Oregon Statewide Tobacco Control Plan 2005-2010

T aking Action for a Tobacco-Free Oregon

OREGON STATEWIDE

TOBACCO CONTROL PLAN

2005-2010

Contributors

We thank the following organizations for their participation in the series of meetings and collaborative goal

setting sessions that led to the development of this plan:

American Cancer Society

American Heart Association

American Lung Association of Oregon

Asian Family Center of IRCO

Benton County Health Department

CareOregon

Crook County Health Department

Douglas County Health Department

Group Health Cooperative

Jackson County Health and Human Services

Kaiser Permanente Northwest

Multnomah County Health Department

National Cancer Institute Cancer Information Service

Northwest Portland Area Indian Health Board

OMPRO- Oregon’s Quality Improvement Organization

Oregon Department of Education

Oregon Department of Human Services

Office of Child and Family Health Services

Office of Disease Prevention and Epidemiology, Tobacco Prevention and Education Program

Office of Medical Assistance Programs

Office of Mental Health and Addiction Services

Oregon Department of Justice Civil Enforcement Division

Oregon Human Development Corporation

Oregon Medical Association

Oregon Research Institute

PAC/WEST Communications

Portland State University

Providence Health System

Tigard-Tualatin School District

Tobacco-Free Coalition of Oregon

Umatilla County Public Health

Yamhill County Public Health

T able of Contents

Background

Taking Action 1

Tobacco’s Effects 2

Why People Use Tobacco 3

Overview of Tobacco Use in Oregon 4

Timeline 6

Goals

Oregon’s Tobacco Control Plan

Goal 1 9

Goal 2 11

Goal 3 13

Goal 4 15

Goal 5 17

Data Sources

Surveys 18

Vital Statistics 18

Other 19

Each year in Oregon, tobacco use kills more than 6,000 people.

It claims more lives than motor vehicle crashes, suicide, AIDS, and murders

combined.

In 2003, 500,000 Oregon adults still smoked cigarettes, and 75,000

still chewed tobacco. For most smokers, addiction to tobacco began in their

youth, before they were 18. Despite gains in preventing youth from starting to

smoke, 45,000 Oregon youth still smoke and 13,000 still chew tobacco.

In addition to the cost of tobacco to Oregonians in lives, tobacco also

imposes a staggering financial burden—of particular concern at a time of seri-

ous economic difficulties in the state. Tobacco use cost Oregonians $1.8 bil-

lion in 2000. The direct cost to the healthcare system alone in Oregon was

nearly $900 million, and every pack of cigarettes sold costs our economy

$7.18—$3.45 in medical costs and $3.73 in lost productivity due to prema-

ture death and disease.

As a state, we simply cannot afford tobacco.

Taking Action

on Oregon’s

Number One

Health Problem:

Tobacco Use

7000

6000

5000

4000

3000

2000

1000

Tobacco Motor Vehicles Suicide AIDS Homicide

Number of Deaths-Selected Causes: Oregon, 2002

Background

T aking Action

T obacco’s Effects

Exposure to

Secondhand Smoke

Increases Risk of

Ear Infection

Asthma Attacks

Pneumonia

Bronchitis

Smoking and Spit Tobacco Cause

Stroke

Mouth Cancer

Throat Cancer

Heart Disease

Lung Cancer

and Emphysema

Pancreatic Cancer

Kidney Cancer

Cervical Cancer

Osteoporosis

Exposure to

Secondhand Smoke

Increases Risk of

Stroke

Heart Disease

Lung Cancer

Asthma Attacks

Why People Use Tobacco

The Office of the U.S. Surgeon General has been telling us since

1964 that tobacco use can cause death. Given that most everyone knows

smoking is dangerous, why do people still use tobacco?

The issue is complex. Smoking exists within a network of social

norms, political controls and tobacco industry influence. Tobacco use is a

cultural issue, with many interwoven factors ultimately affecting a person’s

decision to start or continue smoking.

Some cultures use tobacco differently than the mainstream U.S.

smoker. Sacred or traditional use of tobacco by American Indians is very

different from commercial tobacco use. Tobacco has an important role in

traditional American Indian life. For tribes throughout North America, the

use of traditional tobacco plants for spiritual, ceremonial and medicinal

purposes goes back thousands of years. This historic and enduring relation-

ship with sacred tobacco must be recognized and addressed when shaping

meaningful, culturally appropriate tobacco prevention in American Indian

communities.

