Indicator Definitions - Tobacco
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- Amount of tobacco product excise tax
- Cigarette smoking before pregnancy
- Current cigarette smoking among women aged 18-44 years
- Current cigarette smoking among youth
- Current smokeless tobacco use among adults aged ≥18 years
- Current smokeless tobacco use among youth
- Current smoking among adults aged ≥18 years
- Percent tobacco revenue to fund at CDC recommended level
- Pneumococcal vaccination among non-institutionalized adults aged ≥65 years who smoke
- Pneumococcal vaccination among non-institutionalized adults aged 18-64 years who smoke
- Proportion of the population protected by a comprehensive smoke-free policy prohibiting smoking in all indoor areas of workplaces and public places, including restaurants and bars.
- Quit attempts in the past year among current smokers
- Sale of cigarette packs
- Tobacco-free schools
- States that allow stronger local tobacco control and prevention laws
- States with strong policies that require retail licenses to sell tobacco products
- CDC. Reducing tobacco use: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2000. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2000/complete_report/index.htm.
- Institute of Medicine. Ending the tobacco problem: a blueprint for the nation. Washington, DC: The National Academies Press; 2007. Available at http://www.nap.edu/catalog.php?record_id=11795external icon.
- CDC. State cigarette excise taxes – United States, 2010-2011. MMWR 2012;61(12):201-4.
Cigarette smoking before pregnancy Category: Tobacco |
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Demographic Group: | Women who have had a recent live birth. |
Numerator: | Respondents who reported that they had smoked any cigarettes in the past 2 years and that they smoked any number of cigarettes, including <1 cigarette, on an average day during the 3 months before they got pregnant with their most recent live born infant. |
Denominator: | Respondents who reported the number of cigarettes they smoked on an average day in the 3 months before they got pregnant with their most recent live born infant, including none, as well as those who reported that they had not smoked any cigarettes in the past 2 years (excluding unknowns and refusals). |
Measures of Frequency: | Crude prevalence and 95% confidence interval, and by demographic characteristics when feasible; weighted using the PRAMS methodology (to compensate for unequal probabilities of selection, and adjust for non-response and telephone non-coverage). |
Time Period of Case Definition: | Three months before the pregnancy resulting in the most recent live birth. |
Background: | Despite the adverse impact smoking has on health, approximately 16.5% of women in the United States currently smoke cigarettes,1 and current cigarette smoking ranges from 5.8% to 34.7% among women of reproductive age across all 50 states and the District of Columbia.2 According to 2004 PRAMS data collected from 26 reporting areas, the mean prevalence of pre-pregnancy tobacco use was 23.2%; 45% of these women reported quitting during pregnancy, yet over 50% of them relapsed within six months after delivery.3 |
Significance: | More than 480,000 deaths each year are attributed to cigarette smoking and exposure to tobacco smoke, making it the leading preventable cause of death in the United States.4 Women of reproductive age (18-44 years) who smoke risk adverse pregnancy outcomes, including difficulty conceiving, infertility, spontaneous abortion, prematurity, premature rupture of membranes, low birth weight, neonatal mortality, stillbirth, and sudden infant death syndrome (SIDS), as well as adverse health consequences for themselves.5 Because only 20% of women who smoke are able to quit successfully during pregnancy, the CDC recommends smoking cessation prior to pregnancy.6 Interventions should be provided to tobacco users to include counseling about the benefits of not smoking before, during, and after pregnancy, a discussion of medications, and referral to intensive services that aid individuals attempting to stop smoking.7 |
Limitations of Indicator: | There are two different questions that must be used to construct the indicator related to smoking 2 years and 3 months prior to pregnancy. Grouping women in categories based on the number of cigarettes smoked adds valuable information. |
Data Resources: | Pregnancy Risk Assessment Monitoring System (PRAMS) |
Limitations of Data Resources: | PRAMS data is only collected from women who delivered a live-born infant, not all women of reproductive age, and from 47 states, one territory, and two cities, not the entire US. PRAMS data are self-reported and may be subject to recall bias and under/over reporting of behaviors based on social desirability. While most self-report surveys such as PRAMS might be subject to systematic error resulting from non-coverage (e.g. birth certificate information not available for sampling), nonresponse (e.g. refusal to participate in the survey or to answer specific questions), or measurement bias (e.g. recall bias), PRAMS attempts to contact potential respondents by mail and landline/cell telephone to increase response rates. Another limitation is that women with fetal death or abortion are excluded. PRAMS estimates only cover the population of residents in each state who also deliver in that state; therefore, residents who delivered in a different state are not captured in their resident state. |
Related Indicators or Recommendations: | None. |
Related CDI Topic Area: | Reproductive Health; Oral Health |
- CDC PRAMS Website, https://www.cdc.gov/prams/prams-data/mch-indicators/states/pdf/2018/All-PRAMS-Sites-2016-2017_508.pdf pdf icon[PDF-198KB].
