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Using Behavior Over Time Graphs to Spur Systems Thinking Among Public Health Practitioners


The graph shows years (1900 through 1998) on the x axis and the annual per capita number of cigarettes consumed in the United States on the y axis. A trend line connects data points. The trend line begins at approximately 50 cigarettes consumed per person annually and increases slowly from 1900 to approximately 1915; then the trend line rises rapidly (annotated arrows on the graph show the Great Depression accounting for dips in the upward trend from 1929 through 1933). Annotation notes the end of World War II (in 1944) and then the first concerns about links between cancer and smoking in 1952 as events that preceded small dips in per capita cigarette consumption. The trend continues to rise until approximately 1964 when the first Surgeon General’s report is released. At that time, cigarette consumption peaks at approximately 4,200 cigarettes consumed per capita annually. Cigarette consumption falls from 1964 to 1998 as the following events occur: First World Conference on Smoking and Health, Fairness Doctrine message on television and radio, broadcast advertising ban on tobacco products, first Great American Smokeout, Nonsmoker’s Rights movement beings, federal cigarette tax doubles, Surgeon General’s Report on Environmental Tobacco Smoke is published, nicotine medications become available over the counter, and the Master Settlement Agreement is reached. In 1998 the annual per capita cigarette consumption was approximately 2,320 cigarettes.

Figure 1.
Annotated Behavior Over Time graph that shows annual per capita number of cigarettes consumed and major smoking and health events in the United States from 1900 to 1998 (14).

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Four photos show workshop participants seated at a round table creating behavior over time graphs.

Figure 2.
Photographs of maternal and child health practitioners and partners working on behavior over time graphs at the National Maternal and Child Health Workforce Development Center’s 2016 Skills Institute.

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Page last reviewed: February 1, 2018