COMMUNITY TOBACCO SURVEY OF ADULT RESIDENTS OF ST. LAWRENCE COUNTY (NEW YORK)

Transcription

1 COMMUNITY TOBACCO SURVEY OF ADULT RESIDENTS OF ST. LAWRENCE COUNTY (NEW YORK) Opinions, Behaviors, and Perceptions Related to Exposure to Secondhand Smoke, Spreading the Message About the Dangers of Tobacco, Tobacco Advertising, Tobacco Use, and Tobacco Cessation December 2008 Conducted for the St. Lawrence County Tobacco Free Community Partnership Canton, New York Prepared by Joel LaLone Consulting Watertown, New York

2 Table of Contents St. Lawrence County Community Tobacco Study December 2008 Introduction... Page 1 Methodology Page 1 Table 1 Response Rates for the December 2008 St. Lawrence County Community Tobacco Survey....Page 2 Socio-demographics of the Sample Who was interviewed? Page 2 Table 2 Socio-demographics of the Sample Compared to US Census Estimates for St. Lawrence County Page 3 Summary of Findings Page 5 Presentation of Results......Page 13 Technical Comments for Interpretation of the Presented Results Page 14 Margin of Error Using this Data to Estimate for Entire St. Lawrence County Adult Populations.. Page 14 Table 3 Approximate Margin of Error for Varying Sample Sizes and Varying Sample Percentages..... Page 15 Tests for Statistical Significance Using this Data to Test for Trends, Differences, and Relationships.... Page 15 Table 4 Sample Sizes Within Socio-demographic Subgroups. Page 17 Spreading the Message About the Dangers of Tobacco Results Page 18 Table 5 Heard of the St. Lawrence County Tobacco Free Community Partnership before this survey?.. Page 18 Table 6 Source Where Heard of the St. Lawrence County Tobacco Free Community Partnership... Page 19 Table 7 Heard of Reality Check?... Page 20 Table 8 Source Where Heard of Reality Check.. Page 21 Table 9 Heard of the NYS Smokers Quitline?.... Page 22 Table 10 Television Watching hours per day... Page 23 Table 11 Radio Listening hours per day... Page 24 Table 12 Use of the Internet hours per day... Page 25 Table 13 Most Common Radio Station Listened To... Page 26 Table 14 Frequency of Reading Newspapers..... Page 27 Table 15 Most Common Newspapers Read in Past 30 Days... Page 28 Table 16 Anti-tobacco Advertisements ticed on Television.. Page 29 Table 17 Anti-tobacco Advertisements ticed on the Radio... Page 30 Table 18 Anti-tobacco Advertisements ticed in the Newspaper... Page 31 Table 19 Anti-tobacco Advertisements ticed on the Internet... Page 32 Table 20 Health Professional Ask if you Smoke?... Page 33 Tobacco Advertising Results. Page 34 Table 21 Tobacco Advertising ticed in Newspapers..... Page 34 Table 22 Tobacco Advertising ticed in Magazines.... Page 35 Table 23 Tobacco Advertising ticed on Shop Windows or in Stores Where Tobacco is Sold... Page 36 Table 24 Tobacco Advertising ticed at Sports Events... Page 37 Table 25 Tobacco Advertising ticed at Festivals/Fairs Page 38 Table 26 Tobacco Advertising ticed on the Internet Page 39 Table 27 Tobacco Advertising ticed at Convenience Stores, Supermarkets, Gas Stations... Page 40 Table 28 Should Tobacco Advertising be allowed at all at stores?... Page 41 Table 29 Movies Rated G, PG, PG-13 Should t Show Actors Smoking... Page 42 Table 30 Seeing Smoking on Screen... Page 43 Indoor Secondhand Smoke Exposure Home, Workplace, Multi-unit Dwelling Results. Page 44 Table 31 Do you think breathing secondhand smoke is harmful?... Page 44 Table 32 Rules About Smoking in the Home Page 45 Table 33 Rules About Smoking in the Family Vehicle... Page 46 Table 34 Employment..... Page 47 Table 35 Policy prohibiting smoking on entire grounds at workplace?..... Page 48 Table 36 Opinion About Policy Prohibiting Smoking on Entire Grounds at Workplace... Page 49 Table 37 Employer Offered Stop-smoking Programs/ Page 50 Table 38 to smoking while at workplace in past seven days? Page 51 Table 39 Type of Residence Rent or Own?... Page 52 Table 40 Is there a policy that prohibits smoking in your building?... Page 53 Table 41 Opinion About a Smoke-free Policy in Multiple-unit Dwelling... Page 54 Table 42 Secondhand Smoke Entering One s Living Space... Page 55 Table 43 Is Secondhand Smoke Exposure Causing You to Consider Moving?... Page 56 Table 44 Seen Smoking Inside Public Locations in Your Community?... Page 57

