Arizona Adult Tobacco Survey 2002
Executive Report

Prepared by:
Michele Walsh, Ph.D.
Senior Evaluator
Joanne Basta, Ph.D.
Evaluator
Jesse Nodora, Dr. P.H.
Evaluation Administrator

Tobacco Education and Prevention Program
Evaluation Unit
University of Arizona
P.O. Box 210462
Tucson, AZ 85721-0462
520-318-7259

Frederic I. Solop, Ph.D.
Principal Investigator
Kristi K. Hagen, MA, MA
Co-Principal Investigator
Kelly P. McCarrier
Project Manager

The Social Research Laboratory
Northern Arizona University
P.O. Box 15301
Flagstaff, AZ 86011-5301
928-523-1515

Funded by the Arizona Department of Health Services

This report is available online at:
www.azteppdata.org

2

Table of Contents
EXECUTIVE SUMMARY ............................................................................................................ 5
INTRODUCTION .......................................................................................................................... 9
SMOKING PREVALENCE......................................................................................................... 10
Smoking Prevalence by ADHS Region of Residence ............................................................... 11
Smoking Prevalence by Gender ................................................................................................ 12
Smoking Prevalence by Age...................................................................................................... 13
Smoking Prevalence by Race/Ethnicity .................................................................................... 16
Smoking Prevalence by Education ............................................................................................ 17
SMOKING CESSATION............................................................................................................. 18
Reasons for Quitting.................................................................................................................. 18
MEDICAL AND DENTAL PROVIDER COUNSELING .......................................................... 20
EXPOSURE TO SECONDHAND SMOKE ................................................................................ 23
Household Exposure.................................................................................................................. 23
Workplace Exposure.................................................................................................................. 24
RISK PERCEPTIONS .................................................................................................................. 25
ATTITUDES TOWARD TOBACCO CONTROL ORDINANCES ........................................... 26
ANTI-TOBACCO MEDIA AND TOBACCO PROMOTION ITEMS...................................... 30
TOBACCO TAX OPINIONS....................................................................................................... 31
SMOKELESS TOBACCO ........................................................................................................... 32
CONCLUSIONS........................................................................................................................... 33
METHODS ................................................................................................................................... 35
REFERENCES ............................................................................................................................. 38

3

List of Figures and Tables
Figure 1. Adult smoking prevalence in Arizona: 1990 – 2002................................................................... 10
Figure 2. Estimate of cigarette packs smoked in a month. ......................................................................... 11
Figure 3. Current smoking prevalence by region: 1996, 1999 & 2002. ..................................................... 12
Figure 4. Arizona smoking prevalence compared to national data............................................................. 12
Figure 5. Arizona smoking prevalence by age: 1996, 1999 & 2002. ......................................................... 13
Figure 6. Prevalence of current smokers by age and gender. ..................................................................... 14
Figure 7. Percentage of current smokers reporting smoking 30 days of last month by age. ...................... 15
Figure 8. Estimate of cigarette packs smoked in a month by age: 1996, 1999 & 2002.............................. 15
Figure 9. Arizona estimated smoking prevalence by race & ethnicity, ATS 1996, 1999 & 2002, and
National Health Interview Survey, 2002. ............................................................................................ 16
Figure 10. Current smokers by education for Arizona adults: 1996, 1999 & 2002.................................... 17
Figure 11. Type of assistance used by smokers reporting use of non-pharmaceutical cessation aides….. 18
Figure 12. Most important reasons why smokers decided to quit. ............................................................ 19
Figure 13. Main reasons for stopping smoking by gender. ....................................................................... 19
Figure 14. Reported tobacco counseling practices by medical care providers in previous 12 months:
1996, 1999 & 2002. ............................................................................................................................. 20
Figure 15. Percentage of current tobacco users reporting attempting to quit when advised by a medical
provider................................................................................................................................................ 21
Figure 16. Reported tobacco counseling practices by dental care providers in previous 12 months: 1996,
1999 & 2002. ....................................................................................................................................... 21
Figure 17. Household smoking rules by presence of smoker in household ............................................... 23
Figure 18. Smoking status by type of worksite policy. .............................................................................. 24
Figure 19. Perceptions of harm in breathing secondhand smoke. .............................................................. 25
Figure 20. Percentage of respondents supporting complete smoking bans by type of location: 1996, 1999
& 2002. ................................................................................................................................................ 26
Figure 21. Areas smoking should be allowed in ........................................................................................ 27
Figure 22. Allow sponsorship of sports events by tobacco companies. ..................................................... 28
Figure 23. Storeowners should be required to have a license to sell tobacco............................................. 29
Figure 24. Percentage of adult respondents who have seen anti-tobacco media messages: 1996, 1999 &
2002……….. ....................................................................................................................................... 30
Table 1. Regional Tobacco Use Rates. ........................................................................................................ 6
Table 2. The importance of keeping stores from selling tobacco to minors. .............................................. 28

4

EXECUTIVE SUMMARY
General Summary
This report provides an overview of some of the key findings for the 2002 Arizona Adult
Tobacco Survey, which was conducted by phone with over 6,000 adult Arizona residents.
Overall smoking prevalence remains at a rate close to the previous 1999 ATS prevalence rate
(18.8% in 1999 and 20% in 2002), but when examined by age category, the 18-24 year olds
show a significant increase (21% in 1999 to 29% in 2002). The increase in this age group is
mostly driven by high rates reported by males. Also, the less educated (less than high school)
show substantially higher proportions of current smoking rates than for those with some college
education or a college degree. These results suggest the need for intensified efforts at youth
tobacco prevention, particularly with youth who are at risk for not completing high school.
Although smoking prevalence has remained constant, and even increased among young adults,
there is evidence that Arizona smokers have, on average, decreased the number of cigarettes they
are smoking. The percentage of current smokers reporting smoking every day has declined, as
have the average number of cigarettes they report smoking per day. This translates into a
decrease in the average number of packs smoked per month from 30 packs/month in 1996 and
1999 to 22 packs/month in 2002. This trend is consistent across age groups, with the 18-24 year
olds reporting smoking the least (on average, 12 packs/month).
Although a high percentage of smokers want to quit (43% reported making a quit attempt in the
past year), only 23% used any form of pharmaceutical assistance, and even fewer (7%) used
other types of cessation services such as classes, clinics, self-help materials, or counseling.
Research indicates that healthcare providers can have a powerful influence on smokers’ attempts
to quit. However, only 71% of current tobacco users report being advised to quit by their
healthcare providers. Further efforts by ADHS TEPP to engage healthcare providers in
innovative approaches to promote cutting back and quitting tobacco use could be fruitful.
The results of the survey also indicate a need for providing ongoing information about the harms
of exposure to secondhand smoke, and for encouraging smoke-free policy and advocacy.
Although household smoking restrictions increased in non-smoking households, there was no
change in the percentage of households with a smoker reporting having home smoking
restrictions. Also, of those who are currently employed and report working indoors most of the
time, 15% report that someone had smoked in their work area in the week prior to the survey,
and less than half report having smoke-free worksite policies.

