ARIZONA DEPARTMENT OF HEALTH SERVICES
Bureau of Tobacco Education and Prevention

2008 Biennial Evaluation Report
FY 2007 – 2008

A REPORT ON TOBACCO CONTROL PROGRAMS AND SERVICES
1

ARIZONA DEPARTMENT OF HEALTH SERVICES
BUREAU OF TOBACCO EDUCATION AND PREVENTION

2008 Biennial Evaluation Report

Janet Napolitano, Governor
State of Arizona

January Contreras, Acting Director
Arizona Department of Health Services
150 North 18th Avenue
Phoenix, Arizona 85007-3228
Division of Public Health Services
Bureau of Tobacco Education and Prevention

This Report is Provided as Required By A.R.S 36-772 (F)
Permission to quote or reproduce materials from this publication is granted when
acknowledgment is made.

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THIS REPORT WAS PREPARED BY

ARIZONA DEPARTMENT OF HEALTH SERVICES
DIVISION OF PUBLIC HEALTH SERVICES
Bureau of Tobacco Education and Prevention

THANKS AND APPRECIATION FOR
CONTRIBUTIONS ARE EXTENDED TO
Jeanette Shea-Ramirez, Assistant Director
Division of Public Health Prevention Services

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EXECUTIVE SUMMARY
Overview
Tobacco Control in Arizona has gone through numerous changes over the last decade.
Arizona tobacco taxation laws began in 1994 when voters passed the Tobacco Tax and
Health Care Act (Proposition 200). This tax increased the state sales tax on tobacco
products. Several increases have passed over the years, and the excise tax is now $2.00;
it is voter protected due to Proposition 300. Two percent of this tax is administered by
the Arizona Department of Health Services (ADHS) Bureau of Tobacco Education and
Prevention (BTEP).
Fiscal years 07-08 (FY07, FY08) were an era of change for ADHS BTEP, which led to
new staff, a new direction, and a new strategic plan generated by intensive research and
statewide community involvement. This report contains a description of the tobacco
related activities within the state of Arizona for Fiscal Years 2007 and 2008 (FY07 and
FY08, respectively).

Some highlights of the report include:
Preventing Youth Initiation through Intensive School Based Programming: ADHS BTEP
contractors served approximately 60,000 students in grades four through eight, which is
representative of 15 percent of the entire student population in Arizona.
Preventing Youth Initiation by Restricting Access to Tobacco: Through a contractual
agreement with ADHS BTEP, the Attorney General’s Office (AGO) monitors
compliance and enforces tobacco legislation relating to youth. The AGO found a 10
percent increase in total buys from FY07 to FY08, and in turn, there was a 17 percent
increase in total citations from FY07 to FY08.
Helping Tobacco Users Quit: The Arizona Smoker’s Helpline (ASHLine) provides
access to effective, research-based tobacco use cessation services for Arizona residents,
through telephone counseling in English and Spanish, web-based information, printed
materials, and referrals to local quit tobacco classes. Since its inception, the ASHLine
has received more than 10,000 calls each year.
Medication to Assist Clients in Quitting: Following a nationwide movement to provide
Nicotine Replacement Therapy, including prescription medications, to clients enrolled in
cessation classes, on March 1, 2008, the ADHS BTEP initiated a pilot project during
which each client who enrolled in ASHLine services received free NRT+ for 12 weeks,
including NRT patches, gum, lozenges, Buproprion, or Chantix®. The response to the
benefit was overwhelming, and on May 1, 2008, the benefit was reduced to NRT (patch,
gum, and lozenge) for two weeks. Follow-up with recipients has been ongoing and a
report of findings from the pilot project will be published in early 2009.
Marketing: ADHS BTEP advertised ASHLine services through the “We Can Help”
campaign in 2007. The 12-month campaign consisted of 18 commercials, six each

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featuring three different characters, “Nick” “Jamie” and “Hector,” as they progressed
through the stages of change from pre-contemplation through maintenance of quitting.
The overall goal of the “We Can Help” campaign was to generate awareness of the states
cessation services – to get the message out that help is available for those who want to
quit tobacco. A secondary goal was to get smokers to call ASHLine to seek cessation
services.
-

-

The percentage of polled individuals that reported they had seen or heard
advertising for the help available without being prompted of the advertising
ranged from 20 percent to 34.4 percent.
The 2007 call volumes for ASHLine averaged about 150 calls higher monthto-month than in comparative months in 2006. There was a 103 percent
increase in call volume in for the first quarter of calendar year 2007 over first
quarter 2006.

SmokeFree Arizona: In November 2006, Arizona voters approved the SmokeFree
Arizona Act, which took affect May 1, 2007. The act bans smoking in all indoor public
buildings with the exception of retail tobacco stores, veteran and fraternal clubs,
designated smoking hotel rooms, and outdoor patios. The ADHS Office of
Environmental Health is responsible for monitoring compliance with the law.
Identifying and Eliminating Tobacco-Related Disparities: ADHS BTEP offers a variety
of services aimed at mitigating tobacco-related disparities including cessation counseling,
education and prevention services through a variety of community-based organizations
established to serve specific populations, such as the lesbian, gay, bisexual, or
transgendered (LGBT) community and individuals of low socioeconomic status.
-

Inter Tribal Council of Arizona assists sub-contracted Tribal tobacco
education and prevention programs and Urban Indian Health Center tobacco
education and prevention programs to develop culturally appropriate tobacco
prevention programs.

-

Gila River Indian Community provides tobacco education presentations and
workshops at various conferences and community events.

-

The Wingspan tobacco program provides services that include increasing the
awareness of the incidence and health impact of smoking among Arizona’s
LGBT community, providing smoking cessation classes, and providing
training to volunteers on outreach, brief interventions, and cessation
facilitation.

-

The Tanner Community Development Corporation’s tobacco program’s
mission is to reduce tobacco use in the African American and Faith-based
communities in Arizona by providing education and prevention services and
promoting quitting through cessation programs.

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-

Chicanos Por La Causa focuses on reducing tobacco use among youth and
their families by providing prevention and education services.

-

The Mountain Park Health Center tobacco program works in conjunction with
the various health departments of the MPHC such as integrated behavioral
health, nutrition and physical education, prenatal, asthma, and obesity
prevention classes.

-

The Asian Pacific Community in Action tobacco program provides education,
prevention, and cessation services to multiple Asian and Pacific Islander
communities in Maricopa County.

