The Mississippi Social Climate of Tobacco Control,

Transcription

1 The Mississii Social Climate of Tobacco Control, Robert Cameron McMillen Nell Valentine Kathleen Gresham Elena Sabbatini Wolfgang Frese Arthur G. Cosby SSRC Social Science Research Center

2 ACKNOWLEDGMENT The Mississii Social Climate Survey of Tobacco Control was made ossible through suort rovided by The Partnershi for a Healthy Mississii. The oinio exressed herein are those of the authors and do not necessarily reflect the views of The Partnershi for a Healthy Mississii. The design of the survey itrument was based on an exteive review of extant itruments such as the Behavior Risk Factor Surveillance System, the Current Poulation Survey - Tobacco Sulement, and the California Adult Tobacco Survey, and sulemented by additional items needed to oerationalize the social climate concet. The reliance on existing measurements was greatly enhanced by the review and excellent advice from the Office of Smoking and Health of the Centers for Disease Control and Prevention (CDC). The origi of this study can be traced to research associated with the tobacco settlement in Mississii. We develoed the social climate aroach to hel the Mississii Tobacco Control Foundation The Partnershi for a Healthy Mississii and the Mississii State Deartment of Health - monitor the degree to which their efforts were imacting the social fabric of Mississii. Vivien Carver and Bonnie Reinert, at the Partnershi for a Healthy Mississii, and Ellen Jones and Sheila Keller, formerly of the Mississii State Deartment of Health, worked closely with us in the develoment of a social climate survey. 2

3 The Mississii Social Climate Survey of Tobacco Control, In 1964, the U.S. Surgeon General formally announced the health risks of tobacco, thereby roviding the imetus for one of the most inteive ublic health interventio in the history of the United States. Sanning several decades, the tobacco control movement has develoed an increasingly effective series of social rograms and olicies designed to encourage nomoking and rotect nomokers from environmental tobacco smoke. In the years following the initiation of the tobacco control movement, the ercentage of current cigarette smokers in the American adult oulation has decreased dramatically from 42.4 ercent in 1965 to 23.0 ercent in 2002 (Centers for Disease Control and Prevention, 2004). This decrease tralates into about 40 million fewer adult smokers in the United States today than had the rate remained at 42.4 ercent. Tobacco control has recently witnessed two other major accomlishments. First, the tobacco comanies have been hit with massive comeatory and unitive fines resulting from lawsuits by former smokers, as well as massive settlement exees with individual states to cover health exees related to tobacco use. Second, national and state agencies have imlemented romising multicomonent rograms to revent and reduce youth tobacco use. These rograms have become increasingly comreheive through a shift from focusing rimarily on individual tobacco use to more oulation-based interventio with broad objectives such as social, environmental, and olitical change (United States Deartment of Health and Human Services, 2000). In somewhat simlified terms these national and statewide rograms target changes in the social climate. This aroach is an attemt to denormalize tobacco use through changes in beliefs and knowledge that are incororated into an individual's view of aroriate and accetable behavior, to the rules and regulatio that structure our organizatio, and ultimately in the manner in which we see tobacco use as a art of the social environment (Stillman et al., 1999). Recent research validates this strategy to target intermediate social and olitical olicies to imact the social climate, and ultimately reduce tobacco use. To illustrate, rograms that have successfully reduced ercetio that tobacco use is a normative behavior and/or increased the revalence of smoke-free olicies in ublic and rivate settings have been linked to increased cessation attemts by smokers, lower coumtion by smokers, and decreased initiation by adolescents (Borland, Chaman, Owen, & Hill, 1990; Farkas, Gilin, Distefan, & Pierce, 1999; Farrelly, Eva, & Sfekas, 1999). Although comreheive tobacco control rograms have moved toward logic models that incororate olitical and social intermediate objectives, lanning and evaluation in this area has been hamered by the lack of timely, comreheive data about tobacco control attitudes and ractices of US adults. We develoed the Social Climate Survey of Tobacco Control (SCS-TC) as a methodology to objectively measure and ultimately monitor the fundamental osition of tobacco control in society, and thereby rovide a data collection system to monitor rogram imacts. The survey includes items to measure rogress towards intermediate objectives such as olicy changes, changes in social norms, reductio in exosure of individuals to environmental tobacco smoke, and rejection of ro-tobacco influences. The results resented in this reort are based on annual crosssectional assessments of the social climate of tobacco control within Mississii and within the United States from 2000, 2001, 2002, 2003, 2004 and