3 St. Lawrence County Community Tobacco Study December 2008 Table of Contents (continued) Outdoor Secondhand Smoke Exposure Public Locations Results Page 58 Table 45 Visitation to Public Outdoor Event... Page 58 Table 46 Exposure to SHS at Public Outdoor Event... Page 59 Table 47 Support for a Smoke-free Policy at Public Outdoor Event... Page 60 Table 48 Visitation to Public Beach... Page 61 Table 49 Exposure to SHS at Public Beach... Page 62 Table 50 Support for a Smoke-free Policy at Public Beach. Page 63 Table 51 Visitation to Public Park... Page 64 Table 52 Exposure to SHS at Public Park... Page 65 Table 53 Support for a Smoke-free Policy at Public Park. Page 66 Table 54 Visitation to Public Playgrounds... Page 67 Table 55 Exposure to SHS at Public Playgrounds... Page 68 Table 56 Support for a Smoke-free Policy at Public Playgrounds.. Page 69 Table 57 Visitation to Public Building Entryways... Page 70 Table 58 Exposure to SHS at Public Building Entryways... Page 71 Table 59 Support for a Smoke-free Policy at Public Building Entryways.. Page 72 Table 60 Visitation to the County Fair... Page 73 Table 61 Exposure to SHS at the County Fair... Page 74 Table 62 Support for a Smoke-free Policy at the County Fair. Page 75 Table 63 Visitation to a K-12 School... Page 76 Table 64 Exposure to SHS at a K-12 School... Page 77 Table 65 Support for a Smoke-free Policy at K-12 Schools. Page 78 Table 66 Support for the Recent Smoke-free Policy on the Grounds of Hospitals/Medical Facilities Page 79 Tobacco Use Results. Page 80 Table 67 Smoked at Least 100 Cigarettes in Entire Life?... Page 80 Table 68 Some Every Day, Some Days, or t at All... Page 80 Table 69 Cigarette Use Current, Former, Never Smokers?... Page 81 Table 70 Current Cigarette Number of Cigarettes Per Day... Page 82 Table 71 Tobacco Use Smokeless Tobacco... Page 83 Table 72 Tobacco Use Cigars... Page 84 Table 73 Tobacco Use Pipe Tobacco... Page 85 Table 74 Tobacco Use Bidis... Page 86 Table 75 Tobacco Use Kreteks... Page 87 Table 76 Summary n-cigarette Tobacco Use Use at least one type of product... Page 88 Table 77 Overall Tobacco Use... Page 89 Table 78 Purchasing Cigarettes at an Indian Enterprise... Page 90 Table 79 Purchasing Cigarettes Online... Page 91 Tobacco Cessation Current Smokers - Results... Page 92 Table 80 Were you advised to quit in the past 12 months by a healthcare professional?... Page 92 Table 81 What cessation strategies were advised?... Page 93 Table 82 Quit for at least one day in past 12 months?.. Page 94 Table 83 How long did you remain tobacco-free?... Page 95 Table 84 # Attempts to Quit in Past 3 Years... Page 96 Table 85 Cessation Strategies Which did you try?... Page 97 Table 86 Do you want to quit smoking now?... Page 98 Table 87 Did you ever switch to lights to reduce your risk?... Page 99 Table 88 Familiarity with Cessation Services in the County Page 100 Table 89 Interest in Learning More About Cessation Services... Page 101 Table 90 Has the Clean Indoor Air Act had an impact upon your tobacco use?... Page 102 Table 91 Has the Increase in the Price of Tobacco had an impact upon your tobacco use?... Page 103 Tobacco Cessation Former Smokers - Results. Page 104 Table 92 How long ago did you quit smoking?... Page 104 Table 93 Did the Clean Indoor Air Act have an impact in your quitting?... Page 105 Table 94 Did the Increase in the Price of Tobacco have an impact in your quitting?... Page 106 Table 95 Cessation Strategies What worked for you?... Page 107 Concluding Comments..... Page 108 Appendix The Survey Instrument.... Page 108

4 Contact Information St. Lawrence County Community Tobacco Study December 2008 St. Lawrence County Tobacco Free Community Partnership Joel LaLone Consulting Ms. Sue Britton Mr. Joel LaLone St. Lawrence County Tobacco Free Community Partnership 119 Chestnut Street 80 State Highway 310 Watertown, New York Suite 2 (315) Canton, New York joel@joellaloneconsulting.com Phone: Fax: sbritton@co.st-lawrence.ny.us NYS Smokers Quitline NY-QUITS

5 Introduction St. Lawrence County Community Tobacco Survey December 2008 The St. Lawrence County Tobacco Free Community Partnership is an agency affiliated with the New York Tobacco Control Program, a part of the New York State Department of Health, whose goals include advocating, initiating, funding, and supporting activities that promote the prevention and cessation of tobacco use among St. Lawrence County (New York) residents. Ultimately, the purpose of this tobacco prevention community partnership, and its programs and services, is to better educate residents regarding the risks of tobacco use and to reduce the rates of tobacco use and tobacco-related death and disease in the county. The objectives of the New York Tobacco Control Program and its community partnerships include: 1. eliminating exposure to secondhand smoke; 2. changing the community s attitudes and policies regarding tobacco use, thereby decreasing the social acceptability of tobacco; 3. promoting cessation of tobacco use; 4. preventing the initiation of tobacco use among youths and adults; 5. building and maintaining effective tobacco control infrastructure; and 6. contributing to the science of tobacco control. To accomplish this mission in St. Lawrence County, the St. Lawrence County Tobacco Free Community Partnership has a need for current and accurate information regarding tobacco-related behaviors and attitudes among St. Lawrence County residents. This information will enable the community partnership to better: plan and define goals, objectives, programs, services, initiatives, and promotions to be provided in the future by the St. Lawrence County Tobacco Free Community Partnership, and measure and evaluate the effectiveness of the St. Lawrence County Tobacco Free Community Partnership in meeting its goals and objectives by using this data for comparison to past studies, and future similar studies completed in St. Lawrence County in subsequent years, as well as to comparable regional data. To measure the necessary attitudes and behaviors regarding tobacco issues in St. Lawrence County, the St. Lawrence County Tobacco Free Community Partnership contracted with Joel LaLone Consulting, from Watertown, New York, to complete a community study. The study involved completion of a random telephone survey of a sample of 400 adult residents of St. Lawrence County. The survey included the following seven primary sections of questions/information regarding attitudes and behaviors related to tobacco: 1. Spreading the Message About the Dangers of Tobacco 2. Tobacco Advertising 3. Indoor Secondhand Smoke Exposure Home, Workplace, Multi-unit Dwellings 4. Outdoor Secondhand Smoke Exposure Public Locations 5. Tobacco Use 6. Tobacco Cessation Among Current Smokers 7. Tobacco Cessation Among Former Smokers This report is a summary and explanation of the findings of this community tobacco study completed for the St. Lawrence County Tobacco Free Community Partnership in December When possible, additional comparisons of the current results are made to the results of a similar community tobacco survey completed in St. Lawrence County in December Finally, the current St. Lawrence County results are also compared to current regional average results. The regional average results are derived using the findings from seventeen rthern, Central, and Western New York counties (including St. Lawrence County) that completed similar community tobacco studies to the current the St. Lawrence County Tobacco Free Community Partnership study during Methodology The survey instrument used in this study was developed through the collective efforts of the evaluation specialists at the New York State Department of Health Tobacco Control Program, together with the local tobacco coalition coordinators. The instrument, the introductory script used by interviewers on the telephone, and the required methodology to collect the data (complete interviews) were approved by the Institutional Review Board of the New York State Department of Health in vember The survey included approximately 100 items (questions) regarding the seven sets of tobacco issues outlined in the introduction above. Copies of the script and survey instrument are attached as an appendix. The study included completing interviews of 400 St. Lawrence County adult residents. All interviews were completed via telephone. To be eligible to complete the survey, the resident was required to be at least 18 years old. Three thousand (3,000) personal residence telephone numbers were randomly selected from St. Lawrence page 1