Tobacco Use in Arizona
The estimated overall prevalence of cigarette smoking among adult Arizonans in 2002 was 20%.
That rate has been stable over time as shown by the results of the previous two Arizona Adult
Tobacco Surveys and the last 12 Arizona Behavior Risk Factor Surveys.
5

Although overall prevalence remained steady, there is evidence that Arizona smokers are
smoking less. The percentage of current smokers reporting smoking every day declined from
83% in 1996 and 1999 to 77% in 2002. In addition, current smokers in 2002 reported smoking
few cigarettes per day on average (15/day) than they reported in 1996 and 1999 (20/day).
Taken together, the average number of packs smoked monthly by current smokers in 2002 is
estimated to be 22, down from 30 packs/month reported in 1996 and 1999.
Regional Tobacco Use Rates: See Table 1 below. The prevalence of cigarette smoking among
adults varied somewhat across the five Adult Tobacco Survey regions in Arizona from 19% in
Region 1 (Maricopa County) to 24% in Region 4 (Gila, La Paz, Mohave, and Yavapai Counties).
Table 1. Regional Tobacco Use Rates.
Region 1
Region 2
Region 3
Region 4
Region 5

Maricopa County
Pima County
Coconino, Navajo, Apache
Gila, La Paz, Mojave, Yavapai
Cochise, Graham, Greenlee, Pinal, Santa Cruz, Yuma

19%
21%
19%
24%
21%

In Region 2 (Pima County) the smoking prevalence estimate increased sharply from 15% to 21%
between 1999 and 2002. There is, however, some question about the accuracy of the 1999
estimate so that this increase is likely to be an overestimate of the change in the county 1 . The rate
in Region 4 (Gila, La Paz, Mohave, and Yavapai Counties) decreased from 28% in 1999 to 24%
in 2002. The other three regions saw changes of 1% or less.
Gender: There is no statistically significant difference in overall smoking prevalence between
men and women.
Age: The largest increase in smoking prevalence in a single demographic group between 1999
and 2002 was among 18 to 24 year olds. Prevalence among this group increased from about 21%
in 1999 to about 29% in 2002. No other age groups showed statistically significant changes, and
all rates were substantially lower than the 18-24 year olds. Although the young adult age group
has the highest prevalence rates, they have the lowest rates of self-reported tobacco consumption,
averaging approximately 12 packs/month, roughly half the rate of the other age groups
combined.
Education: Smoking prevalence decreases with increasing education, from a high of about 27%
amongst those reporting less than a high school education, to a low of 12% amongst college
graduates. This pattern has been consistent over all three years of the survey.
Smokeless Tobacco Use: Respondents who reported smoking fewer than 100 cigarettes in their
lifetime were asked questions regarding smokeless tobacco use. Of these, 6% reported having
tried smokeless tobacco products, and of those who have tried them, about 25% reported using
1

Survey methodology changed somewhat between 1999 and 2002, resulting in some anomalous data between the
two time periods.
6

them some days or every day. The overall estimate of smokeless tobacco use prevalence in the
state is about 1%.

Beliefs About Hazards of Tobacco Use
Overall, 72% of respondents recognize the health benefits of quitting smoking, and 92%
recognize that secondhand tobacco smoke is “harmful” or “very harmful” to one’s health.
However, current smokers are less likely to endorse this belief about secondhand smoke, with
only 39% reporting that they believe it to be very harmful, compared to 77% of non-smokers.

Quitting
Forty-three percent (43%) of current smokers reported trying to quit during the past year. Of
those attempting to quit, 23% used a pharmaceutical quit aid and 7% used classes, counseling, or
some other type of non-medicinal quit aid. Of those who attempted to quit, 65% cited “for my
own health” as the most important reason for quitting.
Forty-six percent (46%) of identified current smokeless tobacco users have attempted to quit.
Only 6% of current and former smokeless tobacco users reported using medication to assist with
quitting, and none reported using other services such as classes or counseling.

Medical Provider Advice
Sixty-three percent (63%) of all respondents who saw a medical provider in the year prior to the
survey reported being asked about their tobacco use. Seventy-one percent (71%) of current
tobacco users who reported that their medical provider had asked them about smoking reported
that their medical professional recommended quitting. This is similar to the national median
estimate of 72% of current smokers who had received physician advice to quit during the
preceding year 1 .

Attitudes Towards Smoking Bans
Household Smoking Restrictions: Among non-smoking households, the percentage restricting
smoking inside the home increased from 89% in 1999 to 96% in 2002. The percentage of
household smoking restrictions among smokers’ households remained steady with 72% in 1999
to 71% in 2002.
Public Smoking Bans: Increases were seen between 1999 and 2002 in support for smoking bans
in public areas. Among people who support laws banning smoking, the largest increase was in
support for bans of smoking in “public buildings.” These support levels increased from 72% to
87% between 1999 and 2002.

7

Attitudes about Tobacco Laws
Storeowner License: Respondents (81%) tend to agree that storeowners should be required to
have a license to sell tobacco products in Arizona.
Tobacco Tax: A majority of respondents (69%) support some increase in the tobacco tax.
Among those supporting a tax increase, 49% of respondents are in support of a tax increase of
one dollar or more per pack of cigarettes or tin of smokeless tobacco.

