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Volume 1:
No. 4, October 2004
LETTER TO THE EDITOR
Differences in Smoking Prevalence Between the Adult Tobacco Survey and the
Behavioral Risk Factor Surveillance System
Suggested citation for this article: Ramsey LT, Pelletier A, Knight S.
Differences in smoking prevalence between the Adult Tobacco Survey and the
Behavioral Risk Factor Surveillance System [letter to the editor]. Prev
Chronic Dis [serial online] 2004 Oct [date cited]. Available from:
URL: http://www.cdc.gov/pcd/issues/2004/
oct/04_0056.htm.
PEER REVIEWED
To the Editor:
Smoking prevalence is a principal outcome for evaluating tobacco-control
efforts, but prevalence estimates in New Hampshire differed between two surveys
conducted during 2002. Smoking prevalence was 17.9% (95% confidence interval
[CI] 16.3%–19.5%) in the Adult Tobacco Survey (ATS) and 23.2% (95% CI
21.8%–24.5%) in the Behavioral Risk Factor Surveillance System (BRFSS) (absolute
percentage point difference = 5.3%; relative percentage difference = 22.8%
[5.3%/23.2%]). We examined possible reasons for this observed difference.
The ATS and BRFSS were both developed by the Centers for Disease Control and
Prevention. The ATS included 103 questions related to knowledge, attitudes, and
behaviors regarding tobacco; the BRFSS included 138 questions related to health
behavior risk factors, including 11 questions about tobacco, which followed
questions on nine other health topics. The same survey research firm
administered both surveys, which were population-based, random-digit-dialed
telephone surveys of noninstitutionalized adults aged 18 or older. Smoking
prevalence for both surveys was determined by the number of persons who had
smoked at least 100 cigarettes in their lifetime and were current smokers. The
introduction to the ATS informed potential participants that it was a survey on
health and tobacco; the BRFSS was introduced as a survey on health and health
practices.
The ATS was conducted in August and September with a Council of American Survey
Research Organizations (CASRO) response rate
of 52.6% and a sample size of 3000; the BRFSS was conducted throughout the year with
a CASRO response rate of 53.2% and a sample size of 5039. No monthly variation
existed in smoking prevalence within surveys. The demographics of respondents
were similar in both surveys (Table) (1,2).
Given the similarities between the surveys, possible causes of the
discrepancy in estimated smoking prevalence between the ATS and the BRFSS in New
Hampshire are differences in the survey introduction and differences in question
placement. One study conducted in California suggested the tobacco-specific
introductory statement in the ATS may have caused certain smokers to deny
tobacco use (3). State health departments that conduct the ATS and the BRFSS should be
aware of potential differences in smoking prevalence between these two surveys
and be prepared to address these differences when communicating with the public
and policy makers. Further research is needed to determine if differences in
smoking prevalence between these two surveys exist in other states.
Leigh T. Ramsey, PhD
New Hampshire Department of Health and Human Services
Centers for Disease Control and Prevention
Atlanta, Ga
Andrew Pelletier, MD, MPH
New Hampshire Department of Health and Human Services
Centers for Disease Control and Prevention
Atlanta, Ga
Susan Knight, MSPH
New Hampshire Department of Health and Human Services
Concord, NH
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References
- Knight S, Pelletier A , Ramsey L.
New Hampshire Tobacco Data, 2003.
Concord (NH): N.H. Department of Health and Human Services, Office of Community
and Public Health, Division of Chronic Disease Prevention, Tobacco Prevention
and Control Program; 2003.
- Anderson L, Knight S, Peterson E. New Hampshire Adult Tobacco Survey,
2002. Concord (NH): N.H. Department of Health and Human Services, Office of
Community and Public Health, Division of Chronic Disease Prevention, Tobacco
Prevention and Control Program, 2003.
- Cowling DW, Johnson TP, Holbrook BC, Warnecke RB, Tang H.
Improving the self reporting
of tobacco use: results of a factorial experiment. Tob Control 2003;12:178–83.
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Table
 Demographics of Respondents to Adult Tobacco Survey and Behavioral Risk Factor
Surveillance System (Data Unweighted), New Hampshire, 2002
| |
Adult Tobacco Survey
(n = 3000) |
Behavioral Risk Factor Surveillance System
(n = 5039) |
| |
% |
% |
| Age (years) |
| 18-24 |
5.8 |
6.1 |
| 25-34 |
16.2 |
15.2 |
| 35-44 |
24.0 |
24.3 |
| 45-54 |
21.1 |
21.5 |
| 55-64 |
15.0 |
15.0 |
| ≥65 |
17.9 |
18.0 |
| Years of
education |
| <12 |
5.5 |
6.7 |
| 12 |
28.1 |
29.5 |
| 13-15 |
26.1 |
26.4 |
| ≥16 |
40.3 |
37.3 |
| Income ($) |
|
<10,000-14,999 |
6.8 |
7.7 |
|
15,000-24,999 |
12.4 |
13.8 |
| 25,000-49,999 |
31.1 |
32.7 |
| ≥50,000 |
49.6 |
45.9 |
| Sex |
| Male |
42.0 |
42.0 |
| Female |
58.0 |
58.0 |
| Race |
| White |
93.9 |
95.4 |
|
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