4 Survey Develoment The Social Climate Survey of Tobacco Control (SCS-TC) is an attemt to contribute to the understanding of tobacco control through the introduction of an ititutional-based ersective that stresses not simly individual variatio in behaviors and attitudes, but rather attemts to use cross-sectional survey data for the measurement of societal norms, ractices, and beliefs surrounding tobacco. Put broadly, we want to measure the social norms, ractices, and beliefs surrounding a ublic health issue - in this case tobacco use. This technique is rimarily one of a shift in focus and interretation rather than basic survey methodology. By asking this series of questio to a random samle of American adults, we can measure the extent to which tobacco control and tobacco use are ingrained in the social ititutio that influence decisio about tobacco. The concet of social ititutio, taken from the sociological literature, rovides the framework for our methodology. As a fundamental comonent of a society, social ititutio emerge as clusterings of beliefs, norms, and ractices in order to meet the needs of society. To illustrate, the ititution of family and friendshi grous rovides the nurturing necessary to roduce and raise new members of a society; the education ititution then shaes the individual into a otentially roductive member of society. Seven social ititutio are included in our aroach -- each of which meets secific needs of society. These ititutio are: 1) Family and Friendshi Grous, 2) Education, 3) Government and Political Order, 4) Work, 5) Health and Medical Care, 6) Recreation, Leisure, and Sorts, and 7) Mass Communication and Culture. Moreover, in each of these ititutional areas, beliefs, norms, and ractices about tobacco use and tobacco control have evolved. It is these ititutional beliefs, norms, and ractices that form the essence of the ingrained status of tobacco use in the social fabric of American society. The Social Climate Survey coists of a set of questio designed to measure the norms, ractices, and knowledge concerning tobacco within each of these ititutio. Until recently revalence rates and er caita coumtion measures have frequently been the yardsticks with which tobacco control rograms were evaluated. While several state now have comreheive data collection systems for lanning and evaluation and there have been a substantial number of studies of attitudes toward the control of smoking in ublic settings (Ashley, Bull, & Pederson, 1995; Ashley & Cohen, 1998; Brooks & Mucci, 2001; Centers for Disease Control and Prevention, 2002c), no such descritive studies ublished to date have been comreheive or national in scoe. To our knowledge, the resent roject is the most comreheive survey of the extent to which tobacco control imacts the daily lives of America. The SCS- TC adds to existing national data sources by roviding annual cross-sectional data on a comreheive set of social and environmental indicators selected to monitor the fundamental osition of tobacco control across a broad range of social settings. This emhasis on collecting data on the measurable characteristics of the social climate, as well the brief time lag - 5 months between data collection and data availability, increases the utility of the SCS-TC as a data collection system for lanning secific interventio and evaluation of rogram imacts on the social climate. Researchers at the Social Science Research Center have artnered with State agencies in Mississii and the AAP's Center for Child Health Research to aly findings from the survey to lanning and evaluation. 4

5 Methods The Social Climate Survey of Tobacco Control (SCS-TC) was administered to reresentative samles of Mississii adults who were interviewed by telehone between July and Setember of either 2000, 2001, 2002, 2003, 2004 and s from all years reresent the civilian, non-ititutionalized adult oulation over age 18. Households were selected using random digit dialing rocedures to include households with unlisted numbers. Once a household was contacted, the adult to be interviewed was selected by asking to seak with the erson in the household who is 18 years of age or older and who will have the next birthday. Five attemts were made to contact those selected adults who were not home. The samle was weighted by race and gender, based on the most current U.S. Ceus estimates. Measures The SCS-TC is an annual cross-sectional survey that contai items ertaining to normative beliefs, ractices/olicies, and knowledge regarding tobacco control across seven social ititutio. These ititutio include 1) Family and Friendshi Grous, 2) Education, 3) Government and Political Order, 4) Work, 5) Health and Medical Care, 6) Recreation, Leisure, and Sorts, and 7) Mass Communication and Culture. Although the SCS-TC includes items to measure smoking status and cessation, the survey emhasizes social and environmental indicators. These intermediate indicators were selected to rovide a comreheive assessment of the social climate in which eole are exosed to and make decisio about tobacco control interventio. Survey items were develoed and selected based on an exteive review of extant tobacco control surveys and then reviewed by an external anel of tobacco control researchers. The anel develoed many of the items included in the survey, while others were selected from existing measurement itruments with established validity. Secifically, the SCS-TC included items from the Behavioral Risk Factor Surveillance System (BRFSS) (Centers for Disease Control and Prevention, 2002a) and the Tobacco Use Sulement- Current Poulation Survey (TUS-CPS) (Hartman, Willis, Lawrence, Marcus, & Gibson, 2002), as well as modified items from the California Adult Tobacco Surveys. 5