Highlighted CDC Indicator Data
Youth Smoking Behavior: According to the Arizona Youth Tobacco Survey (YTS),
2007, 59 percent of high school students reported ever using any tobacco product, and 34
percent of middle school students reported ever using any tobacco product. Fewer than 1
in 5 middle school students and 1 in 3 high school students reported current use of any
tobacco product. According to the YTS, 57.4 percent reported never having tried
cigarette smoking, even one or two puffs compared to 37.2 percent who reported ever
trying a cigarette.
Access to Tobacco Products: 23 percent of middle school students under age 18 gave
someone else money to buy them cigarettes and 30% of high school students. Both high
school and middle school students reported gas stations as a typical store location for
purchasing cigarettes (37 percent and 20 percent, respectively).
Media Awareness: Relating to anti-smoking commercials, the Arizona YTS Report
revealed that 25.8 percent of students had not been exposed to any commercials during
the past 30 days, 19.7 percent were exposed to a commercial one to three times in the
past 30 days, 16 percent saw or heard a commercial one to three times per week, 18.8
percent saw or heard a commercial almost daily, and 12.8 percent reported seeing or
hearing a commercial more than once a day.
Cessation: In 2007, roughly half of all current cigarette smokers in high school expressed
a desire to quit. Comparatively, in middle school, there seems to be a declining trend in
the reported desire to quit smoking cigarettes among current smokers.
Pregnant Women and Smoking: According to the Arizona Department of Health Services
Bureau of Public Health Statistics (ADHS BPHS), Health Status and Vital Statistics
Section the prevalence rate of women who report tobacco use during pregnancy is 4.7 per
100 births in 2007, which is slightly lower than 2005 (5.4 per 100 births).

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TABLE OF CONTENTS
INTRODUCTION

9

Background

9

ADHS BTEP Organization Chart

10

ADHS BTEP Expenditures and Contracts

11

Timeline

14

Strategic Planning Process

15

Strategic Plan Stakeholder

16

PROGRAM ACTIVITIES AND SERVICES

17

Preventing Youth Initiation

18

Helping Tobacco Users Quit

19

Reducing Exposure to Second Hand Smoke

24

Identifying and Eliminating Tobacco-Related Disparities 26
Reducing the Burden of Chronic Disease

28

RESULTS

30

AN ERA OF CHANGE

35

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LIST OF FIGURES
Figure 1: Tobacco Curricula use in Grades Four-Five and Grades Six-Eight,
FY07...…………………………………………………………………………18
Figure 2: Ever Tobacco use by Middle and High School………………………...31
Figure 3: Current Tobacco Use by Ethnicity and by Middle and High School…..31
Figure 4: Percent of Current Smokers Wanting to Quit Smoking Cigarettes…….33
LIST OF TABLES
Table 1: Attorney General Compliance Check Results…………………………..19
Table 2: ASHLine Client Demographics…………………………………………22
Table 3: QuitFax Referral System………………………………………………...23
Table 4: Arizona HealthLinks Reach……………………………………………..29
Table 5: How Current Smokers under 18 Reported Getting Cigarettes…………..32
Table 6: Store Types Where Current Smokers under 18 Who Bought Cigarettes
from a Store during the Past 30 Days Reported Buying
Them………………………………………………………………………...…32
Table 7: 2007 Arizona BRFSS: Respondents Who Are Current Smokers……….34

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INTRODUCTION
This report contains a description of the tobacco related activities within the state of
Arizona for Fiscal Years 2007 and 2008 (FY07 and FY08, respectively). The primary
responsibility for its content rests on the Arizona Department of Health Services (ADHS)
Bureau of Tobacco Education and Prevention (BTEP) with supplemental information
from SmokeFree Arizona and the Arizona State University W.P. Carey School of
Business. Key outcome indicators for youth and adult tobacco-related behavior and
attitudes are presented.

Background
In 1994, Arizona voters passed the Tobacco Tax and Health Care Act (Proposition 200)
which increased the state sales tax on tobacco products to fund several programs: health
care for the medically needy, medically indigent, and low income children; tobacco
education and prevention; and tobacco-related research. This marked the beginning of
Arizona’s tobacco taxation, which was increased with the 2006 vote to raise the excise
tobacco tax to $2.00. Proposition 303, passed in 2002, voter protected the tobacco tax
monies; these funds were required to be spent toward tobacco prevention. Administered
by ADHS BTEP in FY07 and FY08, two percent of the tax was dedicated to a chronic
disease fund.
In November 2006, Arizona voters approved the SmokeFree Arizona Act, which took
affect May 1, 2007. The act bans smoking in all indoor public buildings with the
exception of retail tobacco stores, veteran and fraternal clubs, designated smoking hotel
rooms, and outdoor patios. The ADHS Office of Environmental Health is responsible for
monitoring compliance with the law.
Fiscal years 07-08 (FY07, FY08) were an era of change for the ADHS BTEP, which led
to a new staff, a new direction, and a new strategic plan generated by intensive research
and community involvement. To better illustrate the changes, the following pages
include: the current organizational chart for ADHS BTEP, a table containing a list of the
contracts and expenditures, a timeline of the events, and finally, some information about
the strategic plan and a copy of a stakeholder chart.

9

ADHS BTEP Organization Chart

10

ADHS BTEP – Expenditures and Contracts
ADHS BTEP - PROP. 200
Projects

Expenditures
Fiscal Year 2007

Fiscal Year 2008

Local Partners
Apache County
Cochise County
Coconino County
Gila County
Graham County
Greenlee County
La Paz County
Maricopa County
Mohave County
Navajo County
Pima County
Pinal County
Santa Cruz County
Yavapai County
Yuma County
Total Local Partners

217,266
381,623
397,243
144,079
162,482
115,588
74,264
3,927,082
514,141
143,424
2,066,374
375,146
243,145
466,968
389,119
9,617,944

187,872
276,994
372,727
165,402
162,482
74,914
80,019
3,542,576
398,063
166,030
1,488,802
309,741
188,166
357,360
314,134
8,085,282

Administrative
Community Outreach
Evaluation
Marketing and Communication
Native American Outreach
Statewide Projects

1,224,612
828,783
2,399,781
12,194,703
1,167,976
3,524,720

1,369,336
698,636
2,321,144
5,111,071
1,404,231
2,762,240

Total BTEP Expenditures

30,958,519

21,751,940

Community Outreach Vendor List FY07 and FY08
Asian Pacific Community In Action (APCA) / Chicanos Por La Causa / Mountain Park Health Center
(MPHC) / Phoenix Fire / Tanner Community Development Corporation (TCDC) / Wingspan
Evaluation Vendor List FY07
AZ Criminal Justice / Dept. of Education / Northern Arizona University (NAU) / University of Arizona
(U of A) Evaluation, Research and Development Unit (ERDU) (NAU paid an old bill)
Evaluation Vendor List FY08
Dept. of Education / ERDU
Native American Outreach Vendor List FY07
Inner-Tribal Council of Arizona (ITCA) / Gila River Indian Community (contract in place but no
expenditures for FY07)
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Native American Outreach Vendor List FY08
ITCA / Gila River Indian Community
Statewide Projects Vendor List FY07
American Cancer Society / American Interscholastic Association (AIA) / Attorney General’s Office
(AGO) / Coalition for a Tobacco Free Arizona (CTFA) / US Script / U of A HealthLinks / University of
Arizona Smoker’ Helpline (ASHLine)
Statewide Projects Vendor List FY08
American Cancer Society (ACS) / AIA (AIA was phased out and moved to Chronic Disease for the last
leg of the contract) AGO / Coalition for a Tobacco Free Arizona / US Script / U of A HealthLinks /
ASHLine / beBetter Networks, Inc (beBetter)
ADHS CHRONIC DISEASE - PROP. 303
Projects

