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Tobacco Use Data Details

TU-1 Reduce tobacco use by adults
TU-1.1 Reduce cigarette smoking by adults Leading Health Indicators

Leading Health Indicators are a subset of Healthy People 2020 objectives selected to communicate high-priority health issues.

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Health Interview Survey (NHIS); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
Changed Since the Healthy People 2020 Launch
No
Measure
percent (age adjusted—see Comments)
Baseline (Year)
20.6 (2008)
Target
12.0
Target-Setting Method
Retention of Healthy People 2010 target
Numerator
Number of persons aged 18 years and over who have smoked at least 100 cigarettes in lifetime and who now report smoking cigarettes everyday or some days
Denominator
Number of persons aged 18 years and over
Questions Used to Obtain the National Baseline Data

From the 2008 National Health Interview Survey:

[NUMERATOR:]

Have you smoked at least 100 cigarettes in your entire life?

  1. Yes
  2. No
  3. Refused
  4. Don't know

[If yes:] Do you now smoke cigarettes everyday, some days, or not at all?

  1. Everyday
  2. Some days
  3. Not at all
  4. Refused
  5. Don't know
Data Collection Frequency
Annual
Comparable Healthy People 2010 Objective
Retained from HP2010 objective
Leading Health Indicator
Tobacco
Methodology Notes

Persons are considered as using cigarettes if they report that they smoked at least 100 cigarettes in their lifetime and now report smoking cigarettes everyday or some days.

Age Adjustment

This Indicator uses Age-Adjustment Groups:

  • Total: 18-24, 25-34, 35-44, 45-64, 65+
  • Sex: 18-24, 25-34, 35-44, 45-64, 65+
  • Race/Ethnicity: 18-24, 25-34, 35-44, 45-64, 65+
  • Educational Attainment: 25-34, 35-44, 45-64, 65+
  • Family Income: 18-24, 25-34, 35-44, 45-64, 65+
  • Family Type: 18-24, 25-34, 35-44, 45-64, 65+
  • Country of Birth: 18-24, 25-34, 35-44, 45-64, 65+
  • Disability Status: 18-24, 25-34, 35-44, 45-64, 65+
  • Geographic Location: 18-24, 25-34, 35-44, 45-64, 65+
  • Health Insurance Status: 18-24, 25-34, 35-44, 45-64
  • Marital Status: 18-24, 25-34, 35-44, 45-64, 65+
Changes Between HP2010 and HP2020
Starting in 1992, The National Health Interview Survey (NHIS) has defined current smokers as persons who have smoked at least 100 cigarettes and now smoke either everyday or some days. The 1992 inclusion of intermittent smoking increased the prevalence of smoking by approximately one percent compared with estimates derived from the previous smoking definition.

References

Additional resources about the objective.

  1. CDC. Cigarette smoking among adults---United States, 2007. MMWR 2008; 57:1221-1226.
  2. CDC. State-specific smoking-attributable mortality and years of potential life lost---United States, 2000—2004. MMWR 2009; 58:29-33.

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Health Interview Survey (NHIS); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
Changed Since the Healthy People 2020 Launch
No
Measure
percent (age adjusted—see Comments)
Baseline (Year)
2.3 (2005)
Target
0.3
Target-Setting Method
2 percentage point improvement
Numerator
Number of persons aged 18 years and over who report using snuff or chewing tobacco at least 20 times in their lifetime and now use it every day or some days
Denominator
Number of persons aged 18 years and over
Questions Used to Obtain the National Baseline Data

From the 2005 National Health Interview Survey:

[NUMERATOR:]

Have you used snuff such as Skoal, Skoal Bandits, or Copenhagen at least 20 times in your entire life?

  1. Yes
  2. No
  3. Refused
  4. Don't know

[If yes:] Do you now use snuff everyday, some days, or not at all?

  1. Everyday
  2. Some days
  3. Not at all
  4. Refused
  5. Don't know

Have you ever used chewing tobacco such as Redman, Levi Garrett, or Beechnut at least 20 times in your entire life?

  1. Yes
  2. No
  3. Refused
  4. Don't know

[If yes:] Do you now use chewing tobacco everyday, some days, or not at all?

  1. Everyday
  2. Some days
  3. Not at all
  4. Refused
  5. Don't know
Data Collection Frequency
Periodic
Comparable Healthy People 2010 Objective
Retained from HP2010 objective
Methodology Notes

Persons are classified as using either snuff or chewing tobacco if they answer “yes” to either use of snuff or use of chewing tobacco, and they report using the snuff or chewing tobacco “everyday” or “some days.”

Age Adjustment

This Indicator uses Age-Adjustment Groups:

  • Total: 18-24, 25-34, 35-44, 45-64, 65+
  • Sex: 18-24, 25-34, 35-44, 45-64, 65+
  • Race/Ethnicity: 18-24, 25-34, 35-44, 45-64, 65+
  • Educational Attainment: 25-34, 35-44, 45-64, 65+
  • Family Income: 18-24, 25-34, 35-44, 45-64, 65+
  • Family Type: 18-24, 25-34, 35-44, 45-64, 65+
  • Country of Birth: 18-24, 25-34, 35-44, 45-64, 65+
  • Disability Status: 18-24, 25-34, 35-44, 45-64, 65+
  • Geographic Location: 18-24, 25-34, 35-44, 45-64, 65+
  • Health Insurance Status: 18-24, 25-34, 35-44, 45-64
  • Marital Status: 18-24, 25-34, 35-44, 45-64, 65+
Changes Between HP2010 and HP2020
The title of this objective was revised from 'Reduce the use of spit tobacco' in Healthy People 2010 (objective 27-01b) to 'Reduce the use of smokeless tobacco products'. This modification resulted from the introduction of new tobacco products that no longer require the act of spitting. Although the objective language has changed, the measure used to assess progress toward the Healthy People 2020 objective target is identical to the Healthy People 2010 measure.

References

Additional resources about the objective.

  1. CDC. Cigarette smoking among adults---United States, 2007. MMWR 2008; 57:1221-1226.
  2. CDC. State-specific smoking-attributable mortality and years of potential life lost---United States, 2000—2004. MMWR 2009; 58:29-33.

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Health Interview Survey (NHIS); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
Changed Since the Healthy People 2020 Launch
No
Measure
percent (age adjusted—see Comments)
Baseline (Year)
2.2 (2005)
Target
0.2
Target-Setting Method
2 percentage point improvement
Numerator
Number of persons aged 18 years and over who report having smoked at least 50 cigars in lifetime and now smoke cigars everyday or some days
Denominator
Number of persons aged 18 years and over
Questions Used to Obtain the National Baseline Data

From the 2005 National Health Interview Survey:

[NUMERATOR:]

Have you ever smoked a cigar EVEN ONE TIME?

  1. Yes
  2. No
  3. Refused
  4. Don't know

[If yes:]

Have you smoked at least 50 cigars in your entire life?

  1. Yes
  2. No
  3. Refused
  4. Don't know

Do you now smoke cigars every day, some days, or not at all?

  1. Every day
  2. Some days
  3. Not at all
  4. Refused
  5. Don't know
Data Collection Frequency
Periodic
Comparable Healthy People 2010 Objective
Retained from HP2010 objective
Methodology Notes

Persons are classified as smoking cigars if they answer “yes” to smoking 50 cigars in their lifetime, and report smoking cigars “everyday” or “some days.”

Age Adjustment

This Indicator uses Age-Adjustment Groups:

  • Total: 18-24, 25-34, 35-44, 45-64, 65+
  • Sex: 18-24, 25-34, 35-44, 45-64, 65+
  • Race/Ethnicity: 18-24, 25-34, 35-44, 45-64, 65+
  • Educational Attainment: 25-34, 35-44, 45-64, 65+
  • Family Income: 18-24, 25-34, 35-44, 45-64, 65+
  • Family Type: 18-24, 25-34, 35-44, 45-64, 65+
  • Country of Birth: 18-24, 25-34, 35-44, 45-64, 65+
  • Disability Status: 18-24, 25-34, 35-44, 45-64, 65+
  • Geographic Location: 18-24, 25-34, 35-44, 45-64, 65+
  • Health Insurance Status: 18-24, 25-34, 35-44, 45-64
  • Marital Status: 18-24, 25-34, 35-44, 45-64, 65+

References

Additional resources about the objective.

  1. CDC. Cigarette smoking among adults---United States, 2007. MMWR 2008; 57:1221-1226.
  2. CDC. State-specific smoking-attributable mortality and years of potential life lost---United States, 2000—2004. MMWR 2009; 58:29-33.
TU-2 Reduce tobacco use by adolescents

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
Youth Risk Behavior Surveillance System (YRBSS); Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (CDC/NCHHSTP)
Changed Since the Healthy People 2020 Launch
No
Measure
percent 
Baseline (Year)
26.0 (2009)
Target
21.0
Target-Setting Method
Retention of Healthy People 2010 target
Numerator
Number of students in grades 9 through 12 who report using cigarettes, spit tobacco, or cigars on 1 or more of the 30 days preceding the survey
Denominator
Number of students in grades 9 through 1
Questions Used to Obtain the National Baseline Data

From the 2009 Youth Risk Behavior Surveillance System:

[NUMERATOR:]

During the past 30 days, on how many days did you smoke cigarettes?

  1. 0 days
  2. 1 or 2 days
  3. 3 to 5 days
  4. 6 to 9 days
  5. 10 to 19 days
  6. 20 to 29 days
  7. All 30 days

During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, or Copenhagen?

  1. 0 days
  2. 1 or 2 days
  3. 3 to 5 days
  4. 6 to 9 days
  5. 10 to 19 days
  6. 20 to 29 days
  7. All 30 days

During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars?

  1. 0 days
  2. 1 or 2 days
  3. 3 to 5 days
  4. 6 to 9 days
  5. 10 to 19 days
  6. 20 to 29 days
  7. All 30 days
Data Collection Frequency
Biennial
Comparable Healthy People 2010 Objective
Retained from HP2010 objective
Methodology Notes

Students are classified as using tobacco if they report using at least one of the tobacco products cited in the numerator questions on one or more of the 30 days preceding the survey.

TU-2.2 Reduce use of cigarettes by adolescents (past month) Leading Health Indicators

Leading Health Indicators are a subset of Healthy People 2020 objectives selected to communicate high-priority health issues.

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
Youth Risk Behavior Surveillance System (YRBSS); Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (CDC/NCHHSTP)
Changed Since the Healthy People 2020 Launch
No
Measure
percent 
Baseline (Year)
19.5 (2009)
Target
16.0
Target-Setting Method
Retention of Healthy People 2010 target
Numerator
Number of students in grades 9 through 12 who report having smoked cigarettes on 1 or more of the 30 days preceding the survey
Denominator
Number of students in grades 9 through 12
Questions Used to Obtain the National Baseline Data

From the 2009 Youth Risk Behavior Surveillance System:

[NUMERATOR:]

During the past 30 days, on how many days did you smoke cigarettes?

  1. 0 days
  2. 1 or 2 days
  3. 3 to 5 days
  4. 6 to 9 days
  5. 10 to 19 days
  6. 20 to 29 days
  7. All 30 days
Data Collection Frequency
Biennial
Comparable Healthy People 2010 Objective
Retained from HP2010 objective
Leading Health Indicator
Tobacco
Methodology Notes

Students are classified as using cigarettes if they report smoking cigarettes on one or more of the 30 days preceding the survey.

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
Youth Risk Behavior Surveillance System (YRBSS); Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (CDC/NCHHSTP)
Changed Since the Healthy People 2020 Launch
No
Measure
percent 
Baseline (Year)
8.9 (2009)
Target
6.9
Target-Setting Method
2 percentage point improvement
Numerator
Number of students in grades 9 through 12 who report having used smokeless (chewing tobacco, snuff, or dip) tobacco on one or more of the 30 days preceding the survey
Denominator
Number of students in grades 9 through 12
Questions Used to Obtain the National Baseline Data

From the 2009 Youth Risk Behavior Surveillance System:

[NUMERATOR:]

During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, or Copenhagen?

  1. 0 days
  2. 1 or 2 days
  3. 3 to 5 days
  4. 6 to 9 days
  5. 10 to 19 days
  6. 20 to 29 days
  7. All 30 days
Data Collection Frequency
Biennial
Comparable Healthy People 2010 Objective
Retained from HP2010 objective
Methodology Notes

Students are classified as using smokeless tobacco if they report using chewing tobacco, snuff, or dip on one of more of the 30 days preceding the survey.

Changes Between HP2010 and HP2020
The title of this objective was revised from 'Reduce spit tobacco use (past month)' in Healthy People 2010 (27-02c) to 'Reduce use of smokeless tobacco products by adolescents (past month)'. This modification resulted from the introduction of new tobacco products which no longer require the act of “spitting.” Although the objective language has changed, the measure used to assess progress toward the Healthy People 2020 target is identical to the Healthy People 2010 measure.