In spite of all the factors that contribute to tobacco use, we do know

that when done well, tobacco control works! Comprehensive state tobacco

programs reduce tobacco use. These programs, with community and school

programs and policies, counter-marketing campaigns (such as anti-smoking

tobacco ads), and cessation programs for current smokers have proven effec-

tive time and again.

Background

Influences on the Decision to Use Tobacco

A Young Nonsmoker

A Current Smoker

A Former Smoker

Anti -Tobacco Influences

• Health education and

information

• Price of tobacco

• Advertising policies

• Youth access to tobacco

• Smoke free environments

• Local community norms

• Behavioral treatment

• Pharmacological treatment

Pro -Tobacco Influences

• Psychosocial factors

• Adult role models

• Peer pressure

• Product availability

• Tobacco industry influence

including: advertising,

promotion and

counter education

• Addiction

A Brief Overview

of Tobacco Use

in Oregon

Smoking and chewing tobacco are prevalent among both adults and

youth in Oregon today. Twenty-one percent of adults smoke cigarettes, as do

16% of 11th graders. Chewing is less common overall, but use of this still-

deadly form of tobacco is more common among 11th grade males (11%)

than adult males (6%). Lower levels of education and income are both

linked to increased tobacco use.

These dire statistics have motivated the growing trend against tobac-

co use, and have created an increasing awareness of the dangers of second-

hand smoke. Only 17% of Oregonians in 2003 allowed smoking in their

homes, down from 29% in 1997.

The 2002 Smoke Free Workplace

Law protects a full 95% of Oregon

workers from secondhand smoke.

The national downward

trend in tobacco use has become

clear in per capita cigarette sales.

The dramatic drop is even more

pronounced in states like Oregon,

where comprehensive tobacco

reduction programs are in place.

While it is true that overall

cigarette consumption in Oregon is

decreasing, smoking prevalence

remains higher in some communi-

ties than in others. For example,

American Indians, the Lesbian/Gay

community and African Americans

have a high prevalence of smoking

in relation to the statewide average.

Furthermore, while the overall

prevalence among Hispanics,

Asians and Pacific Islanders is

lower than the statewide average,

some population groups within

these communities experience a

significantly higher prevalence than

the non-Hispanic white popula-

tion. The Oregon Statewide

Tobacco Control Plan addresses

these disparities.

'93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04

Annual Per Capita Sales of Cigarettes

Oregon and the Nation: 1993-2004

Oregon

States without

comprehensive

tobacco control

programs*

100

Oregon's Tobacco Program

Source: state cigarette tax receipts

Annual packs per capita

*This national comparison excludes Arizona, California, Massachusetts, and Oregon because these states

have had tobacco prevention programs since at least 1997.

Overview of Tobacco Use in Oregon

Percentage of Adults in Selected

Subgroups Who Smoke

Percentage Who Smoke

50%

40%

30%

20%

10%

Statewide

Average

American

Indian

Gay/

Lesbian/

Bisexual

Low

Socio-

economic

Status

African

American

White

Non-

Hispanic

Asian/

Pacific

Islander

Source: Oregon Behavioral Risk Factor Surveillance System (2003, except by race/ethnicity 2001-2002)

Youth are a group particularly at risk for

tobacco use. Eight percent of 8th graders smoke;

by 11th grade 16% smoke. There are growing

efforts to reduce and eliminate smoking among

young people. For example, the state school

board has ruled that all campuses must be tobac-

co-free by January 1, 2006.

Unfortunately, funding cuts threaten

progress. At present, Oregon’s budgets for tobac-

co control comprise only a small fraction of what

the Centers for Disease Control and Prevention

considers minimum funding for effective tobacco

prevention programs.

Interventions that reduce people’s expo-

sure to tobacco smoke, both primary and second-

ary exposure, can begin to reap immediate finan-

cial savings. Childhood pneumonia, otitis media,

certain birth defects, SIDS and heart attacks all

show immediate risk reductions and associated

cost savings with reduced exposure.