6 Results To facilitate the interretation and alication of the survey results, we have develoed the following heuristic classification scheme for assessing the social enetration of tobacco control in American society. Some issues are fully ingrained into society, such as norms agait smoking in day care centers, and are thus coidered to be universally acceted. Other issues are strongly suorted, but continue to be rejected by a small, but nontrivial segment of society. These issues are coidered as redominant cultural norms, beliefs, and ractices. Contested issues, on the other hand, are areas of tobacco control in which there remain substantial differences of oinion across society. The suort and oosition for these controls are roughly matched across society. Finally, some tobacco control issues, such as norms agait smoking in bars, are suorted by only a small segment of society and are coidered to be culturally marginal norms, ractices, or beliefs. By identifying universal, redominant, contested, and marginal asects of the social climate, it becomes ossible to develo more informed tobacco control efforts. To illustrate, it may not be necessary to target culturally universal norms, ractices, and beliefs because these asects of tobacco control are already deely ingrained. Norms, ractices, and beliefs that are redominantly ingrained in the social climate may serve as anchors for camaign efforts to target contested asects of the social climate. Finally, this aroach can identify those asects of the social climate which are only marginally ingrained and likely to be very resistant to interventio. The following classification scheme is used to categorize the degree to which these asects of tobacco control imact the daily lives of America. Heuristic Classification Scheme for Assessing the Social Penetration of Normative Beliefs, Health Beliefs, and Practices Universal Predominant Contested Marginal Universal normative beliefs, health beliefs, and ractices Held by the overwhelming majority of society members: % Predominant normative beliefs, health beliefs, and ractices Held by a redominance of society members: 65-84% Contested normative beliefs, health beliefs, and ractices Held by half of society members: 35-64% Marginal normative beliefs, health beliefs, and ractices Held by 0-34% of society members 6

7 2000 MS s Of the eligible resondents contacted, 803 resondents comleted the survey (85.0%) and 142 (15.0%) refused to articiate. The samling error (binomial questio with 50/50 slit) for the total data set is no larger than ± 3.5 (95% confidence interval). Of the 803 resondents, 292 (36.4 ercent) were male and 511 (63.6 ercent) were female. The racial comosition of the samle is as follows: white = 577 (71.9 ercent), = 196 (24.4 ercent), Asian or Pacific Islander = 3 (.4 ercent), American Indian or Alaskan Native = 1 (.1 ercent), other races = 8 (1.0 ercent), and unknown (i.e., did not awer the question on race) = 18 (2.2 ercent). The samle was weighted by race and gender, based uon 1998 U.S. Ceus estimates to eure that it is reresentative of the Mississii oulation MS s Of the eligible resondents contacted, 1,504 resondents comleted the survey (87.6%) and 212 (12.4%) refused to articiate. The samling error (binomial questio with 50/50 slit) for the total data set is no larger than ± 2.5 (95% confidence interval). Of the 1,504 resondents, 569 (37.8 ercent) were male and 934 (62.1 ercent) were female. The racial comosition of the samle is as follows: white = 1,050 (69.8 ercent), = 415 (27.6 ercent), Asian or Pacific Islander = 6 (0.4 ercent), American Indian or Alaskan Native = 2 (0.1 ercent), other races = 12 (0.8 ercent), and unknown (i.e., did not awer the question on race) = 19 (1.3 ercent). The samle was weighted by race and gender, based uon 1999 U.S. Ceus estimates to eure that it is reresentative of the Mississii oulation. In the few cases where race and/or gender was missing the resondents were given a weight of MS s Of the eligible resondents contacted, 1,013 resondents comleted the survey (98.0%) and 21 (2.0%) refused to articiate. The samling error (binomial questio with 50/50 slit) for the total data set is no larger than ± 3.1 (95% confidence interval). Of the 1,013 resondents, 321 (31.7 %) were male and 687 (67.8%) were female. The racial comosition of the samle is as follows: white = 713 (70.4%), = 270 (26.7%), Asian or Pacific Islander = 5 (0.5%), American Indian or Alaskan Native = 1 (0.1%), other races = 14 (1.4%), and unknown (i.e., did not awer the question on race) = 10 (1.0%). The samle was weighted by race and gender, based uon 2000 U.S. Ceus estimates to eure that it is reresentative of the Mississii oulation MS s Of the eligible resondents contacted, 815 resondents comleted the survey (90.7%) and 33 (3.9%) did not comlete the survey or refused to articiate. The samling error (binomial questio with 50/50 slit) for the total data set is no larger than ± 3.4 (95% confidence interval). Of the 815 resondents, 255 (31.3%) were male and 560 (68.7%) were female. The racial comosition of the samle is as follows: white = 558 (68.5%), = 237 (29.1%), American Indian or Alaskan Native = 1 (.1%), other races = 7 (.9%), and unknown (i.e., did not awer the question on race) = 12 (1.5%). The samle was weighted by race and gender based uon 2002 U.S. Ceus estimates to eure that it is reresentative of the Mississii oulation MS s Of the eligible resondents contacted, 905 resondents comleted the survey (96.1%) and 93 (9.3%) did not comlete the survey or refused to articiate. The samling error (binomial questio with 50/50 slit) for the total data set is no larger than ± 3.2 (95% confidence interval). Of the 905 resondents, 305 (33.7%) were male and 598 (66.1%) were female. The racial comosition of the samle is as follows: white = 626 (69.2%), = 248 (27.4%), Asian or Pacific Islander = 4 (.4%), American Indian or Alaskan Native = 5 (.6%), other races = 8 (.9%), and unknown (i.e., did not awer the question on race) = 14 (1.5%). The samle was weighted by race and gender based uon 2003 U.S. Ceus estimates to eure that it is reresentative of the Mississii oulation. 7