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
Youth Risk Behavior Surveillance System (YRBSS); Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (CDC/NCHHSTP)
Changed Since the Healthy People 2020 Launch
No
Measure
percent 
Baseline (Year)
14.0 (2009)
Target
8.0
Target-Setting Method
Retention of Healthy People 2010 target
Numerator
Number of students in grades 9 through 12 who report having smoked cigars on 1 or more of the 30 days preceding the survey
Denominator
Number of students in grades 9 through 12
Questions Used to Obtain the National Baseline Data

From the 2009 Youth Risk Behavior Surveillance System:

[NUMERATOR:]

During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars?

  1. 0 days
  2. 1 or 2 days
  3. 3 to 5 days
  4. 6 to 9 days
  5. 10 to 19 days
  6. 20 to 29 days
  7. All 30 days
Data Collection Frequency
Biennial
Comparable Healthy People 2010 Objective
Retained from HP2010 objective
Methodology Notes

Students are classified as using cigars if they report smoking one or more cigars on one of more of the 30 days preceding the survey.

TU-3 Reduce the initiation of tobacco use among children, adolescents, and young adults

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Survey on Drug Use and Health (NSDUH); Substance Abuse and Mental Health Services Administration (SAMHSA)
Changed Since the Healthy People 2020 Launch
Yes
Measure
percent 
Baseline (Year)
7.8 (2008)
Target
5.8
Target-Setting Method
2 percentage point improvement
Numerator
Number of persons aged 12 to 17 years who used tobacco products for the first time in the 12 months prior to the date of the interview
Denominator
Number of persons aged 12 to 17 who did not use tobacco products in their lifetime or who used tobacco products for the first time in the 12 months prior to the date of the interview
Questions Used to Obtain the National Baseline Data

From the 2008 National Survey on Drug Use and Health:

[NUMERATOR:]

How old were you the first time you smoked part or all of a cigarette?

_______

How old were you the first time you used snuff?

_______

How old were you the first time you used chewing tobacco?

_______

How old were you the first time you smoked part or all of any type of cigar?

_______

Data Collection Frequency
Annual
Comparable Healthy People 2010 Objective
Not applicable
Methodology Notes

Initiation of tobacco use in the 12 months prior to date of interview was identified by examining the youth’s interview date, birth date, and initiation date of first tobacco use. Tobacco use includes cigarettes, snuff, chewing tobacco, and any type of cigar. Persons who responded that they have used any of these tobacco products for more than 12 months are not included in this measure.

Revision History

Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

Description of Changes Since the Healthy People 2020 Launch

During regular data collection and processing checks, errors were identified in the NSDUH data. These errors affected the data for Pennsylvania (2006-2010) and Maryland (2008-2009). These errors had minimal impact on the national estimates and no effect on direct estimates for the other 48 states and the District of Columbia. Comparing estimates for Pennsylvania, Maryland, the mid-Atlantic division, and the Northeast region were of most concern. As a result, in 2013, the baseline value was revised from 7.7% to 7.8%. The target was revised from 5.7% to 5.8% following the original target setting method.

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Survey on Drug Use and Health (NSDUH); Substance Abuse and Mental Health Services Administration (SAMHSA)
Changed Since the Healthy People 2020 Launch
Yes
Measure
percent 
Baseline (Year)
6.3 (2008)
Target
4.3
Target-Setting Method
2 percentage point improvement
Numerator
Number of persons aged 12 to 17 years who used cigarettes for the first time in the 12 months prior to the date of the interview
Denominator
Number of persons aged 12 to 17 who did not use cigarettes in their lifetime or who used cigarettes for the first time in the 12 months prior to the date of the interview
Questions Used to Obtain the National Baseline Data

From the 2008 National Survey on Drug Use and Health:

[NUMERATOR:]

How old were you the first time you smoked part or all of a cigarette?

_______

Data Collection Frequency
Annual
Comparable Healthy People 2010 Objective
Retained from HP2010 objective
Methodology Notes

Initiation of cigarette use in the 12 months prior to the date of the interview was identified by examining the youth's interview date, birth date, and initiation date of first cigarette use.

Revision History

Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

Description of Changes Since the Healthy People 2020 Launch

During regular data collection and processing checks, errors were identified in the NSDUH data. These errors affected the data for Pennsylvania (2006-2010) and Maryland (2008-2009). These errors had minimal impact on the national estimates and no effect on direct estimates for the other 48 states and the District of Columbia. Comparing estimates for Pennsylvania, Maryland, the mid-Atlantic division, and the Northeast region were of most concern. As a result in 2013, the baseline value was revised from 6.2% to 6.3%. The target was revised from 4.2% to 4.3% following the original target setting method.

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Survey on Drug Use and Health (NSDUH); Substance Abuse and Mental Health Services Administration (SAMHSA)
Changed Since the Healthy People 2020 Launch
Yes
Measure
percent 
Baseline (Year)
2.6 (2008)
Target
0.6
Target-Setting Method
2 percentage point improvement
Numerator
Number of persons aged 12 to 17 years who used smokeless tobacco products for the first time in the 12 months prior to the date of the interview
Denominator
Number of persons aged 12 to 17 who did not use smokeless tobacco products in their lifetime or who used smokeless tobacco products for the first time in the 12 months prior to the date of the interview
Questions Used to Obtain the National Baseline Data

From the National Survey on Drug Use and Health:

[NUMERATOR:]

How old were you the first time you used snuff?

_______

How old were you the first time you used chewing tobacco?

_______

Data Collection Frequency
Annual
Comparable Healthy People 2010 Objective
Not applicable
Methodology Notes

Initiation of smokeless tobacco use in the 12 months prior to date of interview was identified by examining the youth’s interview date, birth date, and initiation date of first tobacco use. Smokeless tobacco use includes snuff and chewing tobacco. Persons who responded that they have used either snuff or chewing tobacco for more than 12 months are not included in this measure.

Revision History

Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

Description of Changes Since the Healthy People 2020 Launch

During regular data collection and processing checks, errors were identified in the NSDUH data. These errors affected the data for Pennsylvania (2006-2010) and Maryland (2008-2009). These errors had minimal impact on the national estimates and no effect on direct estimates for the other 48 states and the District of Columbia. Comparing estimates for Pennsylvania, Maryland, the mid-Atlantic division, and the Northeast region were of most concern. As a result in 2013, the baseline value was revised from 2.5% to 2.6%. The target was revised from 0.5% to 0.6% following the original target setting method.

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Survey on Drug Use and Health (NSDUH); Substance Abuse and Mental Health Services Administration (SAMHSA)
Changed Since the Healthy People 2020 Launch
Yes
Measure
percent 
Baseline (Year)
4.9 (2008)
Target
2.9
Target-Setting Method
2 percentage point improvement
Numerator
Number of persons aged 12 to 17 years who used cigars for the first time in the 12 months prior to the date of the interview
Denominator
Number of persons aged 12 to 17 who did not use cigars in their lifetime or who used cigars for the first time in the 12 months prior to the date of the interview
Questions Used to Obtain the National Baseline Data

From the National Survey on Drug Use and Health:

[NUMERATOR:]

How old were you the first time you smoked part or all of any type of cigar? _______

Data Collection Frequency
Annual
Comparable Healthy People 2010 Objective
Not applicable
Methodology Notes

Initiation of cigar use in the 12 months prior to the date of the interview was identified by examining the youth's interview date, birth date, and initiation date of first cigar use.

Revision History

Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

Description of Changes Since the Healthy People 2020 Launch

During regular data collection and processing checks, errors were identified in the NSDUH data. These errors affected the data for Pennsylvania (2006-2010) and Maryland (2008-2009). These errors had minimal impact on the national estimates and no effect on direct estimates for the other 48 states and the District of Columbia. Comparing estimates for Pennsylvania, Maryland, the mid-Atlantic division, and the Northeast region were of most concern. As a result in 2013, the baseline value was revised from 4.8% to 4.9%. The target was revised from 2.8% to 2.9% following the original target setting method.

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Survey on Drug Use and Health (NSDUH); Substance Abuse and Mental Health Services Administration (SAMHSA)
Changed Since the Healthy People 2020 Launch
Yes
Measure
percent 
Baseline (Year)
10.9 (2008)
Target
8.9
Target-Setting Method
2 percentage point improvement
Numerator
Number of persons aged 18 to 25 years who used tobacco products for the first time in the 12 months prior to the date of the interview
Denominator
Number of persons aged 18 to 25 who did not use tobacco products in their lifetime or who used tobacco products for the first time in the 12 months prior to the date of the interview
Questions Used to Obtain the National Baseline Data

From the National Survey on Drug Use and Health:

[NUMERATOR:]

How old were you the first time you smoked part or all of a cigarette? _______

How old were you the first time you used snuff? _______

How old were you the first time you used chewing tobacco? _______

How old were you the first time you smoked part or all of any type of cigar? _______

Data Collection Frequency
Annual
Comparable Healthy People 2010 Objective
Not applicable
Methodology Notes

Initiation of tobacco use in the 12 months prior to date of interview was identified by examining the youth’s interview date, birth date, and initiation date of first tobacco use. Tobacco use includes cigarettes, snuff, chewing tobacco, and any type of cigar. Persons who responded that they have used any of these tobacco products for more than 12 months are not included in this measure.

Revision History

Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

Description of Changes Since the Healthy People 2020 Launch

During regular data collection and processing checks, errors were identified in the NSDUH data. These errors affected the data for Pennsylvania (2006-2010) and Maryland (2008-2009). These errors had minimal impact on the national estimates and no effect on direct estimates for the other 48 states and the District of Columbia. Comparing estimates for Pennsylvania, Maryland, the mid-Atlantic division, and the Northeast region were of most concern. As a result in 2013, the baseline value was revised from 10.8% to 10.9%. The target was revised from 8.8% to 8.9% following the original target setting method.

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Survey on Drug Use and Health (NSDUH); Substance Abuse and Mental Health Services Administration (SAMHSA)
Changed Since the Healthy People 2020 Launch
Yes
Measure
percent 
Baseline (Year)
8.4 (2008)
Target
6.4
Target-Setting Method
2 percentage point improvement
Numerator
Number of persons aged 18 to 25 years who used cigarettes for the first time in the 12 months prior to the date of the interview
Denominator
Number of persons aged 18 to 25 who did not use cigarettes in their lifetime or who used cigarettes for the first time in the 12 months prior to the date of the interview
Questions Used to Obtain the National Baseline Data

From the 2008 National Survey on Drug Use and Health:

[NUMERATOR:]

How old were you the first time you smoked part or all of a cigarette?

_______

Data Collection Frequency
Annual
Comparable Healthy People 2010 Objective
Retained from HP2010 objective
Methodology Notes

Initiation of cigarette use in the 12 months prior to the date of the interview was identified by examining the youth's interview date, birth date, and initiation date of first cigarette use.

Revision History

Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

Description of Changes Since the Healthy People 2020 Launch

During regular data collection and processing checks, errors were identified in the NSDUH data. These errors affected the data for Pennsylvania (2006-2010) and Maryland (2008-2009). These errors had minimal impact on the national estimates and no effect on direct estimates for the other 48 states and the District of Columbia. Comparing estimates for Pennsylvania, Maryland, the mid-Atlantic division, and the Northeast region were of most concern. As a result in 2013, the baseline value was revised from 8.3% to 8.4%. The target was revised from 6.3% to 6.4% following the original target setting method.

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Survey on Drug Use and Health (NSDUH); Substance Abuse and Mental Health Services Administration (SAMHSA)
Changed Since the Healthy People 2020 Launch
Yes
Measure
percent 
Baseline (Year)
2.2 (2008)
Target
0.2
Target-Setting Method
2 percentage point improvement
Numerator
Number of persons aged 18 to 25 years who used smokeless tobacco products for the first time in the 12 months prior to the date of the interview
Denominator
Number of persons aged 18 to 25 who did not use smokeless tobacco products in their lifetime or who used smokeless tobacco products for the first time in the 12 months prior to the date of the interview
Questions Used to Obtain the National Baseline Data

From the National Survey on Drug Use and Health:

[NUMERATOR:]

How old were you the first time you used snuff?

_______

How old were you the first time you used chewing tobacco?

_______

Data Collection Frequency
Annual
Comparable Healthy People 2010 Objective
Not applicable
Methodology Notes

Initiation of smokeless tobacco use in the 12 months prior to date of interview was identified by examining the youth’s interview date, birth date, and initiation date of first tobacco use. Smokeless tobacco use includes snuff and chewing tobacco. Persons who responded that they have used either snuff or chewing tobacco for more than 12 months are not included in this measure.