6 County. The telephone numbers were obtained from an unscrubbed list, ensuring that individuals whose households are included in the telemarketing do-not-call list would be represented in this study. After selecting the 3,000 random telephone numbers, the list was randomly sorted a second time. All telephone calls were made between 3:30 p.m. and 9:00 p.m. from a call center in Watertown, New York, on the evenings of December 22 nd, 2008 through January 8 th, The staff of Joel LaLone Consulting, who completed the interviews, has extensive experience and training in human subject research methodology and effective interviewing techniques. Mr. LaLone supervised the telephone interviewing at all times. From the 3,000 personal residence telephone numbers initially randomly generated for St. Lawrence County, it was only necessary to attempt to contact 1,932 households before completing the 400 interviews. When each of the 1,932 telephone number was attempted, one of four results occurred: Completion of an interview; a Decline to be interviewed; Answer/Busy; or an Invalid Number. As required within the research protocol provided by the New York State Department of Health, voluntary informed consent was obtained from each resident before the interview was completed. This protocol included informing each resident that it was his or her right to decline to answer any and all individual questions within the interview. To be categorized as a completed interview, at least half (50%) of the questions on the survey had to be completed. The resident s refusal to answer more than half of the questions was considered a decline to be interviewed. The typical length of a completed survey was approximately ten-to-fifteen minutes. Declines to be interviewed (refusals) were not called back in an attempt to convince the resident to reconsider the interview. If no contact was made at a telephone number ( Answer/Busy), callbacks were made to the number. Telephone numbers that were not successfully contacted and, as a result, were ultimately categorized as Answer/Busy, were attempted a minimum of four times (three callbacks). messages were left on answering machines at homes where no person answered the telephone. The response rate results for the study are summarized below. Table 1 - Response Rates for the December 2008 St. Lawrence County Community Tobacco Survey Complete Decline to be t Valid Answer/ Result: Interview Interviewed Telephone Number Busy TOTALS Frequency % of Numbers Attempted 20.7% 25.5% 7.8% 46.0% 100% % of Valid Numbers 22.4% 27.7% 49.9% 100% % of Contacted Residents 44.8% 55.2% 100% Within the fields of social science and public health research, when using telephone interview methodology, a response rate of almost 45% among the successful contacts, where a person is actually talking on the phone, is considered quite successful. Socio-demographics of the Sample Who was interviewed? This section of the report includes a description of the results for the socio-demographic variables included in the survey sample. The socio-demographic characteristics of the sampled adult residents can be used to attain three separate objectives. Initially, this information adds to the knowledge and awareness about the true characteristics of the population of adult residents in the sampled county (i.e. What is the current typical household size, educational profile, and income level in St. Lawrence County?). Secondly, this socio-demographic information facilitates the ability for the data to be sorted or partitioned to investigate for significant relationships relationships between socio-demographic characteristics of people and their attitudes and behaviors regarding tobacco. Identification of significant relationships allows tobacco community partnerships to use the data more effectively to target specific subgroups of their county population for programming and interventions. Finally, the sociodemographic information also serves an important purpose when compared to established facts about St. Lawrence County - to analyze the representativeness of the sample that was randomly selected in this study. The results for the socio-demographic questions in the survey are summarized in the following table. te that the socio-demographic data presented is raw, or unweighted; it represents the actual characteristics of the residents who were interviewed via the previously described telephone methodology. The socio-demographic characteristics of the entire the St. Lawrence County adult population that were reported by the US Census Bureau in 2007 are also provided for comparison (most current detailed results available for St. Lawrence County). page 2

7 Table 2 - Socio-demographics of the Sample Compared to US Census Estimates for St. Lawrence County December 2008 Sample St. Lawrence County (U.S. Census 2007) (US Census % s are among those age 18 or older) Male 29% (117) 49% Female 71% (283) 51% (US Census % s are among those age 18 or older) % (13) 18% % (36) 16% % (77) 17% % (80) 18% % (80) 14% % (114) 17% HS Graduate 45% (179) 55% Some College 29% (116) 27% College Graduate (4+years) 26% (105) 18% Less than $25,000 26% (74) 31% $25,000-$50,000 30% (85) 30% $50,000-$75,000 20% (56) 21% More than $75,000 25% (71) 18% Children Living in the Home children 64% (253) 68% 1 child 16% (65) 2 children 13% (52) 3 children 4% (14) 4 or more children 3% (11) Employment (Census reports for those over age of 15) Employed for wages 46% (184) Self-employed 4% (15) Out of work more than 1 year 3% (14) Out of work less than 1 year 2% (9) Homemaker 4% (16) Student 1% (2) Retired 34% (136) Unable to work 6% (24) County Where Employed St. Lawrence 91% (177) Jefferson 6% (11) Franklin 2% (3) Lewis 0% (1) Oneida 0% (1) Oswego 0% (1) Health Insurance Coverage, have coverage 92% (364) Weighted=85% 32% of households have at least one child 50% employed 4% unemployed 46% not in labor force comparable statistics available comparable statistics available, do not have HI 8% (30) Race/Ethnicity White 96% (379) 94% Black or African American 0% (1) 2% Hispanic or Latino 0% (1) 1% Asian 0% (0) 1% Native Hawaiian, Pacific Islander 0% (1) 0% American Indian, Alaska Native 2% (6) 1% Other/Multiracial 0% (0) 1% page 3