8 2005 MS s Of the eligible resondents contacted, 809 resondents comleted the survey (84.6 %) and 147 (15.4 %) did not comlete the survey or refused to articiate. The samling error (binomial questio with 50/50 slit) for the total data set is no larger than ± 3.4 (95% confidence interval). Of the 809 resondents, 246 (30.4 %) were male and 561 (69.3%) were female. The racial comosition of the samle is as follows: white = 546 (67.5 %), = 242 (29.9 %), Asian or Pacific Islander = 3 (.4 %), American Indian or Alaskan Native = 8 (1.0 %), other races = 5 (.6%), and unknown (i.e., did not awer the question on race) = 5 (0.6 %). The samle was weighted by race and gender based uon 2004 U.S. Ceus estimates to eure that it is reresentative of the Mississii oulation. s of the original samles are comared with the weighted samles in Table 1.1. The results resented in this reort are based on the weighted samle; the maximum samling error for each suboulation is resented in Table 1.2 Table / Smoking Status Gender Race Age Education s Orig Wtd. Orig. Wtd. Orig. Wtd Nomoker African-American Asian/Pacific Islander American Indian/Alaska Other Race years years years years Not HS Grad HS Grad Some College College Grad For data from 2001,2002, and 2003 lease see revious versio of this reort. 8

9 Table 1.2 Weighted Size and Maximum Confidence Interval Weighted Maximum Weighted Maximum Weighted Maximum Size Confidence Interval Size Confidence Interval Size Confidence Interval / Smoking Status Non Gender Race Age years of age Education Not high school grad High school grad

10 Family and Friendshi Grous, 2000 to % 100% Smoking is never allowed in the resence of children, 9% Parents should not allow children under the age of 18 to smoke cigarettes, 93.4% Smoke from a arent's cigarette harms their children, 96.3% Percent of MS adults in 2005 who suort each indicator 80% 60% 40% 20% Strict household rules agait smoking, 78.1% Smoking is unaccetable in front of children, 81.3% Children are more likely to smoke if their arents smoke, 83.7% s do not smoke in social settings with nomokers, 30.6% 0% Bubble size indicates magnitude of change ( ). Green bubbles reresent significant increases, yellow bubbles reresent non-significant changes, and red bubbles reresent significant decreases from 2000 to

11 FAMILY AND FRIENDSHIP GROUPS Universal Norms, Beliefs and Practices million Mississii households 3 (98.6 ercent) never allow children under the age of 18 years of ages to smoke cigarettes million Mississii adults (96.3 ercent) believe that smoke from arents cigarettes harms their children million Mississii adults (93.4 ercent) believe that arents should not allow children under the age of 18 to smoke cigarettes million Mississii adults (90.7 ercent) never allow smoking in the vehicle when children are resent million Mississii households (9 ercent) never allow smoking in the resence of children Significant Imrovements from 2000 to Family and Friendshi Grous Strict household rules agait MS smoking US Smoking is never allowed in the MS resence of children US No ETS Exosure in the home MS US No ETS Exosure in a car or truck MS US Smoking is never allowed in the MS vehicle US Smoking is never allowed in the MS vehicle when children are resent US Recognize that smoking in a car MS affects the health of children US Children under 18 are never allowed MS to smoke US Smoking is unaccetable in front of MS children US Parents should not allow children MS under the age of 18 to smoke US Smoke from a arent's cigarette MS harms their children US Children are more likely to smoke if MS their arents smoke US s do not smoke in social MS settings with nomokers 6 US , 2000 to , 2004 to 2005, MS v. US, Indicators endorsed by at least 85% of U.S. adults 3 Note that these numbers are based uon U.S. Ceus 2002 oulatio estimates for residents 18 years of age and older 4 All imrovements are statistically significant, α<.05 5 For data from 2001,2002, and 2003 lease see revious versio of this reort. 6 This estimate does not include resondents who reort that none of their friends smoke. 11