8

INTRODUCTION
Adult tobacco use represents an important and on-going, morbidity, mortality and health care
cost problem. The Arizona Department of Health Services Tobacco Education and Prevention
Program (ADHS TEPP) has been working since 1996 to reduce tobacco use in Arizona. The
Arizona Adult Tobacco Survey (ATS) provides one source of data for looking at tobacco use in
Arizona, and at Arizona residents’ beliefs about the hazards of smoking, as well as their attitudes
towards tobacco policies. Because the ATS has been conducted in three different years (1996,
1999, and 2002) it can also be used to compare some tobacco behavior, belief and attitudes over
time.
This Executive Report presents some of the key findings from the 2002 Arizona ATS.

9

SMOKING PREVALENCE
The 2002 estimated smoking prevalence rate is 20% for adult Arizona residents and this rate has
been a stable trend over time. This consistent trend (see Figure 1 below) is supported by the
results for the last three Adult Tobacco Surveys, as well as the last twelve Arizona Behavioral
Risk Factor Surveys (AZ BRFS) (another statewide phone-based survey that includes tobacco
questions). The current national estimate of smoking prevalence for adults, based on the CDC’s
2002 Behavioral Risk Factor Surveillance System (BRFSS), is about 23%.

Percent

Figure 1. Adult smoking prevalence in Arizona: 1990 – 2002.

50.0
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
AZ BRFS
AZ ATS
Nat'l BRFSS

AZ BRFS
AZ ATS
Nat'l BR FSS

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
20.6

23.8

19.2

20.9

23.0

22.9

23.7

21.1

21.8

20.0

18.5

21.5

23.4

-

-

-

-

-

-

23.8

-

-

18.8

-

-

20.1

23

23.1

22.2

22.6

22.7

22.4

23.4

23.2

22.9

22.6

23.2

22.8

23

Sources: Arizona BRFS (1990-2002); Adult Tobacco Survey (1996, 1999 & 2002); CDC National BRFSS (1990-2002)

Although smoking prevalence has remained steady, there is evidence that, on average, Arizonans
have decreased the number of cigarettes they are smoking. The percentage of current smokers
reporting smoking every day declined from 83% in 1996 and 1999 to 77% in 2002. In addition,
current smokers in 2002 reported smoking fewer cigarettes per day on average (15/day) than they
reported in 1996 and 1999 (20/day).

10

Taken together, the average number of packs smoked monthly by current smokers in 2002 is
estimated to be about 22, down from 30 packs per month reported in 1996 and 1999 (see Figure
2). This decrease is consistent across most age groups (see Figure 5 under “Smoking Prevalence
by Age”).
Figure 2. Estimate of cigarette packs smoked in a month, ATS 2002.

60
50
Number of packs

Median
40
30

30

30

22.5

20
10
0
1996

1999

2002

Smoking Prevalence by ADHS Region of Residence
Only two regions showed noteworthy changes in smoking prevalence. Figure 3 illustrates
smoking prevalence rates by region. Region 2 (Pima County) had a 6% increase in smoking
prevalence between 1999 and 2002. This sharp increase is not consistent with other patterns seen
in the data. Unless the next fielding of the survey shows a continuing increase in prevalence in
the county, the most likely explanation is that the 1999 figure of 15%, representing a drop of 6%
from 1996, was an underestimate.
The other item of note is the decrease in prevalence in Region 4 (Gila, La Paz, Mohave, and
Yavapai Counties) from 28% in 1999 to 24% in 2002. This decrease continues from a drop of
5% between 1996 and 1999. It should be noted that these four counties do not form a geographic
region, but they are all fairly sparsely populated.
The other three regions saw changes of 1% or less.

11

Figure 3. Current smoking prevalence by region: 1996, 1999 & 2002.

Percent

100
90

1996

80

1999

70

2002

60
50
40
30
20

31
24

21

18 19

21
15

19
17 19

Region 2

Region 3

28

24

25

21 21

10
0
Region 1

Region 4

Region 5

Smoking Prevalence by Gender
There is no statistically significant difference in overall smoking prevalence between men and
women. The estimated rate for men in Arizona is 21%, and for women it is 19%. This gap is
smaller than that reported nationally through the CDC’s 2002 National Health Interview Survey
(see Figure 4 below), primarily because the overall reported smoking rate for men appears to be
somewhat lower in Arizona 2 .
Figure 4. Arizona smoking prevalence compared to national data.
100
90

National (NHIS 02)

80

Arizona

Percent

70
60
50
40
30

23

25

21

20

20

20

19

10
0
Overall

Males

Females

12

Smoking Prevalence by Age
The largest increase in smoking prevalence in a single demographic group between 1999 and
2002 was among 18 to 24 year olds. As shown in Figure 5, prevalence among this group
increased from 21% in 1999 to 29% in 2002. It is important to note, however, that the low 1999
rate of 21%, a decrease of 5% from 1996, is a bit anomalous and may represent an underestimate
at that time point.
Figure 5. Arizona smoking prevalence by age: 1996, 1999 & 2002.
100

Percent

90

1996

80

1999

70

2002

60
50
40
30

29

26
21

23

20 21

24 24 23

27
22 20

20

22 20
18

14

11 11

10
0
18-24 yrs

25-34 yrs

35-44 yrs

45-54 yrs

55-64 yrs

65+ yrs

The current Arizona smoking rate of 29% for 18-24 year olds is similar to the 2002 national
estimate of 28.5% 3 . Both national and Arizona rates show a large disparity between men and
women in this age bracket, with young men reporting a substantially higher prevalence (see
Figure 6 ).

13

Figure 6. Prevalence of current smokers by age and gender.
100
90

Male

80

Female

Percentage

70
60
50
40
30

33
24

23

23 23

19

20

22

18

17 18
12 10

10
0
18-24 yrs

25-34 yrs

35-44 yrs

45-54 yrs

55-64 yrs

65 or older

Although the 18-24 age group has the highest prevalence rates of all age groups, they have the
lowest rates of self-reported tobacco consumption. Young adults report the lowest percentage of
everyday smoking (see Figure 7), and average approximately 12 packs/month, roughly half the
rate of the other age groups combined (see Figure 8).

14

Figure 7. Percentage of current smokers reporting smoking 30 days of last month by age.

