes measured since the first wave of the MATS was conducted in 1999/2000; (2) to establish a baseline for future program monitoring for new outcomes developed since the 1999/2000 MATS; and (3) to measure a variety of time sensitive outcomes at a specific point in time. The Survey Questionnaire The survey was designed by the Partnership For A Tobacco-Free Maine of the Maine Bureau of Health and its partner program, the Maine Cardiovascular Health Program and its contractors. The contractors included the following organizations: Critical Insights (survey contractor), The Gallup Organization (evaluation contractor), University of New England (epidemiology contractor), Center for Tobacco Independence (tobacco treatment contractor). The survey instrument also had feedback from a broader set of stakeholders. The survey was administered by Critical Insights Inc. over a twelve month period from August 2003 through July 2004. The response data were sent to the Centers for Disease Control and Prevention (CDC) to be weighted to be representative of Maine adults. Finally, the data were sent to The Gallup Organization, its partner firm, Market Decisions of South Portland Maine and the Maine Bureau of Health to conduct analyses. The process for choosing questions for the MATS, was led by The Partnership For A TobaccoFree Maine and involved input from a variety of stakeholders (including The Maine Cardiovascular Health Program, the Center for Tobacco Independence, and the Maine Office of the Attorney General) to reach consensus on survey content. The questions themselves were taken from the previous version of the MATS when possible, and from other questionnaires including the Behavioral Risk Factor Surveillance Survey (BRFSS), the General Social Survey, the U.S. Census, and the National Health Interview Survey. Maine Adult Tobacco Survey 2004, Maine Bureau of Health, Partnership For A Tobacco-Free Maine in collaboration with the Maine Cardiovascular Health Program. -1- Copies of the questionnaire used each month and the schedule of monthly modules can be found in the technical documentation. Sampling The target population for the Maine Adult Tobacco Survey consisted of adults in Maine, 18 years of age and older. Persons residing in group homes, group quarters such as dormitories, military barracks, and institutions and those with no fixed household address (i.e., the homeless or residents of institutional group quarters such as jails or hospitals) were excluded from this survey. The sample population only included those households (and residents therein) with working telephones. People are considered eligible for the survey if they reside in Maine in the 30 days prior to the survey. A total of 5,332 telephone interviews were conducted as stratified samples of 800-1,000 from each of six regions of Maine (Figure A). The six regions were constructed based on contiguous counties with similar demographics for use in epidemiological studies conducted by the Bureau of Health. The regions were defined as follows: East Central: Waldo, Hancock, Penobscot Counties Mid-Coast: Sagadahoc, Lincoln, Knox Counties Northeast: Aroostook, Washington Counties South: York, Cumberland Counties West: Oxford, Somerset, Franklin, Piscataquis Counties West Central: Kennebec, Androscoggin Counties Approximately 400 interviews were completed each month. A disproportionate stratified sampling strategy for selecting households was employed within each region each month. Within strata, the probability of selecting a given household was the same, though probabilities of selection did vary between strata. Because population totals in the six regions varies, probability of selection is less in areas with larger populations. Within each household, a member was randomly selected to participate in the survey. All adults who consider the household their home are eligible to take the survey. Probability of selection is factored into the weighting of the survey responses. Figure A. Stratified Sampling Regions for the Maine Adult Tobacco Survey, 2000 and 2004 Region East Central Mid-Coast Northeast South West West Central Counties Waldo, Hancock, Penobscot Sagadahoc, Lincoln, Knox Aroostook, Washington York, Cumberland Oxford, Somerset, Franklin, Piscataquis Kennebec, Androscoggin Data Collection All telephone interviews were conducted in a central interviewing facility using Computer Assisted Telephone Interviewing (CATI) software. All interviewers were supervised and monitored continuously. The telephone data collection began on August 1, 2003 and went through July 15, 2004. A total of 5,332 interviews were completed. Each telephone number was contacted a minimum of ten times or until there was a final disposition of the number. Survey Response Rates Survey response rates are based on the original list of telephone numbers selected for the survey compared to the number of completed surveys. All dispositions for telephone numbers are not used equally in the final analysis of response, for example, numbers that turn out to be businesses are not the same as a refusal by a private resident. The estimated response rate for the 2004 MATS from August 1, 2003 through July 15, 2004 is calculated with two formulas. The more conservative rate estimate was 52%, with a less conservative or an upper bound response estimate of 66%. Monthly response rates are as follows: 2004 Response Rates By Month August 2003 52% September 2003 55% October 2003 50% November 2003 55% December 2003 56% January 2004 51% February 2004 52% March 2004 57% April 2004 47% May 2004 44% June 2004 44% Data Weighting The data has been weighted to adjust for the probability of selection, non-response, and the sex and age, of the population, telephone lines in a household, and number of people in the household. The sample and survey weights contained in the data set were developed by the Research Triangle Institute on behalf of the CDC and followed the weighting protocols developed for the Behavioral Risk Factor Surveillance Survey (BRFSS). Sampling Error A summary of survey precision for the state and each region is presented below. The precision estimates include the impact of the design effects of the sampling methodology. Design effects estimates were obtained through SUDAAN, a statistical software package. The precision estimates assume a conservative estimate of 50% prevalence on any designated survey variable. In reporting survey data herein, the confidence intervals include the impact of design effects but are calculated based on the number of responses to each question. Survey Region Statewide East Central Mid-Coast Northeast South West West Central Survey Precision (+/-) 1.7% 3.9% 3.9% 3.8% 3.6% 3.9% 3.8% While results from a random sample provide the best estimate of the true percentages in the population it is still just an estimate of the larger population. Confidence Intervals (CI) are provided in the tables of this report to describe the precision of each of these estimates. If the response frequency for a question is 25% with a CI of +/-10% this would indicate that the percentage, if the entire population were surveyed, would be somewhere between 15% and 35%. For this report, confidence intervals were constructed for each response estimate at the 95% confidence level. Using our example, that means that if the sampling and interviewing process were repeated 100 times using the same methods and procedures, 95 times out of the 100, the responses will fall within the 15% to 35% confidence interval range. Typically, larger samples provide better estimates than smaller samples; therefore the CI’s for small samples will be wider than those for large samples. The confidence intervals can be compared to see if two point estimates for the same question are statistically significantly different from year to year or for different groups of respondents. For example, when comparing the responses for the same question asked of the same types of respondents in two different years, the responses are 15% in 2000 and 25% in 2004, each with confidence intervals of +/-3% at the 95% level. Thus, the confidence interval range for the first estimate is 12% to 18% and the range for the second is 22% to 28%. Comparing these two intervals show that the two point estimates are statistically significantly different, as there is no overlap of the two confidence intervals. Comparison to the 2000 Maine Adult Tobacco Survey Maine ATS 1999/2000 used the same methodology as the MATS 2003.2004. It was a densitystratified random sample of Maine residents 18 years and older in households with telephones. Once a household was selected, one adult was randomly selected from adults in the home. The sample was stratified into 6 regions consisting of groups of demographically similar contiguous counties (Figure 1). Survey data collection procedures were the same as the Behavioral Risk Factor Surveillance System (BRFSS) and were completed by the same personnel who conducted the Maine BRFSS. Data was collected in monthly replicates from July 2000 through May 2000. However, after analyzing Maine BRFSS response rates, and in order to minimize costs, only 10 telephone attempts were made to each household rather than 15. The response rate, according to the Council of American Survey Research Organization’s formula was 68%. Survey data were weighted to reflect the probability that a household would get selected and that the particular respondent within that household would get selected. Subsequently, post-stratification weights were constructed so that data was representative of the age and sex of the population, for each of the regions sampled. Population estimates for the post-stratification weights were derived from Census data. Presentation of Survey Results This report presents the findings from the 2003/2004 MATS on tobacco and tobacco-related questions. Where possible, comparisons are made to the earlier MATS conducted in 1999/2000. A detailed listing of question response frequencies by specific demographic category can be found in the detailed data tabulation report titled, “Adult Tobacco Survey 2003/2004 Final Data Set (August 2003 – June 2004) Including a Special Section with Cardiovascular Health Questions”. In the tables and charts provided herein, the percentages listed will always be the percent of valid responses. The tables do not include the percentage of respondents who indicated the item was not applicable, that were unsure of their answer, or that refused to answer the survey question. 2004 Maine Adult Tobacco Survey Highlights Tobacco Use Lifetime Cigarette Use Approximately 53% of adults in the state indicated that they had smoked at least 100 cigarettes in their lifetime. A larger proportion of males (59%) reported smoking at least 100 cigarettes in their lifetime when compared to females (47%). Forty-seven percent (47%) of 18-34 year olds have smoked 100 cigarettes and almost 60% of Maine adults 55 years of age or older have smoked 100 cigarettes. Current Smoking Twenty-one percent (21%) of Maine adults indicated that they are current smokers. Current smokers are defined by the Centers for Disease Control and Prevention as someone who has smoked at least 100 cigarettes in their lives and they now smoke everyday or on some days. This figure is the same as the national smoking average, which was estimated to be 21% in 2004,. This overall current smoking rate has decreased from 23% in 2000, although the difference is not statistically significant. More males (24%) in Maine are current smokers than females (18%). This proportion is comparable to national smoking averages of 25% for males and 20% for females. Forty percent (40%) of adults without health insurance coverage currently smoke cigarettes. Older adults (those over 55 years of age) in the state are more likely to have quit smoking cigarettes in the past and be classified as former smokers. Females who are married or part of a couple are less likely to be current smokers (15%) than those who are not (24%). Females who are more likely to be current smokers include those without health insurance (38%), those age 18 to 24 (31%), those with household incomes below $25,000/year (26%), and those with a high school education or less (25%). Approximately 43% of adults in Maine on Medicaid currently smoke. Additionally, all demographic groupings of Medicaid smokers have high smoking rates. Among all current smokers in Maine, 37% reported that they smoke one to ten cigarettes per day, 48% smoke eleven to twenty cigarettes and 16% smoked more than twenty cigarettes per day. Males were more likely (19%) to smoke more than 20 cigarettes per day than were female smokers (11%). Five percent (5%) of 18-24 year old smokers smoke more than 20 cigarettes per day, while 20% of 45-64 year old smokers smoke more than 20 per day. The average current or former smoker in the state started smoking regularly when they were approximately 17 years old. There is a statistically significant difference between smoking initiation among males (17 years old) and females (18 years old). Smokeless Tobacco Two percent (2%) of adults in Maine use smokeless tobacco. Cigar and Pipe Tobacco Four percent (4%) of Maine adults said that they smoke cigars , on “some days”. When asked about the use of pipe tobacco, 1% indicated that they use pipe tobacco on “some days”. Community Tobacco Use In general, almost all adults feel that it is very important for Maine to keep stores from selling tobacco products to youth under the age of 18. Seventy-one percent (71%) of adults believe “very” or “somewhat strongly” that laws to keep youth in their community from obtaining tobacco products are enforced and 78% believe “very” or “somewhat strongly” that policies such as checking IDs and posting signs are enforced in their community. The majority (88%) of surveyed adults “strongly agree” that youth and adults should be prohibited from using tobacco on school grounds or at school events. Adults’ perception of tobacco use in their community has changed from 2000 to 2004. While less than half of adults saw tobacco use as a “somewhat serious” or “very serious” problem in their community in 2000, over two-thirds felt it was a problem in 2004. Respondents tended to overestimate the percentage of high school students and adults that smoke in their community. Twenty-five percent (25%) of those surveyed estimated that anywhere from 15% to 25% of high school students smoke, 21% stated that between 26% and 49% of high school students smoke and 28% stated that 50% or more of their community's high school students smoke. When asked about the number of adults that they thought smoke in their community, 18% estimated that 15% to 25% of adults smoke, 26% felt that 26% to 49% smoke, and 42% felt that 50% or more of the adults in their community smoke. Approximately 58% of participants reported that they “frequently” see ads for tobacco in convenience stores and gas stations in their community. Fifty-seven percent (57%) felt that the advertisement of tobacco in these community establishments was a “very serious” or “somewhat serious” problem. Seventy percent (70%) of adults surveyed said that they have been exposed to commercials about the dangers of tobacco use “very often” or “often”. The percentage of adults recalling hearing or seeing messages about the dangers of tobacco use were not different from 2000 to 2004. Quitting Tobacco Use Motivation and Assistance to Quit The percentage of former smokers that had quit smoking over 5 years ago increased by over 10% from 2000 to 2004. In 2004, three-quarters (75%) of current smokers stated that they would like to quit smoking, while in 2000, 74% of current smokers stated that they would like to quit smoking. When current smokers were asked about their confidence in quitting smoking, 48% were “very” or “somewhat confident” that they could quit for a year. Among former smokers that have already quit, 70% indicated that they are “very confident” they can keep from smoking for a year while only 3% are “not very confident” or “not at all confident”. Most current smokers (77%) who want to quit reported that they intend to quit smoking within the next 6 months. However, only 40% of this group intends to quit in the next 30 days. Forty-one percent (41%) of smokers reported that they did not try to quit smoking within the past year. Among those that had tried quitting in the past year, 45% quit for one to six days, 26% quit for seven to thirty days and 29% quit for over 30 days. Almost 60% of Maine adults reported trying to quit smoking cigarettes at some point in the past year. There were no significant differences in quitting between males and females. Younger adults (18-34) were more likely to have tried quitting in the past year (66%) than adults over the age of 55 (50%). However, nearly as many older adults want to quit (68%) compared to younger adults who want to quit (71%). Approximately 10% of former smokers quit smoking within the past year. 13% quit between one and five years ago, and 77% quit over five years ago. Tobacco Treatment Services Almost 70% of smokers interested in quitting said that they would try a nicotine replacement medication, such as a patch, gum or inhaler. Forty-six percent (46%) reported that they would try a non-nicotine pill, 35% would try telephone counseling and 32% would try individual or class counseling. Thirty-eight percent (38%) of adults who had quit smoking at least once in the past year reported using nicotine replacement medications, 19% used non-nicotine medications and 7% tried using counseling services such as the Maine Tobacco HelpLine. Most adults (62%) who tried using nicotine-replacement medications paid for the medication by themselves. A quarter (25%) said that their insurance paid for some or all of the medication and 12% were given the medication for free. Thirty percent (30%) of adults that tried using non-nicotine medications paid for it themselves, 62% reported that their insurance paid for some or all of the cost of the medication, and 7% said that they were given the medication free of charge. Advice/Help to Quit Smoking Among adults that had smoked cigarettes and seen a dentist in the past year, only one-quarter (27%) stated that the dentist or dental hygienist had advised them to stop smoking. A larger percentage of those who had smoked cigarettes and had seen a doctor in the past year (72%) had been advised to quit smoking by their healthcare professional or someone in their doctor's office. Overall, most adults who had smoked cigarettes in the past 12 months did not feel that their doctor's efforts to help them quit smoking were particularly helpful. Only 17% found these efforts to be either “very” or “extremely helpful” while 39% indicated that they were “not at all helpful” or that they were not talked to about quitting. Awareness of Community Anti-Tobacco Organizations More than half (55%) of adults in Maine were aware that the state of Maine sponsors the Maine Tobacco HelpLine as a means of assisting tobacco users in their efforts to quit smoking. Younger Maine adults tended to have more awareness of the HelpLine than older adults. Additionally, current smokers tended to be more aware of the HelpLine (71%) than non-smokers (51%). The majority of adults in the state (71%) had heard of the Partnership For A Tobacco-Free Maine (PTM). Half of those adults (50%) thought that the partnership was a part of the Bureau of Health, while 17% believed it was a part of the private sector. Those 18 to 34 were much more aware of the PTM than older adults. Current smokers were also more aware of the PTM (78%) than non-smokers (70%). Mainers without insurance (82%) were more aware of the PTM than those with it (71%). Over half of those surveyed (54%) had heard of the Healthy Maine Partnerships (HMP) but only 7% were aware of any local organization in their community that is part of the HMP. Adults age 18 to 34 are much more aware of the organization than older adults. There is no significant difference in awareness of the HMP between smokers and non-smokers. Secondhand Smoke Opinions and Concern about Secondhand Smoke Most adults favored protection from secondhand smoke. Almost two-thirds of adults (65%) strongly agreed that people should be protected from secondhand smoke, while another quarter (24%) somewhat agreed. Ninety-two percent (92%) of non-smokers strongly or somewhat agreed that people should be protected from secondhand smoke, while 79% of current smokers strongly or somewhat agreed. Overall, adults’ opinions about protection from secondhand smoke have remained steady from 2000 to 2004. Almost half (46%) of adults indicated that they are “very concerned” about exposure to secondhand smoke. Sixty-eight percent (68%) of non-smokers indicated that they were either “very concerned” (51%) or “somewhat concerned” (17%) about exposure to secondhand smoke, while 43% of current smokers were either “very concerned” (29%) or “somewhat concerned” (15%) about exposure to secondhand smoke. Secondhand Smoke in Households When adults were asked how many other people in their household smoked (excluding the respondent), 79% said “none”. Eighteen percent (18%) said that “one” other person in their household smoked, and 3% said “two”. Only 1% percent said that “three” other people in the household smoked and less than 1% of adults in the state said that “four” or more other people smoked in the household. Forty-nine percent (49%) of current smokers live with another smoker, compared to only 14% of non-smokers. Forty-three percent (43%) of current smokers and 37% of non-smokers indicated that they had children. Most adults (80%) indicated that no one had smoked inside their home during the past 30 days. Among smokers, only 40% reported that no one had smoked in their home in the past 30 days, while 47% said that someone had smoked in the house on all 30 days. Overall, 72% of adults indicated they do not allow smoking anywhere inside their home. Additionally, survey results indicate that household rules not allowing smoking are being enforced. Among adults who stated they had rules prohibiting smoking within their homes, 99% also stated that no one had smoked in their home during the past 30 days. Among current smokers, only 36% have rules that do not allow smoking within their home. Younger smokers (those age 18 to 34), however, are more likely than older smokers (those age 35 or older) to have household rules not allowing smoking within their home. Close to half (49%) of smokers age 18 to 34 have such rules. Current smokers who have children are also more likely to not allow smoking inside their home (43%) than smokers without children (57%). The percentage of adults in the state who have had someone smoke anywhere inside their home during the previous 30 days has remained constant from 2000 to 2004. The percentage of households who have rules prohibiting smoking within their home has increased by 10% in the past 5 years. Secondhand Smoke in Vehicles Seventy-nine percent (79%) of respondents reported that they had not ridden in a car with someone who was smoking (excluding the respondent) in the last seven days. Eight percent (8%) of adults in Maine had ridden in a car with someone smoking every day out of the previous week. Adults who smoke are over twice as likely as non-smokers to have ridden in a car with someone who was smoking during the previous seven days. Additionally, close to one-third of current smokers indicated that they had ridden in a car with someone who was smoking cigarettes all seven days the previous week. Secondhand Smoke in the Workplace Most employed adults in Maine (84%) indicated that they have rules restricting smoking in their workplaces. Ten percent (10%) said that they did not have rules restricting smoking and 5% work from home. Among the respondents who stated they have rules restricting smoking at work, 84% indicated that these policies were enforced “very strongly.” Ninety-one percent (91%) of adults in the state indicated that smoking is not allowed in any of the indoor public or common areas of their workplace. Ninety percent (90%) of adults stated that smoking was not allowed in any work areas. When asked if they would like to change their workplace’s smoking policy, 84% of adults wanted “no change”. Twelve percent (12%) preferred a stronger policy and 3% indicated they would prefer a weaker policy. Both current smokers and non-smokers are generally satisfied with their workplace’s smoking policy – 85% of current smokers and 84% of nonsmokers would prefer no change to their workplace’s smoking policy. Seventy-five percent (75%) of employed adults are not exposed to any secondhand smoke at work in a typical week. Thirteen percent (13%) are exposed to one hour or less and 8% are exposed to between two and ten hours in a typical week. Three percent (3%) were exposed to between 10 and 69 hours a week and less than 1% were exposed to more than 70 hours. Current smokers are more likely to be exposed to 2 or more hours of secondhand smoke a week at work (21%) than non-smokers (7%). Results from the survey show that employers in the state have gotten stricter about smoking in the workplace from 2000 to 2004. The percentage of employed adults who stated that their employer does not allow smoking in any public areas increased by over 20% from 2000 to 2004 and the percentage of adults who stated that smoking was allowed in all public areas decreased from 17% in 2000 to 0% in 2004. Exposure to secondhand smoke at work also decreased significantly from 2000 to 2004. While about half of employed adults were exposed to at least some secondhand smoke in 2000, only about one-quarter were exposed to secondhand smoke at work in 2004. Adults employed in manufacturing, construction, or transportation occupations are still exposed to high levels of secondhand smoke. Forty percent (40%) of employed adults who work in this occupation sector were typically exposed to at least one hour of secondhand smoke per week. This percentage is double that of adults in other occupations, such as professional or business, healthcare, education, or social services, and even retail and customer/general services. Tobacco Use by Maine Adults Tobacco Use Overview Cigarette smoking accounts for approximately 20% of all deaths in the United States. It is estimated that 440,000 people die from smoking-related diseases each year.1 Diseases such as coronary heart disease, stroke, chronic lung disease and lung cancer are highly associated with cigarette smoking. Children exposed to second-hand smoke can suffer from asthma and other respiratory tract infections, and pregnant women who smoke are more likely to give birth to low birth-weight babies or to babies at increased risk for sudden infant death syndrome.2 The monetary costs associated with cigarette use are also severe. The medical costs linked with smoking are more than $75 billion per year and approximately 14% of all Medicaid expenditures go toward smoking-related illnesses.3 These figures illustrate the undoubted need for continued smoking prevention and tobacco treatment programming across the country. The 2000 Maine Adult Tobacco Use Survey and the 2004 Maine Adult Tobacco Use Survey were administered to gain insight about people's knowledge, beliefs and behaviors regarding tobacco use. Data collected from the MATS is used to plan, assess and evaluate the Partnership For A TobaccoFree Maine’s tobacco prevention, control and treatment efforts. Lifetime Cigarette Use In order to assess tobacco use and tobacco treatment needs in Maine, it is first important to define the scope of the problem and understand what members of the population, and how many of them, are using tobacco. Approximately 53% of adults in the state indicated that they had smoked at least 100 cigarettes in their lifetime (Figure 1). A larger proportion of males (59%) reported smoking at least 100 cigarettes in their lifetime when compared to females (47%) (Table 1). Forty-seven percent (47%) of 18-34 year olds have smoked 100 cigarettes and almost 60% of Maine adults 55 years of age or more have smoked 100 cigarettes. Mainers that are not covered by health insurance are more likely (60%) than those with health insurance (52%) to have smoked at least 100 cigarettes in their lifetime (Table 1). 1 US Centers for Disease Control, Behavioral Risk Factor Surveillance System (BRFSS), 2004 Prevalence Data, http://apps.nccd.cdc.gov/brfss/ 2 US Centers for Disease Control, Reducing Tobacco Use, http://www.cdc.gov/nccdphp/bb_tobacco/ 3 ibid Figure 1. Lifetime Use of Cigarettes, Maine 2004 1-1. Smoked at Least 100 Cigarettes in Lifetime 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Yes No 53% 47% Denominator Includes: All Respondents (n=5332) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 1. Lifetime Cigarette Use by Gender, Age and Insurance Coverage, Maine 2004 Yes DEMOGRAPHIC GROUPS GENDER Male Female AGE 18-34 35 -54 55+ AGE 18-24 25-44 45-64 65+ HEALTH INSURANCE COVERAGE? Yes No % 58.8 46.9 46.6 51.1 58.9 45.3 47.1 57.3 58.3 51.8 60.0 CI +/2.6 2.2 4.1 2.5 2.6 7.1 2.8 2.6 3.5 1.8 5.9 Current Cigarette Use When asked if they currently smoke cigarettes, 21% of Maine adults indicated that they now smoke “everyday” or on “some days”4. This figure is the same as the national smoking average, which is estimated to be 21%5. The overall current smoking in Maine rate has decreased slightly from 23% in 2000, although the difference is not statistically significant (Figure 2). Current Smokers (All) When current smoking status is examined by gender, more males in Maine are current smokers (24%) than females (18%) (Table 2). These proportions are comparable to national smoking averages of 23% for males and 19% for females6. Older adults (those over 55 years of age) in the state are more likely to have quit smoking cigarettes in the past and be classified as former smokers7. Additionally, adults with lower incomes and with less education are more likely to smoke than the general population. Individuals that are married or part of a committed couple are less likely to be current smokers (17%) than other adults (28%), including those who are single or separated. A segment of the population with one of the highest proportions of current smokers is those lacking health insurance coverage. Forty percent (40%) of adults without health insurance coverage currently smoke cigarettes (Table 2). Female Current Smokers As stated above, 18% of females currently smoke cigarettes. Females who are married or part of a couple are less likely to be current smokers (16%) than those who are not (24%) (Table 2). Other groups of females who are more likely to be current smokers include those without health insurance (38%), those age 18 to 24 (31%), those with household incomes below $25,000/year (26%), and those with a high school education or less (25%) (Table 2). Current Smokers on Medicaid Medicaid recipients are twice as likely as the general population to smoke cigarettes. Approximately 43% of adults in Maine on Medicaid currently smoke (Table 2). Additionally, all demographic groupings of Medicaid smokers have similarly high smoking rates. Studies have shown that Medicaid smokers pass significant additional medical costs on to Federal and State governments. It is estimated that states in the U.S. spend over $20 billion a year on medical costs for smoking-related illnesses. Maine is estimated to spend $169 million a year on smokingrelated medical costs for Medicaid recipients8. It is evident that Maine could have large cost savings by assisting Medicaid recipients in quitting smoking. Even a small decrease in smoking rates among Medicaid recipients could result in millions of dollars of decreased medical costs per year for the state. ‘Current smoker’ is defined as someone who has smoked at least 100 cigarettes in their lifetime (answered ‘Yes’ from Question 1-1) and currently smokes either ‘every day’ or ‘some days’ from Question 1-2. 5 US Centers for Disease Control, Behavioral Risk Factor Surveillance System (BRFSS), 2004 Prevalence Data, http://apps.nccd.cdc.gov/brfss/ 6 ibid 7 ‘Former smoker’ is defined as someone who has smoked at least 100 cigarettes in their lifetime (answered ‘Yes’ from Question 1-1) and currently smokes ‘not at all’ from Question 1-2. 8 CDC, Tobacco Control State Highlights 2002. www.cdc.gov/tobacco/statehi/pdf_2002/140.pdf 4 Figure 2. Current Smoking Status, Maine 2000 and 2004 Smoking Status - 3 Categories 100% 90% 80% 70% 60% 50% 40% 31% 30% 20% 10% 0% Current Smoker Former Smoker 2000 2004 Never Smoked 23% 21% 32% 46% 47% Denominator Includes: Current Smokers (n=1014; n=1056) Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 2. All Current Smokers, Female Current Smokers and Medicaid Current Smokers by Demographics, Maine 2004 DEMOGRAPHIC GROUPS Total GENDER Male Female AGE CATEGORY 18-34 35-54 55+ AGE CATEGORY 18-24 25-44 45-64 65+ AREA OF THE STATE EAST CENTRAL MIDCOAST NORTHEAST SOUTH WEST WEST CENTRAL INCOME < $25,000 $25,000 - $49,999 $50,000+ EDUCATION < HS HS Grad, GED Some College, Technical School College Grad (4 yr) or more MARITAL STATUS Married or couple Other WEIGHT CATEGORY Neither overweight, obese Overweight Obese HEALTH INSURANCE COVERAGE? Yes No All Current Smokers % CI +/20.7% 1.4% 23.5% 18.1% 29.4% 22.0% 12.3% 35.9% 24.9% 17.5% 9.5% 21.8% 20.3% 24.8% 17.6% 23.7% 21.4% 28.5% 23.2% 14.4% 37.5% 26.4% 21.1% 9.1% 17.3% 27.8% 23.0% 19.6% 19.6% 18.7% 39.9% 2.3% 1.8% 3.7% 2.1% 1.7% 6.9% 2.4% 1.9% 2.1% 3.5% 3.4% 3.3% 2.9% 3.5% 3.3% 3.1% 2.6% 2.2% 6.1% 2.6% 2.9% 1.7% 1.6% 2.8% 2.4% 2.3% 3.2% 1.4% 6.2% Female Current Smokers % CI +/18.1% 1.8% 18.1% 25.6% 19.7% 10.8% 31.2% 22.0% 16.4% 7.5% 15.9% 17.3% 23.8% 15.6% 21.5% 20.6% 25.5% 19.3% 11.6% 25.7% 24.2% 19.5% 7.7% 15.5% 23.5% 18.6% 17.3% 19.1% 16.4% 37.7% 1.8% 4.8% 2.6% 2.0% 9.4% 3.0% 2.5% 2.2% 3.6% 4.0% 4.5% 3.6% 4.0% 4.5% 3.7% 3.4% 2.7% 7.1% 3.4% 3.6% 1.9% 2.1% 3.3% 2.5% 3.4% 4.8% 1.7% 10.1% Medicaid Current Smokers % CI +/42.5% 6.2% 50.3% 37.9% 45.2% 47.0% 19.6% 48.5% 46.9% 31.2% 43.9% 50.4% 42.0% 39.7% 40.3% 43.4% 42.7% 38.7% 51.7% 43.2% 41.4% 23.2% 40.8% 44.6% 45.6% 44.8% 37.9% 42.5% 10.6% 7.1% 9.8% 8.9% 9.7% 14.7% 8.0% 9.8% 14.2% 15.6% 11.6% 17.4% 13.5% 13.6% 7.2% 12.8% 15.0% 8.7% 12.8% 14.5% 8.2% 9.2% 11.1% 10.7% 11.0% 6.2% - Daily Cigarette Use Survey results indicate that the daily use of cigarettes among current smokers has decreased slightly from 2000 to 2004. There has been a 9% decease in the percentage of smokers who stated that they smoke over 20 cigarettes per day and a 7% increase in the percentage of smokers who indicated they smoke 6 to 10 cigarettes per day between 2000 and 2004. This decline in the daily use of cigarettes is a statistically significant change (Figure 3). Among all current smokers in Maine (including both every day and some day smokers), 37% reported that they typically smoke one to ten cigarettes, 48% smoke 11 to 20 cigarettes, and 16% smoke more than 20 cigarettes per day (Figure 3). Males were far more likely (19%) to smoke more than 20 cigarettes per day than were female smokers (11%). Adults 18 to 24 years old were the least likely age cohort to smoke more than 20 cigarettes per day (5%), while 20% of those age 45 to 64 years old smoke more than 20 cigarettes per day. Half of current smokers smoke between 11 to 20 cigarettes per day. Forty-two percent (42%) of smokers between the ages of 18 and 24 reported smoking 11 to 20 cigarettes per day, 32% smoke six to ten, and 21% smoke one to five. Among adults age 25 to 44, 53% smoke 11 to 20 cigarettes per day, 19% smoke six to ten per day, and 12% smoke one to five cigarettes (Table 3). Figure 3. Daily Use of Cigarettes among Current Smokers, Maine 2000 and 2004 1-3a. On the average, about how many cigarettes a day do you now smoke? 1-3b. On the average, when you smoked during the past 30 days, about how many cigarettes did you smoke in a day? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 to 5 cigarettes 6 to 10 cigarettes 2000 11 to 20 cigarettes 2004 More than 20 cigarettes 14% 14% 16% 23% 25% 16% 45% 48% Denominator Includes: Current Smokers Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 3. Daily Use of Cigarettes by Gender and Age, Maine 2004 1-3A. On average, how many cigarettes a day do you now smoke? 1-3B. On average, when you smoked in the past 30 days, about how many cigarettes did you smoke in a day? More than 20 1 to 5 cigarettes 6 to 10 cigarettes 11 to 20 cigarettes cigarettes DEMOGRAPHIC GROUPS % CI +/% CI +/% CI +/% CI +/13.7% 2.9% 22.8% 3.4% 47.8% 4.0% 15.6% 2.6% Total GENDER Male 10.0% 3.3% 18.4% 4.6% 52.5% 5.6% 19.1% 4.0% Female 18.3% 5.0% 28.3% 5.1% 42.0% 5.4% 11.3% 3.1% AGE 18-34 17.9% 6.2% 28.1% 7.2% 43.4% 7.5% 10.6% 4.0% 35-54 9.3% 3.0% 16.4% 3.7% 56.4% 5.4% 17.9% 4.1% 55+ 13.7% 5.1% 27.2% 6.7% 38.7% 7.1% 20.4% 5.7% AGE 18-24 21.2% 10.2% 31.9% 11.7% 41.9% 12.0% 5.0% 4.0% 25-44 11.5% 3.5% 18.7% 4.1% 52.5% 5.6% 17.3% 4.4% 45-64 10.4% 3.3% 20.0% 4.9% 49.3% 6.2% 20.2% 4.7% 65+ 14.3% 8.7% 32.2% 10.6% 36.0% 11.1% 17.4% 9.0% Initiation of Tobacco Use On average, current and former smokers in Maine began smoking regularly when they were approximately 17 years old (Table 4). There is a statistically significant difference between smoking initiation among males (17 years old) and females (18 years old), indicating that in general, males start smoking regularly a year before females. Results also show that those in older age groups have a higher mean age for smoking initiation, 18 years, on average, for adults over the age of 55 compared to 16 years for those 18 to 34. Table 4. How old were you when you first started smoking cigarettes fairly regularly? Mean Age 17.4 16.9 17.9 16.3 17.3 18.1 15.8 16.8 17.6 18.5 CI +/0.2 0.3 0.3 0.3 0.3 0.3 0.6 0.3 0.3 0.5 Total GENDER Male Female AGE 18-34 35-54 55+ AGE 18-24 25-44 45-64 65+ Sources of Cigarettes When shaping policies regarding taxes on tobacco products, it is helpful to understand where the majority of smokers obtain their cigarettes. As can be seen in Figure 4, 94% of smokers buy their cigarettes as opposed to rolling them or getting them some other way. Approximately 17% of smokers stated that they had purchased some cigarettes outside of the state of Maine, with 11% stating that they had purchased 10 packs or more out of state (Figure 5). Only 2% of Maine smokers reported buying their cigarettes on the Internet (Figure 6). Figure 4. Sources of Cigarettes, Maine 2004 1-6. How do you usually get your cigarettes? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Roll your own cigarettes Buy cigarettes Some other way 5% 1% 94% Denominator Includes: Current Smokers (n=1056) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 5. Out-of-State Cigarette Purchases, Maine 2004 1-7. In the past month, how many packs of cigarettes did you buy out of the state? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% None 1 to 9 packs 10 or more packs 6% 11% 82% Denominator Includes: Current Smokers (n=1056) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 6. Internet Cigarette Purchases, Maine 2004 1-8. In the past month, how many packs of cigarettes have you bought over the Internet? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% None 1 to 9 packs 10 or more packs 1% 1% 98% Denominator Includes: Current Smokers (n=1056) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Smokeless Tobacco, Cigar and Pipe Use The vast majority of tobacco users in Maine smoke cigarettes rather than use other forms of tobacco. Two percent (2%) of adults in Maine use smokeless tobacco (Figure 7). Only 1% indicated using smokeless tobacco “everyday” and the remaining 1% used smokeless tobacco on “some days”. Five percent (5%) of Maine adults smoke cigars, with 4% reporting that they smoke cigars on “some days” (Figure 8). When asked about use of pipe tobacco, only 1% indicated that they use pipe tobacco (Figure 9). Figure 7. Smokeless Tobacco Use, Maine 2004 3-1. Current smokeless tobacco use 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 1% 0% Everyday Some days Not at all 1% 98% Denominator Includes: All Respondents (n=5332) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 8. Current Cigar Use, Maine 2004 3-2. Current cigar use 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0% Everyday Some days Not at all 4% 95% Denominator Includes: All Respondents (n=5332) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 9. Current Pipe Use, Maine 2004 3-3. Current pipe use 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0% Everyday Some days Not at all 1% 99% Denominator Includes: All Respondents (n=5332) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Adult Perceptions of Youth Tobacco Use/Access Adults’ perception of tobacco use in their community has changed from 2000 to 2004. While less than half of adults saw tobacco use as a “serious” or “very serious” problem in their community in 2000, over two-thirds felt it was a problem in 2004 (Figure 10). Agreement with the statement that adults and children should not be allowed to use tobacco on school grounds or at school events remained very high in both 2000 and 2004 (Figure 16). In general, Mainers see tobacco use as an increasingly serious problem in their communities, and are very supportive of efforts to enforce laws restricting access to tobacco. Approximately 73% of those surveyed felt that tobacco use is a “very serious” or “somewhat serious” problem in their community (Figure 10). Twenty-three percent (23%) of adults reported seeing underage youth smoking cigarettes around town in public view all of the time (Figure 11) and 9% reported seeing youth smoking on or near school grounds all of the time in their community (Figure 12). In general, almost all adults feel that it is very important for Maine to keep stores from selling tobacco products to youth under the age of 18 (Figure 13). Seventy-one percent (71%) of adults feel very or somewhat strongly that laws to keep youth in their community from obtaining tobacco products are enforced (Figure 14) and 78% feel “very strongly” or “somewhat strongly” that policies such as checking IDs and posting signs are enforced in their community (Figure 15). The majority (88%) of surveyed adults “strongly agree” that youth and adults should be prohibited from using tobacco on school grounds or at school events (Figure 16). Figure 10. Community Tobacco Problems, Maine 2000 and 2004 5-1. In your community, how serious of a problem is tobacco use? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Very serious Serious Not serious/somewhat serious 2000 Not serious at all DK/NS 26% 30% 29% 43% 24% 13% 3% 6% 19% 8% 2004 Demonimator Includes: All Respondents Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 11. Smoking among Youth in General Community, Maine 2004 5-2A. How often see youth under 18 years of age smoking cigarettes On streets around town, in public view? 100% 90% 80% 70% 60% 50% 35% 40% 30% 20% 10% 0% All the time Sometimes Every once in a while Rarely or never 23% 24% 17% Denominator Includes: All Respondents (n=5332) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 12. Smoking among Youth on/near School Grounds, Maine 2004 5-2B. How often see youth under 18 years of age smoking cigarettes On, around, or across from school ground? 100% 90% 80% 70% 60% 48% 50% 40% 30% 19% 20% 9% 10% 0% All the time Sometimes Every once in a while Rarely or never 16% Denominator Includes: All Respondents (n=5332) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 13. Youth Access to Tobacco in Stores, Maine 2004 5-6. How important is it that the state keeps stores from selling tobacco products to youth under 18 years of age? 100% 88% 90% 80% 70% 60% 50% 40% 30% 20% 8% 10% 0% Very important Somewhat important Not very important Not important at all DK 2% 2% 0% Denominator Includes: All Respondents (n=5332) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 14. Community Enforcement of Youth Tobacco Sales, Maine 2004 5-7. In community, how strongly do you believe laws that keep kids from buying cigarettes or chewing tobacco are enforced? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Very strongly Somewhat strongly Neither strongly or Not very strongly not strongly Not strongly at all 5% 9% 5% 31% 40% Denominator Includes: All Respondents (n=5332) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 15. Community Enforcement of Youth Tobacco Restriction Policies, Maine 2004 5-8. In community, how strongly do you believe policies like storeowners checking IDs or posting signs are enforced? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Very strongly Somewhat strongly Neither strongly or Not very strongly not strongly Not strongly at all 4% 7% 3% 40% 38% Denominator Includes: All Respondents (n=5332) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 16. Beliefs about Youth and Adult Tobacco Use on School Grounds, Maine 2000 and 2004 5-9. Tobacco use by both children and adults should not be allowed on school grounds or at school events. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Strongly agree Somewhat agree 2000 Strongly disagree 2004 Somewhat disagree 3% 7% 3% 2% 2% 2% 91% 88% Denominator Includes: All Respondents Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Perceived Tobacco Use Comparing perceived tobacco use in 2000 and 2004, survey results indicate that adults think that fewer high school students and fewer adults smoke cigarettes in their community than they did 5 years ago. While the majority of adults felt that more than half of high school students smoked cigarettes in 2000, only 28% of adults felt similarly in 2004 (Figure 17). Likewise the percentage of adults who felt that over half of the adults in their community smoked cigarettes fell by close to 20% from 2000 to 2004 (Figure 18). Participants tended to overestimate the percentage of high school students and adults that smoke when they were asked how many high school students out of 100 in their community smoke cigarettes. Twenty-five percent (25%) of those surveyed estimated that anywhere from 15% to 25% of high school students smoke, 21% stated that between 26% and 49% of high school students smoke, and 28% stated that 50% or more of their community's high school students smoke (Figure 17). When asked about the number of adults that they thought smoke in their community, 18% estimated that 15% to 25% of adults smoke, 26% felt that 26% to 49% smoke, and 42% felt that 50% or more of the adults in their community smoke (Figure 18). Figure 17. Perceptions of Student Smoking Prevalence, Maine 2000 and 2004 5-10. Out of every 100 high school students in your community, how many do you think smoke cigarettes? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% < 15% 15 - 25% 26 - 49% 2000 2004 50% 51%+ 5% 15% 12% 25% 19% 21% 30% 17% 11% 32% Denominator Includes: All Respondents Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 18. Perceptions of Adult Smoking Prevalence, Maine 2000 and 2004 5-11. Out of every 100 adults in your community, how many do you think smoke cigarettes? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 21% 26% 14% 18% 4% 7% 29% 22% 31% 20% < 15% 15 - 25% 26 - 49% 2000 2004 50% 51%+ Denominator Includes: All Respondents Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Tobacco in the Media In 2001, cigarette companies spent $11.2 billion, or more than $30 million per day, on advertising and promotional expenses.9 In a 1999 study of 163 communities in the US, researchers found that 92% of stores in the analysis had some form of tobacco advertising including interior or exterior advertisements, self-service pack placement, multi-pack discounts, tobacco-branded functional objects, or tobacco vending machines.10 The most "tobaccofriendly" stores included convenience stores, convenience/gas stores, and liquor stores. This enormous amount of spending by tobacco companies and community advertising is an indication of what messages the public sees that encourages them to purchase and use tobacco products. Maine ATS participants were asked several questions about their perceptions of tobacco advertising in their community. Approximately 58% of participants reported that they frequently see ads for tobacco in convenience stores and gas stations in their community (Figure 19). Fiftyseven percent (57%) felt that the advertisement of tobacco in these community establishments was a very serious or somewhat serious problem (Figure 20). Seventy percent (70%) of adults surveyed said that they have been exposed to TV commercials about the dangers of tobacco use very often or often (Figure 21). The percentage of adults recalling hearing or seeing messages about the dangers of tobacco use were similar in 2000 and Federal Trade Commission. Cigarette Report for 2001. Washington, DC: Federal Trade Commission; 2003. Accessed: February 2004. 10 Feighery, EC, Ribisl, KM, Schleicher, N, Clark, PI. Retailer participation in tobacco company incentive programs is related to increased levels of cigarette advertising and cheaper cigarette prices in stores. Prev Med. 2004 Jun;38(6):876-84. 9 2004 (Figure 21). When assessing people's exposure to these commercials by current smoking status, 36% of smokers reported to have seen or heard them very often, which was more than non-smokers (25%) (Table 5). One possibility for this result could be that smokers are more intune to these sorts of ads, since they use the product, and tend to recall them at a higher rate than non-smokers. A possible downside to higher recall among smokers is that they may also be more susceptible to traditional tobacco company advertising in addition to the anti-tobacco media campaigns. Figure 19. Tobacco Advertisements in Community, Maine 2004 5-4. When go to convenience stores, gas stations in community, how often do you see ads for tobacco? 100% 90% 80% 70% 58% 60% 50% 40% 30% 20% 10% 0% Frequently Sometimes Occasionally Almost never I don't go to convenience stores or gas stations 14% 13% 12% 1% Denominator Includes: All Respondents (n=5332) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 20. Problems with Tobacco Advertisements in Community, Maine 2004 5-5. How serious of a problem is it that tobacco is advertised at convenience stores, gas stations in community? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Very serious Somewhat serious A little serious Not at all serious 23% 19% 19% 34% Denominator Includes: All Respondents (n=5332) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 21. Anti-Tobacco Commercials, Maine 2000 and 2004 CDM-8. When you see or hear commercials in the media, such as radio or television, how often do you see or hear commercials aobut the dangers of smoking or chewing tobacco? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Very often Often 2000 Not often 2004 Not often at all 4% 8% 33% 27% 42% 38% 21% 22% Denominator Includes: All Respondents Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 5. Anti-Tobacco Commercials by Area of the State and Smoking Status, Maine 2004 CDM-8. When you see or hear commercials in the media, such as radio or television, how often do you see or hear commercials about the dangers of smoking or chewing tobacco? Very Often Often % SE % SE DEMOGRAPHIC GROUPS 27.2 1.4 42.3 1.5 Total AREA OF THE STATE EAST CENTRAL 22.9 3.0 43.4 3.7 MIDCOAST 21.1 2.8 42.5 3.4 NORTHEAST 31.4 3.4 39.5 3.3 SOUTH 29.5 3.0 44.0 3.1 WEST 27.3 3.0 41.2 3.3 WEST CENTRAL 27.2 3.0 39.8 3.3 CURRENT SMOKER? Yes 35.6 3.1 45.0 3.4 No 24.7 1.6 41.6 1.7 Motivation and Assistance to Quit A primary objective of the MATS survey is to gather data that will help guide tobacco treatment efforts for the PTM. Among former smokers that have smoked at least 100 cigarettes in their lifetime, 77% reported that the last time they smoked cigarettes regularly was over 5 years ago, while only 2% reported smoking within the past month (Figure 22). About 3% have quit smoking cigarettes in the past year. The percentage of former smokers that had quit smoking over 5 years ago increased by over 10% from 2000 to 2004 (Figure 22). Since the overall proportion of former smokers has remained steady at just over 30%, it appears that more former smokers are staying away from cigarettes permanently. In 2004, three-quarters (75%) of current smokers stated that they would like to quit smoking (Figure 23). In 2000, 74% of current smokers stated that they would like to quit smoking. When current smokers were asked about their confidence in quitting smoking, 48% were very or somewhat confident that they could quit for a year (Figure 24). Over 50% were not very confident or not at all confident in their ability to quit smoking during the next year. Among former smokers that have already quit, 70% indicated that they are confident they can keep from smoking for a year while only 3% are not very confident or not confident at all (Figure 25). Figure 22. Time Since Last Regular Cigarette Use among Former Smokers, Maine 2004 1-9. About how long has it been since you last smoked cigarettes regularly, that is, daily? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Within the past month Within the past 3 months Within the past year 2000 Within the past 5 More than 5 years years ago 2004 9% 3% 2% 3% 2% 6% 19% 13% 65% 77% Demonimator Includes: Former Smokers (n=1585; n=1767) Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 23. Desire to Quit Smoking, Maine 2004 2-1. Would you like to quit smoking? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Yes 2000 No 2004 DK/NS 3% 4% 23% 22% 74% 75% Demonimator Includes: Current Smokers Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 24. Confidence in Quitting Smoking among Current Smokers, Maine 2004 1-5. If decided to stop smoking cigarettes, how confident are you you could stay off cigarettes for the next year? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Very confident Somewhat confident Not very confident Not at all confident 21% 27% 26% 25% Denominator Includes: Current Smokers (n=1056) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 25. Confidence in Quitting Smoking among Former Smokers, Maine 2004 1-10. You no longer smoke. How confident are you that you can stay off cigarettes for the next year? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Very confident Somewhat confident Not very confident Not at all confident 2% 1% 25% 70% Denominator Includes: Former Smokers who have quit within the past year (n=149) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Intentions to Quit Smoking Most current smokers (77%) that participated in the MATS survey intend to quit smoking within the next 6 months (Figure 26). However, that percentage dropped to 40% when that same group of smokers was asked if they planned on quitting smoking within the next 30 days (Figure 27). These results, when looked at in combination with smokers’ confidence in quitting, above, suggest a barrier in getting smokers to quit. The majority of smokers are confident in their ability to quit and most see themselves quitting in the next 6 months, but a much smaller percentage plan on quitting within the next 30 days. So, while many are confident they will not be smoking in the next 6 months, far fewer will commit to stopping right now. When assessing adults’ intentions to quit smoking within the next six months, there were no significant differences between males and females or among different age categories (Table 6). Quitting intentions also did not appear to differ between those that are married or living as a couple and those in other marital situations. Additionally, smokers who live with other smokers reported similar quitting intentions when compared to smokers who do not live with other smokers. Figure 26. Smoking Intentions in Next 6 Months among Current Smokers, Maine 2004 2-2. Are you considering quitting in the next 6 months? 100% 90% 77% 80% 70% 60% 50% 40% 30% 20% 10% 0% Yes No 23% Denominator Includes: Current smokers who would like to quit smoking from Q2-1 (n=854) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 6. Smoking Intentions in Next 6 Months by Demographic Groups, Maine 2004 2-2. Are you considering quitting in the next 6 months? (% indicating Yes) Yes DEMOGRAPHIC GROUPS Total GENDER Male Female AGE 18-34 35 -54 55+ AGE 18-24 25-44 45-64 65+ MARITAL STATUS Married or couple Other # OF OTHER SMOKERS IN HH None One or More % 76.9 74.4 79.7 77.4 77.4 75.0 69.1 80.9 76.4 74.3 77.3 76.3 78.5 75.3 CI +/3.9 5.9 4.6 7.5 5.3 7.5 13.5 5.1 5.7 13.2 5.0 6.2 4.5 6.3 Figure 27. Smoking Intentions in Next 30 Days among Current Smokers, Maine 2004 2-3. Are you planning to stop smoking in the next 30 days? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Yes 2000 2004 No 38% 40% 62% 60% Demonimator Includes: Current smokers who plan to stop smoking within the next 6 months from Q2-2 Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Quit Attempts among Smokers Fifty-nine percent (59%) of smokers reported that they did try to quit smoking with in the past year (Figure 28). It is interesting to note that this percentage is quite different from the 77% of smokers who indicated that they intend to try quitting smoking in the next six months (Figure 26). It appears that although over three-quarters of current smokers intend to try quitting in the next 6 months, only about 59% actually tried quitting in the past year (Figure 28). Twenty-six percent (26%) reported that they had tried quitting once or twice, 14% tried three or four times and 19% tried quitting 5 times or more. Current smokers were more likely to try to quit five or more times in 2004 than in 2000. Otherwise, quit attempts in 2000 and 2004 were similar (Figure 28). There were no significant differences in quitting between males and females (Table 7). Younger adults (18-34) were more likely to have tried quitting in the past year than adults over the age of 55. The percent of adults that tried to quit in the past year did not differ significantly by marital status, whether or not the respondent has children, or whether the respondent lives with other smokers. Among those that had tried quitting in the past year, 45% were only able to quit for one to six days, 26% quit for seven to thirty days and 29% quit for over 30 days (Figure 29). The fact that almost half of smokers who tried quitting could only do so for one to six days illustrates the difficulty that smokers face when trying to quit smoking. As can be seen in Table 8, approximately 10% of former smokers quit smoking within the past year. Thirteen percent quit between one and five years ago, and 77% quit over five years ago. There were no significant differences between males and females when comparing how long ago they quit smoking (Table 8). A much larger proportion (59%) of 18-24 year olds who quit smoking indicated that they quit smoking within the past year. Figure 28. Quit Attempts during Past Year, Maine 2004 2-5A. During the past 12 months, about how many times have you quit smoking for 1 day or longer? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% None One Two 2000 Three 2004 Four Five or more 17% 14% 15% 12% 9% 10% 5% 4% 10% 19% 43% 41% Demonimator Includes: Current Smokers Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 29. Duration of Staying Quit during the Past Year, Maine 2004 2-5B. In the past 12 months, what is the longest time you have quit smoking? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Quit for 1 to 6 days Quit for 7 to 30 days Quit for over 30 days 26% 45% 29% Denominator Includes: Current smokers who have quit smoking at least once during the past 12 months (n=587) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 7. Percent of Adults that Attempted to Quit Smoking in Past Year by Demographic Groups, Maine 2004 Percent of Current Smokers that Have Quit For One Day or Longer Yes DEMOGRAPHIC GROUPS Total GENDER Male Female AGE 18-34 35-54 55+ AGE 18-24 25-44 45-64 65+ MARITAL STATUS Married or couple Other HAVE CHILDREN Yes No # OF OTHER SMOKERS IN HH None One or More % 59.1 55.2 63.8 66.3 56.7 50.0 68.9 58.2 57.2 45.2 60.9 56.9 61.9 57.0 58.2 60.2 CI +/3.8 5.6 5.0 7.0 5.4 7.3 10.8 5.6 5.9 11.4 5.0 6.0 6.1 4.9 4.8 6.1 Table 8. Profile of Adults who Quit Smoking by Years Since Last Smoked, Maine 2004 DEMOGRAPHIC GROUPS Total GENDER Male Female AGE 18-34 35-54 55+ AGE 18-24 25-44 45-64 65+ REGION EAST CENTRAL MIDCOAST NORTHEAST SOUTH WEST WEST CENTRAL INCOME < $25,000 $25,000 - $49,999 $50,000+ EDUCATION < HS HS Grad, GED Some College, Technical School College Grad (4 yr) or more MARITAL STATUS Married or couple Other WEIGHT CATEGORY Neither overweight, obese Overweight Obese HEALTH INSURANCE Yes No HAVE CHILDREN Yes No MARITAL STATUS Married Divorced Widowed Separated Never married A member of an unmarried couple # OF OTHER SMOKERS IN HH None One or More Within the past year % CI +/9.5 1.8 9.4 9.6 30.3 10.2 2.8 59.4 17.6 5.9 2.1 11.4 11.4 10.1 8.2 12.2 7.3 9.9 12.0 8.3 4.6 12.7 10.0 6.7 9.2 10.6 7.9 7.7 13.2 8.7 23.9 15.3 7.1 6.8 7.9 4.0 3.2 26.6 32.0 8.1 16.9 2.4 2.8 8.6 2.9 1.1 21.2 4.7 2.0 1.1 4.9 4.7 3.9 3.6 4.8 3.4 4.0 3.8 2.8 3.2 3.5 3.7 2.7 2.2 3.3 2.7 2.5 4.8 1.8 10.8 4.1 1.9 1.8 4.0 2.7 4.5 12.0 12.7 1.8 5.9 1 to 5 years ago % CI +/13.3 2.0 11.1 15.9 36.0 12.5 7.3 40.6 25.7 9.0 6.3 15.9 10.9 14.8 11.8 11.1 15.8 16.6 15.0 11.3 17.1 14.3 13.8 10.8 12.8 14.9 13.2 14.0 12.5 12.7 22.0 18.2 11.3 11.1 16.3 6.3 18.7 24.6 28.9 13.0 15.1 2.4 3.1 8.5 2.9 2.0 21.2 5.1 2.3 2.6 5.1 4.0 4.4 3.7 4.3 5.0 4.6 3.7 3.1 8.4 3.3 3.8 3.1 2.3 3.9 3.3 3.2 4.1 0.0 1.9 11.1 4.1 2.1 2.1 6.3 3.5 15.3 11.7 11.4 2.1 5.2 Over 5 years ago % CI +/77.1 2.5 79.4 74.5 33.8 77.2 89.9 0.0 56.7 85.1 91.6 72.7 77.7 75.1 80.0 76.7 76.9 73.4 72.9 80.4 78.3 73.0 76.2 82.5 78.0 74.5 78.9 78.3 74.4 78.6 54.1 66.6 81.7 82.0 75.8 89.7 78.1 48.8 39.1 78.9 68.0 3.2 3.8 9.0 3.8 2.3 0.0 6.0 2.9 2.8 6.3 5.7 5.5 4.8 5.9 5.6 5.5 4.7 3.9 8.6 4.4 5.0 3.9 2.9 4.7 4.0 3.8 5.8 2.5 12.1 5.2 2.7 2.7 7.0 4.4 15.8 14.7 12.1 2.6 7.1 Tobacco Treatment Services When smokers who were interested in quitting were asked about their willingness to use specific cost-free tobacco treatment services if they were to quit smoking in the next year (each treatment service was a stand-alone question based on a yes/no response), almost 70% said that they would try a nicotine medication, such as a patch, gum or inhaler (Figure 30). Forty-six percent (46%) reported that they would try a non-nicotine pill, while 35% would try telephone counseling and 32% would try individual or class counseling. Respondents who had quit smoking at least once in the past year (including former smokers) were asked whether they had tried any of these services in the past year. Thirty-eight percent (38%) reported using nicotine replacement medications, 19% used non-nicotine medications and 7% tried using counseling services or the Maine HelpLine (Figure 31). Most adults (62%) who tried using nicotine-replacement medications paid for the medication by themselves (Figure 32). A quarter (25%) said that their insurance paid for some or all of the medication and 12% were given the medication for free. Thirty percent (30%) of adults who tried using non-nicotine medications paid for it themselves, 62% reported that their insurance paid for some or all of the cost of the medication, and 7% said that they were given the medication free of charge (Figure 33). It is clear from these data that smokers are more interested in medications to help them quit rather than counseling services that are either in-person or over the telephone. This may be due, in part, to the amount of time and energy that is perceived to be involved in tobacco treatment counseling. Nicotine replacement medications, such as patches or gum, are easy and convenient to use, and can be used while doing other things, making them a more attractive alternative.. However, free tobacco help lines, such as the Maine Tobacco HelpLine, appear to be an important and effective non-medication service for helping smokers quit. The American Cancer Society reports that people who use telephone counseling stop tobacco use at twice the rate of those who don't get this type of help11. 11 Guide for Quitting Smoking, American Cancer Society. http://www.cancer.org Figure 30. Willingness to Try Tobacco Treatment Services/Aids, Maine 2004 2-4. If you were to try to quit in the next year, which of these services would you be willing to try, assuming it is free? 100% 90% 80% 67% 70% 60% 50% 40% 30% 20% 10% 0% Nicotine medication (patch, gum, inhaler) Zyban (no-nicotine pill) Counseling by phone (HelpLine) Individual or class cessation counseling 46% 35% 32% Denominator Includes: Current smokers who would like to quit smoking from Q2-1 (n=854) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 31. Use of Tobacco Treatment Resources during Past Year, Maine 2004 2-6A-D. In the past 12 months, have you used any of the following products or services to help you quit smoking? 100% 90% 80% 70% 60% 50% 40% 30% 20% 7% 10% 0% Use a quit smoking class, group, counselor or HelpLine? Use nicotine replacement medications? Use non-nicotine medication? 19% 38% Denominator Includes: Respondents who have quit smoking at least once during the past 12 months (n=756) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 32: 2-6c. How did you pay for the nicotine replacement systems? 2-6C. How did you pay for it (nicotine replacement systems)? 100% 90% 80% 70% 60% 50% 40% 30% 15% 20% 10% 0% I paid for it on my own Insurance paid for some of it Insurance paid for all of it I was given the medication free of charge 10% 12% 62% Denominator Includes: Respondents who have used nicotine replacement systems (n=282) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 33: 2-6e. How did you pay for the non-nicotine medication? 2-6E. How did you pay for the non-nicotine medication? 100% 90% 80% 70% 60% 50% 30% 40% 30% 20% 10% 0% I paid for it on my own Insurance paid for some of it Insurance paid for all of it I was given the medication free of charge 18% 7% 44% Denominator Includes: Respondents who have used non-nicotine medication (n=155) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Quitting Advice and Assistance from Healthcare Professionals The MATS asked a series of questions about advice and assistance that smokers may have received about quitting smoking. These questions were asked to assess guidance that smokers get from various health care professionals. Among respondents that had smoked cigarettes and seen a dentist in the past 12 months, only 27% stated that a dentist or dental hygienist had advised them to stop smoking (Figure 34). Among respondents that had smoked cigarettes and had seen a doctor, more adults (72%) had been advised to quit smoking by a healthcare professional or their doctor's office (Figure 35). Fifty-seven percent (57%) indicated that a doctor had asked them if they wanted to quit smoking. When it came to mentioning particular tobacco treatment services, 40% of adults who have smoked in the past year said that their doctor had talked to them about medication to help them quit, 35% said they were provided with self-help materials, 32% said their doctor had talked about preparing them to quit, and only 27% had mentioned counseling or the Maine Tobacco HelpLine (Figure 35). Overall, most adult smokers did not feel that their doctor's efforts to help them quit smoking were particularly helpful. Only 17% found these efforts to be either “very” or “extremely helpful” while 39% indicated that they were “not at all helpful” or that they were not talked to about quitting (Figure 36). Figure 34: 2-7. In the past 12 months, has a dentist or dental hygienist advised you to stop smoking? (among respondents who have smoked within the past year) 2-7. In the past 12 months, has a dentist, dental hygienist advised you to stop smoking? 100% 90% 72% 80% 70% 60% 50% 40% 30% 20% 10% 0% Yes No 27% Denominator Includes: Respondents who have smoked and visited a dentist in the past 12 months (n=930) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 35: 2-8a-f. During a doctor's visit, in the last 12 months, did any health professional…(among respondents who have smoked within the past year) 2-8. In the past 12 months, has a…(% indicating "yes") 100% 90% 80% 70% 57% 60% 50% 40% 30% 20% 10% 0% Health care professional advised you to quit? Doctor asked if you wanted to quit? Doctor given you Doctor given you self-help counseling materials? information (HelpLine)? Doctor talked to Doctor talked you about about medications smoking or to help you quit? prepared you for quitting? 72% 40% 35% 27% 32% Denominator Includes: Respondents who have smoked and visited a doctor in the past 12 months (n=1026) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 36. Helpfulness of Doctor's/Clinic's Advice on Quitting Smoking, Maine 2004 2-9. In past 12 months, how helpful has doctor's office, clinic been in helping to quit smoking or think about quittin 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Not at all helpful or did not talk about smoking Slightly helpful Moderately helpful Very helpful Extremely helpful 21% 20% 13% 4% 39% Denominator Includes: Respondents who have smoked and visited a doctor in the past 12 months (n=1026) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Awareness of Community Tobacco Prevention and Control Organizations Participants in the MATS were asked about their awareness of different tobacco services in the state of Maine. It is very important to assess whether smokers, in particular, are aware of services intended to help them quit smoking. The first step in encouraging a smoker to use a service is to make them aware of the service. Overall, 55% of adults in Maine were aware of the Maine Tobacco HelpLine (Figure 37). Younger adults in Maine who were surveyed had greater awareness of the HelpLine than older adults (Table 9). Residents in the Western area of the state were the most likely to know about the HelpLine. When examining awareness of the HelpLine by smoking status, current smokers were much more likely (71%) to be aware of the HelpLine than non-smokers (51%) indicating that current smokers are being provided information about this service, possibly by their health care providers or by other acquaintances (Table 9). Most adults (71%) stated that they heard of the Partnership For A Tobacco-Free Maine (PTM) (Figure 38). Half of all adults in the state (50%) thought that the partnership was a part of the Bureau of Health, while 17% believed it was a part of the private sector (Figure 39). As was the case with the Maine Tobacco HelpLine, younger adults were significantly more aware of the PTM than older adults (Table 10). Current smokers (78%) were also more aware of the PTM than non-smokers (70%). When comparing Maine adults with health insurance versus those without health insurance, Mainers without insurance were more aware of the PTM than those with it (Table 10). Over half of those surveyed (54%) had heard of the Healthy Maine Partnerships (HMP) (Figure 40) but only 7% were aware of any local organization in their community that is part of the HMP (Figure 41). Ninety percent (90%) were not aware of any such organization. When assessing awareness of the HMP by age, it is clear that younger adults are more aware of the organization than older adults (Table 11). There was no significant difference in awareness of the HMP between smokers and non-smokers. In general, younger smokers had a greater awareness of services such as PTM, the Maine Tobacco HelpLine, and the HMP. Survey results indicate that young smokers (age 18 to 24) appear to be attempting to quit smoking in higher proportions than older age cohorts. Sixty-nine percent (69%) of current smokers age 18-24, 58% of those age 25-44, 57% those age 45-64 and 45% of smokers 65 years of age or older reported that they had tried to quit (Table 7). Further investigation is needed to explore the potential correlation between young smokers' awareness of these services and the percentage of them that have tried to quit. Figure 37. Awareness of Maine Tobacco HelpLine, Maine 2004 CDM-3. Are you aware that the State of Maine sponsors the Maine Tobacco HelpLine as a means of assisting tobacco users in their efforts to quit smoking? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% YES NO 55% 43% Denominator Includes: All respondents in the original communications module (n=2305) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 9. Awareness of Maine Tobacco HelpLine by Demographic Groups, Maine 2004 CDM-3. Are you aware that the State of Maine sponsors the Maine Tobacco HelpLine as a means of assisting tobacco users in their efforts to quit smoking? Yes DEMOGRAPHIC GROUPS Total AGE 18-34 35 -54 55+ AGE 18-24 25-44 45-64 65+ AREA OF THE STATE EAST CENTRAL MIDCOAST NORTHEAST SOUTH WEST WEST CENTRAL CURRENT SMOKER? Yes No % 55.5 64.4 53.2 51.3 64.5 58.4 53.2 48.9 51.1 54.4 54.8 54.4 64.4 56.1 71.0 51.1 CI +/2.4 5.5 3.8 3.8 9.2 4.3 3.8 5.2 5.7 5.6 5.3 5.0 5.3 5.5 5.1 2.7 Figure 38. Awareness of the Partnership For A Tobacco-Free Maine, Maine 2004 CDM-4. Have you ever heard of the Partnership for a Tobacco Free Maine? 100% 90% 71% 80% 70% 60% 50% 40% 27% 30% 20% 10% 0% YES NO Denominator Includes: All respondents in the original communications module (n=2305) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 10. Awareness of the Partnership For A Tobacco-Free Maine by Demographic Groups, Maine 2004 CDM-4. Have you ever heard of the Partnership For A Tobacco-Free Maine? Yes % CI +/DEMOGRAPHIC GROUPS Total 71.4 2.1 AGE 18-34 90.5 3.1 35 -54 81.3 2.8 55+ 46.5 3.8 AGE 18-24 94.4 4.5 25-44 85.0 3.0 45-64 71.8 3.3 65+ 35.1 4.9 CURRENT SMOKER? Yes 77.7 4.3 No 69.8 2.4 HEALTH INSURANCE COVERAGE? Yes 70.5 2.3 No 82.0 5.5 Figure 39. Knowledge about the Partnership For A Tobacco-Free Maine, Maine 2004 CDM-4A. To the best of your knowledge, is the Partnership for a Tobacco-Free Maine part of the Bureau of Health or do they belong to the private sector? 100% 90% 80% 70% 60% 50% 40% 30% 17% 20% 10% 0% PART OF THE BUREAU OF HEALTH BELONG TO THE PRIVATE SECTOR 50% Denominator Includes: All respondents in the original communications module (n=2305) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 40. Awareness of Healthy Maine Partnerships, Maine 2004 CDM-5. Have you ever heard of the Healthy Maine Partnerships? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% YES NO 42% 54% Denominator Includes: All respondents in the original communications module (n=2305) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 11. Awareness of Healthy Maine Partnerships by Demographic Groups, Maine 2004 CDM-5: Have you ever heard of the Healthy Maine Partnerships? Yes % CI +/DEMOGRAPHIC GROUPS Total 54.3 2.7 AGE 18-34 71.5 5.7 35 -54 58.0 4.1 55+ 36.7 4.0 AGE 18-24 80.4 8.2 25-44 63.4 4.6 45-64 48.4 4.2 65+ 32.4 5.4 CURRENT SMOKER? Yes 59.5 5.9 No 52.9 3.0 Figure 41. Awareness of Community Members of the Healthy Maine Partnerships, Maine 2004 CDM-5A. Are you aware of any local organization in your community that is part of the Healthy Maine Partnerships? 100% 90% 80% 70% 60% 50% 40% 30% 20% 7% 10% 0% YES NO 90% Denominator Includes: All respondents in the original communications module (n=2305) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Involuntary Exposure to Secondhand Smoke The third main goal of the PTM is to protect non-smokers from secondhand smoke, also referred to as environmental tobacco smoke (ETS). There are at least 40 carcinogens among the more than 4,000 chemicals in environmental tobacco smoke. The chemicals in environmental tobacco smoke include nicotine, formaldehyde, cyanide, arsenic, carbon monoxide, methane, asbestos, ammonia and benzene. Many of these toxins are found in higher concentrations in environmental tobacco smoke than in mainstream smoke (the smoke inhaled by smokers)12. Environmental tobacco smoke considered a Class A carcinogen by the Environmental Protection Agency and scientists have determined that no level of human exposure is safe. Exposure is associated with many of the same health conditions as smoking, including low birth weight, sudden infant death syndrome, childhood pneumonia, childhood and adult asthma, heart disease, emphysema, and lung cancer. Exposure to environmental tobacco smoke is estimated by EPA to cause approximately 35,000 deaths from coronary heart disease (CHD) and 3,000 lung cancer deaths in nonsmokers each year13. Opinions and Concern about Secondhand Smoke To assess adults’ opinions about secondhand smoke, respondents were asked about their level of agreement with the statement: “People should be protected from secondhand smoke.” Most adults favored protection from secondhand smoke. Almost two-thirds of adults (65%) agreed strongly with that statement, while another quarter (24%) somewhat agreed (Figure 42). Only ten percent (10%) of adults in the state very or somewhat disagreed with the statement that people should be protected from secondhand smoke. Overall, adults’ opinions about secondhand smoke have remained steady from 2000 to 2004 (Figure 42). Not surprisingly, an adult’s smoking status affected their level of agreement with the statement: “People should be protected from secondhand smoke.” Overall, 92% of non-smokers very or somewhat agreed with the statement, while 79% of current smokers agreed with the statement (Table 12). When all respondents were asked to rate their level of concern about exposure to secondhand smoke, almost half (46%) of adults indicated that they are very concerned (Figure 43). Another sixteen percent (16%) stated that they are concerned. Fifteen percent (15%) stated that they are neither concerned nor unconcerned, while 9% are not very concerned and 13% are not at all concerned (Figure 43). Again, non-smokers were more likely than smokers to express concern about exposure to secondhand smoke. Sixty-eight percent (68%) of non-smokers indicated that they were either very concerned (51%) or somewhat concerned (17%), while 43% of current smokers were either very concerned (29%) or somewhat concerned (14%) (Table 13). 