8 In general, the responses to the socio-demographic questions included in the survey appear to accurately parallel that which is true for the entire adult population of St. Lawrence County. The postal zip code for each participant was recorded, and the geographic distribution of this sample represents St. Lawrence County accurately. The only significant exceptions when comparing this sample to US Census estimates for the county are that women are more likely than men to answer the telephone and/or agree to a survey, older residents are more likely to be sampled, than younger residents, and finally, the lower formal education level individuals appear to be underrepresented. The information included in Table 2 clearly illustrates a type of sampling error that is inherent in telephone methodology: females, older persons, and those with higher formal education levels are typically overrepresented regardless of the subject of the survey. To compensate for this overrepresentation of females, older residents, and those with higher education levels in the sample collected in this study, post-stratification weightings by gender, age, and education level have been completed in any further analysis of the tobacco issues included in this report. All subsequent statistics that will be reported in this document are weighted by gender, age, and education level. The targets that were used for these weighting algorithms are derived from the 2007 US Census updates for the St. Lawrence County adult population. Given the extreme diligence placed on scientific sampling design and the high response rates, after application of post-stratification weightings by gender, age, and education level, it is felt that this random sample of St. Lawrence County adults does accurately represent the population of all St. Lawrence County adults. Therefore, the findings of this study may be generalized to the population of all adults of at least 18 years of age living in St. Lawrence County. The exact margin of error when estimating for the entire population is question-specific, depending upon the sample size for each question and sample statistics that resulted for each question. Sample sizes tend to vary for each question on the survey, since some questions are only appropriate for certain subgroups (i.e. only smokers were asked if they had been advised to quit) and/or as a result of persons refusing to answer questions. In general, the results of this survey for any questions that were answered by the entire sample of 400 residents may be generalized to the population of all adults at least 18 years of age residing in St. Lawrence County with a 95% confidence level to within a margin of error of approximately ±5 percentage points. For questions that were only posed to certain specific subgroups in St. Lawrence County, such as current cigarette smokers or current renters, the resulting sample sizes of n<100 allow generalization to the specific subpopulation of all adults at least 18 years of age residing in St. Lawrence County (i.e. generalization of some specific characteristics of sampled smokers in St. Lawrence County to all cigarette smokers in St. Lawrence County) with a 95% confidence level to within a margin of error of approximately ±8 to ±10 percentage points. Further technical details regarding the margin of error for this survey will be provided later in the Presentation of Results section of this report. All data compilation and statistical analyses within this study have been completed using Minitab, Release 15 and SPSS, Release 16. page 4

9 Summary of Findings St. Lawrence County Community Tobacco Survey December 2008 The following is a detailed summary of the findings of this community tobacco study completed in December 2008 regarding the attitudes and behaviors related to tobacco among the St. Lawrence County (New York) adults. Throughout this Summary of Findings, the regional average rate is defined as the average rate among the 17 Central, rthern, and Western New York counties that completed community tobacco surveys during 2008, including Cayuga, Chenango, Cortland, Herkimer, Jefferson, Madison, Monroe, Oneida, Onondaga, Ontario, Oswego, St. Lawrence, Seneca, Tioga, Tompkins, Wayne, and Yates Counties. Spreading the Message About the Dangers of Tobacco Findings: 1. Almost half of St. Lawrence County adult residents (46.2%) had heard of the St. Lawrence County Tobacco Free Community Partnership before completing this survey. The familiarity rate with the St. Lawrence County Tobacco Free Community Partnership is significantly above the current regional average, where the average Community Partnership familiarity rate is 32.0%. However, familiarity with the St. Lawrence County Tobacco Free Community Partnership has decreased significantly in St. Lawrence County since 2006 (rate was 54.0% in 2006). Familiarity with the St. Lawrence County Tobacco Free Community Partnership is significantly higher among females, residents age 35-64, individuals who have at least a 4-year college degree level of education, and among current smokers than it is among those not in these subgroups. (Table 5) 2. The source where residents most commonly have heard of the St. Lawrence County Tobacco Free Community Partnership has shifted since 2006 currently 29.9% had heard of the agency via television (increased from 28.0% in 2006), and currently 22.7% report radio as their source (decreased from 34.7% in 2006). (Table 6) 3. Approximately two in five St. Lawrence County adults (41.3%) have heard of Reality Check, significantly above the regional average Reality Check familiarity rate of 36.3%. This familiarity rate in St. Lawrence County has not changed significantly since 2006 (the St. Lawrence County rate was 45.7% in 2006). Males, older adult residents (over age 65), and those residents from lower income households (under $25,000 annually) are least likely to have heard of Reality Check, while familiarity is not significantly correlated with any of Smoking or Education. (Table 7) 4. The source where St. Lawrence County residents most commonly have heard of Reality Check is via television (33.5% cite this source), with all sources cited at rates that are not significantly different from regional average rates. (Table 8) 5. More than two-thirds of St. Lawrence County adult residents in 2008 (68.9%) have ever heard of the New York State Smokers Quitline; this level of familiarity is significantly below the average rate found among residents of neighboring counties (80.3%), but has increased significantly from the 51.3% rate found in St. Lawrence County in Familiarity with the quitline among St. Lawrence County residents is correlated with Age, Smoking, and Education, with younger residents, current smokers (80.4% of this subgroup), and those who have some college coursework completed but less than a 4-year degree most likely to have heard of this type of cessation service. (Table 9) 6. St. Lawrence County adults tend to watch television (3.0 hours/day) more than neighboring county residents, but listen to the radio (2.4 hours/day) and use the Internet (1.7 hours/day) to approximately the same degree as the regional averages. Significant relationships found include that older residents tend to watch more television than younger residents, those individuals who have higher education levels tend to watch less television, listen to less radio, and use the Internet more frequently than lower educated individuals. Current cigarette smoking status is not significantly correlated with amounts of any of television watching, radio listening, or Internet usage. (Tables 10-12) 7. When radio listenership among St. Lawrence County adults is further investigated, the following characteristics are discovered: 85.2% listen to the radio at least some, Froggy 97 is the most common radio station listened to (19.7% cite this as the most common station) followed by NPR (10.0% cite this as the most common station). Profiling of the, Age, Smoking, Education, and Income of typical listeners of various rthern New York radio stations are further described in Table 13. (Table 13) page 5