100%
86%

90%

80%

80%

Percent

70%

84%

82%

69%

68%

60%
50%
40%
30%
20%
10%
0%
18-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55-64 yrs

65 or
older

Figure 8. Estimate of cigarette packs smoked in a month by age: 1996, 1999 & 2002.
60
1996

Number of packs

50

1999
2002

40
30 30

30 30
26

25

23

20

30 30 30

30 30

28

30

23

19 18
15
12

10
0
18-24 yrs

25-34 yrs

35-44 yrs

45-54 yrs

55-64 yrs

65 or older

15

Smoking Prevalence by Race/Ethnicity
Overall, the 2002 ATS data show a continuing trend of higher smoking rates among Whites and
African Americans, and lower prevalence rates for Hispanics and American Indians. Prevalence
rates by race and ethnicity were essentially stable between 1999 and 2002 with the exception of a
notable decline in prevalence among respondents who identify as Black or African American
(from 24.1% in 1999 to 20.8% in 2002). This finding should be interpreted cautiously, however,
because of the small number of African Americans surveyed (n=183).
Also, a current school-based youth survey 4 shows high school youth identifying as American
Indian reporting the highest prevalence of any adolescent ethnic group. The 32% estimate of
current smoking by American Indian high school youth is more consistent with the 41% national
estimate of smoking by American Indian adults. This discrepancy between youth and adult
prevalence rates for American Indians in Arizona warrants further investigation.
Figure 9. Arizona estimated smoking prevalence by race & ethnicity, ATS 1996, 1999 &
2002, and National Health Interview Survey, 2002.

100
90

1996
1999

80

2002

Percent

70

National 2002

60
50
40.8

40
30
20

24

23
15 13

20

22 23.6

25 24

21 22.4

22

16.7
12

17 15

14

12

10
0
Hispanic

White

African Am/Black

American
Indian/Alaska
Native

Other

16

Smoking Prevalence by Education
Smoking prevalence decreases with increasing education, from a high of about 27% amongst
those reporting less than a high school education, to a low of 12% amongst college graduates
(Figure 10). This pattern has been consistent over all three years of the survey.
Figure 10. Current smokers by education for Arizona adults: 1996, 1999 & 2002.
100

Percent

90

Less than High School

80

High School Graduate

70

1-3 Yrs. College
College Graduate

60
50
40
30

28

26

26

23

23

27
22

19

16

20

26
12

11

10
0
1996

1999

2002

17

SMOKING CESSATION
Forty-three percent of current smokers reported trying to quit in the 12 months prior to the ATS.
Although many smokers want to quit, of those who attempted to, few (23%) used any form of
pharmaceutical assistance (e.g., nicotine patch, nicotine gum, Zyban). Even fewer (7%) took
advantage of other cessation services (e.g., cessation classes, self-help materials, doctor or nurse
counseling, and phone counseling). Of those few who reported using assistance, classes and selfhelp materials were the most frequently used (see Figure 11 below). We do not know why more
of those who attempted to quit did not seek assistance in doing so. That is another potential issue
for future research.
Figure 11.

Type of assistance used by smokers reporting use of non-pharmaceutical
cessation aides (n=69), ATS 2002.

63
47
34

29

n=
2)
O

th
er
(

=6
)
(n
re

A

cu
p

un
ct
u

os
is
H

yp
n

lin
el
p
H
ne
Ph
o

M
D

or

R

(n
=

23
)
e

(n
g
ns
el
in
ou
C

N

el
p
H

(n
=

=2
4)

32
)
(n
=

M
at
er
ia
ls

Cl
in
ic
Se
l f-

20
)

3

or
la
ss
C

34

8

(n
=4
3)

Percent

100
90
80
70
60
50
40
30
20
10
0

Reasons for Quitting
Current smokers and former smokers were asked what the most important reason was for making
their last quit attempt. The range of responses was wide, but the most frequently reported reason,
as shown in Figure 12, was “for my own health.” When these reasons are examined by gender
(Figure 13), women tend to report the reason “for my family” more frequently than did men.

18

Figure 12. Most important reasons why smokers decided to quit, ATS 2002.
100
90
80
Percent

70

65

60
50
40
30
18

20

13

8

10

2

0

Fo

yo
rm

wn

h
al t
he
Fo

am
yf
m
r

wa
It

ily

g
tin
et
g
s
Fo

o
to

e
si v
en
p
ex

ac
isf
at
s
elf
rs

b
to
n,
o
ti

n
ei

l
ro
nt
o
c

A

m
So

cto
do

on

k
eI

m
old
rt

w
no

o
et

ic
ts
go

m
ro
kf

1

g
in
ok
sm

Percent

Figure 13. Main reasons for stopping smoking by gender.
100
90
80
70
60
50
40
30
20
10
0

Male
70

Female
66

24
15
10

14
9

14
7

2 3

1 3

3 5

2 4

o
l
ily
e
lth
it
et
tro
in g
siv
ea
qu
in g
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fam
h
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y
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Fo
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to r
be
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to
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oc
to
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elf
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at i
ot
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18

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19

MEDICAL AND DENTAL PROVIDER COUNSELING
Amongst the respondents who saw a medical provider in the 12 months prior to the ATS (72%),
there is a consistent increase from 1996 to 2002 in the number who reported that they were asked
if they use tobacco (See Figure 14). Only 71% of current tobacco users, however, report being
advised to not use tobacco by their medical providers. This percentage is down from 83% in
1999 and 80% in 1996, but is similar to the national median estimate of 72% of current smokers
advised by their medical professional to quit 5 . Overall, 25% of tobacco users advised by their
medical care provider to stop using tobacco reported that they attempted to do so.
Figure 14.

Reported tobacco counseling practices by medical care providers in previous
12 months: 1996, 1999 & 2002.

100
90
80

80

1996
1999

71

70
Percent

83

2002

63

60
50
40

43
31

30

30

30
25

20
10
0
Asked about tobacco
use

Recommended they
stop

Attempted to stop

Of those tobacco users reporting being advised by their provider to stop, about 50% reported
being offered cessation assistance by their provider (e.g. medication, information about classes,
materials, quit date, etc.). When this assistance is considered, 39% of those reporting being
advised and assisted to quit did so, compared to 11% of those advised but not assisted (see
Figure 15).