The problem of low birth weight babies

due to smoking mothers is another area where

decreased exposure gives an immediate benefit. In

Oregon, the percentage of infants born to moth-

ers who smoke has decreased 33% since 1996,

resulting in a biennial savings for Medicaid in

Oregon of $2 million.

Oregon's Tobacco Program

35%

30%

25%

20%

15%

10%

'94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04

Percentage of 8th and 11th Graders Who Smoke Cigarettes:

Oregon, 1994-2004

11th Grade

8th Grade

CDC minimum recommended

funding for tobacco prevention

in Oregon: $42 million

The state of Oregon receives $668 million each biennium from tobacco taxes

and payments from tobacco companies under the Master Settlement Agreement

State Tobacco Revenue and Tobacco Prevention Expenditures

2003-2005 Biennium

Total state tobacco revenue:

$668 million

Actual tobacco

prevention spending

$7 million

Oregon's Tobacco Program

20%

16%

12%

'93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03

Oregon

U.S.

Percentage of Infants Born to Mothers Who Used Tobacco During Pregnancy

Oregon vs. U.S., 1993-2003

Background

For additional data about tobacco use in Oregon, please refer to Oregon Tobacco Facts. This document,

which is updated annually, is available online at www

.dhs.state.or.us/publichealth/tobacco.

Oregon Receives

CDC Funding

Oregon receives fund-

ing from the Centers

for Disease Control

and Prevention for

tobacco prevention.

1993-1994

November 1995

First State Plan for

Tobacco Control

Oregon tobacco

control advocates

launch the state’s

first Statewide

Strategic Plan for

Tobacco Control.

1994

Oregon Receives

Grant from RWJ

Foundation

Oregon receives a

grant from the

Robert Wood Johnson

Foundation

to organize statewide

tobacco control efforts.

Voters Approve Tobacco Prevention

and Education Program

Together with healthcare partners,

tobacco control advocates are success-

ful in their campaign to raise tobacco

excise taxes by 30 cents and dedicate a

portion to a tobacco use prevention

program. Ballot Measure 44 passes by

a wide margin despite millions of dol-

lars spent by tobacco companies to

defeat it.

November 1996

Master Settlement

Agreement

In a landmark agreement

in federal court, the

tobacco industry agrees

to pay out an estimated

$206 billion over 25

years to state govern-

ments. Oregon’s attorney

general joins other states

in signing the Master

Settlement Agreement.

1998

1997

A Statewide Tobacco Program is

Launched

The Oregon Department of Human

Services launches the Tobacco Prevention

and Education Program (TPEP). This

new program is grounded in one basic

premise: the only way to reduce tobacco

use is to attack the problem from multi-

ple fronts. Towards this goal, local tobac-

co control coalitions are established,

schools begin to implement comprehen-

sive prevention programs, and the

Department of Human Services estab-

lishes a statewide Quit Line for smokers.

1997 - 2004 Local

policy makers take action

T imeline

Making

Tobacco History

in Oregon

Oregon Indoor Clean Air Act

The Oregon State Legislature

improves Oregon’s Indoor Clean

Air Act by covering more work-

places and public places. Some

workplaces, such as bars, are

exempted.

2001

TPEP De-funded

Faced with a significant budget shortfall, the

Oregon State Legislature de-funds the Tobacco

Prevention and Education program.

2003

1997-2004

Local Policy Makers Take Action

Local policy makers on county commissions,

city councils, tribal councils, park boards,

schools boards and rodeo boards all over

Oregon change local tobacco laws. They pass

ordinances banning smoking in work and

public places, they change local regulations

about where tobacco can be placed in stores,

and they ban tobacco company sponsorship of

community events.

Background

2002

Measure 20

Voters approve Ballot Measure 20, which

again increases the tobacco excise tax and

dedicates a portion of the funds to the

Tobacco Prevention and Education

Program.

1999

TPEP in Full Swing

As a result of the Tobacco

Prevention and Education

Program in Oregon, ciga-

rette consumption drops,

secondhand smoke expo-

sure decreases and smok-

ing-related medical costs

are reduced.

2004

Partial Restoration of

Funding for Tobacco

Programs

The Oregon State

Legislature restores

tobacco prevention

education funding to

$5.8 million per

biennium—73% of

previous biennia, and

14% of the CDC

recommended

minimum level.