12 Families and Friendshi Grous: Percent of resondents who suort normative beliefs, recognize health risks, or reort tobacco control ractices Children under 18 are never allow ed to smoke Smoke from a arent's cigarette harms their children Parents should not allow children under 18 to smoke Smoking is never allow ed in resondent's vehicle w ith children resent Smoking is never allow ed in the resence of children Children are more likely to smoke if their arents smoke Recognize that smoking in a car affects the health of children either a lot or a great extent Smoking is unaccetable in front of children 81.3 Strict household rules agait smoking 78.1 Smoking is never allow ed in resondent's vehicle 78.0 No ETS exosure w ithin an automobile in the ast 7 days 77.1 No ETS exosure w ithin a home in the ast 7 days 63.5 s do not smoke in social settings w ith nomokers 30.6 Universal Predominant Contested Marginal 12

13 Table 2.1 Household Rules About Smoking Which of the following best describes your household s rules about smoking? Smoking is allowed in all arts of the home Smoking is allowed in some arts of the home Smoking is not allowed in any art of the home Total Nomoker 65 years of age and older College Graduate Note: 0.5 ercent of resondents reorted Don t Know or refused <. 001 Table 2.2 Smoking in the Presence of Children In your home, is smoking in the resence of children always allowed, sometimes allowed, or never allowed? Always allowed Sometimes allowed Never allowed Total Nomoker 65 years of age and older College Graduate Note: 1.0 ercent of resondents reorted Don t Know or refused < <

14 Table 2.3 Smoking in Vehicles Please tell me which best describes how cigarette smoking is handled in your car. No one is allowed to smoke in my car Secial guests are allowed to smoke in my car Smoking is allowed in my car only if the windows are oen Smoking is allowed in my car at any time Total Nomoker 65 years of age and older College Graduate Note: 7.2 ercent of resondents reorted Don t Know or refused or did not own a car < Table 2.4 Smoking in Vehicles with Children Present Please tell me which best describes how cigarette smoking is handled in your car when children are resent. No one is allowed to smoke in my car Secial guests are allowed to smoke in my car Smoking is allowed in my car only if the windows are oen Smoking is allowed in my car at any time Total Nomoker 65 years of age and older College Graduate Note: 8.2 ercent of resondents reorted Don t Know or refused or did not own a car <

15 Table 2.5 How Much Does Smoking in a Car Affect the Health of Children In your oinion, how much does smoking in a car affect the health of children? Not at all A little bit Somewhat A lot A great extent Total Nomoker 65 years of age and older College Graduate Note: ercent of resondents reorted Don t Know or refused < Table 2.6 Frequency of ETS Exosure in a Car or Truck During the ast 7 days, on how many days were you in a car or truck with someone who was smoking cigarettes? 0 Days 1 or 2 Days 3 or 4 Days 5 or 6 Days 7 Days (everyday) Total Nomoker 65 years of age and older College Graduate Note: 0.7 ercent of resondents reorted Don t Know or refused < <. 001 <

16 Table 2.7 Frequency of ETS Exosure in the Home During the ast 7 days, on how many days were you in the same room with someone who was smoking cigarettes? 0 Days 1 or 2 Days 3 or 4 Days 5 or 6 Days 7 Days (everyday) Total Nomoker 65 years of age and older College Graduate Note: 0.9 ercent of resondents reorted Don t Know or refused Table 2.8 Household Rules About Youth Smoking In your home, are children under the age of 18 always allowed, sometimes allowed, or never allowed to smoke cigarettes? Always allowed Sometimes allowed Never allowed Total Nomoker 65 years of age and older College Graduate Note: 0.9 ercent of resondents reorted Don t Know or refused <