20

Figure 15. Percentage of current tobacco users reporting attempting to quit when advised
by a medical provider.

100%

Percentage attempting to quit

90%
80%
70%
60%
50%
39%

40%
30%
20%

11%

10%
0%
With provider advice only

With provider advice + provider
assistance

A similar pattern was found for current tobacco users’ reports about dental providers. Figure 16
shows a consistent increase from 1996 to 2002 in those reporting being asked about tobacco use
by their dental care providers and a decrease in those reporting being advised to stop (70%-1996,
75%-1999, 66%-2002).
Figure 16. Reported tobacco counseling practices by dental care providers in previous 12
months: 1996, 1999 & 2002.
100
90

1996
75

80

70

Percent

70

1999
66

2002

60
50
40

32

36

30
20

25

21
15

14

10
0
Asked about tobacco
use

Recommended they
stop

Attempted to stop

21

The increase in reports of being asked about tobacco use may reflect the wider dissemination of
the Tobacco Cessation Guideline 6 , both through efforts of ADHS TEPP, and agencies such as
the National Committee for Quality Assurance 7 .
The reported decrease in being advised to stop is inconsistent with the recommendations of the
Tobacco Cessation Guideline. The guideline recommends not only asking the patient about
tobacco use, but encourages the provider to help the patient quit through brief and intensive
cessation services. It may be that some of the reported decrease in recommendations to stop are
due to changes in the wording of the question from 1999 – 2002 8 .

22

EXPOSURE TO SECONDHAND SMOKE
Household Exposure
Among non-smoking households, the percentage restricting smoking inside the home increased
from 89% in 1999 to 96% in 2002. For smokers’ households, smoking restrictions stayed about
the same, from 72% in 1999 to 71% in 2002 9 .
Figure 17.

Household smoking rules by presence of smoker in household:
1996, 1999 & 2002.

100

96
89

87

90
80

72

Percentage

70

71

65

60
50
40

35
28

30
20

13

29

11

10

4

0
No Smokers
1996

No Smokers
1999

No Smokers
2002

No Restrictions

Smokers 1996 Smokers 1999 Smokers 2002

Banned/Some Restrictions

The increase in home smoking restrictions amongst non-smoking households (Figure 17) is
consistent with the increasing support for clean indoor air in restaurants, public and private
buildings and other indoor venues (Figure 20 on page 25). Since 1999, several key community
ordinances for clean indoor air have been enacted in Arizona (i.e., Tempe, Guadalupe, Tucson,
Pima County, etc.). It is understandable that such “municipal” support would translate to support
for smoke free homes. The increasing public support for clean indoor does not seem to have an
effect on smokers’ household restrictions as indicated by the lack of change in the rates from
1999 to 2002.

23

Workplace Exposure
Respondents were asked a number of questions about workplace exposure to secondhand
tobacco smoke. The majority of respondents (65.6%) are employed in large companies (50 or
more employees) and spend the majority of their working hours indoors (78.4%). Of respondents
who are “employed for wages” or “self-employed” and work indoors “most of the time,” about
15% said they had been exposed to second hand smoke in their work area in the 7 days prior to
their interview. Also, these respondents more frequently reported working in settings that allow
some level of smoking (58%) rather than in settings that have smoke-free policies (42%).
When reported workplace policies are examined by the smoking status of the respondent, a
higher proportion of current smokers (72%) indicate that their worksites allow smoking
compared to former smokers (54%) and non-smokers (56%) (see Figure 18). Conversely, a
higher proportion of non-smokers (45%) and former smokers (46%), than current smokers
(28%), report working in places that have smoke-free policies as compared to the proportion of
current smokers (28%). It cannot be determined from these results if smokers are “choosing”
worksites that allow smoking or if it is a more complicated relationship between the individual’s
background and type of employment (e.g. work in construction, work in gaming). Data from
other state and national surveys show that higher prevalence rates are associated with blue collar
jobs, lower levels of income, and education.
Figure 18. Smoking status by type of worksite policy, ATS 2002.
100
Smoking Allowed/No Policy

90
80

Smoke-free Policy
72

Percent

70
60

56

54
46

50

45

40
30

28

20
10
0
Current Sm oker (n=564)

Form er Sm oker (n=656)

Non-Sm oker (n=1601)

A statewide survey conducted for ADHS TEPP in 2001 10 that followed up on a representative
sample of Arizona worksites on the status of their smoke-free policies indicated that the overall
proportion of workplaces that were smoke-free increased from 1998 to 2001. However, of the
worksites that were smoke-free in 1998, 16% were no longer smoke-free in 2001, indicating that
smoke-free worksite policies can be dynamic and regressive, and suggesting the need for support
of on-going worksite policy efforts.
24

RISK PERCEPTIONS
Overall, 72% of respondents recognize the health benefits of quitting smoking, and 92%
recognize that secondhand tobacco smoke can be “harmful” or ”very harmful” to one’s health.
However, current smokers are less likely to endorse this belief about secondhand smoke, with
only 39% reporting that they believe it to be very harmful, compared to 77% of non-smokers
(see Figure 19).
Figure 19. Perceptions of harm in breathing secondhand smoke, ATS 2002.
100
Very Harmful
Somewhat Harmful
Not Very Harmful
Not Harmful At All

90
80

Percent

70

77

64

60
50
40

44
39
26

30

20

20
10

12
5

6

4

2

1

0
Current Sm oker (n=1145)

Form er Sm oker (n=1622)

Non-sm oker (n=3129)

25

ATTITUDES TOWARD TOBACCO CONTROL ORDINANCES
Increases in support for smoking bans in public areas occurred between 1999 and 2002. Among
people who support smoking laws, the largest increase was in support for bans of smoking in
“public buildings.” These support levels increased from 72% to 87% between 1999 and 2002
(see Figure 20).
Figure 20. Percentage of respondents supporting complete smoking bans by type of
location: 1996, 1999 & 2002.
100
87

90
80
68

Percent

70
60

1996

72

70 70

1999

74

2002

64
51

55

59
53

57

50
39

40

31

30

27

20
10
0
Restaurants

Public
Buildings

Private
Buildings

Indoor Sports
Outdoor
Events
Sports Events

Nationally, the support for restrictions and/or bans on smoking in enclosed areas has been
increasing since the late 1980’s 11 . During the last five years, research evidence has clearly
established the dangers of second hand smoke 12 . This information, along with the growing
number of reports that show the benefits to businesses of going smoke-free 13 , has most likely
contributed to the many municipal and state ordinances on second hand smoke and to broad
public support for complete smoking bans in most indoor areas (Figure 21).