T obacco Control Plan

A Tobacco-Free

Oregon:

The Statewide

Tobacco

Prevention, Control

and Treatment

Plan

2005 - 2010

It is clear that Oregon

has made tremendous

strides in tobacco control.

We have also experienced

significant setbacks. The

good news is we know—

from research and our own

experiences—how to reduce

tobacco use. We have been

successful in the past. With

adequate attention, funding

and energy we will continue

to reduce the terrible toll

tobacco-related death and

disease takes on our state.

The following pages of

this plan outline specific

objectives and strategies for

Oregon, which, if applied,

can reduce or eliminate

tobacco-related death and

disease.

Eliminate Exposure

to Secondhand

Smoke

Exposure to secondhand smoke is a problem almost as serious as

smoking. Those caught in this carcinogenic haze are at increased risk for

many of the same diseases afflicting smokers, such as lung cancer and heart

disease. Reducing and eliminating secondhand smoke exposure, then, must

be an integral part of tobacco control.

Objective 1

Reduce the percentage of individuals exposed to second-

hand smoke by increasing the percentage of indoor public places

and workplaces that prohibit smoking.

Strategy

a. Improve the current law by removing exemptions and strengthening

statutory enforcement, penalty language and surveillance of the State

Indoor Clean Air Act.

Objective 2

Reduce the percentage of individuals exposed to second-

hand smoke in homes and vehicles.

Strategies

a. Identify and evaluate best practices for how to reduce smoking in

homes and vehicles.

b. Pilot a research-based education/media campaign.

c. Maintain an ongoing research agenda.

d. Ensure coordination of groups around the state.

Objective 3

Increase the number of outdoor places that prohibit

smoking.

Strategy

a. Promote local policies prohibiting smoking around building entrances,

in parks, at public transit stops, and in other outdoor public places.

G oal 1

This table outlines benchmarks that will be tracked for progress towards the objectives listed

under each program goal.

Goal 1

Benchmark

number of workers who are

protected from secondhand

smoke

percentage of homes where

there is smoking indoors

percentage of adults who allow

any smoking in their cars

number of local policies

that prohibit smoking in an

outdoor place

Current Status

95%

14%

28%

2010 Target

100%

15%

Data Source

Local ordinances and state laws,

Oregon Department of

Employment data.

BRFSS

DHS Ordinance Database

Prevent the

Initiation of

Tobacco by Youth

Young people start to use tobacco for a variety of reasons. In spite of

their protests to the contrary, this process of youth initiation has long been a

target area for tobacco companies. The hard-fought battle to remove cartoon

advertising from cigarettes is only one example of the struggle to stop the

creation of new school-age smokers.

Only through continued efforts to prevent young people from start-

ing to smoke and chew in the first place can we decrease overall tobacco use

in Oregon.

Objective 1

Decrease young people’s desire to use tobacco.

Strategies

a. Implement culturally appropriate youth strategies using a compre-

hensive, coordinated paid and earned media campaign at the state

and local levels. Select messages based on evidence of effectiveness

with youth.

b. Develop a regionally representative, diverse youth coalition to partici-

pate in developing and implementing effective strategies and media

approaches to address the problem of tobacco use among youth.

c. Increase the percentage of school districts with comprehensive

tobacco use prevention policies and programs.

d. Support and expand the Coordinated School Health Program infra-

structure to implement and enforce a statewide comprehensive school

tobacco policy and assure effective tobacco prevention programs.

Objective 2

Decrease youth access to tobacco.

Strategy

a. Increase tobacco taxes where a portion of the revenue is dedicated in

perpetuity to support comprehensive tobacco prevention programs as

recommended by the CDC guidelines, including effective strategies

for preventing youth access to tobacco.

G oal 2

This table outlines benchmarks that will be tracked for progress towards the objectives listed

under each program goal.