Revision History

Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

Description of Changes Since the Healthy People 2020 Launch

During regular data collection and processing checks, errors were identified in the NSDUH data. These errors affected the data for Pennsylvania (2006-2010) and Maryland (2008-2009). These errors had minimal impact on the national estimates and no effect on direct estimates for the other 48 states and the District of Columbia. Comparing estimates for Pennsylvania, Maryland, the mid-Atlantic division, and the Northeast region were of most concern. However, the baseline and target values did not change as a result.

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Survey on Drug Use and Health (NSDUH); Substance Abuse and Mental Health Services Administration (SAMHSA)
Changed Since the Healthy People 2020 Launch
Yes
Measure
percent 
Baseline (Year)
6.3 (2008)
Target
4.3
Target-Setting Method
2 percentage point improvement
Numerator
Number of persons aged 18 to 25 years who used cigars for the first time in the 12 months prior to the date of the interview
Denominator
Number of persons aged 18 to 25 who did not use cigars in their lifetime or who used cigars for the first time in the 12 months prior to the date of the interview
Questions Used to Obtain the National Baseline Data

From the National Survey on Drug Use and Health:

[NUMERATOR:]

How old were you the first time you smoked part or all of any type of cigar?

_______

Data Collection Frequency
Annual
Comparable Healthy People 2010 Objective
Not applicable
Methodology Notes

Initiation of cigar use in the 12 months prior to the date of the interview was identified by examining the youth's interview date, birth date, and initiation date of first cigar use.

Revision History

Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

Description of Changes Since the Healthy People 2020 Launch

During regular data collection and processing checks, errors were identified in the NSDUH data. These errors affected the data for Pennsylvania (2006-2010) and Maryland (2008-2009). These errors had minimal impact on the national estimates and no effect on direct estimates for the other 48 states and the District of Columbia. Comparing estimates for Pennsylvania, Maryland, the mid-Atlantic division, and the Northeast region were of most concern. As a result in 2013, the baseline value was revised from 6.1% to 6.3%. The target was revised from 4.1% to 4.3% following the original target setting method.

TU-4 Increase smoking cessation attempts by adult smokers

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Health Interview Survey (NHIS); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
Changed Since the Healthy People 2020 Launch
No
Measure
percent (age adjusted—see Comments)
Baseline (Year)
48.3 (2008)
Target
80.0
Target-Setting Method
Retention of Healthy People 2010 target
Numerator
Number of current cigarette smokers aged 18 years and over who quit smoking for 1 day or longer during the 12 months prior to the interview and former smokers abstinent less than 365 days
Denominator
Number of persons aged 18 years and over who are current cigarette smokers or former smokers abstinent less than 365 days
Questions Used to Obtain the National Baseline Data

From the 2008 National Health Interview Survey:

[NUMERATOR:]

Have you smoked at least 100 cigarettes in your entire life?

  1. Yes
  2. No
  3. Refused
  4. Don't Know

[If yes:] Do you now smoke cigarettes everyday, some days, or not at all?

  1. Everyday
  2. Some days
  3. Not at all
  4. Refused
  5. Don't Know

[If everyday or some days:] During the past 12 months, have you stopped smoking for 1 day or longer BECAUSE YOU WERE TRYING TO QUIT SMOKING?

  1. Yes
  2. No
  3. Refused
  4. Don't Know

[If not at all:] How long has it been since you quit smoking cigarettes?

  1. _______ days
  2. _______ weeks
  3. _______ months
  4. _______ years
  5. Refused
  6. Don't Know
Data Collection Frequency
Annual
Comparable Healthy People 2010 Objective
Retained from HP2010 objective
Methodology Notes

Adults are classified as current smokers if they report currently smoking cigarettes "everyday" or "some days".

The methodology counts both successful (currently abstinent less than one year) and failed cessation attempts in the last 12 months.

Age Adjustment

This Indicator uses Age-Adjustment Groups:

  • Total: 18-24, 25-34, 35-44, 45-64, 65+
  • Sex: 18-24, 25-34, 35-44, 45-64, 65+
  • Race/Ethnicity: 18-24, 25-34, 35-44, 45-64, 65+
  • Educational Attainment: 25-34, 35-44, 45-64, 65+
  • Family Income: 18-24, 25-34, 35-44, 45-64, 65+
  • Family Type: 18-24, 25-34, 35-44, 45-64, 65+
  • Country of Birth: 18-24, 25-34, 35-44, 45-64, 65+
  • Disability Status: 18-24, 25-34, 35-44, 45-64, 65+
  • Geographic Location: 18-24, 25-34, 35-44, 45-64, 65+
  • Health Insurance Status: 18-24, 25-34, 35-44, 45-64
  • Marital Status: 18-24, 25-34, 35-44, 45-64, 65+

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Health Interview Survey (NHIS); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
Changed Since the Healthy People 2020 Launch
No
Measure
percent 
Numerator
Number of current cigarette smokers aged 18 years and older who quit smoking for 1 day or longer during the 12 months prior to the interview using evidence-based strategies plus former smokers who are abstinent less than 365 days who used evidence based strategies the last time they quit
Denominator
Number of adults in the survey population aged 18 years and older who are current cigarette smokers plus former smokers abstinent less than 365 days
Questions Used to Obtain the National Baseline Data

From the 2005 National Health Interview Survey Cancer Control Supplement:

[NUMERATOR:]

Proposed Survey Questions:

Have you smoked at least 100 cigarettes in your entire life?

[If yes:]

Do you now smoke cigarettes everyday, some days, or not at all:]

[if everyday or some days]

During the past 12 months, have you stopped smoking for 1 day or longer BECAUSE YOU WERE TRYING TO QUIT SMOKING?

[if not at all]

How long has it been since you quit smoking cigarettes?

[if everyday, some days, or not at all]

Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following PRODUCTS:

Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:

  • A nicotine gum
  • A nicotine patch
  • Any of these other nicotine products-nasal spray, inhaler, lozenge or tablet
  • A prescription pill, such as Zyban, Buproprion, or Wellbutrin

Thinking back to when you last stopped smoking completely, did you use ANY of the following:

  • A telephone help line or quit line
  • A stop smoking clinic, class, or support group
  • One-on-one counseling
Comparable Healthy People 2010 Objective
Not applicable
Methodology Notes

Adults are classified as current smokers if they report currently smoking cigarettes "everyday" or "some days".

The methodology counts both successful (currently abstinent less than one year) and failed cessation attempts in the last 12 months for those who used the evidence based cessation methods listed under the baseline questions above.

TU-5 Increase recent smoking cessation success by adult smokers

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Health Interview Survey (NHIS); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
Changed Since the Healthy People 2020 Launch
No
Measure
percent (age adjusted—see Comments)
Baseline (Year)
6.0 (2008)
Target
8.0
Target-Setting Method
2 percentage point improvement
Numerator
Number of persons aged 18 years and over who ever smoked 100 cigarettes, who do not smoke now, and last smoked 6 months to 1 year ago.
Denominator
Number of persons aged 18 years and over who have ever smoked 100 cigarettes, who do not smoke now, and last smoked less than or equal to 1 year ago, PLUS current smokers who initiated smoking at least 2 years ago.
Questions Used to Obtain the National Baseline Data

From the 2008 National Health Interview Survey:

[NUMERATOR and DENOMINATOR:]

How long has it been since you quit smoking cigarettes?

  1. _______ days
  2. _______ weeks
  3. _______ months
  4. _______ years
  5. Refused
  6. Don't Know

Have you smoked at least 100 cigarettes in your ENTIRE LIFE?

  1. Yes
  2. No
  3. Refused
  4. Don't Know

How old were you when you FIRST started to smoke fairly regularly?

_____ years of age

  • Refused
  • Don't Know
  • Do you NOW smoke cigarettes every day, some days or not at all?

    1. Every day
    2. Some days
    3. Not at all
    4. Refused
    5. Don't Know
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    This indicator measures the proportion of current adult smokers aged 18 years and over who are eligible to be a recent quitter who have had recent smoking cessation success. Persons who are eligible to quit smoking in the last year include persons who have ever smoked 100 cigarettes and who report that they stopped smoking within the past 1 year as well as current (everyday or someday) smokers who initiated smoking 2 or more years ago.

    Time since initiation is determined by subtracting the age reported for when the respondent first started smoking regularly from the respondent’s current age. If the difference is 2 years or greater these persons are considered to be eligible to be a recent quitter. Persons who responded that they were 85 years or older when they first started smoking regularly are counted as initiating at age 85.

    Persons who reported that they stopped smoking in the past 1 year can report time since quitting in days, weeks, months, and years and are included in the denominator if they reported as follows: (1-94 days; 1-52 weeks; 1-12 months; 1 year). Recent success in smoking cessation included persons who reported that they stopped smoking 6 months to 1 year ago and are included in the numerator if they reported as follows: (26-52 weeks; 6-12 months; 1 year).

    Age Adjustment

    This Indicator uses Age-Adjustment Groups:

    • Total: 18-24, 25-34, 35-44, 45-64, 65+
    • Sex: 18-24, 25-34, 35-44, 45-64, 65+
    • Race/Ethnicity: 18-24, 25-34, 35-44, 45-64, 65+
    • Educational Attainment: 25-34, 35-44, 45-64, 65+
    • Family Income: 18-24, 25-34, 35-44, 45-64, 65+
    • Family Type: 18-24, 25-34, 35-44, 45-64, 65+
    • Country of Birth: 18-24, 25-34, 35-44, 45-64, 65+
    • Disability Status: 18-24, 25-34, 35-44, 45-64, 65+
    • Geographic Location: 18-24, 25-34, 35-44, 45-64, 65+
    • Health Insurance Status: 18-24, 25-34, 35-44, 45-64
    • Marital Status: 18-24, 25-34, 35-44, 45-64, 65+
    Caveats and Limitations
    Please note that responses of 1 year ago for time since quit may actually be greater than 1 year depending on how the respondent responded to the survey question.

    References

    Additional resources about the objective.

    1. CDC. Cigarette smoking among adults --- United States, 2007. MMWR 2008; 57:1221-1226.
    2. Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Quick Reference Guide for Clinicians. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. April 2009.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    National Health Interview Survey (NHIS); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    *** Missing *** 
    Numerator
    Number of adults 18+ who ever smoked 100 cigarettes, who do not smoke now, who last smoked 6months to 1 year ago, and who used evidence-based strategies to quit.
    Denominator
    Number of adults 18+ who have ever smoked 100 cigarettes, who do not smoke now, and last smoked less than or equal to 1 year ago, PLUS current smokers who initiated smoking at least 2 years ago.
    Questions Used to Obtain the National Baseline Data

    From the 2005 National Health Interview Survey Cancer Control Supplement:

    [NUMERATOR:]

    Proposed Survey Questions:

    Have you smoked at least 100 cigarettes in your ENTIRE LIFE?

    1. Yes
    2. No

    How old were you when you FIRST started to smoke fairly regularly?

    Do you NOW smoke cigarettes every day, some days or not at all?

    1. Every day
    2. Some days
    3. Not at all

    How long has it been since you quit smoking cigarettes?

    1. _____ Days
    2. _____ Weeks
    3. _____ Months
    4. _____ Years

    Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:

    A nicotine gum

    1. Yes
    2. No

    A nicotine patch

    1. Yes
    2. No

    Any of these other nicotine products-nasal spray, inhaler, lozenge or tablet

    1. Yes
    2. No

    A prescription pill, such as Zyban, Buproprion, or Wellbutrin

    1. Yes
    2. No

    Thinking back to when you stopped smoking completely, did you use ANY of the following:

    A telephone help line or quit line

    1. Yes
    2. No

    A stop smoking clinic, class, or support group

    1. Yes
    2. No

    One-on-one counseling

    1. Yes
    2. No
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    This indicator measures the proportion of current adult smokers age 18+ who are eligible to be a recent quitter who have had recent smoking cessation success using evidence based strategies. Persons who were eligible to quit smoking in the last year include persons who have ever smoked 100 cigarettes who reported that they stopped smoking within the past 1 year as well as current (everyday or someday) smokers who initiated smoking 2 or more years ago. Time since initiation is determined by subtracting the age reported for when the respondent first started smoking regularly from the respondent’s current age. If the difference is 2 years or greater these persons are considered to be eligible to be a recent quitter. Persons who responded that they were 85 years or older when they first started smoking regularly are counted as initiating at age 85. Persons who reported that they stopped smoking in the past 1 year can report time since quitting in days, weeks, months, and years and are included in the denominator if they reported as follows: (1-94 days or 95 plus days; 1-52 weeks; 1-12 months; 1 year).