26

Figure 21. Areas smoking should be allowed in, ATS 2002
98

100
Percent Allow ed in All Areas

87

90
80

74

Percent

70

Percent Allow ed in Some
Areas
Percent Not Allow ed at All

82

64
59

60

49

50

45
40

40

34
27

30

23

27

28

24
17

20

12

10
1

1

3

4

1

1 2

0
s
s
rs
ts
gs
es
s
lls
ng
ert
ng
ert
nte
d in
Ma
ran
ldi
l
i
c
c
u
e
i
u
n
g
u
n
o
u
C
ta
/L
Co
Co
pin
re
cB
es
eB
ars
t s/
ts/
ca
op
b li
f ic
n
rR
n
y
B
f
h
u
e
e
a
o
S
P
O
o
D
r
Ev
Ev
te
Ind
oo
ts
ts
iva
or
nd
or
I
Pr
p
p
rS
rS
oo
oo
d
t
Ind
Ou

Support was not as great for total bans on smoking at concerts, bars, lounges and at outdoor
sports events (see Figure 21), nor for limiting tobacco industry sponsorship of sporting events
and concerts (see Figure 22). This relative lack of support may be due to a perception of reduced
risk in open areas such as outdoor sporting venues and the current norm of bars and lounges as
establishments for drinking and smoking. There is a clear need for clean air educational
interventions that address secondary effects of public smoking (e.g., impacts on social norms),
and the dangers of second hand smoke exposure to non-smoking employees.

27

Figure 22. Allow sponsorship of sports events by tobacco companies, ATS 2002.

100
90
80

Percent

70
60
48

50
40

33

30
20

20
10
0
Definitely

Maybe

Definitely Not

Respondents also strongly support keeping merchants from selling tobacco to minors (Table 2)
and licensing sales of tobacco products (see Figure 22). Public support for “youth-related”
tobacco control measures have been the norm in Arizona and in most states. This is most evident
in the “calls to action” from organizations like the Campaign for Tobacco-Free Kids, one of the
key advocates for tobacco control in the United States 14 .
Table 2. The importance of keeping stores from selling tobacco to minors, ATS 2002.
How important is it to keep stores
from selling tobacco to minors?
Very important
Somewhat important
Not very important
Not important at all
Total

Percent of Response
86.8
8.6
2.2
2.4
100

Number of Responses
5146
508
128
144
5926

28

Figure 23. Storeowners should be required to have a license to sell tobacco, ATS 2002.
100
90
80
80

Percent
Percent

70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
0

48

48
33

33
20
12
5

Strongly
Agree
Agree
Definitely

Disagree
Maybe

2

Strongly
No Opinion
DisagreeDefinitely Not

29

ANTI-TOBACCO MEDIA AND TOBACCO
PROMOTION ITEMS
There were decreases in reported exposure to anti-tobacco media messages in almost all
categories (only “pamphlets” showed an increase in 2002; see Figure 24). For the two primary
sources of anti-tobacco messages, 70% of respondents said they have seen an anti-tobacco
message on television (down from 78% in 1999) and 40% said they have seen an anti-tobacco
message in a magazine (down from 44% in 1999).
The decrease in exposure to anti-tobacco messages was most likely due to the reduction in media
and public relation promotions by the Arizona Department of Health Services Tobacco
Education and Prevention Program before the ATS was administered. The Tobacco Education
and Prevention Program had major television and radio placements from January 1996 through
much of 2001. The transition from one media contractor to another, combined with budget cuts,
reduced the number and type of anti-tobacco media messages on the air. On the other hand, we
have no evidence of the effects of such reductions in media exposure one way or the other.
Figure 24.

Percentage of adult respondents who have seen anti-tobacco media messages:
1996, 1999 & 2002.

100
1996

90
80

1999

79 78

2002

70

Percent

70
60
50

47

43
38

40

41
34

36

39

47
41

44
40

35

30
20
10
0
TV

Radio

Pamphlets

Newspaper

Magazines

30

TOBACCO TAX OPINIONS
A majority of respondents (69%) support some increase in the tobacco tax. Among those
supporting a tax increase, 49% of respondents are in support of a tax increase of one dollar or
more per pack of cigarettes or tin of smokeless tobacco.
The most significant validation of the respondent support for increasing the state tobacco tax
occurred after the ATS was fielded. In November 2002, Arizona voters passed Proposition 303,
which increased the state tobacco tax by 60 cents.

31

SMOKELESS TOBACCO
Respondents who reported smoking fewer than 100 cigarettes in their lifetime were asked
questions regarding smokeless tobacco use. Of these, 6% reported having tried smokeless
tobacco products, and of those who have tried them, about 25% reported currently using them
some days or every day. Put another way, barely more than 1% of respondents who claimed not
to smoke reported regular use of smokeless tobacco.
It is important to note that these figures are not directly comparable with the estimates of
smokeless tobacco use reported in previous years’ ATS reports, because previous rates were
calculated using all respondents, regardless of their smoking status.
However, assuming that 3.1% of current smokers, and 1.6% of former smokers, are also current
smokeless tobacco users (as was the case in 1999), the population estimate of smokeless tobacco
use for 2002 would be approximately 1.0%. This is similar to the 1999 estimate of 1.5%.
Only 6% of current and former smokeless tobacco users used medication to assist with quitting,
and none reported using other services such as classes or counseling.
Although the number of smokeless tobacco users is small relative to the number of smokers,
these tobacco users can also suffer serious health consequences. Further investigations into
quitting patterns of smokeless tobacco users may be warranted, since they report a much lower
use of medication and support services.