Expenditures
Fiscal Year 2007

Fiscal Year 2008

Local partners
Breast Cancer Screening
Colorectal Cancer Screening
Stroke Awareness
Lung – COPD
Hepatitis B
Total Local Partners

3,600
57,855
54,750
0
46,891
163,096

253,325
712,249
486,307
508,171
124,188
2,084,240

Administrative
Community Outreach
Evaluation
Statewide Projects

276,799
801,857
31,500
696,795

436,429
105,694
107,346
1,327,584

1,970,047

4,061,293

Total Chronic Disease
Expenditures

Community Outreach Vendor List FY07
American Lung Association / APCA / Coconino County / Maricopa County / Mountain Park Health
Center / Native American Comm. / Wingspan / TGen / (all projects were phased out and replaced by the
Local Partners for FY08) Wesley Community Center
Community Outreach Vendor List FY08
APCA / Mountain Park Health Center / Phoenix Fire (contracts listed here are different than those listed
in FY07) Wesley Community Center
Statewide Projects Vendor List FY07
American Cancer Society / AIA
Statewide Projects Vendor List FY08
American Cancer Society / AIA (Phased out in FY08)

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ADHS CDC - FEDERAL
Projects

Expenditures

Administrative
Evaluation
Marketing and Communication
Statewide Projects

Fiscal Year 2007
189,457
37,500
372,698
72,500

Fiscal Year 2008
150,556
0
162,500
55,000

672,155

368,056

Total Chronic Disease
Expenditures

Evaluation Vendor List FY07
ERDU
Statewide Projects Vendor List FY07
ACS / CTFA
Statewide Projects Vendor List FY08
CTFA

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Timeline
Fiscal Year 2007, Quarter 1
- Beginning of internal restructuring, driven by ADHS Director Susan Gerard and by
Assistant Director for the Division of Public Health Prevention Services, JeanetteShea Ramirez.
Fiscal year 2007, Quarter 2
- Internal ADHS BTEP staff restructuring and recruitment
- ADHS BTEP Partner’s meeting for reorganization
- SmokeFree Arizona passed
- Excise tax increase of $0.82, leading to a total of $2.00 per pack as the current tax
- “We Can Help” cessation campaign launched (Dec. 26, 2006)
Fiscal year 2007, Quarter 3
- ADHS BTEP Partner’s meeting for reorganization
- New Bureau Chief, Wayne Tormala, begins Feb. 2007

Fiscal year 2007, Quarter 4
- ADHS BTEP Partner’s meeting for reorganization
- SmokeFree Arizona implemented May 1, 2007
Fiscal Year 2008, Quarter 1
- Strategic Plan kickoff (July 25, 2007)
- ADHS BTEP Director Gerard in attendance
- Creation of Steering Committee and Workgroup
- More than 30 community forums held statewide, through October 2007
- Arizona awarded 2009 National Conference on Tobacco or Health (NCTOH) to be
held June, 2009*
Fiscal Year 2008, Quarter 2
- Continued Strategic Planning Activities
- Steering Committee, more than 30 focus groups and community forums held
statewide, gathering of best practices research from national resources, as
well as other states and programs best practices
Fiscal Year 2008, Quarter 3
- ADHS BTEP Marketing received two American Marketing Association Spectrum
Awards for Excellence in Marketing Communications
- Strategic Plan Wrap-Up
- Bureau of Tobacco Education and Prevention named ADHS Team of the Year
- Mary Ehlert, ADHS BTEP Marketing Director, named ADHS Employee of the Year
for her role in the ADHS BTEP transition

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Fiscal Year 2008, Quarter 4
- ADHS BTEP Marketing won three International Association of Business
Communicators (IABC) Phoenix Copper Quill Awards for excellence in marketing
communications
- ADHS BTEP Marketing won an IABC Gold Quill Awards for excellence in
marketing communications from IABC international
*The National Conference on Tobacco or Health (NCTOH) assembles a vast array of leaders from large
and small entities to create one voice on behalf of public health against the scourge of tobacco products.
The forum promotes open dialogue among a collaborative audience of more than 3,500 tobacco control
researchers, advocates, and lobbyists; public health officials from local, state and national agencies;
smoking cessation experts; health policy advisors; legislative representatives; and tobacco control
leaders from across the United States. As the premier national conference, NCTOH is dedicated to
national collaboration on tobacco control and synergy from the field for a collective movement with a
national scope and, more importantly, local impact.

Strategic Planning Process
The Arizona Department of Health Services Bureau of Tobacco Education and Prevention (ADHS
BTEP) began its strategic planning process in August of 2007. This strategic planning process aimed to
create a model that focused on effective tobacco control which would engage stakeholders at the local,
state and national levels. As such it was critical to ensure that the process was both transparent and
participatory and included input and involvement from the full diversity of populations and regions
across Arizona.
The process included a wide range of input, including 34 community forums, 32 focus groups, the
TRUST Commission, an extensive review of the literature ( including new “best practice” reports from
the CDC and the Institute on Medicine), and discussions with key national partners, including other state
tobacco control programs, and the American Legacy Foundation. A Strategic Plan Work Group,
comprised of 30 Arizonans that included a wide range of researchers, healthcare professionals,
advocates, experts from the public and private sectors, and local leaders, met throughout the planning
process to provide direction and oversight during the process.
Eight major goals were identified through the strategic planning process which will contribute to
building an integrated network of individuals, organizations and communities to reduce the impact of
commercial tobacco abuse in Arizona:
• Reduce Initiation of Tobacco Use among Youth
• Eliminate Exposure to Secondhand Smoke
• Promote Smoking Cessation among Youth and Adults and Help Smokers Quit
• Identify and Eliminate Tobacco Related Disparities in Specific Population Groups
• Assist in the Prevention and Early Detection of Four Leading Tobacco-Related Causes of
Death in Arizona
• Develop and Implement a Comprehensive Tobacco Control Plan
• Conduct Surveillance and Evaluation
• Advance Policies that Reduce the Impact of Commercial Tobacco Use

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Strategic Plan Stakeholder

Stakeholders and Partners at the Local, State and National
Levels
• 34 Statewide Community Forums

• 32 Statewide Focus Groups

• Best Practice Reports from the Centers for Disease Control, National Cancer Institute
and Institute of Medicine
• Best Practices of Other States Tobacco Control Programs
• American Cancer Society, American Heart Association
and American Lung Association
• Arizonans Concerned About Smoking
• Arizona Hospital Association
• Local County Health Officers
• TRUST Commission
• Governor’s Office
• 15 County Tour
• 35-Member
statewide
workgroup