    Recent success in smoking cessation using evidence based strategies includes persons who report both that 1. they used at least one of the following evidence base strategies when they stopped smoking: ([A nicotine gum] [A nicotine patch] [Any of these other nicotine products—nasal spray, inhaler, lozenge or tablet] [A prescription pill, such as Zyban, Buproprion, or Wellbutrin] [A telephone help line or quit line] [A stop smoking clinic, class, or support group] [One-on-one counseling]) and 2. they stopped smoking 6 months to 1 year ago reported as : (26-52 weeks; 6-12 months; 1 year).

    The 2008 update to the Clinical Practice Guidelines reviewed the literature on clinical interventions for tobacco use and dependence to provide recommendations for evidence-based cessation methods. At the present time (July 2009), Bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch and Varenicline are first-line medications that have been proven to increase long-term smoking cessation rates. Individual, group and telephone counseling were found to be effective, especially when combined with practical counseling (problem-solving or skills training) and social support delivered as a component of treatment. Self-help materials distributed using books, pamphlets, videotapes and the Internet or the World Wide Web appear to increase smoking cessation rates when compared to no treatment, however the effect was weak. These findings do not provide support for acupuncture or hypnosis as successful smoking cessation methods.

    Caveats and Limitations
    Please note that responses of 1 year ago for time since quit may actually be greater than 1 year depending on how the respondent responded to the survey question.

    References

    Additional resources about the objective.

    1. CDC. Cigarette smoking among adults --- United States, 2007. MMWR 2008; 57:1221-1226.
    2. Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Quick Reference Guide for Clinicians. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. April 2009.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    National Health Interview Survey (NHIS); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    percent 
    Baseline (Year)
    11.3 (2005)
    Target
    30.0
    Target-Setting Method
    Retention of Healthy People 2010 target
    Numerator
    Number of females aged 18 to 49 years who reported having a live birth in the past 5 years and smoking at any time during their pregnancy with their last child and who quit smoking in their first trimester and stayed off cigarettes for the rest of their pregnancy
    Denominator
    Number of females aged 18 to 49 years who reported having a live birth in the past 5 years and smoking at any time during their pregnancy with their last child
    Questions Used to Obtain the National Baseline Data

    From the 2005 National Health Interview Survey:

    [NUMERATOR AND DENOMINATOR:]

    (Has/have) (you/Person) given birth to a liveborn infant in the past 5 years?

    1. Yes
    2. No
    3. Refused
    4. Don't know

    [If yes:] Were you smoking cigarettes when you became pregnant with your last child?

    1. Yes
    2. No
    3. Refused
    4. Don't know

    [If yes:] Did you smoke cigarettes at any time during your pregnancy with your last child?

    1. Yes
    2. No
    3. Refused
    4. Don't know

    [NUMERATOR:]

    [If yes:] Did you quit smoking for 7 days or longer during your pregnancy with your last child?

    1. Yes
    2. No
    3. Refused
    4. Don't know

    [If yes:] In what month of your pregnancy did you first quit for 7 days or longer?

    1. First
    2. Second
    3. Third
    4. Fourth
    5. Fifth
    6. Sixth
    7. Seventh
    8. Eighth
    9. Ninth
    10. Refused
    11. Don't know

    Did you start smoking again during that pregnancy or did you stay off cigarettes for the rest of the pregnancy?

    1. Yes
    2. No
    3. Refused
    4. Don't know
    Data Collection Frequency
    Periodic
    Comparable Healthy People 2010 Objective
    Retained from HP2010 objective
    Methodology Notes

    Females classified as smoking during pregnancy and quitting are those who answered “Yes” to smoking at any time during their pregnancy with their last child, “Yes” to quitting smoking for 7 days or longer, reported that the month they quit was the first through the third, and answered “No” to starting smoking again during the pregnancy.

    References

    Additional resources about the objective.

    1. CDC. Smoking prevalence among women of reproductive age---United States, 2006. MMWR 2008; 57:849-852.
    2. CDC. Women and Smoking: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2001.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    Youth Risk Behavior Surveillance System (YRBSS); Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (CDC/NCHHSTP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    percent 
    Baseline (Year)
    58.5 (2009)
    Target
    64.0
    Target-Setting Method
    Retention of Healthy People 2010 target
    Numerator
    Number of students in grades 9 through 12 who ever smoked at least one cigarette everyday for 30 days and  tried to quit smoking cigarettes in the last 12 months
    Denominator
    Number of students in grades 9 through 12 who ever smoked at least one cigarette everyday for 30 days
    Questions Used to Obtain the National Baseline Data

    From the 2009 Youth Risk Behavior Surveillance System:

    [NUMERATOR:]

    During the past 12 months did you ever try to quit smoking cigarettes?

    1. I did not smoke during the past 12 months
    2. Yes
    3. No

    [NUMERATOR AND DENOMINATOR:]

    Have you ever tried cigarette smoking, even one or two puffs?

    1. Yes
    2. No

    Have you ever smoked cigarettes daily, that is, at least one cigarette everyday for 30 days?

    1. Yes
    2. No
    Data Collection Frequency
    Biennial
    Comparable Healthy People 2010 Objective
    Retained from HP2010 objective

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    number 
    Baseline (Year)
    6 (2008)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of States and the District of Columbia that provide the recommended full coverage of all tobacco-dependence treatments (FDA-approved medications and counseling) to help smokers quit.
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Adapted from HP2010 objective
    Methodology Notes

    States providing the recommended full coverage of all tobacco-dependence treatments (FDA-approved medications and counseling) to help smokers quit are defined as having “Comprehensive Medicaid Coverage of Treatments.”

    The recommended full coverage of all tobacco-dependence treatments (FDA-approved medications and counseling) is defined as coverage of all of the following:

    • Medication coverage
      • Nicotine Patch
      • Nicotine Gum
      • Nicotine Losenge
      • Nicotine Nasal Spray
      • Nicotine Inhaler
      • Varenicline (Chantix®)
      • Bupropion hydrochloride (Zyban®)
    • Counseling coverage
      • Group
      • Individual
      • Telephone (provided through state quitlines)

    In the STATE System, this is equivalent to a value of “Yes” in the “Summary” field for “Comprehensive Medicaid Coverage of Treatments.”

    Changes Between HP2010 and HP2020
    This objective is modified from Healthy People 2010 objective 27-08b. The Healthy People 2010 objective was, "Increase insurance coverage for evidence-based treatment for nicotine dependency: Medicaid programs in States and the District of Columbia" and was measured by the Health Policy Tracking Service; National Conference of State Legislators. For Healthy People 2020 the objective is, "Increase comprehensive Medicaid insurance coverage of evidence-based treatment for nicotine dependency in States and the District of Columbia" and the data souce was changed to the State Medicaid Coverage for Tobacco Survey; CDC/ NCCPHP and University of California, Berkely, Center for Health and Public Policy Studies (Berkely, CHPPS).

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    In 2013 the data source was changed from the State Medicaid Coverage for Tobacco-Dependence Treatments; CDC/ NCCPHP and University of California, Berkely, Center for Health and Public Policy Studies (Berkely, CHPPS) to State Tobacco Activities Tracking and Evaluation System (STATE), CDC/NCCDPHP. As a result, the baseline year was revised from 2007 to 2008. The baseline and target values did not change.

    TU-9 Increase tobacco screening in health care settings

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    National Ambulatory Medical Care Survey (NAMCS); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    percent 
    Baseline (Year)
    62.4 (2007)
    Target
    68.6
    Target-Setting Method
    10 percent improvement
    Numerator
    Number of visits to office-based ambulatory care settings by persons aged 18 years and older at which the patient  is classified as either not a current tobacco user or as a current tobacco user.
    Denominator
    Number of visits to office-based ambulatory care settings by persons aged 18 years and older.
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    “Tobacco use” is identified as a sub-heading of “Patient Information” on the National Ambulatory Medical Care Survey, Patient Record Form. Tobacco use can be classified as not current, current, or unknown.

    Caveats and Limitations
    Unweighted non-response rates for the patients use of tobacco are high (over 30%). Information on patients use of tobacco could be missing from the form either because the doctor didn’t know, the doctor didn’t record, or if the abstracter could not find the information. Because of the high amount of missing information the estimates from these data may serve as a lower bound on the possible value.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    The measure for the objective was revised in 2011. At launch, visits by persons aged 12 years and over were measured; this was revised to visits by persons aged 18 years and over. The rationale for this revision was based on the 2003 US Preventive Task Force conclusion that there was insufficient evidence to recommend for or against the routine screening for tobacco use or interventions to prevent and treat tobacco use and dependence among children or adolescents. As a result of this change, the original baseline was revised from 62.8% to 62.4%. The target was adjusted from 69.1% to 68.6% to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective.

    1. Ambulatory Health Care Data: NAMCS Description. National Center for Health Statistics. 2007. Available at: http://www.cdc.gov/nchs/about/major/ahcd/namcsdes.htm

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    National Hospital Ambulatory Medical Care Survey (NHAMCS); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    percent 
    Baseline (Year)
    60.2 (2007)
    Target
    66.2
    Target-Setting Method
    10 percent improvement
    Numerator
    Number of visits to hospital-based ambulatory care settings by persons aged 18 years and older at which patient  is classified as either not a current tobacco user or as a current tobacco user.
    Denominator
    Number of visits to hospital-based ambulatory care settings by persons aged 18 years and older.
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    “Tobacco use” is identified as a sub-heading of “Patient Information” on the National Hospital Ambulatory Medical Care Survey, Outpatient Department Patient Record Form. Tobacco use can be classified as not current, current, or unknown.

    Caveats and Limitations
    Unweighted non-response rates for the patients use of tobacco are high (over 30%). Information on patients use of tobacco could be missing from the form either because the doctor didn’t know, the doctor didn’t record, or if the abstracter could not find the information. Because of the high amount of missing information the estimates from these data may serve as a lower bound on the possible value.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    The measure for the objective was revised in 2011. At launch, visits by persons aged 12 years and over were measured; this was revised to visits by persons aged 18 years and over. The rationale for this revision was based on the 2003 US Preventive Task Force conclusion that there was insufficient evidence to recommend for or against the routine screening for tobacco use or interventions to prevent and treat tobacco use and dependence among children or adolescents. As a result of this change, the original baseline was revised from 60.3% to 60.2%. The target was adjusted from 66.3% to 66.2% to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective.

    1. Ambulatory Health Care Data: NHAMCS Description. National Center for Health Statistics. 2007. Available at: http://www.cdc.gov/nchs/about/major/ahcd/nhamcsds.htm

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    Survey of Dental Practice (SDP); American Dental Association (ADA)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    percent 
    Baseline (Year)
    52.9 (2010)
    Target
    58.2
    Target-Setting Method
    10 percent improvement
    Numerator
    Number of general practice dentists who reported that they or their dental team usually or always ask patients if they use tobacco
    Denominator
    Number of general practice dentists
    Questions Used to Obtain the National Baseline Data

    From the 2010 American Dental Association’s Survey of Dental Practice:

    Please use the following rating scale to answer the following question: During the past week, how often did you or your dental team personally ask patients if they use tobacco?


    1=Always
    2=Usually
    3=Sometimes
    4=Rarely
    5=Never
    Data Collection Frequency
    Periodic
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Asking patients if they use tobacco is defined as dentists or their dental teams who responded with a “1” (always) or “2” (usually).

    Dental teams include dentists, hygienists, and dental assistants.

    Caveats and Limitations
    The overall crude and adjusted response rates for the survey in 2010 were 27.3% and 29.2%. A low response rate may yield a biased estimate from the survey if the responders and non-responders are inherently different.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    This objective was moved from developmental to measurable in 2013.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    National Survey of Substance Abuse Treatment Services (N-SSATS); Substance Abuse and Mental Health Services Administration (SAMHSA)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    percent 
    Baseline (Year)
    49.8 (2011)
    Target
    54.8
    Target-Setting Method
    10 percent improvement
    Numerator
    Number of substance abuse care facilities that report offering tobacco use screening services.
    Denominator
    Number of substance abuse care facilities.
    Questions Used to Obtain the National Baseline Data

    From the 2011 National Survey of Substance Abuse Treatment Services:

    [NUMERATOR:]

    Which of the following services are provided by this facility at this location, that is, the location listed on the front cover?

    Assessment and Pre-Treatment Services:

    • Answer 5: “Screening for tobacco use”

    Data Collection Frequency
    Biennial
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Facilities include those listed in the National Directory and online Treatment Facility Locator that are designated as eligible by the state substance abuse office.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    This objective was developmental at launch. In 2013 the objective was moved to measurable. The target was set at 54.8% using the 10 percent improvement target setting method.

    TU-10 Increase tobacco cessation counseling in health care settings

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    National Ambulatory Medical Care Survey (NAMCS); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    percent 
    Baseline (Year)
    19.2 (2007)
    Target
    21.1
    Target-Setting Method
    10 percent improvement
    Numerator
    Number of visits to office-based ambulatory care settings by persons aged 18 years and older at which the patient  was classified as a current tobacco user and was ordered/provided tobacco use/exposure health education during that visit.
    Denominator
    Number of visits to office-based ambulatory care settings by persons aged 18 years and older at which patient was classified as a current tobacco user.
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    “Tobacco use” is identified as a sub-heading of “Patient Information” on the National Ambulatory Medical Care Survey, Patient Record Form. Tobacco use can be classified as not current, current, or unknown.