10 8. Over 86% of St. Lawrence County adult residents have read at least one local newspaper in the past 30 days (males significantly more than females), with The Watertown Daily Times the most common newspaper read by adult residents of St. Lawrence County (62.2% read at least once in past 30 days), followed by The Ogdensburg Journal (30.0% read at least once in past 30 days). (Tables 14-15) 9. Television is by far the most common medium where residents recall seeing advertising about the dangers of tobacco (anti-tobacco advertising, produced by the St. Lawrence County Tobacco Free Community Partnership as well as possibly produced by groups other than the St. Lawrence County Tobacco Free Community Partnership). In 2008, over 60% of the St. Lawrence County adults (64.0%) report noticing television advertising about the dangers of tobacco or quitting smoking at least some in the past 30 days, a significant decrease from the 76.1% rate found in 2006, but a rate of exposure to these television messages that is not significantly different from the current regional average of 68.1%. tably, 74.7% of the current smokers report noticing television advertising about the dangers of tobacco or quitting smoking in the past 30 days. In 2008, over 35% of the St. Lawrence County adults (37.0%) report noticing radio advertising about the dangers of tobacco or quitting smoking at least some in the past 30 days, a significant decrease from the 44.6% rate found in This radio exposure rate of 37.0% in St. Lawrence County is not significantly different from the current regional average of 33.7%. St. Lawrence County adult residents are less likely to be exposed to anti-tobacco messages via newspaper and Internet than via television and radio, and exposure in the newspaper has decreased significantly since The following table summarizes the exposure to antitobacco advertising that was reported for the four different media types studied. (Tables 16-19) St. Lawrence County Results: Type of Media 2008 Regional Average 2006 (% At Least 2008 (% exposed) Some) (% ) Television 76.1% 64.0% 68.1% Radio 44.6% 37.0% 33.7% Newspaper 40.9% 33.6% 32.7% Internet NA 13.8% 15.2% 10. The majority of the St. Lawrence County adults (63.7%) have been asked whether or not they smoke by health professionals in the past twelve months. This rate of inquiry is significantly below the regional average rate of 70.3%, but has not changed significantly in the county since 2006 (rate was 64.0% in 2006). Likelihood of being asked whether or not one smokes by health professionals in the past twelve months is significantly correlated with, Age, and Income females, younger adult residents, and those from higher income households are most likely to have been asked. (Table 20) Tobacco Advertising Findings: 11. St. Lawrence County adults tend to support the notion that tobacco advertising should be at least restricted if not entirely eliminated at stores approximately 65% agree with restricting or entirely eliminating tobacco advertisement on the outside of stores or on the inside of windows facing outside (30.9% prefer restricting to certain areas, 34.4% prefer not allowing at all). Level of support is not significantly different from the regional average rate of 67.2%. Support for limiting tobacco advertising at stores among St. Lawrence County adults has not changed significantly from the 70.4% rate of favoring this type of restriction or prohibition that was found in the county in Females and those individuals with at least some college coursework in their educational background are significantly more likely to support restricting or eliminating tobacco advertising at stores than males and lower educated individuals. Even among current smokers in the region, over 57% support the idea of restricting or entirely eliminating tobacco advertisements at stores. (Table 28) 12. Six different locations or types of media were studied to determine the extent of exposure to tobacco advertisements during the past 30 days. Among the following six typical locations for tobacco advertising that were studied, the rates of recalling exposure to the advertisements in the past 30 days are summarized in the following table: St. Lawrence County Results: 2008 Regional Type of Location/Media 2006 (% At Least 2008 Average (% at least Some) (% ) some) on shop windows or inside shops 60.9% 48.8% 53.2% in magazines 50.9% 39.9% 37.9% in newspapers 50.9% 16.7% 18.5% at sports events 12.8% 9.1% 13.5% on the Internet NA 9.1% 10.3% at festivals/fairs 8.2% 7.1% 10.9% page 6