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PROGRAM ACTIVITIES AND SERVICES
Preventing Youth Initiation
INTENSIVE SCHOOL-BASED PREVENTION PROGRAMMING
Beginning in 1996, ADHS BTEP funded local partners (including all 15 counties) to
conduct intensive tobacco prevention education in schools. At the time the intensive
school-based prevention programs targeted grades four through six at higher risk schools.
A higher-risk school has students who are considered high-risk for tobacco initiation and
use.
During FY07, local partners utilized health educators to provide brief and intensive
tobacco prevention programming to area schools for students in grades K – 12. These
services were designed to educate students on the effects of tobacco use and needed to
prevent the initiation of tobacco use. Overall, ADHS BTEP contractors served
approximately 60,000 students in grades four through eight, which is representative of 15
percent of the entire student population in Arizona.
In 2007, ADHS BTEP restructured the intensive school-based prevention program
funding, due to the strategic planning process. One of the main objectives of the new
school-based prevention programs is to increase youth knowledge about the harmful
effects of tobacco and prevent youth initiation of tobacco use by implementing
standardized, evidence-based curricula in selected Arizona schools and other venues.
In order to complete this project, ADHS BTEP will continue funding the local partners to
conduct the intensive school-based prevention programs. However, programs will be
focused in a Title I School, as designated by the Arizona Department of Education,
grades four through eight.
Prevention Curricula
The curriculum utilized by the local partners is evidence-based, and they have been
approved by ADHS BTEP. Some of the curricula include, but are not limited to:
- Toward No Tobacco Use
- Project Alert
- Get Real About Tobacco
- Project BUTT
Each of the county contractors will decide the curriculum they would like to implement.
Some of the partners will directly select the curriculum for the prevention education staff
and the classroom teachers, while others work at the district or school level, allowing the
school administrators and teachers to choose a curriculum.
The contractors typically used “Get Real About Tobacco” to target grades four and five,
which “Project Alert” was the curriculum of choice for grades six, seven, and eight.

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The following charts illustrate the curriculum choices by grade level for the schools in
FY07.
Figure 1: Tobacco Curricula use in Grades Four-Five and Grades Six-Eight, FY07

According to the University of Arizona’s Evaluation, Research and Development Unit,
most of the students expressed satisfaction with this curriculum. In grades four and five,
almost all of the students found the class interesting (92 percent and 91 percent,
respectively), and the majority of them also reported learning about how smoking harms
their bodies (99 percent and 98 percent, respectively). In grades six, seven and eight, the
students felt the information was important to them (95 percent, 91 percent, and 87
percent, respectively), and almost all the students reported learning how smoking harms
their bodies (98 percent, 97 percent, and 96 percent, respectively).
PREVENTING YOUTH INITIATION BY RESTRICTING ACCESS TO
TOBACCO
School Policy Assessment
The Maricopa County Tobacco Use Prevention Program (MACTUPP) was contracted by
ADHS BTEP during FY07 to conduct school policy assessments using a previously
designed school policy assessment tool. The purpose of this contract was for MACTUPP
to generate a comprehensive list of tobacco-free policies at the local high school levels.
In FY07, MACTUPP conducted 80 compliance checks.
Attorney General's Youth Tobacco Program
The Attorney General’s Office (AGO) monitors compliance with and enforces the
tobacco Master Settlement Agreement (MSA), laws restricting the availability and sale of
tobacco products to minors, and Arizona’s non-participating manufacturer legislation,
A.R.S. §§44-7101 and 44-7111. AGO operates and maintains the Arizona Youth
Tobacco Program. The program seeks to:

18

•
•

Facilitate the efforts of local law enforcement agencies seeking to enforce
Arizona’s youth tobacco laws
Monitor the rate at which Arizona tobacco retailers comply with laws that
prohibit the sale of tobacco to minors.

The AGO line systematically performs undercover investigations of tobacco retailers
throughout the state. In order to assess compliance with the law, AGO agents and
officers work with youth volunteers who visit tobacco retail outlets and attempt to buy
tobacco products.
The AGO increased their compliance checks from FY07 to FY08 and found increases in
the number of “failures to comply.” There was a 10 percent increase in total buys from
FY07 to FY08, and in turn, there was a 17 percent increase in total citations from FY07
to FY08.
Table 1: Attorney General Compliance Check Results

Total Inspections
Total Buys
Total Citations

Fiscal Year
2007
4646
859
497

Fiscal Year
2008
4984
943
583

COUNTER MARKETING
“Tobacco Use: It’s a Personal Foul”
The “Tobacco Use: It’s a Personal Foul” youth prevention campaign targeted primarily
young children in grades three through six with an emphasis on lower socio-economic
children. To support segments of this demographic, nearly all campaign materials were
produced in both English and Spanish. The overall goal was to saturate the target
demographic with the new prevention message “Tobacco Use: It’s a Personal Foul” to
raise children’s awareness about not using tobacco, then, to extend that brand and
awareness message via the electronic interactive kiosks and the website personalfoul.org.

Helping Tobacco Users Quit
ARIZONA SMOKERS’ HELPLINE (ASHLine)
ADHS BTEP funds ASHLine and, in FY07, community-based cessation classes.
Beginning in FY08, with the launch of the new Strategic Plan, ADHS BTEP determined
the most effective way to provide cessation assistance statewide, while effectively
utilizing the diminishing tobacco tax revenues, is to primarily fund a quitline for
cessation services, a trend appearing nationwide. Due to this, tobacco cessation classes
are no longer funded by ADHS BTEP, and any mention of cessation classes throughout
this report refers to the past.

19

The goal of ASHLine is to provide access to effective, research-based tobacco use
cessation services for Arizona residents. In order to achieve this goal, ASHLine offers the
following services on an individual basis:
•
•
•
•

Telephone counseling in English and Spanish.
Web-based information
Printed materials
Referrals to local quit tobacco classes in your community.

The ASHLine provides tobacco use cessation services to all Arizona residents. Since its
inception, the ASHLine has received more than 10,000 calls each year. ASHLine utilizes
various approaches to maximize the accessibility of tobacco cessation, including:
•
•
•
•
•
•

Individualized quit planning design
Client anonymity and confidentiality
Proactive counseling
Structured protocol counseling
Culturally competent and sensitive counseling
Multilingual services, including English, Spanish, Korean, and Arabic.

Medication to Assist Clients in Quitting:
Current research indicates that one of the most effective tobacco cessation methods is a
combination of quitline and nicotine replacement therapy, including prescription
medications (NRT+). ADHS BTEP, during FY07 and through February 2008, offered a
medication benefit to clients older than age 18 years who are enrolled in intensive
cessation programs, including ASHLine or the community-based classes. The
distribution service ADHS BTEP contracted with for this service is US Script. The
benefit included a 50 percent discount of the price of over-the-counter nicotine
replacement therapy (NRT), specifically nicotine patch, gum, or lozenge. During this
time period, the only prescription medication covered by this benefit was Buproprion.
Each client received the benefit for six weeks, and the vouchers were dispensed every
two weeks at the class or mailed after the phone counseling session.
Following a nationwide movement to provide NRT+ to clients enrolled in cessation
classes, the ADHS BTEP decided to provide each client who enrolled in cessation
services with the ASHLine free NRT+ for 12 weeks, including patch, gum, lozenge,
Buproprion, and Chantix®. On March 1, 2008, this benefit was launched through the
beBetter Networks, IncTM distribution system. The response to the benefit was
overwhelming, and on May 1, 2008, the benefit was reduced to NRT (patch, gum, and
lozenge) for two weeks.