Goal 2

Benchmark

percentage of 8th graders who

smoke

percentage of 8th grade males

who use smokeless tobacco

percentage of 11th graders

who smoke cigarettes

percentage of 11th grade

males who use smokeless

tobacco

percentage of 8th graders who

say that it is very easy to get

tobacco

Oregon tax on cigarettes

SYNAR non-compliance rate

Current Status

8.1%

16.5%

11%

21%

$1.18

15%

2010 Target

10%

$2.00

10%

Data Source

Oregon Healthy Teens Survey

State Law

Department of Human Services

Increase Access

to Cessation

Resources

for Adults and

Youth

Studies have shown that people who try to quit smoking are two to

three times more likely to succeed if they use specific medications or patches

and get professional counseling. But in 2003, of people trying to quit, only

39% tried the medications and patches that can reduce the physical crav-

ings, and only a tiny fraction (6%) received the counseling that teaches how

to quit and builds confidence. The Oregon Tobacco Quit Line, which offers

free counseling and connects tobacco users to their health systems’ assistance

programs, currently only reaches about 1% of tobacco users.

Oregon has a long way to go in helping tobacco users end their

dependence on nicotine, but the path is clear. We must make high quality

medication and counseling assistance readily available, and must increase the

number of tobacco smokers and chewers who use that assistance.

Objective 1

Increase the percentage of Oregonians who have access to

cessation benefits through their employer or health insurance.

Strategies

a. Create a widespread communication plan targeting businesses, the

uninsured, labor, the health industry, the insurance industry, and bro-

kers. The communication plan will build awareness in these target

groups, sending the message that tobacco cessation assistance works

and provides health improvements, financial benefits and productivity

gains for everyone.

b. Convene a Task Force to coordinate campaign efforts and encourage

public sector employees and major labor unions to secure cessation

benefits for their employees and families.

Objective 2

Increase the demand for and use of cessation services and

programs for adults, youth and populations with tobacco use

disparities.

Strategies

a. Raise tobacco taxes significantly, with new revenue to enhance the

comprehensive tobacco prevention program (including the expansion

of cessation services).

b. Research, promote and implement cost effective population-based

approaches to prompt large numbers of tobacco users to quit.

c. Engage a public-private partnership in finding and funding creative

ways to increase access to pharmacological interventions and cessation

counseling support.

d. Develop earned media strategies to drive calls to the Quitline, and

evaluate their effectiveness as compared to paid media strategies.

G oal 3

Goal 3

Benchmark

percentage of Oregonians

whose health insurance covers

cessation services

percentage of smokers who

plan to quit in the next 30 days

percentage of smokers who say

that it would be very helpful to

have assistance when

trying to quit smoking

percentage of adults who say

their health insurance

covers smoking cessation

Current Status

39%

27%

34%

19%

2010 Target

50%

32%

40%

25%

Data Source

Survey of health plans by

TOFCO

BRFSS

This table outlines benchmarks that will be tracked for progress towards the objectives listed

under each program goal.

Eliminate

Disparities in

Tobacco Use

Despite all of Oregon’s tobacco control successes, some population

groups are not experiencing the benefits equally. Declining tobacco use

exposes disparities among distinct populations, such as American Indians

and people of low socioeconomic status. The tobacco companies

aggressively target these and other groups in an effort to maximize profits

and expand markets.

Disparities in tobacco use prevent everyone from having equal access

to the benefits of tobacco use reduction. An effective tobacco control effort

must work to eliminate these disparities.

Objective 1

Develop and implement effective population-specific

tobacco control programs directed at specific ethnic and cultural

groups affected by tobacco use disparities.

Strategies

a. Increase the involvement of tobacco control partners and populations

affected by tobacco related disparities in the development and imple-

mentation of tobacco control programs.

b. Develop a task force to disseminate the results of the CDC - spon-

sored disparities planning project. Inform influential community

leaders from the disparate groups, advocating for tobacco control

programs and activities targeted toward specific populations.

Objective 2

Expand data collection and develop innovative data

collection strategies for populations affected by tobacco-related

disparities.

Strategy

a. Obtain funding for effective data collection on those affected by

tobacco-related disparities.

G oal 4

This table outlines benchmarks that will be tracked for progress towards the objectives listed

under each program goal.