32

CONCLUSIONS
Overall estimates of smoking prevalence place current smoking rates at essentially the same
levels as reported in 1999 (18.8% in 1999 and 20% in 2002) but when examined by age
category, the 18-24 year olds show a significant increase (21% in 1999 to 29% in 2002). This
increase in smoking among young adults mirrors national trends of high rates in this age group
and, as is the case nationally, within Arizona the rate is mostly driven by the high rates for males
(33% in AZ). Also, the less educated (less than high school) show markedly higher current
smoking rates than those with some college education or a college degree. These results suggest
the need for intensified efforts at youth tobacco prevention, particularly with youth who are at
risk for not completing high school.
Although smoking prevalence has remained constant, and even increased among young adults,
evidence indicates that Arizona smokers are, on average, smoking less. The percentage of current
smokers reporting smoking every day has declined, as have the average number of cigarettes
they report smoking per day. These changes translate into a decrease in the average number of
packs smoked per month from 30 packs/month in 1996 and 1999 to 22 packs/month in 2002.
This trend is consistent across age groups.
Although a high percentage of smokers want to quit (43% reported making a quit attempt in the
past year), only 23% used any form of pharmaceutical assistance, and fewer (7%) used other
types of cessation services such as classes, clinics, self-help materials, or counseling. These
results are not uncommon across the nation—that is, finding attractive, economically feasible
and effective cessation services for addressing tobacco use addiction is a major challenge for all
tobacco control programs. The reasons current and former smokers (e.g. personal health, and
family) give for quitting may be helpful for future efforts at motivating smokers to quit.
Research indicates that healthcare providers can have a powerful influence on smokers’ attempts
to quit 15 16 . However, only 71% of current tobacco users report being advised to quit.
The most recent Surgeon General’s Report on the Health Effects of Smoking, 2004, affirms that
smoking affects almost every organ in the human body and that there is definitive evidence that
smoking causes more types of cancers, diseases, and health conditions. For example, evidence is
now sufficient to infer causation for glaucoma, oral cancer, and laryngeal cancer, as well as
respiratory effects in childhood and adolescence. This evidence may help to motivate
pediatricians, dental professionals and other healthcare providers to share this evidence with their
patients of all ages. Further efforts by ADHS TEPP to engage healthcare providers in innovative
approaches to promote cutting back and quitting tobacco use could be fruitful.
The results from the Arizona survey indicate that exposure to environmental tobacco smoke
continues to be an area for policy and advocacy work. Although household smoking restrictions
by non-smoking households increased, there was no change in the percentage of smokers’
households reporting restrictions. Also, total smoke-free worksite policies are not the majority
for those currently employed, and smokers tend to work in settings that allow smoking. In
general, respondents tend to support smoking bans in public buildings, indoor sport events, and
33

private buildings, but report less support for bans in restaurants, bars and at outdoor sport events.
Overall perceptions of the health risks of smoking and secondhand smoke are high, but smokers
tend to report a lower perception of risk.
The 2002 Arizona Adult Tobacco Survey (ATS) represents the third iteration of a surveillance
tool intended to capture a variety of state-level tobacco control information from Arizona adults.
These findings are one part of the Arizona Department of Health Services Tobacco Education
and Prevention Program (ADHS TEPP) surveillance and evaluation system. ADHS TEPP will
continue to use the ATS results, and other data, to develop and improve its services.

34

METHODS
The Northern Arizona University Social Research Laboratory (SRL) used computer-assisted
telephone interviewing (CATI) to deliver the survey and collect data. The sample for 2002,
purchased from Genesys Marketing Systems Group, was a disproportionate stratified sample
(DSS) of Arizona households stratified to over-represent rural areas according to criteria set by
the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance
System (BRFSS).
For sampling purposes, the geographic locations (county identifiers) of households in the dataset
were used to divide the state into five “regions” as defined by ADHS. These five regions are:
Maricopa County (Region 1), Pima County (Region 2), Coconino, Navajo, and Apache Counties
(Region 3), Gila, La Paz, Mohave, and Yavapai Counties (Region 4), and Cochise, Graham,
Greenlee, Pinal, Santa Cruz, and Yuma Counties (Region 5).
To qualify for the interview, contacted individuals had to have been Arizona residents, at least 18
years of age or older, English speaking, and residing in households with telephones. Active duty
military personnel living in dormitories, institutionalized populations and residential college
students were excluded from the eligible population. Based on these selection criteria, 6,020
adult Arizonans were included in the 2002 ATS. In prior years, ATS surveys were administered
in both English and Spanish. For the 2002 fielding, interviews were conducted only in English. A
Spanish-language survey is being conducted in 2004.
The ADHS Adult Tobacco questionnaire utilizes several standardized measures of tobacco use
and attitudes towards tobacco developed by the CDC. In general, the survey assesses tobacco use
and attitudes, including: Smoking Prevalence and Tobacco Use History, Purchase Patterns,
Quitting Behavior, Interactions with a Medical or Dental Providers, Exposure to Environmental
Tobacco Smoke, Attitudes toward Smoking and Tobacco Restrictions, Perception of Health
Risks, Exposure to Media Sources, and Attitudes toward Tobacco Industry Practices.
In addition to these broad areas, the 2002 ATS included a series of questions for users of
smokeless tobacco, an additional section to assess household exposure to cigarette smoke, and
several items to assess support for a proposed revision of Arizona’s tobacco tax laws. Fielding of
the survey began April 15, 2002 and was completed August 5, 2002. The survey took an average
of 16 minutes of the respondent’s time to complete.
For this survey, a final completion rate was calculated. Completion rates are calculated to
indicate the percentage of contacted respondents completing the survey. This formula
specifically computes the percentage of contacted respondents who agreed to take the survey.
Final study calculations indicate a 67% completion rate.
Descriptive data analysis was performed by the SRL. The analysis included a demographic
profile of the sample. Computation of the prevalence of 2002 tobacco use by age, gender,
education, race and ethnicity for the statewide population and comparisons of these estimates to