17 Table 2.9 Accetability of Parents Smoking in Front of Children It is accetable for arents to smoke in front of children. agree Agree Disagree disagree Total Nomoker 65 years of age and older College Graduate Note: 3.8 ercent of resondents reorted Don t Know or refused < Table 2.10 Should Parents Allow Children to Smoke Cigarettes? Parents should not allow children under the age of eighteen to smoke cigarettes. agree Agree Disagree disagree Total Nomoker 65 years of age and older College Graduate Note: 1.3 ercent of resondents reorted Don t Know or refused

18 Table 2.11 Beliefs about Health Effects of Parent s Cigarette Smoke on Children Inhaling smoke from a arent s cigarette harms the health of babies and children. agree Agree Disagree disagree Total Nomoker 65 years of age and older College Graduate Note: 2.6 ercent of resondents reorted Don t Know or refused Table 2.12 Beliefs about Risk of Children Smoking if Parents are s Children are more likely to smoke if arents are smokers. agree Agree Disagree disagree Total Nomoker 65 years of age and older College Graduate Note: 3.6 ercent of resondents reorted Don t Know or refused

19 Table 2.13 Do Friends who are s Smoke in Social Settings with Nomokers In social settings where there are smokers and nomokers, do your friends who are smokers tend to: Always refrain from smoking Sometimes refrain from smoking Never refrain from smoking Total Nomoker 65 years of age and older College Graduate Note: ercent of resondents reorted Don t Know or refused < <

20 Education, 2000 to % Percent of MS adults in 2005 who suort each indicator 100% 80% 60% 40% 20% Students should be unished for violating school rules agait smoking, 96.7% 0% Bubble size indicates magnitude of change ( ). Green bubbles reresent significant increases, yellow bubbles reresent non-significant changes, and red bubbles reresent significant decreases from 2000 to

21 EDUCATION Universal Norms, Beliefs and Practices million Mississii adults (96.7 ercent) believe that students should be unished for violating school rules agait smoking million Mississii adults (94.3 ercent) believe that it is accetable for schools to ut u anti-tobacco osters Significant Imrovements 2000 to Education It is accetable for schools to ut u MS anti-tobacco osters US 90.6 Students should be unished for MS violating school rules agait smoking US 91.8 Schools should rohibit students from MS wearing clothing or bringing gear with US tobacco brand logos to school, 2000 to 2005, 2004 to 2005, MS v. US, 2005 Education: Percent of resondents who suort normative beliefs, recognize health risks, or reort tobacco control ractices Students should be unished for violating school rules agait smoking 96.7 It its accetable for schools to ut u anti-tobacco osters 94.3 Schools should rohibit students from w earing clothing or bringing gear w ith tobacco brand logos to school 83.9 Universal Predominant Contested Marginal 7 For data from 2001,2002, and 2003 lease see revious versio of this reort. 21

22 Table 3.1 Should Schools Prohibit Tobacco Brand Logos Schools should rohibit students from wearing clothing or bringing gear with tobacco brand logos to school. Do you strongly agree, agree, disagree, or strongly disagree? (Percent resonding by rural/urban, smoking status, gender, race, age, and education.) agree Agree Disagree disagree Total Nomoker Note: 3.8 ercent of resondents reorted Don t Know or refused Table 3.2 Students Should be Punished for Violating Rules agait Smoking Students should be unished for violating school rules agait smoking. Do you strongly agree, agree, disagree, or strongly disagree? (Percent resonding by rural/urban, smoking status, gender, race, age, and education.) agree Agree Disagree disagree Total Nomoker Note: 1.5 ercent of resondents reorted Don t Know or refused

23 Table 3.3 Suort for Anti-Tobacco Posters in Schools How accetable is it for schools to ut u anti-tobacco osters? (Percent resonding by rural/urban, smoking status, gender, race, age, and education.) Very accetable Somewhat accetable Somewhat unaccetable Very accetable Total Nomoker Note: 2.6 ercent of resondents reorted Don t Know or refused

24 Government and Political Order, 2000 to % Percent of MS adults in 2005 who suort each indicator 100% 80% 60% 40% 20% Stores should need a licee to s ell tobacco roducts, 86.2% Tobacco should be regulated as a drug, 75.7% Stores should be enalized for the sale of tobacco to minors, 97.6% Government should NOT limit fines from lawsuits agait the tobacco comanies, 45.8% Youth should be enalized for the ossession of tobacco, 85.2% 0% Bubble size indicates magnitude of change ( ). Green bubbles reresent significant increases, yellow bubbles reresent non-significant changes, and red bubbles reresent significant decreases from 2000 to