Goal 4

Benchmark

African American adult smoking

prevalence

American Indian adult smoking

prevalence

Asian/Pacific Islander adult

smoking prevalence

Hispanic adult smoking

prevalence

lesbian, gay and bisexual adult

smoking prevalence

low socioeconomic status adult

smoking prevalence

percentage of African American

homes where there was

smoking indoors

percentage of American Indian

homes where there was

smoking indoors

percentage of Asian/Pacific

Islander homes where there

was smoking indoors

percentage of Hispanic homes

where there was

smoking indoors

percentage of lesbian, gay and

bisexual homes where there

was smoking indoors

percentage of low socio-

economic status homes where

there was smoking indoors

Current Status

27%

44%

14%

18%

34%

35%

17%

28%

12%

29%

23%

2010 Target

15%

10%

15%

Data Source

BRFSS

Develop the

Infrastructure for

Tobacco Use

Prevention

The activities that create an environment for tobacco prevention do

not happen in isolation. Legislation, medical services and counseling for the

smoker, and community education programs for the general public all

require adequate funding and organization.

Objective 1

Reevaluate and rebuild the infrastructure for tobacco use

prevention and control and the level of funding and commitment

necessary to implement the new Statewide Plan.

Strategies

a. Enhance and advance the communication, coordination and coopera-

tion among all partners to implement the Statewide Plan.

b. Develop a Communications, Coordination and Implementation Plan

that includes all stakeholders and addresses public relations, organiza-

tional activities, message development, and policy and program strate-

gies for the Statewide Plan.

c. Ensure that all partners have adequate funding to implement the

Statewide Plan.

d. Enhance and advance the systems (procedures, organizations and pro-

grams) among all partners to implement the Statewide Plan.

Benchmark

The Centers for Disease Control and Prevention (CDC) recom-

mends that Oregon spend $21 million annually on public health tobacco

prevention and education programs.

G oal 5

Goal 5

D ata Sources

A. Surveys

Behavioral Risk F

actor Surveillance System

The Behavioral Risk Factor Surveillance System

(BRFSS) is an ongoing random-digit dialed telephone

survey of adults concerning health-related behaviors.

The BRFSS was developed by the Centers for Disease

Control and Prevention (CDC) and is conducted in all

states in the U.S. Each year, between 3,000 and 7,000

adult Oregonians are interviewed. The BRFSS includes

questions on health behavior risk factors such as seat

belt use, diet, weight control, tobacco and alcohol use,

physical exercise, preventive health screenings, and use

of preventive and other healthcare services. The data are

weighted to represent all adults aged 18 years and older.

A core set of questions, which includes the question of

smoking prevalence, is asked annually and other topics

are surveyed on a rotating basis of two years. Each state

may add questions to the CDC survey, and Oregon asks

an additional sixty questions on attitudes and behaviors

regarding tobacco. Except as noted below, 2003 BRFSS

data are used in this report.

Data presented by race/ethnicity are from a special com-

bined 2000 & 2001 file which includes additional sur-

veys from an oversample among African Americans,

American Indians, and Asian/Pacific Islanders. The

oversampling ensured that there would be a minimum

of 100 surveys in each county and a minimum of 250

surveys for each racial/ethnic group. Data for each

region and each racial/ethnic group were weighted to

represent the group’s population by age and gender.

regon Healthy Teens Survey

Since 2000, the Youth Risk Behavior Survey and the

Oregon Public School Drug Use Survey have been com-

bined into a single annual survey, Oregon Healthy

Teens. In 2004, approximately 13,503 8th graders from

119 middle schools and 9,247 11th graders from 99

high schools were surveyed.

outh Risk Behavior Survey

The YRBS was developed by the Centers for Disease

Control and Prevention and was administered in a sam-

ple of Oregon schools every other year from 1991-2000.

The sample size varied between 1,600 and 32,000 and

the final data were weighted to more accurately repre-

sent the Oregon high school population. The question-

naire assessed behavioral risks among Oregon high

school students (grades 9 through 12) in the areas of

vehicle safety, weapon carrying and violence, tobacco

use, alcohol use, other drug use, sexual activity and

pregnancy, HIV knowledge and attitudes, eating behav-

iors, nutrition, exercise, and access to healthcare includ-

ing use of school-based health centers. A sample of

middle school students (grades 6 through 8) was added

in 1997. In 2000, over 7000 students participated in

the survey.

regon Public School Drug Use Survey

The Oregon Office of Mental Health and Addiction

Services (OMHAS) administered this anonymous sur-

vey every other year from 1986-2000 through the

Oregon public school system. It was patterned after the

ongoing national surveys of the National Institute on

Drug Abuse and included eighth and eleventh graders

since 1986; a sixth grade sample was added in 1994.