    “Health Education” is a heading on the National Ambulatory Medical Care Survey, Patient Record Form. Tobacco counseling is identified as whether health education was ordered or provided for tobacco use/exposure.

    Caveats and Limitations
    Unweighted non-response rates for the patients use of tobacco are high (over 30%). Information on patients use of tobacco and on whether health education on tobacco use/exposure was ordered or provided could be missing from the form either because the doctor didn’t know, the doctor didn’t record, or if the abstracter could not find the information. Because of the high amount of missing information the estimates from these data may serve as a lower bound on the possible value for current tobacco users.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    The measure for the objective has been revised. At launch, visits for persons aged 12 years and over were measured; this was revised to visits for persons aged 18 years and over. The rationale for this revision was based on the 2003 US Preventive Task Force conclusion that there was insufficient evidence to recommend for or against the routine screening for tobacco use or interventions to prevent and treat tobacco use and dependence among children or adolescents. As a result of this change,in 2011 the original baseline was revised from 19.3% to 19.2%. The target was adjusted from 21.2% to 21.1% to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective.

    1. Ambulatory Health Care Data: NAMCS Description. National Center for Health Statistics. 2007. Available at: http://www.cdc.gov/nchs/about/major/ahcd/namcsdes.htm

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    National Hospital Ambulatory Medical Care Survey (NHAMCS); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    percent 
    Baseline (Year)
    22.6 (2007)
    Target
    24.9
    Target-Setting Method
    10 percent improvement
    Numerator
    Number of visits to hospital-based ambulatory care settings by persons aged 18 years and older at which the  patient was classified as a current tobacco user and was ordered/provided tobacco use/exposure health education during that visit.
    Denominator
    Number of visits to hospital-based ambulatory care settings by patients aged 18 years and older where the patient was classified as a current tobacco user.
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    “Tobacco use” is identified as a sub-heading of “Patient Information” on the National Hospital Ambulatory Medical Care Survey, Outpatient Department Patient Record Form. Tobacco use can be classified as not current, current, or unknown.

    “Health Education” is a heading on the National Hospital Ambulatory Medical Care Survey, Outpatient Department Patient Record Form. Tobacco counseling is identified as whether health education was ordered or provided for tobacco use/exposure.

    Caveats and Limitations
    Unweighted non-response rates for the patients use of tobacco are high (over 30%). Information on patients use of tobacco and on whether health education on tobacco use/exposure was ordered or provided could be missing from the form either because the doctor didn’t know, the doctor didn’t record, or if the abstracter could not find the information. Because of the high amount of missing information the estimates from these data may serve as a lower bound on the possible value for current tobacco users.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    The measure for the objective was revised in 2011. At launch, visits for persons aged 12 years and over were measured; this was revised to visits for persons aged 18 years and over. The rationale for this revision was based on the 2003 US Preventive Task Force conclusion that there was insufficient evidence to recommend for or against the routine screening for tobacco use or interventions to prevent and treat tobacco use and dependence among children or adolescents. As a result of this change, the original baseline was revised from 22.5% to 22.6%. The target was adjusted from 24.8% to 24.9% to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective.

    1. Ambulatory Health Care Data: NHAMCS Description. National Center for Health Statistics. 2007. Available at: http://www.cdc.gov/nchs/about/major/ahcd/nhamcsds.htm

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    Survey of Dental Practice (SDP); American Dental Association (ADA)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    percent 
    Baseline (Year)
    35.7 (2010)
    Target
    39.3
    Target-Setting Method
    10 percent improvement
    Numerator
    Number of general practice dentists who reported that they or their dental team usually or always personally counsel patients who use tobacco products on tobacco cessation
    Denominator
    Number of general practice dentists
    Questions Used to Obtain the National Baseline Data

    From the 2010 American Dental Association’s Survey of Dental Practice:

    Please use the following rating scale to answer the following question: During the past week, how often did you or your dental team personally counsel patients who use tobacco on tobacco cessation?


    1= Always
    2= Usually
    3= Sometimes
    4= Rarely
    5= Never

    Data Collection Frequency
    Periodic
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Personally counsel patients is defined as dentists or their dental teams who responded with a “1” (always) or “2” (usually).

    Dental teams include dentists, hygienists, and dental assistants.

    1495 general dentists returned the survey out of 4725 mailed the survey for a response rate of 31.6% (this is the unit response rate or overall specific to general dentists).

    1036 general practice dentists responded to the questions about counseling. Of the full sample, the item response rate was 21.9% (1036/4725).

    Among the 1495 general practice dentists who returned the survey, the item response rate was 69.3% (1036/1495).

    Caveats and Limitations
    A low response rate may yield a biased estimate from the survey if the responders and non-responders are inherently different.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    This objective was moved from developmental to measurable in 2013.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    National Survey of Substance Abuse Treatment Services (N-SSATS); Substance Abuse and Mental Health Services Administration (SAMHSA)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    percent 
    Baseline (Year)
    34.2 (2011)
    Target
    37.6
    Target-Setting Method
    10 percent improvement
    Numerator
    Number of substance abuse care facilities that report offering smoking cessation counseling services.
    Denominator
    Number of substance abuse care facilities.
    Questions Used to Obtain the National Baseline Data

    From the 2011 National Survey of Substance Abuse Treatment Services:

    [NUMERATOR:]

    Which of the following services are provided by this facility at this location, that is, the location listed on the front cover?

    Ancillary Services:

    • Answer 35: “Smoking cessation counseling”

    Data Collection Frequency
    Biennial
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Facilities include those listed in the National Directory and online Treatment Facility Locator that are designated as eligible by their state substance abuse office.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    This objective was developmental at launch. In 2013 the objective was moved to measurable. The target was set at 37.6% using the 10 percent improvement target setting method.

    TU-11 Reduce the proportion of nonsmokers exposed to secondhand smoke
    TU-11.1 Reduce the proportion of children aged 3 to 11 years exposed to secondhand smoke Leading Health Indicators

    Leading Health Indicators are a subset of Healthy People 2020 objectives selected to communicate high-priority health issues.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    National Health and Nutrition Examination Survey (NHANES); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    percent 
    Baseline (Year)
    52.2 (2005-2008)
    Target
    47.0
    Target-Setting Method
    10 percent improvement
    Numerator
    Number of nonsmokers aged 3 to 11 years who had a serum cotinine level greater than or equal to 0.05 ng/mL and less than or equal to 10 ng/ml.
    Denominator
    Number of non-smokers aged 3 to 11 years.
    Data Collection Frequency
    Periodic
    Comparable Healthy People 2010 Objective
    Adapted from HP2010 objective
    Leading Health Indicator
    Environmental Quality
    Methodology Notes

    Children aged 3 to 11 years are classified as nonsmokers if they have a serum cotinine level less than or equal to 10ng/mL. The limit of detection used for cotinine is 0.05 ng/mL to be more consistent with other similar measures including indicators from Healthy People 2010 and the National Prevention Strategy. Using a lower level of detection of cotinine, may have allowed us to detect cotinine in persons who are currently categorized as ‘unexposed’.

    According to the 2006 Surgeon General’s Report, more than 126 million nonsmoking Americans had detectable serum cotinine levels as of 1999–2002. Moreover, significant population disparities continue to exist and are in some cases widening. For example, children are more heavily exposed than nonsmoking adults.

    Trend Issues
    Two-year data are used as a placeholder to provide the latest data available and will be replaced with four-year data when available. Two-year and four-year data are not comparable. Two-year estimates are generally less stable and reliable than four-year estimates.
    Changes Between HP2010 and HP2020
    Since HP2010 the language of the objective has been modified from, 'Reduce the proportion of nonsmokers exposed to environmental tobacco smoke' to 'Reduce the proportion of nonsmokers exposed to secondhand smoke'. In HP2010 only one measure was calculated; the measure was for persons ages 4 and older. In HP2020 we have three objectives--ages 3-11, 12-17, and 18+. The HP2010 measure did not use an upper limit for non-smokers cotinine levels. The HP2020 measure is using an upper limit of 10ng/mL. Persons with cotinine levels greater than 10 ng/mL could have been counted as exposed non-smokers in the HP2010 measure, but in the HP2020 measure these persons are considered to be smokers.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    The limit of detection for cotinine used for the baseline at launch was 0.015ng/mL. The measure was revised in 2011 to use a limit of detection for cotinine of 0.05ng/mL, to be more consistent with similar measures including indicators from Healthy People 2010 and the National Prevention Strategy. As a result of this change, the original baseline was revised from 82.2% to 52.2%. The target was adjusted from 74.0% to 47.0% to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective.

    1. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. 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, 2006.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    National Health and Nutrition Examination Survey (NHANES); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    percent 
    Baseline (Year)
    45.5 (2005-2008)
    Target
    41.0
    Target-Setting Method
    10 percent improvement
    Numerator
    Number of nonsmokers aged 12 to 17 years who had a serum cotinine level greater than or equal to 0.05 ng/mL and less than or equal to 10 ng/ml
    Denominator
    Number of non-smokers aged 12 to 17 years
    Questions Used to Obtain the National Baseline Data

    From 2005 National Health and Nutrition Examination Survey:

    [NUMERATOR AND DENOMINATOR:]

    [For ages 12 years and older:]

    During the past 5 days did you use any product containing nicotine including cigarettes, pipes, cigars, chewing tobacco, snuff, nicotine patches, nicotine gum, or any other product containing nicotine?

    1. Yes
    2. No
    Data Collection Frequency
    Periodic
    Comparable Healthy People 2010 Objective
    Adapted from HP2010 objective
    Methodology Notes

    Adolescents aged 12 to 17 years are classified as nonsmokers if they respond “no” to using any product containing nicotine in the past 5 days and if their serum cotinine level is less than or equal to 10 ng/mL. Only responses to the questions asked of persons who participated in the examination component of the survey were used, so that serum levels of cotinine could be available for analysis.

    The limit of detection for cotinine was revised to 0.05 ng/mL to be more consistent with other similar measures including indicators from Healthy People 2010 and the National Prevention Strategy. Using a lower level of detection of cotinine, may have allowed us to detect cotinine in persons who are currently categorized as ‘unexposed’.

    Trend Issues
    Two-year data are used as a placeholder to provide the latest data available and will be replaced with four-year data when available. Two-year and four-year data are not comparable. Two-year estimates are generally less stable and reliable than four-year estimates.
    Changes Between HP2010 and HP2020
    Since HP2010 the language of the objective has been modified from, 'Reduce the proportion of nonsmokers exposed to environmental tobacco smoke' to 'Reduce the proportion of nonsmokers exposed to secondhand smoke'. In HP2010 only one measure was calculated; the measure was for persons ages 4 and older. In HP2020 we have three objectives--ages 3-11, 12-17, and 18+. The HP2010 measure did not use an upper limit for non-smokers cotinine levels. The HP2020 measure is using an upper limit of 10ng/mL. Persons with cotinine levels greater than 10 ng/mL could have been counted as exposed non-smokers in the HP2010 measure, but in the HP2020 measure these persons are considered to be smokers.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    The limit of detection for cotinine used for the baseline at launch was 0.015ng/mL. The measure was revised in 2011 to use a limit of detection for cotinine of 0.05ng/mL, to be more consistent with similar measures including indicators from Healthy People 2010 and the National Prevention Strategy. As a result of this change, the original baseline was revised from 78.0% to 45.5%. The target was adjusted from 70.2% to 41.0% to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective.

    1. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. 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, 2006.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    National Health and Nutrition Examination Survey (NHANES); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    percent (age adjusted—see Comments)
    Baseline (Year)
    37.6 (2005-2008)
    Target
    33.8
    Target-Setting Method
    10 percent improvement
    Numerator
    Number of nonsmokers aged 18 years and over who had a serum cotinine level greater than or equal to 0.05 ng/mL and less than or equal to 10 ng/ml
    Denominator
    Number of nonsmokers aged 18 years and over
    Questions Used to Obtain the National Baseline Data

    From 2005 National Health and Nutrition Examination Survey:

    [NUMERATOR AND DENOMINATOR:]

    [For ages 12 years and older:]

    During the past 5 days did you use any product containing nicotine including cigarettes, pipes, cigars, chewing tobacco, snuff, nicotine patches, nicotine gum, or any other product containing nicotine?