25 GOVERNMENT AND POLITICAL ORDER Universal Norms, Beliefs and Practices million Mississii adults (97.6 ercent) believe that stores should be enalized for the sale of tobacco to minors million Mississii adults (86.2 ercent) believe that stores should need a licee to sell tobacco roducts million Mississii adults (85.2 ercent) believe that youth should be enalized for the ossession of tobacco Significant Imrovements 2000 to Government and Political Order Tobacco should be regulated as a drug MS US Stores should need a licee to sell MS tobacco roducts US Stores should be enalized for the sale MS of tobacco to minors US Youth should be enalized for the MS ossession of tobacco US Government should NOT limit fines from MS lawsuits agait the tobacco comanies US , 2000 to , 2004 to 2005, MS v. US, For data from 2001,2002, and 2003 lease see revious versio of this reort. 25

26 Government and Political Order: Percent of resondents who suort normative beliefs, recognize health risks, or reort tobacco control ractices Stores should be enalized for the sale of tobacco to minors 97.6 Stores should need a licee to sell tobacco roducts 86.2 Youth should be enalized for the ossession of tobacco 85.2 Tobacco should be regulated as a drug 75.7 Government should NOT limit fines from lawsuits agait the tobacco comanies 45.8 Universal Predominant Contested Marginal 26

27 Table 4.1 Tobacco Should Be Regulated as a Drug Tobacco roducts should be regulated as a drug by a government agency such as the Food and Drug Administration. Do you strongly agree, agree, disagree, or strongly disagree? agree Agree Disagree disagree Total Nomoker 65 years of age and older Note: 6.8 ercent of resondents reorted Don t Know or refused < Table 4.2 Tobacco Liceing Store owners should need a licee to sell tobacco, just like they do to sell alcohol. Do you strongly agree, agree, disagree, or strongly disagree? agree Agree Disagree disagree Total Nomoker Note: 3.4 ercent of resondents reorted Don t Know or refused <

28 Table 4.3 Stores Should Be Penalized for the Sale of Tobacco Products to Minors Stores should be enalized for the sale of tobacco roducts to erso under the age of 18. Do you strongly agree, agree, disagree, or strongly disagree? agree Agree Disagree disagree Total Nomoker Some College Note: 0.8 ercent of resondents reorted Don t Know or refused Table 4.4 Possession of Tobacco by Minors Perso under the age of 18 should be enalized for the ossession of tobacco roducts. Do you strongly agree, agree, disagree, or strongly disagree? agree Agree Disagree disagree Total Nomoker Note: 8.4 ercent of resondents reorted Don t Know or refused

29 Table 4.5 Lawsuit Limit agait Tobacco Comanies The government should limit fines from lawsuits agait the tobacco comanies. Do you strongly agree, agree, disagree, or strongly disagree? agree Agree Disagree disagree Total Nomoker Note: 10.4ercent of resondents reorted Don t Know or refused

30 Work, 2000 to % Percent of MS adults in 2005 who suort each indicator 100% 80% 60% 40% 20% 0% Smoking in work areas should not be allowed, 73.4% Smoking is not allowed in any area at work, 73.5% Strictly enforced tobacco olicy at work, 82.8% Cigarettes are not available for sale at work lace, 93.9% Emloyer offered a cessation rogram in ast 12 months, 19.4% -20% Bubble size indicates magnitude of change ( ). Green bubbles reresent significant increases, yellow bubbles reresent non-significant changes, and red bubbles reresent significant decreases from 2000 to

31 WORK Universal Norms, Beliefs and Practices ercent of Mississii adult workers reort that cigarettes are not available for sale at their work lace ercent of Mississii adult workers reort not ETS exosure in the work lace in the ast 7 days Significant Imrovements 2000 to Work Smoking in work areas should not be MS allowed US Smoking is not allowed in any area at MS work US Strictly enforced tobacco olicy at MS work US No ETS exosure at work in the ast MS days US Cigarettes are not available for sale at MS work lace US Emloyer offered a cessation MS rogram in ast 12 months US , 2000 to , 2004 to 2005, MS v. US, For data from 2001,2002, and 2003 lease see revious versio of this reort. 31

32 Work: Percent of resondents who suort normative beliefs, recognize health risks, or reort tobacco control ractices Cigarettes are not available for sale at w ork lace 93.9 No ETS exosure at w ork in the ast 7 days 88.5 Strictly enforced tobacco olicy at w ork 82.8 Smoking is not allow ed in any area at w ork 73.5 Smoking in w ork areas should not be allow ed 73.4 Emloyer offered a cessation rogram in ast 12 months 19.4 Universal Predominant Contested Marginal 32