11 In general, recollection of exposure to tobacco advertisements in various locations among St. Lawrence County adults has decreased since 2006, and is currently similar to regional average rates. Significant correlations with exposure to tobacco advertising vary depending upon which location of the advertising, and should be referenced in Tables (Tables 21-26) 13. Residents of St. Lawrence County were asked whether they recall seeing tobacco advertisements the last time they visited a convenience store, supermarket, or gas station (not necessarily in the past 30 days) 85.6% reported recalling tobacco ads at these locations (not significantly different from the current regional average of 85.1%), this rate has not changed significantly in the St. Lawrence County since 2006 (87.5% in 2006). Males and younger adult residents are most likely to recall exposure to tobacco advertising at convenience stores, with 99.1% of adult residents under age 35 indicating that they recall seeing tobacco advertisements when they visit a convenience store, supermarket, or gas station. (Table 27) 14. St. Lawrence County adults tend to agree that movies rated G, PG, PG-13 should not show actors smoking (32.0% strongly agree and 39.7% agree). This rate (71.7%) is significantly below the rate found in St. Lawrence County in 2006 (79.3% in 2006). The 71.7% agreement rate in St. Lawrence County with not showing actors smoking in G, PG, and PG-13 rated movies is not significantly different from the current regional average rate of 73.3%. Females and non-smokers are least likely to disagree with this statement. However, even among current smokers in the county, 54.9% agree that movies rated G, PG, PG-13 should not show actors smoking. (Table 29) 15. Almost four out of five adult residents of the St. Lawrence County (79.3%) report that they recall seeing adults smoking on screen when they watched movies in a movie theatre or on video, DVD, cable, or satellite at least once during the past 30 days; a rate that is not significantly different from the current regional average of 76.4%, and one that has not changed significantly from the St. Lawrence County rate found in 2006 (77.9% in 2006). (Table 30) Indoor Secondhand Smoke Exposure Findings: 16. An overwhelming majority of the St. Lawrence County respondents consider exposure to secondhand smoke to be harmful (92.0%), of which 76.2% indicated they believe it is very harmful. This rate is not significantly different from the current regional average rate of 93.8% agreeing that exposure to secondhand smoke is somewhat or very harmful, and has not changed significantly from the 2006 St. Lawrence County rate of 92.3% reporting very or somewhat harmful. Recognition of the harmful effects of secondhand smoke exposure is significantly lower among males, those residents with lower education levels, and among current smokers. Nevertheless, it is still the case that the vast majority of the current smokers in the St. Lawrence County (85.3%) do consider exposure to secondhand smoke to be at least somewhat harmful. (Table 31) 17. St. Lawrence County adult residents are very likely to indicate that they do not allow smoking in their home 76.2% report that this is their in-home policy. This rate has not changed significantly in St. Lawrence County since 2006 (when the rate was 71.4% not allowing), but is currently significantly below the regional average of 83.0% not allowing smoking in one s home. Females, those residents with at least some college education, those from households with annual income of at least $50,000, and those who are non-smokers are most likely to not allow smoking in their homes. However, over 45% of current St. Lawrence County smokers (45.8%) do not allow smoking in their homes, while another 14.2% restrict smoking in their homes to certain places. (Table 32) 18. A large majority of St. Lawrence County adult residents (74.9%) indicate that they do not allow smoking in their family vehicle. This rate has not changed significantly in St. Lawrence County since 2006 (when the rate was 70.9% not allowing), but is currently significantly below the regional average of 80.9% not allowing smoking in one s family vehicle. Females, older residents, current non-smokers, and those with higher education levels are most likely to not allow smoking in their family vehicles. However, over 37% of current St. Lawrence County smokers (37.1%) do not allow smoking in their family vehicles, while another 18.1% only allow smoking in their family vehicles at certain times. (Table 33) 19. Approximately 55% of the adult residents (55.4%) in St. Lawrence County are employed, similar to the current regional average rate of 59.9%. Among these employed residents, more than half (56.1%) reported that there is a policy that prohibits smoking on the entire grounds of their workplace. This rate is significantly above the current regional average of 49.3% of employed individuals working at entirely smokefree workplaces. (Tables 34-35) page 7

12 20. By approximately a two-to-one margin, St. Lawrence County employed adults favor a policy that prohibits smoking on the entire grounds of their workplace 60.5% favor while only 31.4% oppose. This level of support among currently employed individuals for a smokefree workplace is not significantly different from the current regional average rate of 62.2% favoring a smoking prohibition at the workplace policy. Employed females, employed residents with higher education levels, and those who are non-smokers are most likely to favor a policy that prohibits smoking on the entire grounds of their workplace. tably, approximately 34% of the employed current smokers favor a smoking prohibition at the workplace policy. (Table 36) 21. Approximately one-third of St. Lawrence County employed adults indicate that their employer has offered a stop-smoking program or any other help to employees who want to quit smoking 34.8% indicate that their employers have offered these types of tobacco cessation programs. This availability of employersponsored stop-smoking programs among currently employed St. Lawrence County individuals is not significantly different from the current regional average rate of 34.7% of employed individuals having these services offered. (Table 37) 22. Approximately one in six St. Lawrence County employed adults (16.1%) indicate that they have been exposed to secondhand smoke in their work area or work vehicle in the past seven days not significantly different from the current regional average rate of 15.6%, and not changed significantly from the rate found in St. Lawrence County in an earlier study (11.5% in 2006). Male employees, those under age 35, and those individuals who have lower education levels are most likely to report secondhand smoke exposure while at work. (Table 38) 23. Approximately one in five adult residents in St. Lawrence County (20.4%) report to rent their home, a rate significantly above the regional average rate of 13.2% renting. Among those residents who rent their home, 24.9% report that there is a policy in place currently that restricts or prohibits indoor smoking in their building 15.8% indicate indoor smoking is prohibited, while another 9.1% indicate indoor smoking is restricted to certain areas. This rate in St. Lawrence County is not significantly different from the current regional average rate of 18.0% having a prohibition policy, and not significantly different from the 16.1% rental unit smoking prohibition rate found in St. Lawrence County in (Tables 39-40) 24. Strong support for policies that restrict or prohibit indoor smoking in rental housing buildings has been found in St. Lawrence County over 25% of the adults who currently rent their home (28.2%) indicated that they are in favor of not allowing smoking anywhere in their building, while an additional 34.8% prefer to allow smoking only in certain areas. Only about one in four renters (29.1%) believe that smoking should be allowed anywhere in their building. However, level of support for restricting or prohibiting smoking in rental units among St. Lawrence County renters is significantly below the current regional average support level. (Table 41) 25. Over 40% of residents in St. Lawrence County who rent their home (42.5%) report that secondhand smoke enters their living space from somewhere in or around their building with 22.3% reporting this exposure occurs daily. Exposure to secondhand smoke in rental units among St. Lawrence County renters is significantly above the current regional average rate of 30.2% reporting exposure. (Table 42) 26. It is not common among residents in St. Lawrence County who rent their home to indicate that exposure to secondhand smoke in their area is causing them to consider moving only 14.9% of the renters report this to be true. This rate of secondhand smoke exposure causing consideration of moving among St. Lawrence County renters is not significantly different from the current regional average rate of 14.5%. (Table 43) 27. St. Lawrence County adult residents increasingly report that they have observed individuals smoking inside public places in their community in the past seven days currently 7.6% of the adults report observing this prohibited smoking in their community in the past seven days, the rate was 3.0% in the county in The current regional average rate is 5.9%. Males, younger adult residents, current non-smokers, and lower income residents ($25,000-$50,000 annually in the household) are more likely to report this observation 12.6% of those under age 35 have seen the indoor smoking in the past seven days, while 11.1% of those in $25,000- $50,000 annual income households report to have observed this indoor smoking in the past week. (Table 44) page 8