    1. Yes
    2. No
    Data Collection Frequency
    Periodic
    Comparable Healthy People 2010 Objective
    Adapted from HP2010 objective
    Methodology Notes

    Adults aged 18 years and older are classified as nonsmokers if they respond “no” to using any product containing nicotine in the past 5 days and if their serum cotinine level is less than or equal to 10 ng/mL. Only responses to the questions asked of persons who participated in the examination component of the survey were used, so that serum levels of cotinine could be available for analysis.

    The limit of detection used for cotinine was revised to 0.05 ng/mL to be more consistent with other similar measures including indicators from Healthy People 2010 and the National Prevention Strategy. Using a lower level of detection of cotinine, may have allowed us to detect cotinine in persons who are currently categorized as ‘unexposed’.

    Age Adjustment

    This Indicator uses Age-Adjustment Groups:

    • Total: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
    • Race/Ethnicity: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
    • Sex: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
    • Educational Attainment: 25-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
    • Family Income: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
    • Country of Birth: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
    • Disability Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
    • Health Insurance Status: 18-29, 30-39, 40-49, 50-59, 60-64
    • Marital Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
    • Veteran Status: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
    • Obesity Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+

    For two year data estimates:

    • Total: 18-39, 40-59, 60+
    • Sex: 18-39, 40-59, 60+
    • Race/Ethnicity: 18-39, 40-59, 60+
    • Educational Attainment: 25-39, 40-59, 60+
    • Family Income: 18-39, 40-59, 60+
    • Country of Birth: 18-39, 40-59, 60+
    • Disability Status: 20-39, 40-59, 60+
    • Health Insurance Status: 18-39, 40-59, 60-64
    • Marital Status: 20-39, 40-59, 60+
    • Veteran Status: 18-39, 40-59, 60+
    • Obesity Status: 20-39, 40-59, 60+
    Trend Issues
    Two-year data are used as a placeholder to provide the latest data available and will be replaced with four-year data when available. Two-year and four-year data are not comparable. Different age adjustment groups are used for the two year and four year data. Two-year estimates are generally less stable and reliable than four-year estimates.
    Changes Between HP2010 and HP2020
    Since HP2010 the language of the objective has been modified from, 'Reduce the proportion of nonsmokers exposed to environmental tobacco smoke' to 'Reduce the proportion of nonsmokers exposed to secondhand smoke'. In HP2010 only one measure was calculated; the measure was for persons ages 4 and older. In HP2020 we have three objectives--ages 3-11, 12-17, and 18+. The HP2010 measure did not use an upper limit for non-smokers cotinine levels. The HP2020 measure is using an upper limit of 10ng/mL. Persons with cotinine levels greater than 10 ng/mL could have been counted as exposed non-smokers in the HP2010 measure, but in the HP2020 measure these persons are considered to be smokers.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    The limit of detection for cotinine used for the baseline at launch was 0.015ng/mL. The measure was revised in 2011 to use a limit of detection for cotinine of 0.05ng/mL, to be more consistent with similar measures including indicators from Healthy People 2010 and the National Prevention Strategy. As a result of this change, the original baseline was revised from 75.5% to 37.6%. The target was adjusted from 67.9% to 33.8% to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective.

    1. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. 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, 2006.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    Tobacco Use Supplement-Current Population Survey (TUS-CPS); U.S. Census Bureau and Department of Labor, Bureau of Labor Statistics and National Institutes of Health, National Cancer Institute (Census, DOL/BLS, NIH/NCI)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    percent 
    Baseline (Year)
    75.3 (2006-2007)
    Target
    100
    Target-Setting Method
    Projection/trend analysis
    Numerator
    Number of persons aged 18 years and over with known smoking status who were covered by indoor worksite smoking policies that prohibit smoking
    Denominator
    Number of employed persons aged 18 years and over who work in indoor public workplaces
    Questions Used to Obtain the National Baseline Data

    From the 2006-2007 Current Population Survey:

    Which of these best describes the area in which you work MOST of the time?

    [NUMERATOR:]

    Does your place of work have an official policy that restricts smoking in any way? [DO NOT READ: "PLACE OF WORK" RESTRICTIONS INCLUDE POLICIES OF THE EMPLOYER, BUILDING OWNER OR ANY GOVERNMENTAL LAWS-THUS "ANY POLICY" AT THE PLACE OF WORK REGARDLESS OF WHO IS RESPONSIBLE FOR IT."]

    1. Yes
    2. No [skip following two questions]

    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?

    1. Not allowed in ANY public areas
    2. Allowed in SOME public areas
    3. Allowed in ALL public areas
    4. IF NOT APPLICABLE

    Which of these best describes your place of work's smoking policy for WORK AREAS?

    1. Not allowed in ANY work areas
    2. Allowed in SOME work areas
    3. Allowed in ALL work areas
    4. IF NOT APPLICABLE

    [NUMERATOR AND DENOMINATOR:]

    [DO NOT READ: WORK PLACE QUESTIONS PERTAIN TO THE SAMPLE PERSON'S MAIN JOB. IF EQUAL AMOUNT OF TIME SPENT "INDOORS" AND "OUTDOORS" AT WORK - REPORT ON POLICY WITH RESPECT TO "INDOOR" WORK]

    1. Mainly work indoors
    2. Mainly work outdoors
    3. Travel to different buildings or sites
    4. In a motor vehicle
    5. Somewhere else
    6. VARIES

    Do you mainly work in an office building, in your own home, in someone else's home, or in another indoor place?

    1. Office building
    2. Own home [skip out of question series]
    3. Someone else's home [skip out of question series]
    4. Another indoor place
    Data Collection Frequency
    Periodic
    Comparable Healthy People 2010 Objective
    Retained from HP2010 objective
    Methodology Notes

    Persons are covered by indoor worksite policies that prohibit smoking if they answer that smoking is not allowed in ANY "public areas" or ANY " work areas".

    The denominator for this measure only includes persons who reported that they work in indoor public workplaces and does not include persons who work at home or at someone else's home. (Persons who answer that they work in an "office building" or " another indoor place" are included). In addition, persons whose cigarette smoking status is missing are excluded from this measure. This is consistent with how measures from the data system are typically analyzed.

    The Current Population Survey (CPS) collects family income information in categories that include a range of incomes. Family income levels are determined using poverty thresholds from the U.S. Census Bureau. For this measure CPS family income categories that fall completely below the poverty threshold are displayed as "Below", income categories that contain the poverty threshold are displayed as "Borderline", and income categories that fall completely above the poverty threshold are displayed as "Above".

    Target Calculation Methods
    Using historical baseline data, least squares linear regression was performed. The resulting equation was used to estimate future prevalence through 2020, assuming the rate of increase or decrease would remain unchanged.

    References

    Additional resources about the objective.

    1. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. 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, 2006.
    TU-13 Establish laws in States, District of Columbia, Territories, and Tribes on smoke-free indoor air that prohibit smoking in public places and worksites

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    30 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with comprehensive laws for private workplaces prohibiting smoking
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Retained from HP2010 objective
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    Private workplaces are tracked in the STATE system as "private worksites". To be counted as prohibiting smoking, states should be coded as "banned" in the STATE system.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    34 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with comprehensive laws for public workplaces prohibiting smoking
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Retained from HP2010 objective
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    Public workplaces are tracked in the STATE system as "government worksites". To be counted as prohibiting smoking, states should be coded as "banned" in the STATE system.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    28 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with comprehensive laws for restaurants prohibiting smoking
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Retained from HP2010 objective
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    Restaurants are tracked in the STATE system as "restaurants". To be counted as prohibiting smoking, states should be coded as "banned" in the STATE system.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    22 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with comprehensive laws for bars prohibiting smoking
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Retained from HP2010 objective
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    Bars are tracked in the STATE system as "bars". To be counted as prohibiting smoking, states should be coded as "banned" in the STATE system.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    number 
    Baseline (Year)
    25 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with smoke-free laws for gaming halls prohibiting smoking
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    In the STATE system smoke-free laws for gaming halls is equivalent to value of “Banned” for bingo halls, casinos , AND racetrack casinos -OR- A value of “Banned” for bingo halls, casinos, AND racetrack casinos in states that allow gaming, OR a value of “No Such Gaming” for bingo halls, casinos, AND racetrack casinos in states that don’t allow gaming. -OR- A value of “No Such Gaming” for bingo halls, casinos, AND racetrack casinos. States with values of “Designated Areas,” “Separate Ventilated Areas,” or “None” are not included as states having smoke-free laws prohibiting smoking in gaming halls.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    This measure was developmental at launch, and became measurable in 2012. The original baseline was 20 states in data year 2009. Due to errors in the file,in 2012, the baseline was revised to 23 states. After further analysis and interpretation of state laws, the baseline was revised again in 2013 to 25 states. The target did not change.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    38 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with comprehensive laws for commercial day care centers prohibiting smoking
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Adapted from HP2010 objective
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    Commercial day care centers are tracked in the STATE system as "commercial day care centers". To be counted as prohibiting smoking, states should be coded as "banned" or "restriction in effect when child on premises" in the STATE system.

    Changes Between HP2010 and HP2020
    This objective differs from Healthy People 2010 objective 27-13e in that the Healthy People 2010 objective tracked all day care centers while this objective tracks only commercial day care centers.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    37 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with comprehensive laws for home-based daycare centers prohibiting smoking.
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Adapted from HP2010 objective
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    Home-based daycare centers are tracked in the STATE system as "home-based day care centers". To be counted as prohibiting smoking, states should be coded as "banned" or "restriction in effect when child on premises" in the STATE system.

    Changes Between HP2010 and HP2020
    This objective differs from Healthy People 2010 objective 27-13e in that the Healthy People 2010 objective tracked all day care centers while this objective tracks only home based day care centers.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    38 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with comprehensive laws for public transportation prohibiting smoking
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Retained from HP2010 objective
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    Public transportation is tracked in the STATE system as "public transportation". To be counted as prohibiting smoking, states should be coded as "banned" in the STATE system.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    0 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with comprehensive laws for hotels and motels with 100% smokefree sleeping rooms prohibiting smoking
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    Hotels and motels are tracked in the STATE system as "hotels and motels". To be counted as prohibiting smoking, states should be coded using the following criteria in the STATE systm: In the STATE system under "Restrictions": Type of Restriction in Lobby and Common Area of Hotel and Motel=Banned. In the STATE system under Additional Requirements Sleeping Room Designation = Yes: Sleeping Room Designation (Type) = Smoking Room, Maximum Percent of Sleeping Rooms Designated = 0 OR Sleeping Room Designation =Yes, Sleeping Room Designation (Type)=Non-smoking Room; Minimum Percent of Sleeping Rooms Designated =100

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    0 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with comprehensive laws in the living areas of public and private multiunit housing prohibiting smoking.
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    Multiunit housing is tracked in the STATE system as "Private Multi-Unit Housing" and "Government Multi-Unit Housing". To be counted as prohibiting smoking, states should be coded using the following criteria in the STATE system" In the STATE System under Restrictions Type of Restriction in Lobby and Common Area of Government Multi-Unit Housing : Banned AND Type of Restriction in Lobby and Common Area of Private Multi-Unit Housing: Banned AND In the STATE system under Restrictions Type of Restriction in Living Area of Government Multi-Unit Housing : Banned AND Type of Restriction in Living Area of Private Multi-Unit Housing: Banned

    TU-13 Establish laws in States, District of Columbia, Territories, and Tribes on smoke-free indoor air that prohibit smoking in public places and worksites

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    4 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with comprehensive laws prohibiting smoking in vehicles with children
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    Vehicles with children are tracked in the STATE system as "Personal vehicles". To be counted as prohibiting smoking, states should be coded using the following criteria in the STATE system: In the STATE system under Restrictions: Type of Restriction in Personal Vehicles = Banned AND In the STATE system under Additional Requirements Requires a Child in the Vehicle = Yes

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    8 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with comprehensive laws for prisons/correctional facilities prohibiting smoking
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    Prisons/correctional facilities are tracked in the STATE system as "prisons". To be counted as prohibiting smoking, states should be coded as "banned" in the STATE system.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    number 
    Baseline (Year)
    9 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with smoke-free laws for substance abuse treatment facilities prohibiting smoking
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    In the STATE system, smoke-free laws for substance abuse treatment facilities is equal to a “banned” status for both substance abuse- residential facilities and substance abuse-outpatient facilities.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    This objective was developmental at launch and became measureable in 2012.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    number 
    Baseline (Year)
    9 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with smoke-free laws for mental health treatment facilities prohibiting smoking
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    In the STATE system, smoke-free laws for mental health treatment facilities is equal to a “banned” status for both mental health- residential facilities and mental health-outpatient facilities.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    This objective was developmental at launch and became measureable in 2012.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    number 
    Baseline (Year)
    1 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with smoke-free laws for entrances/exits of all public places prohibiting smoking
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    In the STATE system, smoke-free laws for entrances/exists is at least 25ft for restaurants, bars, private worksites, AND government worksites.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    This objective was developmental at launch and became measureable in 2012.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    number 
    Baseline (Year)
    0 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with smoke-free laws for hospital campuses prohibiting smoking
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    In the STATE system, hospital campuses are found under the measure selection “Smokefree Indoor Air- Other sites.” Smoke-free laws for hospital campuses include all states where the buildings, facilities, and grounds of a hospital have a “banned” status.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    This objective was developmental at launch and became measureable in 2012.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    number 
    Baseline (Year)
    1 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of states and the District of Columbia with smoke-free laws for college/university campuses prohibiting smoking
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Newly enacted state tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, Office on Smoking and Health (OSH) searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include the comprehensiveness of the law, includes smoking areas permitted or required, separately ventilated smoking areas required, and no smoking allowed (i.e., banned). In some cases, data on enforcement authority, penalty for violation, and signage required are also collected.