12 U.S. Environmental Protection Agency, http://www.epa.gov/ , “Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders, 1992. 13 ibid Figure 42. Beliefs about Protection from Secondhand Smoke, Maine 2004 4-1. People should be protected from secondhand smoke. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Strongly agree Somewhat agree 2000 Somewhat disagree 2004 Strongly disagree 6% 7% 4% 3% 24% 20% 70% 65% Demonimator Includes: All Respondents Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 12: Beliefs about Protection from Secondhand Smoke, Maine 2004 Question 4-1. People should be protected from second hand smoke? (By current smoking status) Current Smoker % Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree 42.0% 36.5% 13.5% 6.8% CI +/3.9% 3.8% 2.7% 1.9% Non-Smoker % 71.4% 20.2% 5.4% 2.4% CI +/1.7% 1.5% 0.9% 0.6% Figure 43. Concern over Exposure to Secondhand Smoke, Maine 2004 CDM-6. Using a scale of 1 to 5 where a 1 means "Not At All Concerned" and a 5 means "Very Concerned," how concerned are you about exposure to secondhand smoke for you and your family? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 --> NOT AT ALL CONCERNED 2 3 4 5 --> VERY CONCERNED 13% 9% 15% 16% 46% Denominator Includes: All respondents in the original communications module (n=2305) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 13: Question CDM-6. Using a scale of 1 to 5 where a 1 means "Not At All Concerned" and a 5 means "Very Concerned," how concerned are you about exposure to secondhand smoke for you and your family? (By current smoking status) Current Smoker 1 --> NOT AT ALL CONCERNED 2 3 4 5 --> VERY CONCERNED % 20.0% 12.8% 24.2% 13.7% 28.8% CI +/4.3% 3.8% 4.8% 4.0% 5.0% Non-Smoker % 10.9% 7.6% 12.9% 16.9% 51.0% CI +/1.7% 1.5% 1.9% 2.2% 2.7% Secondhand Smoke in Households A major source of secondhand smoke, especially for children and young adults, occurs in the home. When adults were asked how many other people in their household smoked (excluding the respondent), 79% said none (Figure 44). Eighteen percent (18%) said that one other person in their household smoked, and 3% said two. Only 1% percent said that three other people in the household smoked and less than 1% of adults in the state said that four or more others smoked. Additionally, adults who currently smoke are three and a half times more likely to live with at least one other smoker than adults who do not smoke. Forty-nine percent (49%) of current smokers live with another smoker, compared to only 14% of non-smokers. Current smokers are also more likely to have children than non-smokers. Forty-three percent (43%) of current smokers and 37% of non-smokers indicated that they had children (Table 13). Respondents were also asked about smoking rules inside their home. Overall, 72% of adults indicated they do not allow smoking anywhere inside their home (Figure 46). Sixteen percent (16%) said that smoking is allowed in some places or at some times. Twelve percent (12%) said that smoking is allowed anywhere inside their home. The survey results indicate that household rules not allowing smoking are being enforced. Among adults who stated they had rules prohibiting smoking within their homes, 99% also stated that no one had smoked in their home during the past 30 days. When asked how many days out of the past month someone had smoked inside their house, 80% of adults indicated that no one smoked inside their home (Figure 45). Three percent (3%) stated that someone had smoked one to five days inside their home, while 2% said six to twenty nine days. Fourteen percent (14%) of adults said that someone had smoked inside their home all of the last thirty days. Among smokers, 40% reported that no one had smoked in their home in the past 30 days, while 47% said that someone had smoked in the house on all 30 days (Table 15). Secondhand Smoke in Households with Current Smokers The majority of current smokers have no rules that prohibit smoking within their home. Among current smokers, only 36% have rules that do not allow smoking within their home. Younger smokers (those age 18 to 34), however, are more likely than smokers age 35 or older to have household rules not allowing smoking within their home. Close to half (49%) of smokers age 18 to 34 have such rules. Current smokers who have children are also more likely to not allow smoking inside their home (43%) than smokers without children (57%) (Table 14). Based upon this survey, adults who are married or in a couple relationship and those with children are more likely to have rules prohibiting smoking in their household (Table 15). Current smokers who are married or in a coupled relationship with a non-smoker are more likely than current smokers not married or in a relationship to have rules prohibiting smoking within their household. Similarly, current smokers in two-adult households are twice as likely to have rules prohibiting smoking (40%) than smokers in one-adult households (21%). Finally, in one-smoker families with children, households with two parents (who are married or in a relationship) are almost twice as likely to have rules not allowing smoking in the home (63%) than in households with only one parent (36%). Secondhand Smoke in Households 2000 to 2004 The percentage of adults in the state who have had someone smoke anywhere inside their home in the previous 30 days has remained constant from 2000 to 2004 (Figure 45). The percentage of households who have rules prohibiting smoking within their home has increased by 10% in the past 5 years (Figure 46). It would appear from the survey results that more homes had smoking rules in 2004, but people living in households without smoking rules were more likely to smoke within their home in 2004 than in 2000. This could be the result of more non-smokers taking more of a proactive step of creating firm no-smoking rules for their household in 2004. Figure 44. Other Household Smokers, Maine 2004 4-2. Other than yourself, how many people in your household smoke cigarettes, cigars, or pipes? 100% 90% 79% 80% 70% 60% 50% 40% 30% 20% 10% 0% None One Two Three 4 or more 18% 3% 1% 0% Denominator Includes: All Respondents (n=5332) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 14: Other Household Smokers and Children in Household By Current Smoking Status, Maine 2004 Current Smoker % CI +/# of People Who Smoke in HH? None One or More Have Children? Yes No 51.3% 48.7% 42.9% 57.1% 4.0% 4.0% 4.0% 4.0% Non-Smoker % CI +/85.8% 14.2% 36.6% 63.4% 1.5% 1.5% 1.8% 1.8% Figure 45. Indoor Household Smoking during Past 30 Days, Maine 2004 4-3. On how many of the past 30 days has someone, smoked cigarettes, cigars, or pipes anywhere inside your home? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% None 1 to 5 days 2000 6 to 29 days 2004 30 days 1% 3% 1% 2% 15% 14% 83% 80% Denominator Includes: All Respondents Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 15. Indoor Household Smoking during Past 30 Days by Smoking Status, Maine 2004 4-3. On how many of the past 30 days has someone smoked cigarettes, cigars, or pipes anywhere inside your home? None 1 to 5 days 6 to 29 days 30 days % CI +/% CI +/% CI +/% CI +/CURRENT SMOKER Yes 39.5 3.9 7.0 1.9 6.7 1.7 46.5 3.9 No 90.3 1.2 2.5 0.5 1.3 0.5 5.9 1.0 Figure 46. Household Smoking Rules, Maine 2004 4-4. Which of the following statements best describes the rules about smoking inside your home? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Smoking not allowed anywhere inside home Smoking allowed some places or some time 2000 2004 Smoking allowed anywhere inside home 16% 16% 20% 12% 63% 72% Denominator Includes: All Respondents Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 15. Indoor Household Smoking during Past 30 Days by Smoking Status, Maine 2004 4-4. Which of the following best describes the rules about smoking inside your home? (% stating ‘Smoking is not allowed anywhere inside home’) % CI +/DEMOGRAPHIC GROUPS AGE 18-24 66.4% 7.0% 25-44 73.8% 2.4% 45-64 70.7% 2.3% 65+ 72.0% 3.2% INCOME LEVEL < $25,000 62.1% 3.3% $25,000 - $49,999 70.7% 2.7% $50,000+ 79.2% 2.4% EDUCATION < HS 53.9% 6.2% HS Grad, GED 65.2% 2.6% Some College, Technical School 73.0% 3.1% College Grad (4 yr) or more 83.5% 2.2% MARITAL STATUS Married or couple 74.9% 1.8% Other 64.7% 3.0% CURRENT SMOKER? Yes 35.6% 3.9% No 80.9% 1.5% HAVE CHILDREN Yes 76.5% 2.5% No 68.6% 2.0% # OF OTHER PEOPLE WHO SMOKE IN HH None 80.4% 1.4% One or More 39.2% 4.1% Secondhand Smoke in Vehicles Seventy-nine percent (79%) of respondents reported that they had not ridden in a car with someone who was smoking (excluding the respondent) in the last seven days. Five percent (5%) had ridden with someone smoking one day out of the last week and four percent (4%) had ridden two of the last seven days. Two percent (2%) had on three days and 2% had ridden in a car with someone smoking on four to six days out of the last week. Eight percent (8%) of adults in Maine had ridden in a car with someone smoking every day out of the previous week (Figure 47). Adults who smoke are over twice as likely as non-smokers to have ridden in a car with someone who was smoking during the previous seven days (Table 16). Additionally, close to one-third of current smokers indicated that they had ridden in a car with someone who was smoking cigarettes all seven days the previous week. Figure 47. Exposure to Secondhand Smoke in a Car during Past 7 Days, Maine 2004 4-5. During the past 7 days, on how many days did you ride in a car with someone who was smoking cigarettes in that car? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% None One Two Three Four Five Six Seven 5% 4% 2% 1% 1% 0% 8% 79% Denominator Includes: All Respondents (n=5332) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 16: 4-5. During the past 7 days, on how many days did you ride in a car with someone who was smoking cigarettes in that car? (By current smoking status) (This question refers to people smoking other than the respondent) Current Smoker HOURS None 1 2 3 4 5 6 7 % 42.2% 7.4% 7.8% 5.2% 2.7% 3.7% 1.8% 29.0% CI +/3.8% 2.0% 2.0% 1.6% 1.1% 1.5% 1.5% 3.9% Non-Smoker % 88.1% 4.5% 2.4% 1.3% 0.7% 0.9% 0.1% 2.0% CI +/1.3% 0.8% 0.6% 0.4% 0.3% 0.5% 0.1% 0.6% Secondhand Smoke at the Workplace The State of Maine provides protection from secondhand smoke to people in the workplace; prohibiting smoking in most workplace areas and in all enclosed public areas. Employers in the state who employ at least one employee must also establish a written policy concerning smoking and nonsmoking by employees in their business facilities.14 When asked about the smoking policies of their employer, most employed adults in Maine (84%) indicated that they have rules restricting smoking in their workplaces (Figure 48). Ten percent (10%) said that they did not have rules restricting smoking and 5% work from home. Among the respondents who stated they have rules restricting smoking at work, 84% indicated that these policies were enforced very strongly. Thirteen percent (13%) of employed adults thought that they were enforced somewhat strongly and 3% stated that rules at their workplace were enforced neither strongly nor not strongly, not very strongly, or not strongly at all (Figure 49). Respondents were also asked to describe their workplace’s policy for indoor public or common areas, such as lobbies, rest rooms, and lunch rooms, as well as to describe their workplace’s smoking policy for work areas. Ninety-one percent (91%) of adults in the state stated that smoking is not allowed in any of the indoor public or common areas of their workplace (Figure 50). Nine percent (9%) stated smoking was allowed in some public areas, while less than 1% stated that smoking was allowed in all public areas. Ninety percent (90%) of adults stated that smoking was not allowed in any work areas. Ten percent (10%) said that smoking was allowed in some work areas and less than 1% said that smoking was allowed in all work areas (Figure 51). When asked if they would like to change their workplace’s smoking policy, 85% of adults wanted no change. Twelve percent (12%) preferred a stronger policy and 3% indicated they would prefer a weaker policy (Figure 52). Both current smokers and non-smokers are generally satisfied with their workplace’s smoking policy – 85% of current smokers and 84% of nonsmokers would prefer no change to their work’s policy. Seventy-six percent (76%) of employed adults say that they are not exposed to secondhand smoke at work in a typical week (Figure 53). Thirteen percent (13%) are exposed to one hour or less and 8% are exposed to between two and ten hours in a typical week. Three percent (3%) were exposed to between 10 and 69 hours a week and less than 1% were exposed to more than 70 hours. Current smokers are more likely to be exposed to 2 or more hours of secondhand smoke a week at work (21%) than non-smokers (7%). Secondhand Smoke at the Workplace 2000 to 2004 While the awareness of policies prohibiting smoking in the workplace and in enclosed public areas did not reach 100% of employed adults in the 2004 MATS survey, significant improvements in awareness of policies and exposure to secondhand smoke occurred from 2000 to 2004. The percentage of employed adults who stated that their employer does not allow smoking in any public areas increased by over 20% from 2000 to 2004 and the percentage of adults who stated that smoking was allowed in all public areas decreased from 17% in 2000 to 0% in 2004 (Figure 50). Exposure to secondhand smoke at work also decreased significantly from 2000 to 2004 (Figure 53). While about half of employed adults were exposed to at least 14 Partnership For A Tobacco-Free Maine, Healthy Maine Partnerships: http://www.tobaccofreemaine.org/ some secondhand smoke in 2000, only about one-quarter were exposed to secondhand smoke at work in 2004. Secondhand Smoke at the Workplace among Occupation Groups In the 2004 MATS, employed adults who work for manufacturing, construction, or transportation companies were found to have more exposure to secondhand smoke at their jobs than other employed adults. Forty percent (40%) of employed adults who work in manufacturing, construction, or transportation were typically exposed to at least one hour of secondhand smoke per week (Table 17). This percentage is double that of adults in other occupations, such as professional or business, healthcare, education, or social services, and even retail and customer/general services. Figure 48. Workplace Restrictions on Cigarette Smoking, Maine 2004 4-9. Does your workplace have rules restricting smoking in any way? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 10% 0% YES NO WORK AT HOME 5% 84% Denominator Includes: Respondents who are employed or self-employed for wages (n=3296) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 49. Enforcement of Workplace Smoking Restrictions, Maine 2004 4-9. Does your workplace have rules restricting smoking in any way? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 10% 0% YES NO WORK AT HOME 5% 84% Denominator Includes: Respondents who are employed or self-employed for wages from Q4-6(n=3296) Source: 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 50. Workplace Smoking Policies for Indoor Public/Common Areas, Maine 2000 and 2004 4-11. Which of these best describes your place of work's smoking policy for indoor public or common areas? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Not allowed in any public areas Allowed in some public areas 2000 2004 Allowed in all public areas 14% 9% 0% 17% 69% 91% Denominator Includes: Respondents with rules restricting smoking at work Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 51. Workplace Smoking Policies for Work Areas, Maine 2000 and 2004 4-12. Which of these best describes your place of work's smoking policy for work areas? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Smoking is not allowed in any It is allowed in some work areas work areas 2000 2004 It is allowed in all work areas 6% 10% 6% 0% 87% 90% Denominator Includes: Respondents with rules restricting smoking at work Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 52. Preferred Changes in Workplace Smoking Policies, Maine 2000 and 2004 4-13. Would you prefer a stronger workplace smoking policy, a weaker workplace smoking policy, or no change from the current policy? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Prefer stronger policy Prefer weaker policy 2000 2004 Prefer no change 12% 12% 3% 3% 85% 85% Denominator Includes: Respondents with rules restricting smoking at work Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Figure 53. Weekly Workplace Secondhand Smoke Exposure, Maine 2000 and 2004 4-14. In a typical week, about how many hours would you say you are exposed to secondhand smoke at work? 100% 90% 80% 70% 60% 50% 40% 30% 20% 7% 10% 0% None 1 hour or less 2 to 10 hours 2000 10 to 69 hours 2004 70+ hours 13% 9% 8% 3% 0% 0% 32% 52% 76% Denominator Includes: Respondents with rules restricting smoking at work Source: 2000 & 2004 Maine Adult Tobacco Survey. Percentages weighted to population characteristics. Table 17: Weekly Workplace Secondhand Smoke Exposure, Maine 2004 Question 4-14. In a typical week, about how many hours would you say you are exposed to Secondhand smoke at work? None Type of Occupation Professional/Business Healthcare/Education/Social Services Retail/Customer/General Services Manufacturing/Construction/Transportation Other % 81.4% 84.2% 73.3% 59.6% 82.3% CI +/2.9% 3.0% 5.4% 4.5% 6.8% 1hr or More % 18.6% 15.9% 26.7% 40.4% 17.7% CI +/2.9% 3.0% 5.4% 4.5% 6.8% Summary of Progress and Challenges The 2004 Adult Tobacco Survey results provide insight into the progress of the PTM program, and also identify challenges and areas for program improvement in tobacco use prevention, control and tobacco treatment efforts. Tobacco Use by Adults Remained Level from 2000 to 2004 The Situation: Comparisons of the 2000 MATS and 2004 MATS show that the percentage of adults in Maine who smoke cigarettes has not changed significantly from 2000 to 2004. However, the number of cigarettes smoked per day by current smokers has decreased in the past 5 years. Taking a closer look, there are several groups of adults that are more likely to have a higher prevalence of current smokers than other groups. Those include young adults, 18 – 24 years of age, adults on Medicaid, and those without insurance. There was no statistically significant change in the prevalence of adult smokers in Maine from 2000 to 2004 (21%). While there is no statistically significant decrease in the prevalence of adult smokers in Maine, it appears that the rate is decreasing for the …(NOT SURE WHAT NOTE SAYS???) The percentage of current smokers in the state who smoke more than 20 cigarettes decreased from 25% in 2000 to 16% in 2004, while the percentage who smoke 6 to 10 cigarettes increased from 16% to 23%. Thirty-six percent (36%) of 18-24 year olds are considered current smokers. Medicaid recipients are twice as likely as the general population to smoke cigarettes. Approximately 43% of adults in Maine on Medicaid currently smoke Adults without any insurance have a high prevalence of current smokers, 40%. The Challenge: One in every five adults in Maine currently smokes cigarettes. This proportion has remained the same from 2000 to 2004 despite increases in taxes on cigarettes, laws prohibiting smoking in public places, and an increase in the number of anti-tobacco messages in the media. While these efforts have appeared to decrease the number of cigarettes smoked per day, they have not decreased the percentage of adults in the state who smoke. There appears to be an opportunity for the PTM to work more closely with those adults who have cut back on the number of cigarettes they smoke per day, to help them to quit completely. It may be beneficial to work with the Medicaid program in the state to provide additional services to their recipients who smoke. Reducing the proportion of Medicaid recipients who smoke would not only improve their health, but also reduce Medicaid costs related to smoking and tobacco use. The PTM also has the opportunity to work with young adults on a prevention program, to keep them from taking up smoking. Continued prevention work with youth, bridging into the 18 – 24 year old age group could help this group avoid becoming current smokers. Adults See Tobacco Use in their Community as a Problem The Progress: The majority of adults in Maine see tobacco use in their community as a very or somewhat serious problem. Almost all adults in Maine feel that it is very important that the state keeps stores from selling tobacco products to youth under 18 years of age and most feel that these laws are strongly enforced. In addition, the majority of adults say that they frequently see tobacco advertisements when they go to convenience stores. Many adults also report hearing or seeing anti-tobacco warnings in the media on radio or television. Seventy-three percent of adults feel that tobacco use in their community is a very or somewhat serious problem. This has increased from 55% in 2000. Ninety-five percent of adults agreed that tobacco use by adults and children should not be allowed on school grounds. This percentage remained the same from 2000. Almost all adults in Maine (96%) feel that it is important for the state to keep stores from selling tobacco products to youth under 18 years of age. Seventy-one percent feel that these laws are being strongly enforced, while 78% feel that policies (like checking IDs) are being strongly enforced. Fifty-eight percent of adults in Maine frequently see ads for tobacco when they go to convenience stores. Fifty-seven percent of adults indicated that it is a very or somewhat serious problem that tobacco is advertised at convenience stores or gas stations in their community. The Challenge: Most adults in the state believe that tobacco use in their community is a serious problem and that laws and policies to protect underage youth from smoking are important and are being enforced. There is an opportunity to build on this support to address the remaining loopholes in the laws addressing exposure to secondhand smoke in indoor public places. (The current laws allow schools and other worksites to have a separately vented smoking area, away from students, if agreed to by labor in a collective bargaining agreement.) In addition, working with schools to prohibit smoking on school grounds, fields or at any school or school sponsored event would also reduce youth exposure to secondhand smoke and reinforce positive rolemodeling of not smoking. There is also an opportunity to build on this support to address tobacco advertising and promotion in local stores. The PTM has an opportunity to work through the local Healthy Maine Partnerships to have storeowners voluntarily reduce the amount and the placement of tobacco advertising in their storefronts and at the point of purchase. Continued support of the enforcement of Maine’s underage tobacco sales laws is important to reduce youth access to cigarettes and address an important and acknowledged community need. Many Smokers Want to Quit The Situation: There are many adults smokers who would like to quit smoking cigarettes. While interest in using tobacco treatment services or aids among current smokers is high, actual experience using these services is lower. The majority of current smokers (59%) have tried to quit smoking at least once in the past 12 months. Nineteen percent stated they tried to quit five or more times. Forty-five percent of those who quit smoking at least once in the past 12 months had only quit for 1 to 6 days. Seventy-five percent (75%) of current smokers in 2004 indicated they would like to quit smoking cigarettes. Most smokers (77%) stated that they are considering quitting in the next 6 months. Among smokers who plan to quit within the next 6 months, 40% in 2004 stated they plan to stop within the next 30 days. Sixty-seven percent of current smokers who would like to quit smoking would be willing to try nicotine medication to help them quit. Forty-six percent would be willing to try Zyban, 35% counseling by phone, and 32% individual classes or tobacco treatment services. Among respondents that have tried to quit smoking in the past 12 months, 8% tried a quit smoking class, group, counselor or the Maine Tobacco HelpLine, 40% used nicotine replacement medications, and 21% used non-nicotine medications. The Challenge: Most adult smokers want to quit smoking and the majority has tried to quit at least once. However, among smokers that have quit, almost half their quit attempts lasted less than a week. Other smokers have quit for a longer period of time, but they also went back to smoking cigarettes. This means that adults who smoke, especially those who are motivated to quit, must be provided with the appropriate supports, resources and information needed to help them achieve the goal of quitting and staying quit. The Maine Tobacco HelpLine is well positioned to help fill that need. There is an opportunity for the PTM and the Maine Tobacco HelpLine to remind adult smokers that quitting is difficult and that it takes several attempts before a smoker quits and stays quit. There appears to be a gap between what supports smokers say that they would be willing to use and what treatment aids they do use. Promoting the availability of the tobacco treatment services offered through the Maine Tobacco HelpLine might yield more interest in quitting, more quit attempts and ultimately more people who quit smoking and stay quit. Over half of adult smokers who had used nicotine replacement therapy or non-nicotine medications paid for all or part of it themselves. This points out an opportunity to promote low or no cost tobacco treatment services already provided by PTM. Raising awareness among smokers of treatment supports provided through insurance benefits either through private providers or Medicaid, is an additional area of opportunity for the PTM to increase smoker’s knowledge of resources available to help them quit. Exposure to Harmful Secondhand Smoke The Progress: Maine has led the nation in creating smoke-free environments with smoking banned in most indoor public places, including restaurants and bars, as well as requiring strict policies protecting workers in all workplaces. The percentage of households that have rules prohibiting smoking within their home has increased by 10% in the past 5 years. Overall, 72% of adults indicated they do not allow smoking anywhere inside their home. Most employed adults in Maine indicated that they have rules restricting smoking in their workplaces. However, ten percent said that they did not have rules restricting smoking and 5% work from home. Employers in the state have increased and enforced smoking restrictions in the workplace from 2000 to 2004. The percentage of employed adults who stated that their employer does not allow smoking in any public areas increased by over 20% from 2000 to 2004 and the percentage of adults who stated that smoking was allowed in all public areas decreased from 17% in 2000 to 0% in 2004. Exposure to secondhand smoke at work also decreased significantly from 2000 to 2004. While about half of employed adults were exposed to at least some secondhand smoke in 2000, only about one-quarter were exposed to secondhand smoke at work in 2004. However, 40% of employed adults who work for manufacturing, construction or transportation companies were exposed to secondhand smoke at least one hour per week, double the percentage of adults from other professions such as professional, business, healthcare, education , social services, and general services. Forty-three (43%) of current smokers have children living with them, pointing out a remaining challenge. The Challenge: While significant progress has been made since 2000 in reducing involuntary exposure to secondhand smoke in public places, many adults in Maine are still exposed to secondhand smoke regularly at home, in the car, and at work. Twenty percent of adults had someone smoke inside their house in the past month, 21% had been exposed to secondhand smoke in a car during the past week, and 25% had been exposed to secondhand smoke at work. It is critical to educate adults about these health risks to reduce exposure to secondhand smoke. There is an added important responsibility to reduce children’s exposure to secondhand smoke from adults. PTM has the opportunity to continue to raise awareness of the health effects of exposure to secondhand smoke through communications campaigns. Continued effort is needed to communicate as well as strengthen laws that address secondhand smoke in indoor public places particularly in the workplace. The PTM has the opportunity to work with manufacturing, construction and transportation organizations to help them reduce employee exposure to secondhand smoke. Demographic Characteristics As stated in the methodology, the 2004 Maine Adult Tobacco Survey data were weighted to the age, sex, and area profile of the state. Overall, 48% of the population was male and 52% female. Twenty-six percent (26%) of the population was age 18 to 34 years old, 40% were age 34 to 54 years old, and 34% were age 55 years or older. Twelve percent (12%) of adults in the state are 18 to 24 years old, 35% are 25 to 44 years old, 34% are 45 to 64 years old, and 19% are 65 years of age or older. Nineteen percent (19%) of the population lives in the East Central area of the state, 8% in the Midcoast, 9% in the Northeast, 34% in the South, 13% in the West, and 17% in the West Central region. Twenty-six percent (26%) of the adults in the state have household incomes of less than $25,000 a year, 36% have household incomes between $25,000 and $50,000, and 38% have household incomes over $50,000 a year. Nine percent of adults (9%) have less than a high school education, 36% have a high school education or GED, 26% some college or technical school, and 30% have a college education or greater. Sixty-eight percent (68%) of adults are married or in a coupled relationship, while 32% are not. Thirty-eight percent (38%) of Maine adults are classified as overweight, 21% are considered obese, and 41% are neither overweight nor obese. Over 90% of adults in Maine indicated they have health insurance coverage, while 9% do not. Thirty-eight percent (38%) of adults reported that they have children. Ninety-seven percent (97%) described themselves as heterosexual. Table 18: Demographic Characteristics of the Maine Adult Tobacco Survey Respondents, Maine 2004 % Gender Male Female Age Category 18-34 35-54 55+ Age Category 18-24 25-44 45-64 65+ Area of the State EAST CENTRAL MIDCOAST NORTHEAST SOUTH WEST WEST CENTRAL Annual Household Income < $25,000 $25,000 - $49,999 $50,000+ Level of Education < HS HS Grad, GED Some College, Technical School College Grad (4 yr) or more Marital Status Married or couple Other Weight Category Neither Overweight, Obese Overweight Obese Health Insurance Coverage Yes No Have Children Yes No Sexual Preference Heterosexual Homosexual or other 47.9% 52.1% 26.3% 40.1% 33.6% 11.7% 35.0% 34.0% 19.4% 18.6% 8.3% 8.8% 33.8% 13.2% 17.3% 26.0% 35.9% 38.1% 8.6% 35.6% 25.8% 30.0% 67.8% 32.2% 40.8% 37.8% 21.4% 90.8% 9.2% 37.8% 62.2% 97.1% 2.9% CI +/1.7% 1.7% 1.7% 1.6% 1.5% 1.5% 1.6% 1.5% 1.3% 0.6% 0.3% 0.3% 0.8% 0.5% 0.5% 1.5% 1.7% 1.7% 1.0% 1.6% 1.5% 1.5% 1.6% 1.6% 1.7% 1.7% 1.5% 1.1% 1.1% 1.7% 1.7% 0.6% 0.6% Appendix: 2004 MATS Survey Instrument MAINE ADULT TOBACCO SURVEY INSTRUMENT Schedule of Modules Every month contained the “core questionnaire”. JULY 2003 – Sections 6, 9, and 10. AUGUST 2003 – Sections 6 and 9. SEPTEMBER 2003 – Section 9. OCTOBER 2003 – Original CDM section. NOVEMBER 2003 – Original CDM section. DECEMBER 2003 – Section 9. JANUARY 2004 – Original CDM section. FEBRUARY 2004 – Section 9. MARCH 2004 – Revised CDM section. APRIL 2004 – Both original and revised CDM sections (with duplicate questions only asked once). MAY 2004 – Section 9 and original CDM section. JUNE 2004 – Section 9 and original CDM section. In addition: MAINE ADULT TOBACCO SURVEY INSTRUMENT INTRODUCTION AND INITIAL SCREEN Hello, my name is (INSERT NAME) and I'm calling for the Maine State Bureau of Health. We're trying to learn more about the health of Mainers and we need your help. I won't ask for your name, address, or other personal information that could identify you. But I do need to ask a few questions to make sure I have called you correctly. Could I please speak with an adult who lives in the household who is 18 years of age or older? 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. RESPONDENT IS ON THE PHONE NO ANSWER BUSY DISCONNECT/NOT IN SERVICE BUSINESS/GOV’T/FAX/COMPUTER TONE RESPONDENT NOT AVAILABLE FIRST REFUSAL LANGUAGE PROBLEM SCHEDULE CALLBACK ANSWERING MACHINE Please enter “yes” to indicate that the respondent listened to the introduction. 1. 2. YES NO IF NO: Please enter the number of sentences that you were able to complete before the respondent hung up. (8=DON’T KNOW) Is this (INSERT PHONE NUMBER)? Yes No --------CONTINUE --------CONTINUE W/ (Thank you very much, but I seem to have dialed the wrong number. It's possible that your number may be called at a later time.) AND END. Is this a private residence? Yes No --------CONTINUE --------CONTINUE W/ (Thank you very much, but we are only interviewing private residences.) AND END. PROTOCOL FOR SELECTION OF HOUSEHOLD RESPONDENT I have some questions about health that I'd like to ask one adult who lives in the household. How many members who live in your household, including yourself, are 18 years of age or older and residents of the state of Maine? Please do not include students who are away at college. (RECORD NUMBER BELOW) (IF QUESTION ABOUT RESIDENCY, PROMPT WITH: A person is considered a resident of Maine if they have been or will be living in the state for at least 30 days.) _________ Number of adults (IF “2” OR MORE ABOVE, GO TO HOUSEHOLD COMPOSITION TABLE) (IF “1” ABOVE, ASK:) Are you the adult who lives in the household? Yes --------CONTINUE W/ (Then you are the person I need to speak with). ENTER 1 MAN OR 1 WOMAN IN TABLE BELOW AND CONTINUE TO SECTION 1; ASK GENDER IF NECESSARY --------CONTINUE W/ (Is the adult a man or a woman?) ENTER 1 MAN OR 1 WOMAN IN TABLE BELOW AND CONTINUE W/ (May I speak with that adult? WHEN R IS ONE PHONE, GO TO CORRECT RESPONDENT SECTION AND CONTINUE. No HOUSEHOLD COMPOSITION TABLE How many of these adults are men and how many are women? __________Number of men __________Number of women [INSERT CATI ALGORITHM FOR RESPONDENT SELECTION] May I please speak with _______________________________? (IF “You” ABOVE, GO TO SECTION 1) (IF Other ABOVE, ASK FOR R AND GO TO CORRECT RESPONDENT SECTION) INTRODUCTION TO CORRECT RESPONDENT Hello. My name is (INSERT NAME) and I'm calling for the Maine State Bureau of Health. We're trying to learn more about the health of Mainers. I won't ask for your name, address, or other personal information that could identify you. Please enter “yes” to indicate that the respondent listened to the introduction. 1. 2. YES NO IF NO: Please enter the number of sentences that you were able to complete before the respondent hung up. (8=DON’T KNOW) I'd like to ask you some questions about health issues in Maine. We will keep your answers private. You don't have to answer any question you don't want to. I will also give you a phone number to call if you have questions about the survey. Please enter “yes” to indicate that the respondent listened to the introduction. 1. 2. YES NO IF NO: Please enter the number of sentences that you were able to complete before the respondent hung up. (8=DON’T KNOW) SECTION 1: CIGARETTE USE The first part of this survey is about your use of cigarettes. 1-1. Have you smoked at least 100 cigarettes in your life? (NOTE TO INTERVIEWER: FIVE PACKS = 100 CIGARETTES) 1. 2. 8. 9. YES (CONTINUE) NO (SKIP TO Q3-1) DON'T KNOW (SKIP TO Q3-1) REFUSED (SKIP TO Q3-1) 1-2. Do you now smoke cigarettes… (READ OPTIONS) 1. 2. 3. 8. 9. Every day (CONTINUE) Some days (SKIP TO Q1-3B) Not at all (SKIP TO Q1-4) DON'T KNOW (DO NOT READ; SKIP TO Q1-4) REFUSED (DO NOT READ; SKIP TO Q1-4) 1-3a. On the average, about how many cigarettes a day do you now smoke? (ENTER NUMBER BELOW; NOTE TO INTERVIEWER: 1 PACK = 20 CIGARETTES) _____ Enter Number of cigarettes 88. DON'T KNOW 99. REFUSED "1 pack = 20 cigarettes" [SKIP TO Q1-4] 1-3b. On the average, when you smoked during the past 30 days, about how many cigarettes did you smoke in a day? (ENTER NUMBER BELOW; NOTE TO INTERVIEWER: 1 PACK = 20 CIGARETTES.) _____ Enter Number of cigarettes 88. DON'T KNOW 99. REFUSED 1-4. How old were you when you first started smoking cigarettes fairly regularly? (ENTER NUMBER BELOW.) ____ years 77. DON'T KNOW 88. NEVER SMOKED REGULARLY (IF Q1-1=1 AND Q1-2=3 AND Q1-4=88 SKIP TO Q3-1) 99. REFUSED [IF “yes” to Q1-1 and “not at all” to Q1-2, SKIP TO Q1-9] 1-5. If you decided to stop smoking cigarettes today, how confident are you that you could stay off cigarettes for the next year? Would you say…(READ OPTIONS) 1. 2. 3. 4. 8. 9. Very confident Somewhat confident Not very confident Not at all confident DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) 1-6. How do you usually get your cigarettes? OPTIONS) 1. 2. 3. 8. 9. Roll your own cigarettes Buy cigarettes Some other way DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) Would you say…(READ 1-7. In the past month, how many packs of cigarettes did you buy out of state, on a military base, or on an Indian Reservation? (ENTER NUMBER BELOW) ___ 888. 999. DON'T KNOW REFUSED 1-8. In the past month, how many packs of cigarettes have you bought over the Internet? ___ 888. 