20

How Clients Heard About the Program
The primary way that clients heard about the ASHLine was through their health care
providers. A description of the proactive Quitfax Referral program is detailed in the
Healthcare Provider Services section.
ADHS BTEP advertised ASHLine services through a major advertising campaign
launched at the end of 2006 through 2007. The “We Can Help” campaigns generated
awareness of cessation services. The call to action was to get smokers to call ASHLine.
The 12-month campaign consisted of 18 commercials, six each featuring three different
characters, “Nick” “Jamie” and “Hector,” as they progressed through the stages of
change from pre-contemplation through maintenance of quitting.
Users’ Satisfaction with Tobacco Cessation Classes
The Evaluation, Research and Development Unit (ERDU) at the University of Arizona
developed a report titled: “Results of the Cessation Class Satisfaction Survey Report:
Arizona Summary”. The following information was obtained from the executive
summary of that report.
1,535 of the individuals who completed a cessation class in Arizona filled out a
satisfaction survey. “This number represents 35 percent of individuals who completed a
Client Intake Form (CIF) on the initial session of the cessation class (4376 CIFs were
received from local project clients in FY06-FY07).” Eighty-two percent of Arizona
cessation class participants who completed a satisfaction survey indicated that the class
met their needs, and almost all, 94 percent, would refer another tobacco user to the class.
Most of the class and facilitator ratings on the satisfaction survey were positive with
ratings of “excellent” and “good”. For the items ‘Easy to use the coupons for patches,
gum, Zyban or lozenges’ and ‘audio-visual materials’, many respondents in a number of
the counties answered ‘Not Applicable’ suggesting classes differed in their use of these
materials.
Who Are Service Users?
The clientele of ASHLine is diverse, in part due to media reach. The following table
(Table 2: ASHLine Client Demographics) is an indication of the clientele for FY07 and
the first quarter of FY08. The final data for FY08 is still being processed by ERDU and
will not be reported. The percentages in this table are based on the number of CIFs
completed for the fiscal year.

21

Table 2: ASHLine Client Demographics

Client Intake Forms Completed
Gender
Male
Female
Service Language
English
Spanish
Sexual Orientation
Heterosexual
Gay, Lesbian, Bisexual or
Transgender
Race
American Indian/Alaska Native
Asian
Black or African-American
Native Hawaiian or Other
Pacific Islander
White/Caucasian
Other
Hispanic
Yes
No

Fiscal Year 2007
(N/%)
2949/100%

Fiscal Year 2008,
Quarter 1 (N/%)
911/100%

1219/41.3%
1640/55.6%

324/35.6%
578/63.4%

2758/93.5%
185/6.3%

881/96.7%
29/3.2%

2627/89.1%

863/94.7%

85/2.9%

34/3.7%

42/1.4%
15/0.5%
166/5.6%

14/1.5%
5/0.5%
51/5.6%

6/0.2%

1/0/1%

2040/69.2%
485/16.4%

676/74.2%
129/14.2%

545/18.5%
2223/75.4%

131/14.4%
760/83.4%

HEALTHCARE PROVIDER SERVICES
HealthCare Partnership
The Healthcare Partnership (HCP) has evolved into an “evidence-based statewide
education and training model that brings together seasoned professionals in the areas of
tobacco dependence treatment, adult education methods and techniques, instructional
design and teaching, data management and analysis, and public health.” The program’s
mainstay is its continuing education, certification, and training programs.
Proactive Referral System/QuitFax
Health and human service providers are recommended to ask every client about their
tobacco use at every visit. For those clients who are looking for help quitting tobacco,
ASHLine has created a fax referral form (QuitFax) making it easier for providers to
ensure their clients have access to tobacco cessation services.
The form provides ASHLine with a client’s name and contact information. Within 24
hours of receiving a QuitFax, a counselor attempts to contact the client, with a minimum
22

of three attempts to reach them in 10 days. The clients are informed of the telephone
cessation coaching available at the ASHLine, as well as about quit tobacco classes that
meet in their area. In order to keep the providers informed, ASHLine sends a fax with
information on the services a client has accepted to the healthcare provider.
Table 3: QuitFax Referral System
Fiscal Year 2007
Total Referrals
3059
Percent of Clients Reached by Phone
69% (2110)
Received Some Level of Service (of the 55% (1160)
Clients Reached)

Fiscal Year 2008
9647
67% (6449)
84% (5447)

FREE NRT PILOT – MOHAVE
Mohave County served as a pilot project for free NRT. This benefit was offered to
county residents from April 2006 to July 2006. In order to be eligible for this benefit, the
client had to attend the first or second session of a cessation class offered by Mohave
County. For every week of class attended, the client would receive one week of NRT.
More participants were returned throughout the program when free NRT was offered.
For example, on the last week of classes, the free NRT period had a retention rate of
60%, while the group who did not receive free NRT had a retention rate of 48%.
COUNTER-MARKETING
Arizona’s highest smoking prevalence is among white males age 18-34 years and age 3564 years old of low socio-economic status (ADHS BTEP 2006 Biennial Evaluation
Report). However, men in the lower age category typically do not seek out cessation
assistance as readily as those males age 35-64 years. ADHS BTEP Marketing wanted to
develop a cessation campaign to target the age group with the highest prevalence but also
with highest likelihood of seeking services. This campaign focused on 30-40 year old,
white, low socio-economic status males. Additionally, the campaign targeted women.
Arizona, especially in some of its rural counties, has high smoking prevalence numbers
among women age 35-64 years of low socio-economic status. Hispanic males age 35-64
were included in our intended audience due to the fact the Hispanic population is
approaching 50 percent of Arizonans.
The overall goal of the “We Can Help” campaign was to generate awareness of the states
cessation services – to get the message out that help is available for those who want to
quit tobacco. A secondary goal was to get smokers to call ASHLine to seek cessation
services.
The 12-month campaign consisted of 18 commercials, six each featuring three characters
“Nick” “Jamie” and “Hector” as they progressed through the stages of change from precontemplation through maintenance.

23

The campaign included television advertising, radio advertising, in-theater advertising,
print advertising, and public relations (earned media) activities. The television and radio
commercials featured the characters having frank discussions with the viewers/listeners
about the desire to quit. A public relations effort was executed for the campaign’s kickoff for New Year’s 2007. Additional media interviews took place throughout the
campaign.
An independent media evaluation source was engaged to evaluate the campaign. The
evaluators utilized telephone surveying of 125 unique calls per month as the source for
their evaluation. According to their research, ADHS BTEP achieved and far exceeded its
goals with the “We Can Help” campaign. The primary goal was to increase awareness of
the help available to smokers. The percentage of polled individuals that reported they had
seen or heard advertising for the help available without being prompted of the advertising
ranged from 20 percent to 34.4 percent. Individuals that did not recall the advertising, but
remembered after a description was read to them ranged from 26.4 percent to 45.4
percent. Total awareness from all individuals, whether they were reminded or not, ranged
from 31.2 percent to 57.6 percent. When asked how well the advertising “got its message
across” (with 1=not very well and 6=very well) the averages ranged between 4.70 and
4.11. After rating the attributes, the percentages for “got its message across?” ranged
from 41 percent to 67 percent.
The secondary goal of the campaign was to increase calls to the ASHLine by six percent
over the prior year’s calls. The campaign far exceeded this goal as well. In fact, the “We
Can Help” campaign generated the highest average monthly television-initiated calls to
ASHLine over all previous years combined. The 2007 call volumes averaged about 150
calls higher month-to-month than in comparative months in 2006. There was a 103
percent increase in call volume in for the first quarter of calendar year 2007 over first
quarter 2006. ASHLine’s total call volume during the campaign was increased by 45
percent over the prior year’s calls.