    In the STATE system, smoke-free laws for college/university campuses is equal to a “yes” status for both private colleges and public colleges for “smoke-free campus.”

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    This measure was developmental and moved to measurable in 2012.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    Tobacco Use Supplement-Current Population Survey (TUS-CPS); U.S. Census Bureau and Department of Labor, Bureau of Labor Statistics and National Institutes of Health, National Cancer Institute (Census, DOL/BLS, NIH/NCI)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    percent 
    Baseline (Year)
    79.1 (2006-2007)
    Target
    87.0
    Target-Setting Method
    10 percent improvement
    Numerator
    Number of persons aged 18 years and over who report that no smoking is allowed in their home
    Denominator
    Number of persons aged 18 years and over
    Questions Used to Obtain the National Baseline Data

    From the 2006-2007 Tobacco Use Supplement to the Current Population Survey:

    [NUMERATOR:]

    Which statement best describes the rules about smoking INSIDE YOUR HOME?

    NOTE: "HOME" IS WHERE YOU LIVE. "RULES" INCLUDE ANY UNWRITTEN "RULES" AND PERTAIN TO ALL PEOPLE WHETHER OR NOT THEY RESIDE IN THE HOME OR ARE VISITORS, WORKMEN, ETC.

    1. No one is allowed to smoke anywhere INSIDE YOUR HOME
    2. Smoking is allowed in some places or at some times INSIDE YOUR HOME
    3. Smoking is permitted anywhere INSIDE YOUR HOME
    Data Collection Frequency
    Periodic
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Persons whose cigarette smoking status is missing are excluded from this measure.

    TU-15 Increase tobacco-free environments in schools, including all school facilities, property, vehicles, and school events

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    School Health Policies and Practices Study (SHPPS); Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (CDC/NCHHSTP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    percent 
    Baseline (Year)
    65.4 (2006)
    Target
    100
    Target-Setting Method
    Total coverage
    Numerator
    Number of junior high schools that reported that no smoking and no smokeless tobacco use was allowed by students, staff, or visitors on school facilities, property, vehicles, and school events
    Denominator
    Number of public and private junior high schools
    Questions Used to Obtain the National Baseline Data

    From the 2006 School Health Policies and Programs Study:

    [NUMERATOR:]

    Does your school's policy specifically prohibit cigarette smoking by students...

    • In school buildings?
      1. Yes
      2. No
    • Outside on school grounds, including parking lots and playing fields?
      1. Yes
      2. No
    • On school buses or other vehicles used to transport students?
      1. Yes
      2. No
    • At off-campus, school-sponsored events?
      1. Yes
      2. No

    Does your school's policy specifically prohibit smokeless tobacco use by students...

    • In school buildings?
      1. Yes
      2. No
    • Outside on school grounds, including parking lots and playing fields?
      1. Yes
      2. No
    • On school buses or other vehicles used to transport students?
      1. Yes
      2. No
    • At off-campus, school-sponsored events?
      1. Yes
      2. No

    Does your school's policy specifically prohibit cigarette smoking by faculty and staff...

    • In school buildings?
      1. Yes
      2. No
    • Outside on school grounds, including parking lots and playing fields?
      1. Yes
      2. No
    • On school buses or other vehicles used to transport students?
      1. Yes
      2. No
    • At off-campus, school-sponsored events?
      1. Yes
      2. No

    Does your school's policy specifically prohibit smokeless tobacco use by faculty and staff...

  • In school buildings?
    1. Yes
    2. No
  • Outside on school grounds, including parking lots and playing fields?
    1. Yes
    2. No
  • On school buses or other vehicles used to transport students?
    1. Yes
    2. No
  • At off-campus, school-sponsored events?
    1. Yes
    2. No

    Does your school's policy specifically prohibit cigarette smoking by school visitors...

    • In school buildings?
      1. Yes
      2. No
    • Outside on school grounds, including parking lots and playing fields?
      1. Yes
      2. No
    • On school buses or other vehicles used to transport students?
      1. Yes
      2. No
    • At off-campus, school-sponsored events?
      1. Yes
      2. No
    Data Collection Frequency
    Periodic
    Comparable Healthy People 2010 Objective
    Adapted from HP2010 objective
    Methodology Notes

    Starting with the 2012 survey, the name of the SHPPS survey was changed from the School Health Policies and Programs Study to the School Health Policies and Practices Study.

    Changes Between HP2010 and HP2020
    This objective differs from Healthy People 2010 objective 27-11 in that the Healthy People 2010 objective tracked junior high, middle, and senior high schools while this objective tracks only junior high schools. In addition, the objective language has been changed from 'smoke-free and tobacco-free environments' to 'tobacco-free environments.'

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    School Health Policies and Practices Study (SHPPS); Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (CDC/NCHHSTP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    percent 
    Baseline (Year)
    58.7 (2006)
    Target
    100
    Target-Setting Method
    Total coverage
    Numerator
    Number of middle schools that reported that no smoking and no smokeless tobacco use was allowed by students, staff, or visitors on school facilities, property, vehicles, and school events
    Denominator
    Number of public and private middle schools
    Questions Used to Obtain the National Baseline Data

    From the 2006 School Health Policies and Programs Study:

    [NUMERATOR:]

    Does your school's policy specifically prohibit cigarette smoking by students...

    • In school buildings?
      1. Yes
      2. No
    • Outside on school grounds, including parking lots and playing fields?
      1. Yes
      2. No
    • On school buses or other vehicles used to transport students?
      1. Yes
      2. No
    • At off-campus, school-sponsored events?
      1. Yes
      2. No

    Does your school's policy specifically prohibit smokeless tobacco use by students...

    • In school buildings?
      1. Yes
      2. No
    • Outside on school grounds, including parking lots and playing fields?
      1. Yes
      2. No
    • On school buses or other vehicles used to transport students?
      1. Yes
      2. No
    • At off-campus, school-sponsored events?
      1. Yes
      2. No

    Does your school's policy specifically prohibit cigarette smoking by faculty and staff...

    • In school buildings?
      1. Yes
      2. No
    • Outside on school grounds, including parking lots and playing fields?
      1. Yes
      2. No
    • On school buses or other vehicles used to transport students?
      1. Yes
      2. No
    • At off-campus, school-sponsored events?
      1. Yes
      2. No

    Does your school's policy specifically prohibit smokeless tobacco use by faculty and staff...

  • In school buildings?
    1. Yes
    2. No
  • Outside on school grounds, including parking lots and playing fields?
    1. Yes
    2. No
  • On school buses or other vehicles used to transport students?
    1. Yes
    2. No
  • At off-campus, school-sponsored events?
    1. Yes
    2. No

    Does your school's policy specifically prohibit cigarette smoking by school visitors...

    • In school buildings?
      1. Yes
      2. No
    • Outside on school grounds, including parking lots and playing fields?
      1. Yes
      2. No
    • On school buses or other vehicles used to transport students?
      1. Yes
      2. No
    • At off-campus, school-sponsored events?
      1. Yes
      2. No
    Data Collection Frequency
    Periodic
    Comparable Healthy People 2010 Objective
    Adapted from HP2010 objective
    Methodology Notes

    Starting with the 2012 survey, the name of the SHPPS survey was changed from the School Health Policies and Programs Study to the School Health Policies and Practices Study.

    Changes Between HP2010 and HP2020
    This objective differs from Healthy People 2010 objective 27-11 in that the Healthy People 2010 objective tracked junior high, middle, and senior high schools while this objective tracks only middle schools. In addition, the objective language has been changed from 'smoke-free and tobacco-free environments' to 'tobacco-free environments.'

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    School Health Policies and Practices Study (SHPPS); Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (CDC/NCHHSTP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    percent 
    Baseline (Year)
    66.1 (2006)
    Target
    100
    Target-Setting Method
    Total coverage
    Numerator
    Number of high schools that reported that no smoking and no smokeless tobacco use was allowed by students, staff, or visitors on school facilities, property, vehicles, and school events
    Denominator
    Number of public and private high schools
    Questions Used to Obtain the National Baseline Data

    From the 2006 School Health Policies and Programs Study:

    [NUMERATOR:]

    Does your school's policy specifically prohibit cigarette smoking by students...

    • In school buildings?
      1. Yes
      2. No
    • Outside on school grounds, including parking lots and playing fields?
      1. Yes
      2. No
    • On school buses or other vehicles used to transport students?
      1. Yes
      2. No
    • At off-campus, school-sponsored events?
      1. Yes
      2. No

    Does your school's policy specifically prohibit smokeless tobacco use by students...

    • In school buildings?
      1. Yes
      2. No
    • Outside on school grounds, including parking lots and playing fields?
      1. Yes
      2. No
    • On school buses or other vehicles used to transport students?
      1. Yes
      2. No
    • At off-campus, school-sponsored events?
      1. Yes
      2. No

    Does your school's policy specifically prohibit cigarette smoking by faculty and staff...

    • In school buildings?
      1. Yes
      2. No
    • Outside on school grounds, including parking lots and playing fields?
      1. Yes
      2. No
    • On school buses or other vehicles used to transport students?
      1. Yes
      2. No
    • At off-campus, school-sponsored events?
      1. Yes
      2. No

    Does your school's policy specifically prohibit smokeless tobacco use by faculty and staff...

  • In school buildings?
    1. Yes
    2. No
  • Outside on school grounds, including parking lots and playing fields?
    1. Yes
    2. No
  • On school buses or other vehicles used to transport students?
    1. Yes
    2. No
  • At off-campus, school-sponsored events?
    1. Yes
    2. No

    Does your school's policy specifically prohibit cigarette smoking by school visitors...

    • In school buildings?
      1. Yes
      2. No
    • Outside on school grounds, including parking lots and playing fields?
      1. Yes
      2. No
    • On school buses or other vehicles used to transport students?
      1. Yes
      2. No
    • At off-campus, school-sponsored events?
      1. Yes
      2. No
    Data Collection Frequency
    Periodic
    Comparable Healthy People 2010 Objective
    Adapted from HP2010 objective
    Methodology Notes

    Starting with the 2012 survey, the name of the SHPPS survey was changed from the School Health Policies and Programs Study to the School Health Policies and Practices Study.

    Changes Between HP2010 and HP2020
    This objective differs from Healthy People 2010 objective 27-11 in that the Healthy People 2010 objective tracked junior high, middle, and senior high schools while this objective tracks only middle schools. In addition, the objective language has been changed from 'smoke-free and tobacco-free environments' to 'tobacco-free environments.'

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Changed Since the Healthy People 2020 Launch
    No
    Measure
    *** Missing *** 
    Numerator
    *** Missing ***
    Comparable Healthy People 2010 Objective
    Not applicable
    TU-16 Eliminate State laws that preempt stronger local tobacco control laws

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    12 (2009)
    Target
    0
    Target-Setting Method
    Total elimination
    Numerator
    Number of States and the District of Columbia with preemptive laws on smoke-free indoor air
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Adapted from HP2010 objective
    Methodology Notes

    Newly enacted State tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, OSH searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include preemption related to smoke-free indoor air.

    Changes Between HP2010 and HP2020
    This objective differs from Healthy People 2010 objective 27-19 in that the Healthy People 2010 objective measured the number of States and the District of Columbia with preemptive laws in the areas of clean indoor air, minors’ access, or marketing while this objective measures only preemptive laws on smoke-free indoor air.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    18 (2009)
    Target
    0
    Target-Setting Method
    Total elimination
    Numerator
    Number of States and the District of Columbia with preemptive laws on advertising of tobacco products.
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Adapted from HP2010 objective
    Methodology Notes

    Newly enacted State tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, OSH searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include preemption related to advertising.