33 Table 5.1 Should Smoking Be Allowed in Work Areas In indoor work areas, do you think smoking should be allowed in all areas, some areas, or not at all? In all areas In some areas Not allowed at all Total Nomoker Note: 0.9 ercent of resondents reorted Don t Know or refused < Table 5.2 Emloyer Smoking Policy Which of the following best describes your lace of work s official smoking olicy for indoor work areas? Smoking is not allowed in any area It is allowed in some areas It is allowed in all areas There is no official olicy Total Nomoker Note: 43.2 ercent of resondents reorted Don t Know or refused or did not work <

34 Table 5.3 Enforcement of Smoking Policy Would you say that this smoking olicy is not enforced at all, oorly enforced, somewhat enforced, or strictly enforced? Not enforced at all Poorly enforced Somewhat enforced Strictly enforced Total Nomoker Note: 49.9 ercent of resondents reorted Don t Know or refused or did not work Table 5.4 Frequency of ETS Exosure at Work During the ast 7 days, on how many days were you in the same room at work with someone who was smoking cigarettes? 0 Days 1 or 2 Days 3 or 4 Days 5 or 6 Days 7 Days Total Nomoker 65 years of age and older College Graduate Note: 85.0 ercent of resondents reorted Don t Know or refused or did not work

35 Table 5.5 Availability of Cigarettes for Sale at Work Are cigarettes for sale at your work lace? Yes No Total Nomoker Some College Note: 43.3 ercent of resondents reorted Don t Know or refused or did not work Table 5.6 Emloyer Cessation Program Within the ast 12 months, has your emloyer offered any sto smoking rograms or any other hel to emloyees who want to quit smoking? Yes No Total Nomoker Note: 45.3 ercent of resondents reorted Don t Know or refused or did not work

36 Health and Medical Care, 2000 to % Believe that smoking cigarettes is very dangerous, 88.8% Percent of MS adults in 2005 who suort each indicator 80% 60% 40% 20% Believe that chewing tobacco is very dangerous, 73.7% Believe that using snuff is very dangerous, 74.6% Believe that smoking cigars is very dangerous, 77.8% Hositals should be smoke-free, 89.0% 0% Bubble size indicates magnitude of change ( ). Green bubbles reresent significant increases, yellow bubbles reresent non-significant changes, and red bubbles reresent significant decreases from 2000 to

37 HEALTH AND MEDICAL CARE Universal Norms, Beliefs and Practices million Mississii adults ( 89.0 ercent) believe that smoking should not be allowed in hositals million Mississii adults (88.8 ercent) believe that smoking cigarettes is very dangerous million Mississii adults (85.0 ercent) believe that MS should fund anti-smoking education for MS residents Significant Imrovements 2000 to Health and Medical Care Hositals should be smoke-free MS US Believe that breathing second-hand MS smoke is very dangerous US Believe that chewing tobacco is MS very dangerous US Believe that smoking cigarettes is MS very dangerous US Believe that using snuff is very MS dangerous US Believe that smoking cigars is very MS dangerous US Has a health iurance olicy that covers the costs of sto smoking MS rograms US Believe that health iurance should cover the costs of sto MS smoking rograms US Believe that MS should fund quit MS smoking rograms for MS residents Believe that MS should fund antismoking education for MS residents US MS US , 2000 to , 2004 to 2005, MS v. US, For data from 2001,2002, and 2003 lease see revious versio of this reort. 37

38 Health and Medical Care: Percent of resondents who suort normative beliefs, recognize health risks, or reort tobacco control ractices Hositals should be smoke-free Believe that smoking cigarettes is very dangerous Mississii should fund anti-smoking education rograms for residents of this state Believe that smoking cigars is very dangerous Health iurance should cover the cost of sto smoking rogram or other sto smoking methods Mississii should fund quit smoking rograms for residents of this state Believe that snuff is very dangerous 74.6 Believe that chew ing tobacco is very dangerous 73.7 Believe that second hand smoke is very dangerous 73.5 Has a health iurance olicy that covers the cost of sto smoking rogram or other sto smoking methods 13.4 Universal Predominant Contested Marginal 38

39 Table 6.1 Should Hositals be Smoke-free In hositals, do you think smoking should be allowed in all areas, some areas, or not at all? Some areas Not at all Total Nomoker Note: ercent of resondents reorted Don t Know or refused < Table 6.2 Danger of Second Hand Smoke Is breathing second hand smoke very dangerous, somewhat dangerous, or not very dangerous? Very dangerous Somewhat dangerous Not very dangerous Total Nomoker Note: 1.4 ercent of resondents reorted Don t Know or refused < <