Reducing exposure to secondhand smoke
COMMUNITY-BASED OUTREACH
In order to raise awareness of the dangers of secondhand smoke, ADHS BTEP contracted
with local partner programs, specifically the counties, to conduct activities to reach the
community. The Partners conducted health fairs, festivals, or presented the information
to various community groups. In FY07 and FY08, more than 5000 events were conducted
statewide reaching more than 400,000 people annually.
WORKSITE SECONDHAND SMOKE POLICY ASSISTANCE
ADHS BTEP local and statewide contractors provide information and technical
assistance to worksites in creating and maintaining smoke-free policies. They also
provide information on the benefits of developing and maintaining in-home rules about
smoke.

24

Primarily, the Arizona HealthLinks (AzHL) program promotes and helps employers
establish smoke-free policies. The worksites they specifically target are staffed with
workers who are at higher-risk for chronic disease, including tobacco-related diseases.
According the Arizona HealthLinks final report, “between October 2004 and December
2007, AzHL delivered a pitch and/or other wellness programs in 1629 worksites
throughout Arizona.”
MOHAVE AIR QUALITY STUDY
ERDU evaluated a study, conducted by the Mohave County Department of Public Health
(MCDPH), to determine the impact of air pollution in Mohave County establishments
prior to instatement of the statewide smoking ban. MCDPH began this study by
identifying a sample of bars and restaurants, which allowed smoking before the ban. It
measured the air quality before and after the smoking ban.
The study included seven establishments, and the visits lasted approximately 30 minutes
each. After following a procedure for measuring air quality, utilizing Environmental
Protection Agency standard, the study demonstrated a 99 percent decrease in air
pollution. This indicates that compliance with the statewide smoking ban will help
decrease exposure to secondhand smoke.
SMOKEFREE ARIZONA
Arizona went SmokeFree in FY07. In November 2006, Arizona voters approved a
statewide smoking ban (Smoke-Free Arizona Act A.R.S. §36-601.01), which essentially
prohibits smoking in most enclosed public places, as well as worksites. The
establishments are required to follow the 20 foot rule: smoking within 20 feet of an
entrance is prohibited. According the SmokeFree Arizona website
(www.smokefreearizona.com), the following establishments were required to implement
the ban:
•
•
•
•
•
•
•
•

Restaurants, bars, grocery stores, or any establishment that serves food
Office buildings and work areas such as meeting rooms, employee lounges,
classrooms, and private offices
Healthcare facilities, hospitals, health care clinics, and doctor’s offices
Company-owned or employer-owned vehicles during working hours if the vehicle is
occupied by more than one person
Enclosed common areas in hotels and motels
Lobbies, elevators, restrooms, reception areas, halls, stairways, and any other
enclosed common-use areas in public and private buildings including condominiums
and other multiple-unit residential facilities
Any place of employment not exempted
Tribes are Sovereign Nations. The SmokeFree Arizona Act has no application on
Indian reservations as defined in A.R.S. §42-3301 (2).

25

The ADHS Office of Environmental Health is responsible for monitoring compliance
with the law.

Identifying and eliminating tobacco-related disparities
There are certain groups that exhibit disproportionately high morbidity and mortality
rates associated with tobacco use. Factors including, but not limited to, an individual’s
age, race/ethnicity, educational attainment, income, and sexual orientation greatly
contribute to health disparities within a given population. Tobacco-related disparities are
demonstrated by increased prevalence of tobacco use, greater exposure to secondhand
smoke, and limited access to educational information and prevention/cessation
programming among other considerations.
ADHS BTEP offers a variety of services aimed at mitigating tobacco-related disparities
including cessation counseling, education and prevention services through a variety of
community-based organizations established to serve specific populations, such as the
lesbian, gay, bisexual, or transgendered (LGBT) community and individuals of low
socioeconomic status. ADHS BTEP also works with nine tribal nations and three urban
Indian centers which provide an array of services to Native American communities
throughout the state. Most recently, ASHLine has coordinated with an ADHS BTEP
community project, Asian Pacific Community in Action (APCA) to provide cessation
services to Vietnamese, Korean, and Chinese-speaking populations within Arizona.
A unique government-to-government relationship exists between Indian Tribes and
Federal and State Governments. ADHS BTEP recognizes the uniqueness of tribes and
urban American Indian populations. ADHS BTEP, in collaboration with tribes, urban
American Indian organizations, and the Inter Tribal Council of Arizona, Inc, supports
local partners in tribal communities planning and implementing tobacco education and
prevention programs. These local partners play a key role in developing strategies that
best fit their community’s needs.
INTER TRIBAL COUNCIL OF ARIZONA, INC. (ITCA)
The Inter Tribal Council of Arizona, Inc. sub-contracts with eight tribal nations and three
urban Native American organizations. The tribal nations are located in the northern,
central, southern, and western regions of Arizona. The urban center provide services to
the Native American populations located in Flagstaff, Phoenix, and Tucson
The objective of the ITCA is to fund and assist program capacity of sub-contracted Tribal
tobacco education and prevention programs and Urban Indian Health Center tobacco
education and prevention programs to develop culturally appropriate tobacco prevention
programs. ITCA also provides program management, research, data collection, resource
development and evaluation. The ITCA also organizes and conducts meetings,
workshops, and conferences to facilitate participation of the Tribes in Arizona and the
urban Indian communities.