    Changes Between HP2010 and HP2020
    This objective differs from Healthy People 2010 objective 27-19 in that the Healthy People 2010 objective measured the number of States and the District of Columbia with preemptive laws in the areas of clean indoor air, minors’ access, or marketing while this objective measures only preemptive laws on tobacco advertising.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    22 (2009)
    Target
    0
    Target-Setting Method
    Total elimination
    Numerator
    Number of States and the District of Columbia with preemptive laws in the areas on minors’ access to tobacco products.
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Adapted from HP2010 objective
    Methodology Notes

    Newly enacted State tobacco-control legislation is downloaded from Westlaw, an on-line legal database. CDC, OSH searches the Westlaw LEGIS-ALL database for all 50 states and D.C.’s enacted bills for the quarter using date restrictions. The bills are coded according to variables identified by CDC, OSH, which include preemption related to minors' access.

    Changes Between HP2010 and HP2020
    This objective differs from Healthy People 2010 objective 27-19 in that the Healthy People 2010 objective measured the number of States and the District of Columbia with preemptive laws in the areas of clean indoor air, minors’ access, or marketing while this objective measures only preemptive laws on youth access to tobacco.
    TU-17 Increase the Federal and State tax on tobacco products

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    0 (2010)
    Target
    52
    Target-Setting Method
    Maintain consistency with national programs, regulations, policies, and laws.
    Numerator
    Number of States, D.C., and the Federal government that increased tax on cigarettes by $1.50 over the decade
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Adapted from HP2010 objective
    Methodology Notes

    For the purpose of measuring this indicator, the Federal government is counted as the 52nd 'state'. Also, measurement is counted as of January 1st for each year.

    On April 1, 2009, the largest Federal excise tax increase in history went into effect, increasing the excise tax on cigarettes from 39 cents to $1.01 per pack. This increase brought the combined Federal and average state excise tax for cigarettes above $2.00 per pack.

    Changes Between HP2010 and HP2020
    This objective differs from Healthy People 2010 objective 27-21a in that the Healthy People 2010 objective measured the mean combined Federal and State tax on cigarettes based on excise taxes on the retail price on a pack of 20 cigarettes in all 50 states and DC (based on full priced brands). This objective counts the number of states, D.C., and the Federal government that, over the Healthy People 2020 tracking period, increase the tax on a pack of cigarettes by $1.50.

    References

    Additional resources about the objective.

    1. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, Georgia: 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, 2000.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    0 (2010)
    Target
    52
    Target-Setting Method
    Maintain consistency with national programs, regulations, policies, and laws.
    Numerator
    Number of states, D.C., and the Federal government that increased smokeless tobacco taxes by $1.50 per unit or the equivalent.
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Adapted from HP2010 objective
    Methodology Notes

    For the purpose of measuring this indicator, the Federal government is counted as the 52nd 'state'. The data for each year are counted as of January 1.

    Smokeless tobacco includes all loose leaf and non-combustible tobacco, generally sold in packages weighing 1.2 oz. For those products that do not meet these criteria, including those sold in discrete single-use pouches, capsules, units, or in packages of single dose units, the target tax increase per each single does unit is also $1.50.

    Changes Between HP2010 and HP2020
    This objective differs from Healthy People 2010 objective 27-21b in that the Healthy People 2010 objective measured the number of states and D.C. that increased taxes on smokeless tobacco during the tracking period. This objective measures the number of states, DC, and the Federal government that, over the Healthy People 2020 tracking period, increased smokeless tobacco taxes by $1.50 per unit or the equivalent.

    References

    Additional resources about the objective.

    1. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, Georgia: 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, 2000.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    *** Missing *** 
    Numerator
    *** Missing ***
    Comparable Healthy People 2010 Objective
    Not applicable
    TU-18 Reduce the proportion of adolescents and young adults in grades 6 through 12 who are exposed to tobacco marketing

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    National Youth Tobacco Survey (NYTS); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health (CDC/NCCDPHP/OSH)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    percent 
    Baseline (Year)
    36.8 (2009)
    Target
    33.1
    Target-Setting Method
    10 percent improvement
    Numerator
    Number of students in grades 6 through 12 exposed to Internet tobacco marketing
    Denominator
    Number of students in grades 6 through 12 who use the internet
    Questions Used to Obtain the National Baseline Data

    From the 2009 National Youth Tobacco Survey:

    [NUMERATOR:]

    When you are searching the Internet, how often do you see ads for cigarettes and other tobacco products?

    1. I don't search the Internet
    2. Most of the time
    3. Some of the time
    4. Hardly ever
    5. Never

    From the 2011 National Youth Tobacco Survey:

    [NUMERATOR:]

    When you are using the Internet, how often do you see ads for tobacco products?

    1. I do not use the Internet
    2. Never
    3. Rarely
    4. Sometimes
    5. Most of the time
    6. Always
    Data Collection Frequency
    Biennial
    Comparable Healthy People 2010 Objective
    Retained from HP2010 objective
    Methodology Notes

    Students are considered to be exposed to Internet tobacco advertising if they answered 'most of the time' or 'some of the time' to the Numerator question.

    The question wording 2011 was slightly different from that used 2009. In 2011, the answer category 'always' was also included as exposed.

    Changes Between HP2010 and HP2020
    In the year 2000 (Healthy People 2010 baseline) the question asked 'when you are searching the internet on a computer". The question text changed in 2002 to "when you are using the internet" to account for different methods of internet access. Also, the answer categories available for this question are sometimes different: "all of the time" was an option in 2002 but not in other data years; "always" was an option in 2011 but not in other data years.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    The objective text was changed in 2013 from "reduce the proportion of adolescents and young adults in grades 6 through 12 who are exposed to tobacco advertising and promotion on the Internet" to "reduce the proportion of adolescents and young adults in grades 6 through 12 who are exposed to tobacco marketing on the Internet", and the numerator was changed in 2013 from "number of students in grades 6 through 12 exposed to Internet tobacco advertising and promotion" to "number of students in grades 6 through 12 exposed to Internet tobacco marketing".

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    National Youth Tobacco Survey (NYTS); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health (CDC/NCCDPHP/OSH)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    percent 
    Baseline (Year)
    48.6 (2009)
    Target
    19.3
    Target-Setting Method
    Projection/trend analysis
    Numerator
    Number of students in grades 6 through 12 exposed to magazine and newspaper tobacco marketing
    Denominator
    Number of students in grades 6 through 12 who read newspapers and magazines
    Questions Used to Obtain the National Baseline Data

    From the 2009 National Youth Tobacco Survey:

    [NUMERATOR:]

    When you read newspapers or magazines, how often do you see ads or promotions for cigarettes and other tobacco products?

    1. I don't read newspapers or magazines
    2. All of the time
    3. Most of the time
    4. Some of the time
    5. Hardly ever
    6. Never
    Data Collection Frequency
    Biennial
    Comparable Healthy People 2010 Objective
    Retained from HP2010 objective
    Methodology Notes

    Students are considered to be exposed to tobacco advertisements and promotions if they answer 'all of the time', 'most of the time', or 'some of the time' to the question listed. In 2011, the answer categories 'always', 'most of the time', and 'sometimes' were considered to be exposed.

    Changes Between HP2010 and HP2020
    In the year 2000 (Healthy People 2010 baseline year) the question asked did not include "all of the time" as an answer category while subsequent survey years did include the "all of the time" answer category for the question used for this measure.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    In 2013, the objective text was changed from 'Reduce the proportion of adolescents and young adults in grades 6 through 12 who are exposed to tobacco advertising and promotion in magazines and newspapers' to 'Reduce the proportion of adolescents and young adults in grades 6 through 12 who are exposed to tobacco marketing in magazines and newspapers', and the numerator was chanced from 'Number of students in grades 6 through 12 exposed to magazine and newspaper tobacco advertising and promotion' to 'Number of students in grades 6 through 12 exposed to magazine and newspaper tobacco marketing'.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    National Youth Tobacco Survey (NYTS); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health (CDC/NCCDPHP/OSH)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    percent 
    Baseline (Year)
    77.6 (2009)
    Target
    69.8
    Target-Setting Method
    10 percent improvement
    Numerator
    Number of students in grades 6 through 12 exposed to movie and television tobacco marketing
    Denominator
    Number of students in grades 6 through 12 who watch television or go to the movies
    Questions Used to Obtain the National Baseline Data

    From the 2009 National Youth Tobacco Survey:

    [NUMERATOR:]

    When you watch TV or go to the movies, how often do you see actors using tobacco?

    1. I don’t watch TV or go to the movie
    2. Most of the time
    3. Some of the time
    4. Hardly ever
    5. Never
    Data Collection Frequency
    Biennial
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Students are considered to be exposed to movie and television tobacco marketing if they answered ‘most of the time’ or ‘some of the time’ to the questions above. In 2011, the answer categories 'always', 'most of the time', and 'sometimes' were considered to be exposed.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    This objective was moved from developmental to measurable in 2013. The objective title was revised from "Reduce the proportion of adolescents and young adults in grades 6 through 12 who are exposed to tobacco advertising and promotion in movies" to "Reduce the proportion of adolescents and young adults in grades 6 through 12 who are exposed to tobacco marketing in movies and television" at the same time.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    National Youth Tobacco Survey (NYTS); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health (CDC/NCCDPHP/OSH)
    Changed Since the Healthy People 2020 Launch
    Yes
    Measure
    percent 
    Baseline (Year)
    85.7 (2009)
    Target
    77.1
    Target-Setting Method
    10 percent improvement
    Numerator
    Number of students in grades 6 through 12 exposed to point of purchase tobacco marketing
    Denominator
    Number of students in grades 6 through 12 who go to convenience stores, supermarkets, or gas stations
    Questions Used to Obtain the National Baseline Data

    From the 2009 National Youth Tobacco Survey:

    [NUMERATOR:]

    When you go to a convenience store, super market, or gas station, how often do you see ads for cigarettes and other tobacco products or items that have tobacco company names or pictures on them?

    1. I never go to a convenience store, supermarket, or gas station.
    2. All of the time
    3. Most of the time
    4. Some of the time
    5. Hardly ever
    6. Never
    Data Collection Frequency
    Biennial
    Comparable Healthy People 2010 Objective
    Not applicable
    Methodology Notes

    Students are considered to be exposed to tobacco marketing if they answer ‘all of the time,’ ‘most of the time’ or ‘some of the time’ or to the survey question. In 2011, the answer categories 'always', 'most of the time', and 'sometimes' were considered to be exposed.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch

    This objective was moved from developmental to measurable in 2013. The objective text was revised from "Reduce the proportion of adolescents and young adults in grades 6 through 12 who are exposed to tobacco advertising and promotion at point of purchase (convenience store, supermarket, or gas station)" to "Reduce the proportion of adolescents and young adults in grades 6 through 12 who are exposed to tobacco marketing at point of purchase (convenience store, supermarket, or gas station)" at the same time.

    TU-19 Reduce the illegal sales rate to minors through enforcement of laws prohibiting the sale of tobacco products to minors

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    Synar Program; Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention (SAMHSA/CSAP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    5 (2009)
    Target
    51
    Target-Setting Method
    Total coverage
    Numerator
    Number of States and the District of Columbia with a 5 percent or less illegal sales rate to minors in compliance checks
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Retained from HP2010 objective
    Methodology Notes

    As required by the Synar Amendment, all 50 States and the District of Columbia submit their baseline sales rates in compliance checks to SAMHSA as part of their annual Substance Abuse Prevention and Treatment (SAPT) block grant applications.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    Synar Program; Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention (SAMHSA/CSAP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Baseline (Year)
    1 (2009)
    Target
    8
    Target-Setting Method
    Total coverage
    Numerator
    Number of U.S. territories with a 5-percent or less illegal buy rate among minors in compliance checks
    Data Collection Frequency
    Annual
    Comparable Healthy People 2010 Objective
    Retained from HP2010 objective
    Methodology Notes

    As required by the Synar Amendment, all 50 States and the District of Columbia submit their baseline sales rates in compliance checks to SAMHSA as part of their annual Substance Abuse Prevention and Treatment (SAPT) block grant applications. SAMHSA also tracks 8 territories that receive SAPT Block Grants.

    U.S. territories eligible for inclusion are: American Samoa, Guam, Marshall Islands, Federated States of Micronesia, Commonwealth of the Northern Mariana Islands, Republic of Palau, Puerto Rico, and the Virgin Islands.

    TU-20 (Developmental) Increase the number of States and the District of Columbia, Territories, and Tribes with sustainable and comprehensive evidence-based tobacco control programs.

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Numerator
    *** Missing ***
    Comparable Healthy People 2010 Objective
    Adapted from HP2010 objective

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Numerator
    *** Missing ***
    Comparable Healthy People 2010 Objective
    Retained from HP2010 objective

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    National Data Source
    State Tobacco Activities Tracking and Evaluation System (STATE); Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC/NCCDPHP)
    Changed Since the Healthy People 2020 Launch
    No
    Measure
    number 
    Numerator
    *** Missing ***
    Comparable Healthy People 2010 Objective
    Retained from HP2010 objective