35

the 1996 and 1999 surveys were completed. Frequencies of the responses to additional items
were compiled, and selected comparisons were made to prior years’ data.
To measure smoking prevalence, the ATS utilizes the two standard screening measures
developed by the CDC. These measures categorize respondents as current smokers, former
smokers, or never-smokers. To qualify as a current smoker, respondents have to indicate that
they have smoked at least 100 cigarettes in their lives and smoke “everyday” or “some days” at
the time of the interview. Former smokers are defined as having smoked 100 lifetime cigarettes,
but smoke “not at all” at the time of the interview. Never-smokers are defined by having smoked
fewer than 100 cigarettes in their lifetime.
The survey produced sample estimates on statewide prevalence that is within ±1.3%. The
margin of error associated with regional estimates ranges from +/-1.6% to +/-5.4%. Estimates
within age, race and gender groupings vary by group, but most are within +/-4%. The table
below details the estimated margins of error associated with the 2002 ATS for statewide and
regional data. Additional details on methodology may be found in Appendix A.
Margin of Error for ATS 2002 Estimates; Statewide and Regional
Geographic Area

Number of ATS
2002 Respondents

2000 Census
Adult Population

Margin of Error (at
95% Confidence
Interval)

6020

3,763,685

+/- 1.3%

3603

2,244,146

+/- 1.6%

984

635,850

+/- 3.1%

329

188,530

+/- 5.4%

464

305,287

+/- 4.6%

628

389,872

+/- 3.9%

Entire State
ADHS Region
1-Maricopa County
2-Pima County
3-Coconino, Apache
and Navajo Counties
4-Gila, La Paz,
Mohave and Yavapai
Counties
5-Cochise,Graham,
Greenlee,Pinal,Santa
Cruz, Yuma Counties

36

Survey Limitations
The goal of this survey was to interview a representative sample of adult residents from
households within the state of Arizona. However, despite the use of rigorous scientific
methodology, all telephone sample surveys face certain challenges and limitations. Only
households that contain a working non-cellular telephone were capable of participating in the
survey. Other types of survey methodologies (e.g., mail, intercept, etc.) were not used to reach
residents who may not have a working telephone in the home. Random-digit dial (RDD)
telephone sampling generates telephone numbers that are both listed and unlisted. Since
telephone companies’ boundaries for telephone exchange areas are not necessarily coterminous
with geopolitical boundaries such as counties, telephone companies are not exact in assigning
phone numbers within a defined geographical region. This survey was administered in English,
as this is the single most spoken language in the state, and was not provided in other languages.
In an effort to account for disproportionate stratified sampling (DSS) telephone sampling and
other types of sampling error, ratio-estimation adjustments were made to the final dataset after
fielding was completed. Populations of the counties vary, so ratio-estimation adjustments were
also made to ensure that each county was proportionally represented in the regional dataset.
Due to the smaller numbers of non-White respondents, caution should be exercised when
interpreting cross-tabulations by race and ethnicity. As mentioned above, sampling error for
subgroups is often much higher than that for the total sample and can vary widely.

37

REFERENCES
1

CDC. (2004). State-Specific Prevalence of Current Cigarette Smoking Among Adults – United
States, 2002. MMWR, 52 (53), 1277-1280.

2

CDC. (2002). Early Release of Selected Estimates Based on Data from the 2002 National
Health Interview Survey. http://www.cdc.gov/nchs/data/nhis/earlyrelease/200306_08.pdf
3

CDC. (2002). Cigarette Smoking Among Adults – United States, 2002. MMWR, 53 (20), 427431.
4

Brown, C. Walsh, M., Bothe, T. (2004). 2003 Youth Tobacco Survey Summary Report. Report
in preparation. Tobacco Education and Prevention Program Evaluation Unit. Department of
Psychology, The University of Arizona.
5

CDC. (2004). State-Specific Prevalence of Current Cigarette Smoking Among Adults – United
States, 2002. MMWR, 52 (53), 1277-1280.

6

U.S. Department of Health and Human Services. Clinical Practice Guideline: Treating
Tobacco Use and Dependence. Public Health Service, June 2000.
http://www.surgeongeneral.gov/tobacco/
7

National Committee for Quality Assurance. (2000). L Street NW, Suite 500, Washington, DC
20036. (202) 955-3500. http://www.ncqa.org/index.htm
8

In 1996 and 1999, after being screened for having visited a doctor, current smokers who
reported that their doctor, nurse practitioner or physician assistant discussed smoking with them,
were asked, “In the past 12 months, did a medical practitioner such as a doctor, a nurse
practitioner, or a physician’s assistant advise you to stop smoking?” In 2002, after being
screened for having visited a doctor, current smokers and chewers who had reported that they
were asked by their doctor, nurse, or other physician assistant if they used tobacco, were asked,
“During the past 12 months, did any doctor, nurse or other physician assistant advise you to not
use tobacco (smoke or chew)?”
9

The 1996 and 1999 ATS asked the smoking household rules of all households. In contrast, the
2002 ATS only asked the smoking household rules of households with greater than one member
in the household. For comparability across the three surveys, the 1996 and 1999 ATS analysis
for this item included only households with greater than one member in the household.
10

Eisenberg, M., Lee, H., Keppel, J. & Stanley, L. (2001). Workplace Smoking Policy Survey
Report. Technical Report prepared for Arizona Department of Health Services Tobacco
Education and Prevention Program. College of Public Health, University of Arizona.

11

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
38

Disease Control and Prevention, National Center for Chronic Disease Prevention and Health
Promotion, Office on Smoking and Health, 2000, 203.
12

National Cancer Institute. (1999). Health effects of exposure to environmental tobacco smoke:
the report of the California Environmental Protection Agency. Smoking and Tobacco Control
Monograph 10, August, 1999. http://cancercontrol.cancer.gov/tcrb/monographs/10/
13

Americans for Non-Smokers’ Rights. 2530 San Pablo Avenue, Suite J
Berkeley, California 94702. (510) 841-3032 2003. http://www.no-smoke.org/business.html
14

Campaign For Tobacco-Free Kids. (2003). Special Reports: Behind the Smoke Screen.
http://www.tobaccofreekids.org/reports/smokescreen/blowingsmoke.shtml
15

Cofta-Gunn, L., Wright, K.L., and Wetter, D. W. (2004). Evidence-based treatments for
tobacco dependence. Evidence-Based Prevention Medicine 1(1), 7-19.
16

Fiore, M.C., Bailey, W.C., Cohen, S.J., et al. (2000). Treating tobacco use and dependence.
Rockville MD: US Department of Health and Human Services, Public Health Service, Agency
for Health Care Policy and Research.

39