13 Outdoor Secondhand Smoke Exposure Findings: 28. Among the seven types of public outdoor locations that were investigated in this community tobacco survey (public outdoor events like auto shows, festivals, or concerts; public beach; public parks; public playgrounds; areas around public building entryways; county fair; and the grounds of a K-12 school), public building entryways are the most frequently visited by St. Lawrence County residents. Visitation rates are summarized in the following table. Overall, St. Lawrence County visitation rates to outdoor public locations tend to be at levels that are slightly below regional average rates. The only significant change in visitation among St. Lawrence County residents between 2006 and 2008 is at public building entryways (a decrease since (Tables 45, 48, 51, 54, 57, 60, and 63) % who have visited in past 12 months Type of Outdoor Location St. Lawrence County 2006 St. Lawrence County 2008 Regional Average (2008) Public building entryway 96.9% 90.3% 94.5% Public outdoor event 68.4% 69.6% 76.0% Public park 62.4% 68.0% 74.7% Grounds of K-12 school NA 63.5% 64.9% Public beach 48.3% 53.0% 56.4% County fair NA 51.4% 51.6% Public playground 47.0% 50.8% 59.8% 29. Among those residents who had attended these seven types of public outdoor locations, exposure to secondhand smoke was reported most frequently by those passing through public building entryways as well as those attending the county fair and outdoor public events, with over 55% of the persons who reported visiting each of these locations also reporting that they are exposed to secondhand smoke when visiting. Outdoor secondhand smoke exposure rates are summarized in the table below. St. Lawrence County exposure rates in general tend to be similar to regional averages at all locations except public outdoor events, public parks, and public playgrounds, where the exposure rates in the county are significantly lower than the regional average rates of exposure. Exposure to secondhand smoke at public building entryways, public parks, and public beaches has increased in St. Lawrence County between 2006 and 2008, especially at beaches where the rate of exposure increased from 22.8% to 39.0%. (Tables 46, 49, 52, 55, 58, 61, and 64) Among those who visited in past 12 months, % who Type of Outdoor Location were exposed to secondhand smoke while visiting St. Lawrence St. Lawrence Regional County 2006 County 2008 Average (2008) Public building entryway 55.8% 73.1% 74.7% County fair NA 61.0% 58.7% Public outdoor event 55.6% 56.4% 63.1% Public park 28.8% 39.4% 46.2% Public beach 22.8% 39.0% 34.4% Public playground 15.1% 19.6% 29.4% Grounds of K-12 school NA 12.6% 12.3% 30. There appears to be a very high level of support among St. Lawrence County residents for reducing secondhand smoke exposure at public outdoor locations, with at least 78% of the residents supporting either restricting or completely eliminating cigarette smoking at each of the seven types of locations studied. Opinions among St. Lawrence County adults regarding prohibiting or restricting smoking at public outdoor locations are summarized in the following table. In general, the level of support among St. Lawrence County residents for restricting outdoor smoking has remained stable between 2006 and 2008, and is now not significantly different from the average level in neighboring counties at the studied public outdoor locations. (Tables 47, 50, 53, 56, 59, 62, and 65) page 9