999. DON'T KNOW REFUSED [SKIP TO Q2-1] 1-9. About how long has it been since you last smoked cigarettes regularly, that is, daily? Would you say…(READ OPTIONS) 1. 2. 3. 4. 5. 6. 8. 9. Within the past month Within the past 3 months Within the past year Within the past 5 years (SKIP TO Q1-11) More than 5 years ago (SKIP TO Q3-1) NEVER SMOKED REGULARLY DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 1-10. You have just told me that you no longer smoke. How confident are you that you can stay off cigarettes for the next year? Would you say…(READ OPTIONS) 1. 2. 3. 4. 8. 9. Very confident Somewhat confident Not very confident Not at all confident DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 1-11. When you last smoked, about how many cigarettes a day did you smoke? (ENTER NUMBER BELOW; NOTE TO INTERVIEWER: 1 PACK = 20 CIGARETTES.) _____ Enter Number of cigarettes 88. DON'T KNOW 99. REFUSED [IF ANSWERED RESPONSE CODE 4 OR ABOVE TO Q1-9, GO TO Q3-1] [IF ANSWERED RESPONSE CODE 3 OR BELOW TO Q1-9, GO TO Q2-6] SECTION 2: SMOKING CESSATION The next questions are about your feelings regarding quitting smoking. 2-1. Would you like to quit smoking? 1. 2. 8. 9. YES NO (SKIP TO Q2-5) DON’T KNOW REFUSED 2-2. Are you seriously considering quitting within the next 6 months? 1. 2. 8. 9. YES NO (SKIP TO Q2-4) DON’T KNOW REFUSED 2-3. Are you planning to stop within the next 30 days? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED 2-4. Now I’m going to read you a list of products and services that might help you quit smoking. For each one of them, if you were to try to quit in the next year, which of these would you be willing to try? Assume you could get it for free. Would you be willing to try… (INSERT PRODUCT/SERVICE)? 1. Nicotine medication such as a nicotine patch, gum or inhaler? 1 YES 2 NO 8 DON’T KNOW 9 REFUSED Zyban (Wellbutrin, a non-nicotine pill)? 1 YES 2 NO 8 DON’T KNOW 2. 9 REFUSED 3. Counseling by telephone, such as the Maine Tobacco HelpLine? 1 YES 2 NO 8 DON’T KNOW 9 REFUSED Individual counseling or smoking cessation class? 1 YES 2 NO 8 DON’T KNOW 9 4. REFUSED 2-5a. During the past 12 months, about how many times have you quit smoking for 1 day or longer? (ENTER NUMBER BELOW.) ___ times 88. DON’T KNOW 99. REFUSED [IF “Zero” SKIP TO Q2-7] [IF “1” OR MORE, CONTINUE] 2-5b. In the past 12 months, what is the longest time you have quit smoking? Would you say…(READ OPTIONS) 1. 2. 3. 8. 9. Quit for 1 to 6 days Quit for 7 to 30 days Quit for over 30 days DON’T KNOW REFUSED 2-6. Now I’m going to read you a list of products and services that you might have used to help you quit smoking. For each one of these products and services, can you please tell me whether you have used it the last 12 months? In the last 12 months, have you used… (INSERT PRODUCT/SERVICE; ROTATE) 2-6a. Self-help materials such as booklets, tapes, videos? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED 2-6b. Nicotine replacement medications such as nicotine patches, gum, inhaler or nasal spray? 1. 2. 8. 9. YES NO (SKIP TO Q2-6D) DON’T KNOW REFUSED 2-6c. How did you pay for it (nicotine replacement systems)? you say… (READ OPTIONS) 1. 2. 3. 4. 8. 9. I paid for it on my own Insurance paid for some of it Insurance paid for all of it I was given the medication free of charge DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) Would 2-6d. Non-nicotine medication such as Zyban, Wellbutrin or other medication? 1. 2. 8. 9. YES NO (SKIP TO Q2-6f) DON’T KNOW (SKIP TO Q2-6f) REFUSED (SKIP TO Q2-6f) 2-6e. How did you pay for it (non-nicotine medication)? Would you say… (READ OPTIONS) 1. 2. 3. 4. 8. 9. I paid for it on my own Insurance paid for some of it Insurance paid for all of it I was given the medication free of charge DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) 2-6f. A quit smoking class, group, counselor, or The Maine Tobacco HelpLine? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED CLINICAL INTERVENTIONS 2-7. In the past 12 months, has a dentist or dental hygienist advised you to stop smoking? (READ OPTIONS) 1. 2. 3. 8. 9. Yes No I have not seen a dentist in the last 12 months DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) The next set of questions are about experiences you may have had during a visit to a doctor’s office in the last 12 months. During any such visit, did any health professional… (INSERT OPTIONS) 2-8a. Advise you to stop smoking? 1. 2. 3. to 8. 9. Would you say… (READ OPTIONS) Yes No I have not visited a doctor’s office in the last 12 months. (Skip q3-1) DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) 2-8b. Ask you if you were interested in quitting smoking? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED 2-8c. Give you self-help materials (brochures or pamphlets) about quitting smoking? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED 2-8d. Give you information about counseling classes or programs, such as the Maine Tobacco HelpLine to help you quit smoking? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED 2-8e. Spend time talking with you about your smoking or helping you to prepare for quitting? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED 2-8f. Talk with you about medications to help you stop smoking? (IF CLARIFICATION NEEDED ON ‘Medications’, STATE: Such as nicotine patch or gum, nicotine inhaler or nasal spray, or Zyban or Wellbutrin). 1. 2. 8. 9. YES NO DON’T KNOW REFUSED 2-9. In the past 12 months, how helpful has your doctor’s office or clinic been in helping you to quit smoking or think about quitting? Would you say… (READ OPTIONS) 1. 2. 3. 4. 5. 8. 9. Not at all helpful or did not talk to you about your smoking Slightly helpful, Moderately helpful, Very helpful, or Extremely helpful DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) SECTION 3: SMOKELESS/ CIGARS/ PIPES Now I would like to ask you some questions about your usage of other forms of tobacco. 3-1. Do you currently use chewing tobacco or snuff ‘every day,’ ‘some days,’ or ‘not at all’? 1. 2. 3. 8. 9. EVERY DAY SOME DAYS NOT AT ALL DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) 3-2. Do you now smoke cigars ‘every day,’ ‘some days,’ or ‘not at all’? 1. 2. 3. 8. 9. EVERY DAY SOME DAYS NOT AT ALL DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) 3-3. Do you now smoke tobacco in a pipe ‘every day,’ ‘some days,’ or ‘not at all’? 1. 2. 3. 8. 9. EVERY DAY SOME DAYS NOT AT ALL DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) SECTION 4: ENVIRONMENTAL TOBACCO SMOKE Now I’m going to ask you some questions about secondhand cigarette smoke. 4-1. Do you agree or disagree with the following statement "People should be protected from secondhand smoke"? Would you say you… (READ OPTIONS) 1. 2. 3. 4. 8. 9. Strongly agree Somewhat agree Somewhat disagree Strongly disagree DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 4-2. Other than yourself, how many people living in your household smoke cigarettes, cigars, or pipes? (RECORD NUMBER) __ people 88. DON'T KNOW 99. REFUSED 4-3. On how many days in the past 30 days has someone, including yourself, smoked cigarettes, cigars, or pipes anywhere inside your home? RECORD NUMBER) __ days 88. DON'T KNOW 99. REFUSED 4-4. Which of the following statements best describes the rules about smoking inside your home? (READ OPTIONS) 1. 2. 3. 8. No one is allowed to smoke anywhere inside your home Smoking is allowed in some places or at some times Smoking is permitted anywhere inside your home DON'T KNOW (DO NOT READ) 9. REFUSED (DO NOT READ) 4-5. During the past 7 days, on how many days did you ride in a car with someone who was smoking cigarettes in that car? (This question refers to people other than the respondent.) __ days 8. DON'T KNOW 9. REFUSED 4-6. Now I'm going to ask a question related to your work place. you… (READ OPTIONS) 1. Employed for wages 2. Self-employed 3. Out of work for more than 1 year 4. Out of work for less than 1 year 5. Homemaker (SKIP TO Q5-1) 6. Student (SKIP TO Q5-1) 7. Retired (SKIP TO Q5-1) 8. Unable to work (SKIP TO Q5-1) 9. DON’T KNOW (DO NOT READ) (SKIP TO Q5-1) 10. REFUSED (DO NOT READ) (SKIP TO Q5-1) [IF ANSWER 5 OR ABOVE ON Q4-6, SKIP TO Q5-1; OTHERWISE, CONTINUE] Are 4-7. What kind of work do you do? For example, are you a registered nurse, a logger, an accountant…[If you are not currently working, please describe the most recent kind of work that you did. If you have more than one job, please answer the question for the job that you spend the most hours doing.] _________________________________________________________________ _________________________________________________________________ 4-8. What are your most important activities or duties? a nurse’s most important duties may be patient care.] [For example, _________________________________________________________________ _________________________________________________________________ IF Q4-6=3 OR Q4-6=4 GO TO Q5-1 According to the law, employers in Maine must protect workers from exposure to smoke while at work. 4-9. Does your workplace have rules restricting smoking in any way? 1. 2. 3. 8. 9. YES NO (SKIP TO Q4-13) WORK AT HOME (SKIP TO Q4-14) DON'T KNOW (SKIP TO Q4-13) REFUSED (SKIP TO Q4-13) 4-10. How strongly are the rules restricting smoking being enforced? Would you say… (READ OPTIONS) 1. 2. 3. 4. 5. 8. 9. Very strongly Somewhat strongly Neither strongly or not strongly Not very strongly Not strongly at all DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) 4-11. Which of these best describes your place of work's smoking policy for indoor public or common areas, such as lobbies, rest rooms and lunch rooms? Would you say smoking is… (READ OPTIONS) 1. 2. 3. 8. 9. Not allowed in any public areas Allowed in some public areas Allowed in all public areas DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 4-12. Which of these statements best describes your place of work's smoking policy for work areas? Would you say… (READ OPTIONS) 1. 2. 3. 8. 9. Smoking is not allowed in any work area It is allowed in some work areas It is allowed in all work areas DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 4-13. Would you prefer a stronger workplace smoking policy, a weaker workplace smoking policy, or no change from the current policy? 1. 2. 3. 8. 9. PREFER STRONGER POLICY PREFER WEAKER POLICY PREFER NO CHANGE DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 4-14. In a typical week, about how many hours would you say you are exposed to secondhand smoke at work? (ENTER NUMBER BELOW) ____ 222. 333. 444. 888. 999. HOURS 1 HOUR OR LESS 70 HOURS OR GREATER NONE DON'T KNOW REFUSED SECTION 5: SMOKING BELIEFS and YOUTH ACCESS Now, I am going to ask your opinions about the effects you believe tobacco has on your community and young people. 5-1. In your community, how serious of a problem is tobacco use? Would you say… (READ OPTIONS) 1. 2. 3. 4. 8. 9. Very serious Somewhat serious A little serious Not at all serious DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 5-2. How often do you see youth under 18 years of age smoking cigarettes… (INSERT OPTIONS; ROTATE) 5-2a. On the streets around town, in public view? OPTIONS) 1. 2. 3. 4. 8. 9. All the time Sometimes Every once in a while Rarely or never DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) Would you say…(READ 5-2b. On, around, or across from school grounds? OPTIONS) 1. 2. 3. 4. 8. 9. All the time Sometimes Every once in a while Rarely or never DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) Would you say…(READ 5-3. In your opinion, where do most youth under 18 years of age get their cigarettes? Would you say…(READ OPTIONS) 1. 2. 3. 4. 5. 6. 7. 8. 9. Buy them in stores Get them from their parents Get them from older friends Get them from friends their own age Steal them Over the Internet By mail order DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 5-4. When you go to convenience stores or gas stations in your community, how often do you see advertisements for cigarettes, chewing tobacco, or other tobacco products? Would you say…(READ OPTIONS) 1. 2. 3. 4. 7. 8. 9. Frequently Sometimes Occasionally Almost never I DON’T GO TO CONVENIENCE STORES OR GAS STATIONS (DO NOT READ) DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 5-5. How serious of a problem is it that tobacco is advertised at convenience stores or gas stations in your community? Would you say…(READ OPTIONS) 1. 2. 3. 4. 8. 9. Very serious Somewhat serious A little serious Not at all serious DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 5-6. How important is it that the state keeps stores from selling tobacco products to youth under 18 years of age. Would you say…(READ OPTIONS) 1. 2. 3. 4. 8. Very important Somewhat important Not very important Not important at all DON'T KNOW (DO NOT READ) 9. REFUSED (DO NOT READ) 5-7. In your community, how strongly do you believe the laws that keep kids from buying cigarettes or chewing tobacco are being enforced? Would you say…(READ OPTIONS) 1. 2. 3. 4. 5. 8. 9. Very strongly Somewhat strongly Neither strongly or not strongly Not very strongly Not strongly at all DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 5-8. In your community, how strongly do you believe that policies -like storeowners checking IDs or posting signs-- are being enforced to keep kids from buying cigarettes or chewing tobacco? Would you say these policies are being enforced…(READ OPTIONS) 1. 2. 3. 4. 5. 8. 9. Very strongly Somewhat strongly Neither strongly or not strongly Not very strongly Not strongly at all DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 5-9. Do you agree or disagree with the following statement "Tobacco use by both children and adults should not be allowed on school grounds or at any school events?" Would you say you…(READ OPTIONS) 1. 2. 3. 4. 8. 9. Strongly agree Somewhat agree Somewhat disagree Strongly disagree DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 5-10. Out of every 100 high school students in your community, how many do you think smoke cigarettes? (ENTER NUMBER BELOW) _____ out-of-100 high school students smoke 888. DON'T KNOW 999. REFUSED 5-11. Out of every 100 adults in your community, how many do you think smoke cigarettes? (ENTER NUMBER BELOW) _____ out-of-100 adults smoke 888. DON'T KNOW 999. REFUSED SECTION 7: GENERAL HEALTH We’re done talking about tobacco. Now I’m going to ask you some questions about some other health and community issues. 7-1. Have you ever been told by a doctor that you have diabetes? (If “Yes” and female, ask “Was this only when you were pregnant”). 1. 2. 3. 8. 9. YES YES, BUT FEMALE TOLD ONLY DURING PREGNANCY NO DON’T KNOW REFUSED 7-2. What type of health care coverage do you use to pay for most of your medical care? (READ OPTIONS) 01. 02. 03. 04. 05. 06. 07. 08. 09. 10. 11. Your employer Someone else's employer A plan that you or someone else buys on your own Medicare Medicaid or Maine Care The military, CHAMPUS, TriCare, or the VA [or CHAMP-VA] The Indian Health Service [or the Alaska Native Health Service] Some other source None DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) SECTION 8: SOCIAL TRUST The next set of questions relate to your feelings about the people who live in your community. [NOTE TO INTERVIEWER: Depending upon where someone lives, community may be one town or it may be a neighborhood, or many towns combined. Allow the respondent to define community using any of these definitions.] 8-1. Generally speaking, would you say that most people living in your community can be trusted, or that you can’t be too careful in dealing with people? 1. 2. 3. 8. 9. Most people can be trusted Can’t be too trustful IT DEPENDS (DO NOT READ) DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) 8-2. Do you think most people living in your community would try to take advantage of you if they got the chance, or would they try to be fair? 1. 2. 3. 8. 9. MOST PEOPLE WOULD TAKE ADVANTAGE OF YOU MOST PEOPLE WOULD TRY TO BE FAIR IT DEPENDS (DO NOT READ) DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) 8-3. Would you say that most of the time people in your community try to be helpful, or are they mostly looking out for themselves? 1. 2. 3. 8. 9. PEOPLE TRY TO BE HELPFUL PEOPLE MOSTLY LOOK OUT FOR THEMSELVES IT DEPENDS (DO NOT READ) DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) This question is about social or volunteer groups you might belong to. For example, you are a member of a group in town that tries to improve the schools. More examples of these groups are: a social club like the Elks, a parent-teacher organization, a business group, a union, a religious or church group, a music or arts group, or a political organization. 8-4. If you belong to any groups like this, I’d like to know how often you attend meetings. Would you say…(READ OPTIONS) 1. 2. 3. 4. 8. 9. At least once per month Less than once per month but more than twice a year Twice a year or less I do not belong to such a group DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) 8-5. In a town called “Roseville,” people may not always agree with one another, but when there’s an important issue or problem facing the town, people are willing to pitch in and get the job done. How do you feel about this statement, “My town is a lot like Roseville”. Would you… (READ OPTIONS) 1. 2. 3. 8. 9. Agree Neither agree nor disagree Disagree DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) SECTION 11: DEMOGRAPHICS The last set of questions are general questions about you, such as, your age and race. The answers to these items are used only to classify your answers appropriately. 10-1. What is your age? _____ years old 888. DON'T KNOW 999. REFUSED (RECORD NUMBER) 10-2. [Interviewer: Indicate gender of respondent] (Do not ask unless necessary) 1 MALE 2 FEMALE 10-3. What is your height in feet and inches? _____ feet _____ inches [PROGRAMMING NOTE: INSERT PROGRAMMING LOGIC TO CONVERT TO A TOTAL INCHES FIGURE] _____ Total inches 888. DON'T KNOW 999. REFUSED 10-4. What is your body weight in pounds? _____ lbs. 888. 999. DON'T KNOW REFUSED 10-5. Are you Hispanic or Latino? (IF THE RESPONDENT NEEDS A DEFINITION:) Coming from a Spanish-speaking country. 1. 2. 8. 9. YES NO DON'T KNOW REFUSED 10-6. Which one or more of the following would you say is your race? Are you… (READ OPTIONS; ALLOW UP TO THREE RESPONSES) 1. 2. 3. 4. 5. 6. 8. 9. White Black or African American Asian Native Hawaiian or other Pacific Islander American Indian or Alaskan Native Some other race DON’T KNOW REFUSED 10-7. [INTERVIEWER INSTRUCTIONS: IF TWO OR MORE RESPONSES IN Q10-6, THEN CONTINUE; OTHERWISE, PLEASE SKIP TO INSTRUCTIONS PRECEDING Q10-8] Which one of these groups would you say best describes your race?( READ RESPONSES) 1. 2. 3. 4. 5. 6. 8. 9. White Black or African American Asian Native Hawaiian or other Pacific Islander American Indian or Alaskan Native Some other race DON’T KNOW [DO NOT READ] REFUSED [DO NOT READ] 10-9. Are you…? (READ OPTIONS) 1. 2. 3. 4. 5. 6. 8. 9. Married Divorced Widowed Separated Never married A member of an unmarried couple that is living together DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) 10-10A. MALES: Now I'm going to ask you a question about sexual orientation. Just to remind you, this survey is anonymous. Do you consider yourself to be… (READ OPTIONS.) 