26

GILA RIVER INDIAN COMMUNITY (GRIC)
The Gila River Indian Community tobacco program provides services to the tribal
members on the Gila River Indian Community. The reservation is comprised of 372,000
acres and borders the cities of Tempe, Phoenix, Mesa, and Chandler.
The services provided to the GRIC community include tobacco education presentations
and workshops at various conferences and community events. The GRIC tobacco
program also provides education to other tribal government health education staff. The
program works closely with the Gila River Health Care Corporation which provides
cessation services to community members through their Quit Now program.
WINGSPAN
Wingspan tobacco program provides services to the lesbian, gay, bi-sexual, and transgender (LGBT) population in southern Arizona.
The Wingspan tobacco program provides services that include increasing the awareness
of the incidence and health impact of smoking among the LGBT community, providing
smoking cessation classes, and providing training to volunteers on outreach, brief
interventions, and cessation facilitation.
TANNER COMMUNITY DEVELOPMENT CORPORATION (TCDC)
The Tanner Community Development Corporation provides services to the African
American and Faith-Based community in Arizona.
The TCDC tobacco program’s mission is to reduce tobacco use in the African American
and Faith-based communities in Arizona by providing education and prevention services
and promoting quitting through cessation programs. An additional goal of the program is
to increase the communities’ capacity to move from awareness of the problem to
reducing tobacco use and preventing youth from becoming smokers in the future.
CHICANOS POR LA CAUSA (CPLC)
The Chicanos Por La Causa provides services to the Hispanic community members and
providers throughout Arizona.
The CPLC tobacco program focuses on reducing tobacco use among youth and their
families by providing prevention and education services. Additionally, CPLC provides
information through outreach at various community events, workshops, and training to
staff of early childhood programs in addition to working with community schools.
MOUNTAIN PARK HEALTH CENTER (MPHC)

27

The Mountain Park Health Center provides services in medically underserved areas and
improves the health status of medically underserved population. The MPHC tobacco
program provides services in two major communities in the Phoenix metropolitan areas –
South Mountain and Maryvale.
The MPHC tobacco program works in conjunction with the various health departments of
the MPHC such as integrated behavioral health, nutrition and physical education,
prenatal, asthma and obesity prevention classes. The tobacco program provides
education and prevention services in addition to providing cessation services in both
English and Spanish.
ASIAN PACIFIC COMMUNITY IN ACTION (APCA)
The APCA tobacco program provides education, prevention, and cessation services to
multiple Asian and Pacific Islander communities in Maricopa County. Integrated in the
program is chronic disease prevention education which includes information on
cardiovascular and cancer risks related to tobacco use, lack of physical activity, and
unhealthy eating habits.

Reducing the Burden of Chronic Disease
In November 2002, Arizona voters approved Proposition 303, which increased the tax on
cigarettes by 60 cents per pack and taxed other tobacco products. The proposition set
aside money for the prevention and early detection of the four leading disease related
causes of death in Arizona. Currently, the four leading causes of death in the state are
cancer, heart disease, stroke and chronic obstructive pulmonary disease (COPD).
According to the CDC, 70 percent of all deaths in the U.S. can be attributed to these four
chronic diseases. Furthermore, in the U.S., chronic diseases are consistently the most
expensive yet preventable diseases, accounting for about 75 percent of the nation’s health
care budget.
ADHS BTEP provides administrative oversight for chronic disease programs funded with
tobacco tax dollars. ADHS BTEP partners with the ADHS Bureau of Chronic Disease
Prevention and Control, which provides direct management of a number of programs,
including programs to provide screening for breast cancer and colorectal cancer, public
awareness campaigns, training health care professions regarding COPD risk reduction, as
well as a telemedicine project aimed at assisting individuals in rural areas of the state
who suffer from stroke-related conditions.
WORKSITE CHRONIC DISEASE PREVENTION
Arizona HealthLinks (AzHL), in partnership with the American Cancer Society, Great
West Division, provides worksites with programs and services that focus on wellness and
lifestyle improvement. AzHL assists businesses with employee-based activities that focus
on physical activity (Active for Life, W.E.L.L. Arizona, and Walking Works), nutrition
(Meeting Well), and tobacco policy and cessation information.

28

AzHL works with employers to develop comprehensive internal worksite policies that
assist with reducing healthcare expenses and containing costs through the implementation
of a health preventative program. According to the American Cancer Society, there is “an
infrastructure in place to implement the AzHL program in all fifteen counties of Arizona
which brings vast national experience in addressing chronic disease prevention and
healthy lifestyles in the worksite setting.”
Table 4: Arizona HealthLinks Reach
Fiscal Year 2007
# of Worksites pitched
# of Worksites received services
# of Programs Delivered

308
406
944

Fiscal Year 2008
(Based on first 9 months)

342
455
896

CHRONIC DISEASE PARTNERSHIPS
When Arizona voters passed Proposition 303 in 2002 which increased the state tax on
cigarettes by 60 cents per pack and taxed other tobacco products, two percent of this tax
was set aside for a chronic disease fund which as administered by the ADHS BTEP.
During FY07, ADHS BTEP funded nine community outreach programs and two
statewide outreach programs for chronic disease prevention; however, these projects were
phased out and replaced by county programs in FY08. Shown below are lists of the
programs which were funded under this provision.
Community Outreach Vendor List FY07
American Lung / APCA / Coconino County / Maricopa County / Mountain Park CHC /
Native American Comm. / Wingspan / TGen / (all projects were phased out and replaced
by the Local Partners for FY08) Wesley Community Center
Community Outreach Vendor List FY08
APCA / Mountain Park CHC / Phoenix Fire (contracts listed here are different than those
listed in FY07) Wesley Community Center
Statewide Projects Vendor List FY07
American Cancer Society / AIA
Statewide Projects Vendor List FY08
American Cancer Society / AIA (Phased out in FY08)

29

RESULTS
This section contains additional data relevant to the results of the Arizona tobacco control
program. The data have been assembled to correspond with the outcome indicators for
evaluating comprehensive tobacco control programs developed by the CDC. Results for
all identified CDC outcome indicators are not presented here. Rather, a selection of
outcome measures with the highest relevance to Arizona tobacco control activities is
provided. The behavioral and attitude-related results are reported separately for youth and
adults.
For every outcome measure reported the respective CDC indicator number and label are
presented to ensure consistency of reported results with CDC recommended and
approved standard outcome measures for comprehensive tobacco control measures.

Youth Smoking Behavior
It is important to remember that the data in these school-based surveys are representative
of the public school student population. Private schools, parochial schools, juvenile
detention centers and other special schools are not included in the surveys. This limitation
is important because of existing evidence demonstrating that adolescents who are not in
school (and those with high numbers of absences) have higher rates of tobacco use than
do adolescents who are in school. This is known to be true for high school drop-outs in
particular.
TOBACCO USE
CDC Outcome Indicator 1.14.1 Prevalence of tobacco use among young people
According to the Arizona Youth Tobacco Survey (YTS), 2007, 59 percent of high school
students reported ever using any tobacco product, and 34 percent of middle school
students reported ever using any tobacco product. Cigarettes were the most popular
tobacco product ever tried across both groups. (Please refer to Figure 2.) Fewer than 1 in
5 middle school students and 1 in 3 high school students reported current use of any
tobacco product. American Indian/Alaskan Native students reported the highest rates of
ever tobacco use, as well as current tobacco use, in both middle and high school. In
2007, White students reported the lowest rates in both middle and high school. In high
school, Hispanic/Latino and White students showed an increase in prevalence rates. In
middle school, Hispanic/Latino and White students appear to have decreasing prevalence
rates. American Indian/Alaskan Native and Black/African American students show a
decrease for both middle and high school when compared to 2000. (Please refer to Figure
3.)