14 Among all surveyed residents, % who support either Type of Outdoor Location restricting or entirely eliminating smoking St. Lawrence St. Lawrence Regional Average County 2006 County 2008 (2008) Grounds of K-12 school NA 93.7% 93.8% Public playground 89.6% 89.9% 90.0% Public building entryway 84.6% 87.6% 87.5% Public beach 80.2% 81.5% 81.0% Public outdoor event 77.9% 79.9% 81.8% Public park 82.2% 79.9% 81.4% County fair NA 78.7% 81.6% 31. Even among current cigarette smokers, there is a large degree of support for the notion of at least restricting cigarette smoking to certain areas at public outdoor locations. At each of the seven studied public outdoor locations, over 68% of the St. Lawrence County current cigarette smokers believe that smoking should be restricted or not allowed at all. Of note, 95.2% of the St. Lawrence County current cigarette smokers believe that smoking should be restricted or not allowed on the grounds of a K-12 school, 91.7% of the St. Lawrence County current cigarette smokers believe that smoking should be restricted or not allowed at public playgrounds, and 81.4% of the St. Lawrence County current cigarette smokers believe that smoking should be restricted or not allowed in public building entryways. (Tables 47, 50, 53, 56, 59, 62, and 65) 32. There is strong support among St. Lawrence County residents for tobacco-free policy recently put in place on the grounds of a hospital or medical facility in the county, with 75.3% of the residents favoring this policy, and only 14.4% opposed. This level of support is not significantly different from the current regional average rate of 78.4% favoring. Females and non-smokers are most in favor of this tobacco-free policy, however, it should be noted that over 50% of the current smokers in the St. Lawrence County (52.4%) do, in fact, support this tobacco-free policy. (Table 66) Tobacco Use Findings: 33. The current cigarette smoking rates found in the St. Lawrence County are: 20.1% smoke every day and 3.3% smoke some days, for a total estimate of 23.4% current smokers. This cigarette smoking rate has not changed significantly from the 25.4% found in the county in 2006, and is currently significantly above the regional average rate of 16.3% current smokers. Significant correlations discovered include that males (29.6% smokers), younger residents (38.0% of year olds smoke), and those with lower formal education levels (30.3% of those with no college coursework smoke), are most likely to be current cigarette smokers. The average number of cigarettes smoked per day among St. Lawrence County current smokers is 14.70, not significantly different from a rate of found in the county in 2006, and not significantly different from the current regional average rate of cigarettes per day. (Tables 67-70) 34. Use of other tobacco products (those other than cigarettes) among the St. Lawrence County residents has increased significantly since 2006, with 8.5% of St. Lawrence County adults currently using at least one form of non-cigarette tobacco product (rate was 4.5% in 2006). The current reported rate of use of smokeless tobacco among St. Lawrence County adults (3.8%) is the highest rate found among 17 rthern, Central, and Western New York counties studied in Similarly, the current rate of 6.4% of the adults in the county smoking cigars or cigarellos is the highest rate found among these recently-studied counties. The current non-cigarette tobacco use rate in the county is significantly above the current regional average of 4.9%. Males, younger residents, those from low-income households, and current cigarette smokers are most likely to be users of other non-cigarette tobacco products. tably, 19.6% of the current cigarette smokers in St. Lawrence County also use at least one other type of tobacco product. (Tables 71-76) 35. The overall tobacco-use rate among St. Lawrence County residents is summarized in the following table. The overall use of tobacco by St. Lawrence County residents (27.3%) has not changed significantly from the rate found in the county in 2006 (was 28.3%), and is significantly above the current regional average of 19.2% using at least one type of tobacco product. Males (36.5% use tobacco), younger adults (43.9% of those age use tobacco), and those with lower education levels (32.2% of those with no college coursework in their educational background use tobacco), are most likely to be users of tobacco products in St. Lawrence County. (Table 77) page 10

15 Tobacco Use: St. Lawrence County Results: Regional Average Use cigarettes only 23.8% 18.8% Use only non-cigarette tobacco 2.9% 3.9% products 19.2% Use cigarettes along with other tobacco products 1.6% 4.6% Use NO TOBACCO products 71.7% 72.7% 80.8% t sure 0.0% 0.0% 0.0% 36. Approximately two-thirds of the current cigarette smokers (62.7%) in the St. Lawrence County purchase their cigarettes at an Indian reservation or through an Indian enterprise, (not significantly different from the current regional average rate of 57.8%, but significantly decreased from the 2006 St. Lawrence County rate of 82.2%). Smokers in the St. Lawrence County are much less likely to purchase their cigarettes from a website or on the Internet, with 3.1% reporting to do so in 2008 (the current regional average is 7.0%, and the St. Lawrence County 2006 rate was 2.7%). (Tables 78-79) Tobacco Cessation Findings Current Smokers: 37. Among cigarette smokers in the St. Lawrence County, the majority has been advised to quit by health professionals in the past twelve months (57.3%), a rate that is not significantly different from the rate found in St. Lawrence County in 2006 (60.8%), and not significantly different from the current regional average rate of 58.4%. (Table 80) 38. The most common advice provided by healthcare professionals in the St. Lawrence County to potential cigarette quitters continues to be to prescribe nicotine patches, gum, spray, inhalers, and/or pills (82.9% advised to do this, significantly increased from 45.0% in 2006). Currently approximately one in twenty (5.4%) of the advised-to-quit smokers in the St. Lawrence County report that they were advised to call a telephone quitline (was 22.4% in 2006). (Table 81) 39. More than half (51.9%) of the St. Lawrence County smokers have attempted to quit smoking in the past year. This rate in St. Lawrence County is not significantly different from the current regional average of 52.6%, and has not changed significantly from the rate of 47.8% found in the county in Approximately two-fifths of those who tried to quit in the past year (41.2%) remained tobacco free for less than one month (rate was 69.2% in 2006, current regional average rate is 61.3%). (Tables 82-83) 40. Approximately three-fourths of the St. Lawrence County smokers have attempted to quit smoking at least once in the past three years (74.7%). This rate in St. Lawrence County is not significantly different from the current regional average of 70.4%. The most common cessation method utilized in these unsuccessful cessation attempts continues to be Cold Turkey, however, the rate of using Cold Turkey has decreased from 59.0% to 46.2% between 2006 and During the same time, the rate of using NRT has increased from 17.0% to 26.7%. (Tables 84-85) 41. Almost half (48.5%) of the St. Lawrence County current smokers indicate that they want to quit smoking now. This rate in St. Lawrence County is not significantly different from the current regional average of 49.7%, and has not changed significantly from the rate of 60.3% found in the county in (Table 86) 42. Approximately one-third (31.9%) of the St. Lawrence County current smokers report that in the past they have switched to low tar or nicotine cigarettes to reduce their health risk. (not changed significantly from 37.6% in St. Lawrence County in 2006, and not different from current regional average is 37.2%) (Table 87) 43. In St. Lawrence County, three-fourths (75.0%) of the current smokers report familiarity with local tobacco cessation services (no significant trend from 65.9% in St. Lawrence County in 2006). The current 75.0% familiarity rate in St. Lawrence County is significantly above the current regional average of 64.0%. Disappointingly, about one in eight (12.7%) of the current St. Lawrence County smokers are interested in learning more about cessation services. (decreased significantly from 30.6% in St. Lawrence County in 2006, and significantly below the current regional average is 26.0%) (Tables 88-89) page 11