- CDC. Smoking prevalence among women of reproductive age—United States, 2006. MMWR 2008; 57(31):849-852. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5731a2.htm.
- CDC. Preconception and interconception health status of women who recently gave birth to a live-born infant – Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 Reporting Areas, 2004. MMWR 2007;56(SS10):1-35.
- U.S. Department of Health and Human Services. The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
- US Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC: 2010. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2010/index.htm.
- CDC. Recommendations to improve preconception health and health care—United States. MMWR 2006; 55 (RR-6). http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm
- Floyd RL, Jack BW, Cefalo R, et al. The clinical content of preconception care: alcohol, tobacco, and illicit drug exposures. Am J Obstet Gynecol 2008; 199 (6 Suppl B):S333- S339.
- CDC. Current cigarette smoking among adults – United States, 2011. MMWR 2012;61:889-894. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6144a2.htm?s_cid=mm6144a2_w.
- CDC. Smoking prevalence among women of reproductive age—United States, 2006. MMWR 2008; 57(31):849-852. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5731a2.htm.
- CDC. Preconception and interconception health status of women who recently gave birth to a live-born infant – Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 Reporting Areas, 2004. MMWR 2007;56(SS10):1-35.
- U.S. Department of Health and Human Services. The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
- US Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC: 2010. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2010/index.htm.
- CDC. Recommendations to improve preconception health and health care—United States. MMWR 2006; 55 (RR-6). http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm
- Floyd RL, Jack BW, Cefalo R, et al. The clinical content of preconception care: alcohol, tobacco, and illicit drug exposures. Am J Obstet Gynecol 2008; 199 (6 Suppl B):S333- S339.
- CDC.U.S. Department of Health and Human Services. The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
- US Department of Health and Human Services. Preventing tobacco use among youth and young adults. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2012/index.htm.
- CDC. Youth Risk Behavior Surveillance – United States, 2011. MMWR. 2012;61(4):1-162.
- US Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC: 2010. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2010/index.htm
- CDC. Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC). Available at https://chronicdata.cdc.gov/Health-Consequences-and-Costs/Smoking-Attributable-Mortality-Morbidity-and-Econo/ezab-8sq5.
- CDC. Youth Risk Behavior Surveillance System. Available at http://www.cdc.gov/mmwr/PDF/rr/rr5312.pdf pdf icon[PDF-261KB].
- CDC. Youth Risk Behavior Surveillance—United States, 2011. MMWR 2012;61(No. SS-4).
- International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans: smokeless tobacco and some tobacco specific n-nitrosamines [volume 89]. Lyon, France: World Health Organization, International Agency for Research on Cancer; 2007. Available at http://monographs.iarc.fr/ENG/Monographs/vol89/mono89.pdfpdf iconexternal icon.
- CDC. The health consequences of smoking: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2004.
- CDC. State-specific prevalence of cigarette smoking and smokeless tobacco use among adults — United States, 2009. MMWR 2010;59(43):1400-6.
- U.S. Department of Health and Human Services. The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
- CDC. Youth Risk Behavior Surveillance – United States, 2011. MMWR. 2012;61(4):1-162.
- U.S. Department of Health and Human Services. Preventing tobacco use among youth and young adults: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2012.
- CDC. Youth Risk Behavior Surveillance System. Available at http://www.cdc.gov/mmwr/PDF/rr/rr5312.pdf pdf icon[PDF-261KB].
- Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf pdf icon[PDF-121KB]
- CDC. Current cigarette smoking among adults – United States, 2011. MMWR 2012;61:889-894. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6144a2.htm?s_cid=mm6144a2_w.
- U.S. Department of Health and Human Services. The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
- US Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC: 2010. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2010/index.htm.
- Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 2004;328:1519–28.
- CDC. Best practices for comprehensive tobacco control programs—2007. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2007.
- CDC. State Tobacco Revenues Compared with Tobacco Control Appropriations – United States, 1998-2010. Morbidity and Mortality Weekly Report 2012;61(20):370–4.
- CDC. Current Cigarette Smoking Among Adults – United States, 2011. Morbidity and Mortality Weekly Report 2012;61(44):889–94.
- Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics, 2001. Healthy people 2010 statistical notes, no. 20. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf pdf icon[PDF-121KB]
- CDC. Current cigarette smoking among adults – United States, 2011. MMWR 2012;61:889-894. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6144a2.htm?s_cid=mm6144a2_w
- CDC. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997;46(No. RR-8):1-24. http://www.cdc.gov/mmwr/preview/mmwrhtml/00047135.htm
- CDC. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR 2010;59:1102-1106. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5934a3.htm
- U.S. Department of Health and Human Services. The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
- US Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC: 2010. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2010/index.htm.
- Shenson D, DiMartino D, Bolen J, Campbell M, Lu PJ, Singleton JA. Validation of self-reported pneumococcal vaccination in behavioral risk factor surveillance surveys: experience from the sickness prevention achieved through regional collaboration (SPARC) program. Vaccine 2005;23:1015-1020.
- Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics, 2001. Healthy people 2010 statistical notes, no. 20. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf pdf icon[PDF-121KB]
- CDC. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR 2010;59:1102-1106. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5934a3.htm
- CDC. Current cigarette smoking among adults – United States, 2011. MMWR 2012;61:889-894. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6144a2.htm?s_cid=mm6144a2_w
- U.S. Department of Health and Human Services. The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
- US Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC: 2010. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2010/index.htm
- Shenson D, DiMartino D, Bolen J, Campbell M, Lu PJ, Singleton JA. Validation of self-reported pneumococcal vaccination in behavioral risk factor surveillance surveys: experience from the sickness prevention achieved through regional collaboration (SPARC) program. Vaccine 2005;23:1015-1020.
- U.S. Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006.
- CDC. State smoke-free laws for worksites, restaurants, and bars–United States, 2000-2010. MMWR 2011;60(15):472-5.
- U.S. Department of Health and Human Services. The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
- CDC. Quitting smoking among adults–United States, 2001-2010. MMWR 2011;60(44):1513-9.
- CDC. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2010. Available at http://www.surgeongeneral.gov/library/tobaccosmoke/ report/full_report.pdf.
- Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 2004;328:1519–28.
- US Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC: 2010. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2010/index.htm.
- CDC. Consumption of cigarettesand combustible tobacco – United States, 2000-2011. MMWR 2012;61(30):565-569.
- U.S. Department of Health and Human Services. The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
- CDC. Guidelines for school health programs to prevent tobacco use and addiction. MMWR 1994;43(RR-2):1–18.
- US Department of Health and Human Services. Preventing tobacco use among youth and young adults. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2012/index.htm.
- CDC. Vital Signs: Nonsmokers Exposure to Secondhand Smoke – United States, 1999-2008. MMWR 2010;59(35):1141-1146.
- U.S. Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006.
- CDC. State preemption of local smoke-free laws in government work sites, private work sites, and restaurants—United States, 2005–2009. MMWR 2010;59(04):105–8.
- CDC. State preemption of local tobacco control policies restricting smoking, advertising, and youth access—United States, 2000–2010. MMWR 2011;60(33):1124–7.
- McLaughlin I. License to Kill?: Tobacco Retailer Licensing as an Effective Enforcement Tool. Tobacco Control Legal Consortium. 2010. Available at http://publichealthlawcenter.org/sites/default/files/resources/tclc-syn-retailer-2010.pdf pdf icon[PDF-385KB]external icon.
- CDC. State Activities Tracking and Evaluation (STATE) System. Available at https://www.cdc.gov/statesystem/.
Page last reviewed: January 15, 2015