30

Figure 2: Ever Tobacco use by Middle and High School

Figure 3: Current Tobacco Use by Ethnicity and by Middle and High School

SUSCEPTIBILITY TO INITIATING SMOKING
CDC Outcome Indicator 1.13.2 Prevalence of young people who report never having
tried a cigarette
According to the YTS, 57.4 percent reported never having tried cigarette smoking, even
one or two puffs compared to 37.2 percent who reported ever trying a cigarette.
ACCESS TO TOBACCO PRODUCTS
CDC Outcome Indicator 1.11.2 Proportion of young people reporting that they have been
sold tobacco products by a retailer
Students under age 18 years often acquire tobacco products through social networks such
as borrowing or bumming cigarettes from friends. However, middle and high school
students show different patterns of sources they reported for acquiring cigarettes.
Potential sources for current smokers under age 18 year are shown below.

31

Table 5: How Current Smokers under 18 Reported Getting Cigarettes
Middle School
Gave someone else money to buy them
23%
Took them from a store or family member
17%
Borrowed or bummed them from someone else
16%
A person 18 years old or older gave them to me
9%
Bought them in a store such as a convenience store,
4%
supermarket, discount store, or gas stations
Other
32%

High School
30%
4%
22%
9%
21%
13%

Both high school and middle school students reported gas stations as a typical store
location for purchasing cigarettes. Tobacco or smoke shops and convenience stores were
also often used.
Table 6: Store Types Where Current Smokers under 18 Who Bought Cigarettes from a
Store during the Past 30 Days Reported Buying Them
Middle School
High School
Gas Station
20%
37%
Tobacco or Smoke Shop
11%
15%
Convenience store
7%
14%
Grocery Store
4%
6%
Internet
2%
4%
Drugstore
3%
2%
Other
53%
22%
MEDIA AWARENESS
CDC Outcome Indicator 1.6.2. Level of receptivity to anti-tobacco media messages
Item 71 of the Arizona YTS Report asks students whether they have seen or heard
commercials on TV, the Internet, or on the radio about the dangers of cigarette smoking.
Responses to this item reveal that 25.8 percent have not been exposed to any commercial
during the past 30 days, 19.7 percent have been exposed to a commercial one to three
times in the past 30 days, 16 percent saw or heard a commercial one to three times per
week, 18.8 percent saw or heard a commercial almost daily, and 12.8 percent reported
seeing or hearing a commercial more than once a day.
CESSATION
CDC Outcome Indicator 3.11.2. Proportion of young smokers who have made a quit
attempt
In 2007, roughly half of all current cigarette smokers in high school expressed a desire to
quit. Comparatively, in middle school, there seems to be a declining trend in the reported
desire to quit smoking cigarettes among current smokers. (Please refer to Figure 4.)

32

Figure 4: Percent of Current Smokers Wanting to Quit Smoking Cigarettes

Adult Smoking Behavior
The Arizona Adult Tobacco Survey (ATS) is conducted tri-yearly; meaning the most
recent data available for this report comes from the 2005 ATS. This information was
published in the last Biennial Report, and will not be repeated here.
CDC Outcome Indicator 3.14.1 Smoking Prevalence
According to the 2007 Arizona Behavioral Risk Factor Surveillance Survey (BRFSS),
19.8 percent of respondents identified themselves as current smokers. Table 7 lists the
weighted percentages of the respondents who are current smokers.

33

Table 7: 2007 Arizona BRFSS: Respondents Who Are Current Smokers
Gender
Male
23.3%
Female
16.3%
Age
18-24
64.4%
45-54
20.8%
25-34
21.9%
55-64
21.0%
35-44
16.9%
65+
10.1%
Marital Status
Married
15.2%
Divorced
33.7%
Widowed
17.5%
Separated
31.3
Never Married
30.2%
Unmarried Couple
19.6%
Education
Less than High
33.9%
Some College/Tech 16.3%
School
School
High School
24.1%
College Graduate
14.9%
Graduate/GED
Employment
Employed for
22.7%
Self-employed
17.4%
Wages
Out of work
34.1%
Homemaker
9.4%
Student
13.8%
Retired
12.7%
Unable to work
29.9%
Income
<$25,000
26.6%
$50,000 - $74,999
16.6%
$25,000 – $34,999
17.7%
$75,000 or more
15.7%
$35,000 - $49,999
24.5%
Race/Ethnicity
White, Non19.5%
Black, Non23.9%
Hispanic
Hispanic
Other race, Non24.8%
Hispanic
18.1%
Hispanic
CDC Outcome Indicator 3.14.2. Prevalence of tobacco use during pregnancy
According to the Arizona Department of Health Services Bureau of Public Health
Statistics (ADHS BPHS), Health Status and Vital Statistics Section the prevalence rate of
women who report tobacco use during pregnancy is 4.7 per 100 births in 2007, which is
slightly lower than 2005 (5.4 per 100 births).

34

AN ERA OF CHANGE
In an era of entrenched and disquieted tobacco users [The term “tobacco users” is used in
this context to refer to the smoking and or chewing of all forms of commercial tobacco
(e.g. cigarettes, cigars, pipes, chew tobacco, etc.)], created in large part by successful
efforts to raise tobacco taxes and prohibit the use of commercial tobacco in public places,
and in which further reduction in tobacco use can not be achieved by expecting past
successes to continue…….. a new way of doing business is called for!
In the summer of 2007, the Bureau of Tobacco Education and Prevention announced that
“change is in the air” and that “no stone would go unturned.” For nine intensive months,
staff were fully engaged on an exciting campaign to engage stakeholders at the state and
local levels, and worked tirelessly to restore hope and energy across Arizona through the
creation of an effective tobacco control model. There were many individuals and
organizations who supported this endeavor, and they are listed at the end of this
document. However, there are some outstanding contributions that warrant a special
recognition, including: Susan Gerard, Director of the ADHS; Jeanette Shea-Ramirez,
Assistant Director of Public Health Services at ADHS; members of the Tobacco
Revenue, Use, Spending and Tracking (TRUST) Commission: the BTEP staff and
Leadership Team; Dave Nakashima, our strategic planning facilitator; members of the
Strategic Plan Workgroup; our community forum facilitators at On-the-Mark, Inc.; our
focus group facilitators at Riester; and the many partners and stakeholders across Arizona
who helped plan and participate in the forums, focus groups, and statewide meetings that
were key to the planning process. This strategic plan would have been impossible without
their help.
It is important to note that the timing of a new Strategic Plan for A Tobacco-Free
Arizona is ideal! Indeed, it challenges us all to design and implement major shifts in
thinking and doing, and a process in which “no stone goes unturned” creates
understandable resistance within a broad-based network of service delivery and
advocacy. But through the deployment of a community-based participatory process,
combined with an evidence-based approach and the recent release of publications
detailing the CDC Best Practices and Institute of Medicine (IOM) recommendations for
tobacco programs, a statewide network of people and programs committed to a tobaccofree Arizona is now positioned to propel Arizona back into the national spotlight as a
model for tobacco prevention and control.
Wayne Tormala, Bureau Chief
Bureau of Tobacco Education and Prevention
Arizona Department of Health Services
April, 2008

35