Schools were randomly sampled using a cluster sample

design and in 2000 included over 15,000 students.

The questionnaire assessed community characteristics,

tobacco use, drug use, alcohol use, drug/alcohol use

in student’s peer and family network, refusal skills,

susceptibility to future use, and attitudes toward school

and family.

B. Vital Statistics Data

Birth Certificate Statistical File

Data from the Birth Certificate Statistical File are coded

from birth certificates collected by the State Registrar

and represent all births occurring in Oregon and all

births occurring out-of-state to Oregon residents. This

database includes parental demographic information,

conditions of the newborn, congenital anomalies, med-

ical factors of pregnancy, method of delivery, complica-

tions of labor and delivery, smoking, drinking, or illicit

drug use during pregnancy, antenatal and intrapartum

procedures, and payor source. The birth data analyzed

for this report consist of births to Oregon residents and

exclude missing and unknown values.

eath Cer

tificate Statistical File

The Death Certificate Statistical File includes all deaths

occurring in Oregon and deaths occurring out-of-state

to Oregon residents. Data are obtained from death cer-

tificates that are collected by the State Registrar. The

data are used to examine trends in mortality and causes

of death. Variables in this database include cause of

death, date and place of death, decedent demographic

information, whether the death was related to tobacco

use, and county, place, and date of injury (if applicable).

The mortality data analyzed for this report consist of

deaths of Oregon residents.

C. Other

Oregon Department of Revenue Cigarette Tax Receipts

Data on the number of cigarettes smoked by

Oregonians are estimated based on tobacco tax revenue

collected by the Oregon Department of Revenue. The

Department of Revenue’s Monthly Receipt Statements

include data on cigarette tax collections. The number of

packs of cigarettes sold is calculated by dividing the cig-

arette tax receipts by the tax rate per pack. The number

of packs per capita is calculated by dividing the total

number of cigarette packs sold by the smoking popula-

tion estimate for Oregon.

moking-Attributable Morbidity, Mortality and

Economic Costs (SAMMEC)

SAMMEC is a computer software program developed

by the Centers for Disease Control and Prevention to

calculate several measures of the impact of cigarette

smoking for the entire U.S. and for each state. Using

state-specific data on smoking prevalence, overall mor-

tality rates, and population data, SAMMEC generates

the number of deaths and death rates due to smoking,

years of life lost due to premature death from cigarette

smoking, and lost productivity (earnings) due to illness

and premature death from smoking-related diseases.

Tobacco Sales to Minors Inspection Repor ts (Synar)

In July 1992, Congress enacted the Alcohol, Drug

Abuse and Mental Health Administration Act, which

includes an amendment aimed at decreasing access to

tobacco products among youth under 18. Named for its

sponsor, Congressman Mike Synar, the regulation

requires states to enact and enforce laws prohibiting any

manufacturer, retailer, or distributor from selling or dis-

tributing products to individuals under 18. In addition,

the regulation requires that each state annually conduct

random, unannounced inspections of a sample of tobac-

co vendors to assess their compliance with state law.

Oregon has conducted these inspections annually since

1994. The sample size has ranges from 352 in 1995 to

860 in 2004. Oregon Liquor Control Commission lists

are used as a sampling frame after exclusion of certain

classes of licensees that customarily do not sell tobacco

products. Retired state police accompanied by a teen

"buyer" conduct the inspections. Purchase attempts are

recorded in a database which includes the following

variables: county, region, inspection data, type of busi-

ness, type of access to tobacco product, type of purchase

attempted, whether age and/or ID was requested,

results, whether illegal vending machine was present,

whether signs are posted for minimum age require-

ments, and whether single cigarettes are available.

For more information, contact:

Tobacco Prevention & Education Program

Oregon Department of Human Services

800 NE Oregon Street, Suite 730

Portland, OR 97232

(503) 731-4273

(503) 731-4082 - fax

[email protected].us

www.healthoregon.org/tobacco

For additional copies, contact:

American Lung Association of Oregon

(503) 924-4094

1-800-LUNG-USA

www.lungoregon.org

Northwest Portland Area

Indian Health Board