1 2 3 4 8 9 Heterosexual, that is, straight Homosexual, that is, gay or lesbian Bisexual or Other DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 10-10B. FEMALES: Now I'm going to ask you a question about sexual orientation. Just to remind you, this survey is anonymous. Do you consider yourself to be… (READ OPTIONS.) 1 2 3 4 8 9 Heterosexual, that is, straight Homosexual, that is, gay or lesbian Bisexual or Other DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 10-11. How many children live in your household who are under 1 year of age? (RECORD NUMBER BELOW) ___ 88. DON'T KNOW (DO NOT READ) 99. REFUSED (DO NOT READ) 10-12. How many children live in your household who are at least 1 years old but less than 5 years old? (RECORD NUMBER BELOW) ___ 88. DON'T KNOW (DO NOT READ) 99. REFUSED (DO NOT READ) 10-13. How many children live in your household who are at least 5 years old but less than 18? (RECORD NUMBER BELOW) ___ 88. DON'T KNOW (DO NOT READ) 99. REFUSED (DO NOT READ) 10-14. What is the highest grade or year of school you completed? (READ OPTIONS) 1. 2. 3. 4. 5. 6. 8. 9. Never attended school or only attended kindergarten Grades 1 through 8 (Elementary) Grades 9 through 11 (Some high school) Grade 12 or GED (High school graduate) College 1 year to 3 years (Some college or technical school) College 4 years or more (College graduate) DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) 10-15. Is your annual household income from all sources less than $25,000? (If under, ask:)B (If under, ask:)C (If under, ask:)D (If over, ask:)E (If over, ask:)F (If over, ask:)G Is it less than $20,000? Is it less than $15,000? Is it less than $10,000? Is it less than $35,000? Is it less than $50,000? Is it less than $75,000? 01. 02. 03. 04. 05. 06. 07. 08. 09. 10. Less than $10,000 From $10,000 to $14,999 From $15,000 to $19,999 From $20,000 to $24,999 From $25,000 to $34,999 From $35,000 to $49,999 From $50,000 to $74,999 From $75,000 or more DON’T KNOW (DO NOT READ) REFUSED (DO NOT READ) 10-16. What is the name of the town in which you live? [USE STATE GEOCODE LIST FOR CODING] (RECORD BELOW) 10-17. Do you have more than one telephone number in your household? Do not include cell phones or numbers that are only used by a computer or fax machine. 1. 2. 8. 9. YES NO (SKIP TO CLOSE) DON'T KNOW (SKIP TO CLOSE) REFUSED (SKIP TO CLOSE) 10-18. How many of these are residential numbers? (RECORD BELOW; RANGE IS 0 TO 6, WITH 6 BEING EQUIVALENT TO 6 OR MORE) CLOSE Those are all the questions that I have. time. Thank you very much for your MAINE ADULT TOBACCO SURVEY INSTRUMENT: Section 6 (Asked July, August) SECTION 6-OPINIONS TO FRAME PUBLIC POLICY: The next questions ask your opinions about what you believe should be legal in Maine. 6-1. Do you think it should be legal to purchase cigarettes over the Internet? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED 6-2. Do you think it should be legal to purchase cigarettes via mail order? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED 6-5. In the past year, did you avoid going to either a public or a private place because you knew that you would be exposed to too much secondhand smoke? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED 6-6. In the past year, did you avoid going somewhere because smoking was not allowed? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED MAINE ADULT TOBACCO SURVEY INSTRUMENT: Section 9 asked: July, August, December, February, May, June SECTION 9: BLOOD PRESSURE AND CHOLESTEROL The next set of questions pertains to health issues and your experiences with health care professionals. 9-1. Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure? 1. 2. 8. 9. YES NO (SKIP TO Q9-5) DON’T KNOW (SKIP TO Q9-5) REFUSED (SKIP TO Q9-5) 9-2. Were you told on two or more different visits that you had hypertension, also called high blood pressure? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED 9-3. Because of your high blood pressure or hypertension, have you ever been told to…(INSERT OPTIONS; ROTATE) a. take prescribed medicine? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED b. control your weight or lose weight? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED c. cut down on salt or sodium in your diet? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED d. exercise more? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED e. cut down your alcohol consumption? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED 9-4a.Are you now following this advice to {DISPLAY/ACTIVITY}? RESPONSES: YES = 1, NO = 2, REFUSED = 7, DON'T KNOW = 9. a. b. c. d. e. take prescribed medicine? control your weight or lose weight? cut down on salt or sodium in your diet? exercise more? cut down your alcohol consumption? ____ ____ ____ ____ ____ 9-5. Have you ever been told by a doctor or other health professional that your blood cholesterol level was high? YES . . . . . . . . . . . . . . . . . . . . . .1 NO . . . . . . . . . . . . . . . . . . . . . . 2 (Q35) REFUSED . . . . . . . . . . . . . . . . . . . .7 (Q35) DON'T KNOW . . . . . . . . . . . . . . . . . . 9 (Q35) 9-6. To lower your blood cholesterol, have you ever been told by a doctor or other health professional . . . RESPONSES: YES = 1, NO = 2, REFUSED = 7, DON'T KNOW = 9. a. b. c. d. to to to to eat fewer high fat or high cholesterol foods? control your weight or lose weight? increase your physical activity or exercise? take prescribed medicine? 9-7.Are you now following this advice to {DISPLAY/ACTIVITY}? RESPONSES: YES = 1, NO = 2, REFUSED = 7, DON'T KNOW = 9. a. b. c. d. eat fewer high fat or high cholesterol foods control your weight or lose weight increase your physical activity or exercise take prescribed medicine 9-8 {Even though a doctor or other health professional has never told you that your blood cholesterol was high} to lower your blood cholesterol, have you made any major changes on your own. Specifically {DISPLAY ACTIVITY}? INSTRUCTIONS: DISPLAY "EVEN THOUGH A DOCTOR OR OTHER HEALTH PROFESSIONAL HAS NEVER TOLD YOU THAT YOUR BLOOD CHOLESTEROL IS HIGH" ONLY IF Q32 IS 'NO' (CODE 2), DK (CODE 9), OR REF (CODE 7). RESPONSES: YES = 1, NO = 2, REFUSED = 7, DON'T KNOW = 9. a. do you eat fewer high fat or high cholesterol foods in order to lower your blood cholesterol ____ b. have you controlled your weight or lost weight in order to lower your blood cholesterol ____ c. have you increased your physical activity or exercise in order to lower your blood cholesterol ____ 9-9. Even though a doctor or other health professional has never told you to eat fewer high fat or high cholesterol foods, to lower your blood cholesterol, have you made any major changes on your own? Specifically, do you eat fewer high fat or high cholesterol foods in order to lower your blood cholesterol? YES . . . . . . . . . . . . . . . . . . . . . . .1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 REFUSED . . . . . . . . . . . . . . . . . . . . .7 DON'T KNOW . . . . . . . . . . . . . . . . . . . 9 9-10. Even though a doctor or other health professional has never told you to control your weight or lose weight, to lower your blood cholesterol, have you made any major changes on your own? Specifically, have you controlled your weight or lost weight in order to lower your blood cholesterol? YES . . . . . . . . . . . . . . . . . . . . . . .1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 REFUSED . . . . . . . . . . . . . . . . . . . . .7 DON'T KNOW . . . . . . . . . . . . . . . . . . . 9 9-11. Even though a doctor or other health professional has never told you to increase your physical activity or exercise, to lower your blood cholesterol, have you made any major changes on your own? Specifically, have you increased your physical activity or exercise in order to lower your blood cholesterol? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . .2 REFUSED . . . . . . . . . . . . . . . . . . . . . 7 DON'T KNOW . . . . . . . . . . . . . . . . . . . .9 MAINE ADULT TOBACCO SURVEY INSTRUMENT: Section 10 Asked July SECTION 10: SOCIAL CAPITAL The next part of this survey is related to social groups that you may be a part of. Do you regularly participate in the activities of… (INSERT OPTIONS BELOW; ROTATE) M1. A fraternal organization? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED M2. A service club? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED M3. A Veterans group? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED M4. A Labor union? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED M5. A sports group? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED M6. Working with a youth group? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED M7. A school service group? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED M8. A farm organization? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED M9. A hobby or garden club? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED M10 A professional or academic society? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED M11. A literary, arts, discussion, or study group? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED M12. A church group or a group with any religious affiliation? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED M13. Some other kind of group? 1. 2. 8. 9. YES NO DON’T KNOW REFUSED MAINE ADULT TOBACCO SURVEY INSTRUMENT:INITIAL CDM QUESTIONS MAINE ADULT TOBACCO SURVEY INSTRUMENT: Original CDM Questions Asked October, November, January, March, May, June CDM-S1. Do you, or does anyone in your family, work in advertising, market research or public relations? 1. 2. 8. 9. YES (SKIP TO NEXT SECTION) NO DON'T KNOW (SKIP TO NEXT SECTION) REFUSED (SKIP TO NEXT SECTION) CDM-S2. Are you or is any member of your family involved in journalism (print or media)? 1. 2. 8. 9. YES (SKIP TO NEXT SECTION) NO DON'T KNOW (SKIP TO NEXT SECTION) REFUSED (SKIP TO NEXT SECTION) CDM-S3. Do you, or does anyone in your family, work or have any affiliation with Healthy Maine Partnerships? 1. 2. 8. 9. YES (SKIP TO NEXT SECTION) NO DON'T KNOW REFUSED (SKIP TO NEXT SECTION) CDM-1. Are you aware of any programs or services sponsored by the State of Maine to assist tobacco users in their efforts to quit smoking? 1. 2. 8. 9. YES NO (SKIP TO CDM-3) DON'T KNOW (SKIP TO CDM-3) REFUSED (SKIP TO CDM-3) CDM-2. What State programs or services are you aware of to assist tobacco users in their efforts to quit smoking? _________________________________________________________________ _________________________________________________________________ CDM-3. Are you aware that the State of Maine provides the Maine Tobacco HelpLine as a means of assisting tobacco users in their efforts to quit smoking? 1. 2. 8. 9. YES NO DON'T KNOW REFUSED Have you ever heard of the Partnership for a Tobacco Free CDM-4. Maine? 1. 2. 8. 9. YES NO (SKIP TO CDM-5) DON'T KNOW (SKIP TO CDM-5) REFUSED (SKIP TO CDM-5) CDM-4A. To the best of your knowledge, is the Partnership for a Tobacco Free Maine part of the Bureau of Health or do they belong to the private sector? 1. 2. 8. 9. PART OF THE BUREAU OF HEALTH BELONG TO THE PRIVATE SECTOR DON'T KNOW REFUSED Have you ever heard of the Healthy Maine Partnerships? CDM-5. 1. 2. 8. 9. YES NO (SKIP TO CDM-6) DON'T KNOW (SKIP TO CDM-6) REFUSED (SKIP TO CDM-6) CDM-5A. Are you aware of any local organization in your community that is part of the Healthy Maine Partnerships? 1. 2. 8. 9. YES NO (SKIP TO CDM-6) DON'T KNOW (SKIP TO CDM-6) REFUSED (SKIP TO CDM-6) CDM-5B. What local organizations in your community are part of Healthy Maine Partnerships? _________________________________________________________________ _________________________________________________________________ CDM-6. Using a scale of 1 to 5 where a 1 means "Not At All Concerned" and a 5 means "Very Concerned," how concerned are you about exposure to secondhand smoke for you and your family? 1. 2. 3. 4. 5. 8. 9. NOT AT ALL CONCERNED 1 2 3 4 5 VERY CONCERNED DON'T KNOW REFUSED CDM-7. Using a scale of 1 to 5 where a 1 means "Disagree Completely" and a 5 means "Agree Completely," how much do you agree or disagree that engaging in any kind of physical activity can have a positive impact on your health? 1. 2. 3. 4. 5. 8. 9. 1 DISAGREE COMPLETELY 2 3 4 5 AGREE COMPLETELY DON'T KNOW REFUSED CDM-8. When you see or hear commercials in the media, such as radio or television, how often do you see or hear commercials about the dangers of smoking or chewing tobacco? (READ RESPONSE CHOICES.) 1. 2. 3. 4. 8. 9. Very often Often Not very often Not often at all DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) MAINE ADULT TOBACCO SURVEY INSTRUMENT:REVISED CDM QUESTIONS Asked March, April CDM-S1. Do you, or does anyone in your family, work in advertising, market research or public relations? 1. 2. 8. 9. YES (SKIP TO NEXT SECTION) NO DON'T KNOW (SKIP TO NEXT SECTION) REFUSED (SKIP TO NEXT SECTION) CDM-S2. Are you or is any member of your family involved in journalism (print or media)? 1. 2. 8. 9. YES (SKIP TO NEXT SECTION) NO DON'T KNOW (SKIP TO NEXT SECTION) REFUSED (SKIP TO NEXT SECTION) CDM-S3. Do you, or does anyone in your family, work or have any affiliation with Healthy Maine Partnerships? 1. 2. 8. 9. YES (SKIP TO NEXT SECTION) NO DON'T KNOW REFUSED (SKIP TO NEXT SECTION) NEW-CDM-1. Are you aware of any programs or services sponsored by the State of Maine to provide information about how residents can maintain a healthy weight? 1. 2. 8. 9. YES NO (SKIP TO NEW-CDM-3) DON'T KNOW (SKIP TO NEW-CDM-3) REFUSED (SKIP TO NEW-CDM-3) NEW-CDM-2. What State programs or services are you aware of to help Maine residents maintain a healthy weight? _________________________________________________________________ _________________________________________________________________ NEW-CDM-3. Program? 1. 2. 3. 8. 9. Have you ever heard of the Maine Cardiovascular Health YES NO NOT SURE/MAY HAVE HEARD OF IT DON'T KNOW REFUSED Have you ever heard of the Healthy Maine Partnerships? NEW-CDM-4. 1. 2. 3. 8. 9. YES NO (SKIP TO NEW-CDM-5) NOT SURE/MAY HAVE HEARD OF IT (SKIP TO NEW-CDM-5) DON'T KNOW (SKIP TO NEW-CDM-5) REFUSED (SKIP TO NEW-CDM-5) NEW-CDM-4A. Are you aware of any local organization in your community that is part of the Healthy Maine Partnerships? 1. 2. 8. 9. YES NO (SKIP TO NEW-CDM-5) DON'T KNOW (SKIP TO NEW-CDM-5) REFUSED (SKIP TO NEW-CDM-5) NEW-CDM-4B. What local organizations in your community are part of Healthy Maine Partnerships? _________________________________________________________________ _________________________________________________________________ NEW-CDM-5. Using a scale of 1 to 5 where a 1 means "Not At All Concerned" and a 5 means "Very Concerned," how concerned are you about your family members maintaining a healthy weight? 1. 2. 3. 4. 5. 8. 9. NOT AT ALL CONCERNED 1 2 3 4 5 VERY CONCERNED DON'T KNOW REFUSED NEW-CDM-6. Using a scale of 1 to 5 where a 1 means "Disagree Completely" and a 5 means "Agree Completely," how much do you agree or disagree that engaging in any kind of physical activity can have a positive impact on your health? 1. 2. 3. 4. 5. 8. 9. DISAGREE COMPLETELY 1 2 3 4 5 AGREE COMPLETELY DON'T KNOW REFUSED NEW-CDM-7. How often do you see or hear advertisements and other messages about residents needing to maintain a healthy weight? (READ RESPONSE CHOICES.) 1. 2. 3. 4. 8. 9. Very often Often Not very often Not often at all DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) NEW-CDM-8. How often do you see or hear advertisements and other messages about residents needing to reduce their portion sizes at mealtimes? (READ RESPONSE CHOICES.) 1. 2. 3. 4. 8. 9. Very often Often Not very often Not often at all DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) NEW-CDM-9. How often do you see or hear advertisements and other messages about household tasks and activities -- things like climbing stairs, doing housework, and so forth -- serving as ways residents can engage in greater physical activity? (READ RESPONSE CHOICES.) 1. 2. 3. 4. 8. 9. Very often Often Not very often Not often at all DON'T KNOW (DO NOT READ) REFUSED (DO NOT READ) NEW-CDM-10. Have you ever heard of a website for a program called Healthy Maine Walks? 1. 2. 3. 8. 9. YES NO NOT SURE/MAY HAVE HEARD OF IT DON'T KNOW REFUSED NEW-CDM-11. Are you aware that the website for Healthy Maine Walks allows residents to find a walking trail or path near their home? 1. 2. 3. 8. 9. YES NO NOT SURE/MAY HAVE HEARD OF IT DON'T KNOW REFUSED Specific Questions Examined During Data Editing Number of adults in the household: This is checked against Q 10-9 to ensure that respondents who are "Married" or "A member of an unmarried couple that is living together" have at least two adults in the household. Respondents who do not are called back to clarify their living situations. Q 1-4: This is checked against Q 10-1. If Q 1-4 is higher than Q 10-1, the respondent is called back. Also, ages less than 5 are called back to verify. Q 4-2: This is checked against Q 10-13 and the number of adults in the household. If Q 4-2 lists more smokers than adults and children between 5 and 18, the respondent is called back. Q 4-3: No answers over 30 are accepted. Q 4-5: No answers over 7 are accepted. Q 4-7 and 4-8: Vague or incomplete answers are called back to clarify. Q 4-14: 0, 1, or a number over 69 is edited to reflect the correct codes. Answers over 60 are called back to verify. Q 5-10: No answers over 100 are accepted. Answers of 100 are called back to verify. Q 5-11: No answers over 100 are accepted. Answers of 100 are called back to verify. Q 7-2: Respondents who answer "Your employer" are checked against Q 4-6 to ensure that they are employed. Otherwise they are called back to clarify. Q 10-3: No answers of 12 or more are accepted in the "inches" field. No answers of 7 or more are accepted in the "feet" field. Q 10-11: Answers over 7 are called back to verify. Q 10-12: Answers over 7 are called back to verify. Q 10-13: Answers over 7 are called back to verify. Q CDM-2, CDM-5B, NEW-CDM-2, and NEW-CDM-4B: Vague or incomplete answers are called back to clarify. CONFIDENTIALITY AGREEMENT I, the undersigned, agree that I will maintain the highest standards of confidentiality in conducting telephone research for Critical Insights, Inc. → I will not divulge to any person outside the scope of my employment at Critical Insights any information having to do with the specific details of my current research assignment. This includes: → → → → The name of the project or client for whom the research is being conducted The nature of the questions which are included on the questionnaire The name or any identifiable aspect of any person whom I have interviewed as part of my research employment I also acknowledge that accuracy and reliability are critical elements of my work as a market researcher. I further agree that I will never falsify or alter data which is supplied to me as part of my research efforts. I further acknowledge that failure to maintain confidentiality or reliability in capturing the data is grounds for immediate dismissal. I understand that these terms are non-negotiable elements of my assignment with Critical Insights, Inc. → → Signed: Printed Name: Date: Witnessed: