COMMUNITY TOBACCO SURVEY OF ADULT RESIDENTS OF TIOGA COUNTY (NEW YORK)

Transcription

1 COMMUNITY TOBACCO SURVEY OF ADULT RESIDENTS OF TIOGA COUNTY (NEW YORK) Opinions, Behaviors, and Perceptions Related to Exposure to Secondhand Smoke, Spreading the Message About the Dangers of Tobacco, Tobacco Advertising, Tobacco Sales, Tobacco Use, and Tobacco Cessation December 2011 Conducted for Tobacco Free Broome and Tioga Owego, New York Prepared by Joel LaLone Consulting Watertown, New York

2 Table of Contents Tobacco Free Broome and Tioga Tioga County Adult Tobacco Survey December 2011 Introduction... Page 1 Methodology Page 1 Table 1 Response Rates for the December 2011 Tioga County Community Tobacco Survey... Page 2 Demographics of the Sample Who was interviewed?...page 2 Table 2 Demographics of the Sample Compared to US Census Estimates for Tioga County Page 3 Summary of Findings Page 5 Presentation of Results......Page 10 Technical Comments for Interpretation of the Presented Results Page 11 Margin of Error Using this Data to Estimate for Entire Tioga County Adult Populations....Page 11 Table 3 Approximate Margin of Error for Varying s and Varying Sample Percentages..... Page 13 Tests for Statistical Significance Using this Data to Test for Trends, Differences, and Relationships. Page 14 Table 4 s and Approximate Margins of Error Within Demographic Subgroups... Page 16 Spreading the Message About the Dangers of Tobacco Findings..Page 18 Table 5 Heard of the NYS Smokers Quitline?.... Page 18 Tobacco Advertising Findings... Page 19 Table 6 tice cigarettes displayed behind cash register in stores in past 30 days?... Page 19 Table 7 Displaying tobacco advertisements in stores make teens more likely to smoke?... Page 20 Table 8 Displaying tobacco products in visible location in stores make teens more likely to smoke?... Page 21 Table 9 Feelings about tobacco products being displayed in stores unacceptable vs. acceptable. Page 22 Table 10 Opinion about a policy that would ban the display of tobacco products in stores. Page 23 Table 11 Do you think that tobacco advertising in convenience stores or gas stations should be allowed?... Page 24 Tobacco Sales Findings. Page 25 Table 12 Pharmacies should or should not sell tobacco products?... Page 25 Table 13 Feelings about tobacco products being sold in stores located near schools unacceptable vs. acceptable.. Page 26 Table 14 Opinion about a policy that would restrict the sale of tobacco products in stores located near schools?... Page 27 Table 15 Should tobacco retailers be required to keep tobacco out of view of customers?... Page 28 Table 16 Support a policy that would limit the maximum number of tobacco retailers allowed in a neighborhood?... Page 29 Table 17 Opinion about a policy that would limit the # stores that could sell tobacco in your community?... Page 30 Tobacco On Screen....Page 31 Table 18 How often do you see tobacco use or images on screen?... Page 31 Table 19 Youth-rated movies should not include tobacco use or images agree or disagree?...page 32 Table 20 Internet sites, and TV shows that youth use and watch should include tobacco use or images?... Page 33 Table 21 Support a policy that restricts showing the use of tobacco in media rated for youth viewership?... Page 34 Secondhand Smoke Exposure Findings In One s Personal Vehicle, At Public Outdoor Locations, At the Workplace, and In One s Home..... Page 35 Table 22 Support for a law in NYS prohibiting smoking inside a car when a person under the age of 18 is present. Page 35 Table 23 Support for a Smoke-free Policy at a Public Building Entryways... Page 36 Table 24 Support for a Smoke-free Policy at a Public Beach or Municipal Pool... Page 37 Table 25 Support for a Smoke-free Policy at a Public Park or Outdoor Recreation Area Page 38 Table 26 Support for a Smoke-free Policy at a Public Playground... Page 39 Table 27 Type of Residence Multi-unit Dwelling (or, Apartment ) or Single-family Home?... Page 40 Table 28 Rules about smoking inside residential units in your building?... Page 41 Table 29 Opinions About a Smoke-free Policy in MUDs... Page 42 Tobacco Use Findings... Page 43 Table 30 Smoked at Least 100 Cigarettes in Entire Life?... Page 43 Table 31 Some Every Day, Some Days, or t at All... Page 44 Table 32 Cigarette Use Status Current, Former, Never Smokers?... Page 45 Table 33 n-cigarette Tobacco Use Use at least one non-cigarette type of product... Page 46 Table 34 Overall Tobacco Use... Page 47 Further Attitudes, Behaviors, Interests, and Familiarity among Current Smokers Findings. Page 48 Table 35 Stopped smoking for at least one day in past 12 months trying to quit?... Page 48 Table 36 Purchase cigarettes online in past 12 months?... Page 49 Table 37 Purchase cigarettes from another state to avoid NYS excise tax in past 12 months?... Page 50 Table 38 Has the price of tobacco had an impact on your tobacco use? Page 51 Table 39 Do you want to quit smoking now?... Page 52 Concluding Comments, and Appendix The Survey Instrument.... Page 53

3 Contact Information Tobacco Free Broome and Tioga Tioga County Adult Tobacco Survey December 2011 Tobacco Free Broome and Tioga Joel LaLone Consulting Ms. Diana Chandler, M.Ed. Mr. Joel LaLone Program Coordinator, Reality Check 428 Flower Avenue West Cornell Cooperative Extension Tioga Watertown, New York Main Street (315) Owego, NY Telephone: (607) Fax: (607) NYS Smokers Quitline NY-QUITS

4 Introduction Tobacco Free Broome and Tioga Tioga County Adult Tobacco Survey December 2011 Tobacco Free Broome and Tioga, and Tioga-Broome Reality Check, are agencies affiliated with the New York Tobacco Control Program, a program 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 Tioga County (New York) residents. Ultimately, the purpose of these tobacco prevention community partnerships, and their 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 Tioga County, Tobacco Free Broome and Tioga, and Tioga-Broome Reality Check, have a need for current and accurate information regarding tobacco-related behaviors and attitudes among Tioga County residents. This information will enable the community partnerships to better: plan and define goals, objectives, programs, services, initiatives, and promotions to be provided in the future by Tobacco Free Broome and Tioga, and Tioga-Broome Reality Check, and measure and evaluate the effectiveness of Tobacco Free Broome and Tioga, and Tioga- Broome Reality Check, in meeting their goals and objectives by using this data for comparison to past studies, and future similar studies completed in Tioga County in subsequent years, as well as to comparable regional data. To measure the necessary attitudes and behaviors regarding tobacco issues in Tioga County, Tobacco Free Broome and Tioga, and Tioga-Broome Reality Check, 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 approximately 400 adult residents of Tioga 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. Tobacco Sales 4. Tobacco On Screen 5. Secondhand Smoke Exposure In One s Personal Vehicle, At Public Outdoor Locations, At the Workplace, and In One s Home 6. Tobacco Use 7. Further Attitudes, Behaviors, Interests, and Familiarity among Current Smokers This report is a summary and explanation of the findings of the Tioga County community tobacco study completed for Tobacco Free Broome and Tioga, and Tioga-Broome Reality Check, in December When possible, comparisons of the current results are made to the results of previous community tobacco surveys completed in Tioga County in 2006 and Additionally, the current Tioga County results are compared to current regional average results. The regional average results are derived using the findings from twenty separate Central, rthern, and Western New York county-wide tobacco-related studies that were completed by tobacco community partnerships during the interval of December 2010 December 2011 (including Tioga County). Each of these twenty studies is similar to the current Tobacco Free Broome and Tioga, and Tioga-Broome Reality Check, study in methodology, goals, and scope. Finally, the current Tioga County results are cross-tabulated by the possible explanatory factors of Gender, Age, Education Level, Income Level, and Current Cigarette Smoking Status. 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 coordinators at Tobacco Free Broome and Tioga, and Tioga-Broome Reality Check. The instrument, the introductory script used by interviewers on the telephone, and the required methodology to collect the data (complete interviews) were each approved by the Institutional Review Board of the New York State Department of Health in vember The survey included approximately 40 items (questions) regarding the seven sets of tobacco issues outlined in the page 1

5 preceding introduction (including demographic questions). Copies of the script and survey instrument are attached as an appendix. The study included completing interviews of 394 adult residents of Tioga County. All interviews were completed via telephone. To be eligible to complete the survey, the resident was required to be at least 18 years of age. Personal residence telephone numbers were randomly selected from Tioga County The randomly-selected landline 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 random landline telephone numbers, the list was randomly sorted a second time. Approximately 10% of the interviews were completed on cellular phones of the participants (40 of the 394 completed interviews were on the cellular phone of the participant). The cellular phone numbers attempted were generated randomly, by generating random 4-digit sets of numbers to attach to the most common area codes and prefixes that are in use for cellular phones in Tioga County. 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 between December 27 th, 2011 and January 4 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. It was only necessary to attempt to contact 2,370 households before completing the contracted 394 interviews (cellular phones and landline results combined). When each of the 2,370 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 one-half (50%) of the questions in the survey had to be completed. The resident s refusal to answer more than one-half of the questions was considered a decline to be interviewed. The typical length of a completed survey was approximately ten minutes. Declines to be interviewed (refusals) were not called back with 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. rewards or gifts were offered to contacted adults to encourage their participation. The response rate results for the study are summarized below. Table 1 Response Rates for the December 2011 Tioga County Community Tobacco Survey Result: Complete Interview Decline to be Interviewed t Valid Telephone Number Answer/ Busy TOTALS Frequency % of Numbers Attempted 16.6% 21.0% 13.3% 49.1% 100% % of Valid Numbers 19.2% 24.2% 56.6% 100% % of Contacted Residents 44.2% 55.8% 100% Within the fields of social science and public health research, when using telephone interview methodology including calling cellular phones, a response rate of over 44% among the successful contacts, where a person is actually talking on the phone, is considered quite successful. Demographics of the Sample Who was interviewed? This section of the report includes a description of the results for the demographic variables included in the survey sample. The demographic characteristics of the sampled adult residents can be used to attain the following 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 Tioga County?). Secondly, this demographic information facilitates the ability for the data to be sorted or partitioned to investigate for significant relationships relationships between 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 the county population for programming and interventions. Finally, the demographic information also serves an important purpose when compared to established facts about Tioga County to analyze the representativeness of the sample that was randomly selected in this study. The results for the demographic questions in the survey are summarized in the following table. The estimated demographic characteristics of the entire adult population residing in Tioga County that were reported by the US Census Bureau in 2009 (most current detailed U.S. Census results available for Tioga County) are also summarized for each demographic variable and provided for comparison. page 2

6 Table 2 Demographics of the Sample Compared to U.S. Census Estimates for Tioga County Tioga County page 3 Tioga County (U.S. Census 2009) (December 2011 Sample) Gender (US Census % s are among those age 18 or older) (sample weighted for Gender, Age, Education Level) Male 50% 50% Female 50% 50% Age Group (US Census % s are among those age 18 or older) (sample weighted for Gender, Age, Education Level) % 11% % 13% % 18% % 22% % 16% % 19% Education Level (sample weighted for Gender, Age, Education Level) HS Graduate or less 50% 50% Some College 28% 28% College Graduate (4+years) 22% 22% Annual Household Income (sample weighted for Gender, Age, Education Level) Less than $25,000 18% 23% $25,000-$50,000 33% 26% More than $50,000 49% 51% Race/Ethnicity (sample weighted for Gender, Age, Education Level) White 95% 97% Black or African American 1% 1% Hispanic or Latino 1% 1% Asian 0% 1% Native Hawaiian or Pacific Islander 0% 0% American Indian, Alaska Native 0% 0% Don t Know, Prefer t to Answer 4% -- Employment Status (Census reports for those over age of 15) (sample weighted for Gender, Age, Education Level) Employed for wages 47% Self-employed 8% 61% employed Out of work more than 1 year 2% Out of work less than 1 year 2% Homemaker 4% 4% unemployed Student 6% 35% not in labor force Retired 25% Unable to work 4% t sure 2% Children in the Household (sample weighted for Gender, Age, Education Level) persons under age 18 in home. 69% 66% no children in household 1 person under age 18 in home. 15% 2 persons under age 18 in home. 11% 3 persons under age 18 in home. 4% 34% 1+ children in household 4 persons under age 18 in home. 1% 5+ persons under age 18 in home. 0% In general, the responses to the demographic questions included in the survey appear to accurately parallel that which is true for the entire adult population of Tioga County. The postal zip code for each participant was recorded, and the geographic distribution of this sample represents Tioga County accurately. The primary exceptions when comparing the raw (unweighted) demographics of this sample to U.S. Census estimates for the county are that women are overrepresented in the sample (women are more likely than men to answer the telephone and/or agree to a survey, whereas the distribution of men and women in the Tioga County population is essentially equal), older residents are also overrepresented (again, older residents are more likely than younger adult residents to participate in a telephone survey), and those adult residents with lower formal education levels are underrepresented (less likely to participate in a survey). These types of sampling error are 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 the highly-educated in the sample collected

7 in this study, post-stratification weightings by gender, age, and education level have been applied 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 gender, age, and education level targets that were used for these weighting algorithms were derived from the 2009 US Census updates for the Tioga County adult population. Given the extreme diligence placed on scientific sampling design and protocol, and the high response rates, after application of post-stratification weightings by gender, age, and education level, it is felt that this sample of Tioga County adults does accurately represent the population of all Tioga 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 Tioga County. In survey research, the exact margin of error when estimating for an entire population is question-specific, depending upon the sample size for each question and sample statistics that result 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 purchased cigarettes from a website or on the Internet during the past 12 months) 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 394 interviewed Tioga County adults may be generalized to the population of all adults at least 18 years of age residing in the county with a 95% confidence level to within a margin of error of approximately ±5.6 percentage points. For results that are investigated for certain specific subgroups in Tioga County, such as current cigarette smokers, the resulting smaller sample sizes allow generalization to the specific subpopulation of all adults at least 18 years of age residing in Tioga County (i.e. generalization of some specific characteristics of sampled smokers in Tioga County to all cigarette smokers in Tioga County) with a 95% confidence level to within a margin of error that will be larger than ±5.6 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 16 and SPSS, Release 16. page 4

8 Summary of Findings Tobacco Free Broome and Tioga Tioga County Adult Tobacco Survey December 2011 The following is a detailed summary of the findings of this community tobacco study completed in December 2011 regarding the attitudes and behaviors related to tobacco among adult residents of Tioga County (New York). Throughout this Summary of Findings, the regional average rate is defined as the average rate among twenty similar tobacco-related studies completed in counties in Central, rthern, and Western New York. Each of these counties completed county-specific community tobacco surveys during the twelve month period of December 2010 through December Spreading the Message About the Dangers of Tobacco Findings: 1. Approximately three-fourths of Tioga County adult residents (71.1%) have ever heard of the New York State Smokers Quitline; this level of familiarity is not significantly different from the current average rate found among residents of neighboring counties (75.6%). The familiarity rate in Tioga County increased significantly between 2006 and 2008 from 46.7% to 77.6%, and has not changed significantly between 2008 and (Table 5) Tobacco Advertising Findings: 2. Approximately two-thirds of adults in Tioga County (67.9%) have noticed packs of cigarettes or cigars displayed behind the cash register or in other areas of stores at least occasionally during the past 30 days, with 25.8% of participants indicating that they noticed these displays almost every visit. This rate of 67.9% noticing at least occasionally in Tioga County is not significantly different from the current regional average of 70.7%. (Table 6) 3. Almost one-half of adults in Tioga County (45.6%) agree that seeing cigarette and other tobacco product advertisements in stores that sell tobacco products makes teens more likely to smoke when asked whether they think this is true, 16.6% responded with definitely yes and another 29.0% responded with probably yes. This rate of 45.6% agreeing that tobacco ad exposure makes teens more likely to smoke in Tioga County is not significantly different from the current regional average of 49.4%. Even among current smokers in Tioga County, 33.0% agree that seeing cigarette and other tobacco product advertisements in stores that sell tobacco products makes teens more likely to smoke. (Table 7) 4. Almost one-half of adults in Tioga County (42.8%) agree that seeing the displays of cigarettes and other tobacco products in very visible locations in stores that sell tobacco makes teens more likely to smoke. When asked whether they think this is true, 14.2% responded with definitely yes and another 28.6% responded with probably yes. This rate of 42.8% agreeing that exposure to these displays makes teens more likely to smoke in Tioga County is not significantly different from the current regional average of 45.3%. Even among current smokers in Tioga County, 30.2% agree that exposure to these displays in stores that sell tobacco products makes teens more likely to smoke. (Table 8) 5. When asked How do you feel about tobacco products such as packs of cigarettes or cigars being displayed in stores?, approximately one-third of adults in Tioga County (29.3%) respond with either somewhat unacceptable (14.0%) or totally unacceptable (15.3%). This rate of 29.3% indicating totally or somewhat unacceptable in Tioga County is not significantly different from the current regional average of 32.4%. Even among current smokers in Tioga County, 10.2% feel that these displays are somewhat or totally unacceptable. (Table 9) 6. Approximately 40% of Tioga County adults report that are in favor of a policy that would ban the display of tobacco products such as packs of cigarettes or cigars from stores (20.6% strongly in favor and another 19.0% somewhat in favor), while only 36.2% are against such a policy. This rate of 39.6% indicating strongly or somewhat in favor in Tioga County is not significantly different from the current regional average of 43.9%. Even among current smokers in Tioga County, 21.0% are in favor of a policy that would ban the display of tobacco products such as packs of cigarettes or cigars from stores. (Table 10) 7. A large majority of Tioga County adults (71.6%) believe that advertising of tobacco products in convenience stores and gas stations should be restricted or eliminated with approximately 28% favoring complete elimination. This 71.6% rate is not significantly different from the current regional average of 70.3%. Even among current cigarette smokers 50.0% believe that advertising of tobacco products in convenience stores and gas stations should be restricted or eliminated with 10.8% of current smokers favoring complete elimination of tobacco advertising at convenience stores and gas stations. (Table 11) page 5

9 Tobacco Sales Findings: Tobacco Free Broome and Tioga Tioga County Adult Tobacco Survey December By a large margin, Tioga County adults believe that pharmacies should not sell tobacco (68.0% indicated Should not, while only 23.8% indicated Should ). Level of opposition to selling tobacco products at pharmacies in Tioga County is significantly higher than the current regional average of 59.7% indicating Should not. Belief that pharmacies should not sell tobacco is even evident among current cigarette smokers in Tioga County with 49.4% of current smokers responding Should not. (Table 12) 9. When asked How do you feel about tobacco products being sold in stores that are located near schools?, approximately one-half of adults in Tioga County (48.5%) respond with either somewhat unacceptable (13.8%) or totally unacceptable (34.7%). This rate of 48.5% in Tioga County feeling that the sale of tobacco products near schools is unacceptable is not significantly different from the current regional average of 54.6%. Even among current smokers in Tioga County, 19.7% respond with either somewhat unacceptable or totally unacceptable. (Table 13) 10. When asked their opinion about a policy that would restrict the sale of tobacco products in stores that are located near schools, the majority of Tioga County adults (51.3%) are in favor (33.9% strongly in favor, and 17.4% somewhat in favor). Level of support in Tioga County (51.3%) is not significantly different from the current regional average rate of 55.0%. Even among current smokers in Tioga County, 33.4% are in favor of this ban of tobacco sales near schools. (Table 14) 11. Strong support for tobacco retailers being required to keep tobacco products out of the view from customers in stores is present among Tioga County adults 59.7% support this potential requirement for tobacco retailers, while only 34.4% oppose (not significantly different from the current regional average of 61.6% supporting). tably, even among current smokers in the county there is a high level of support for this potential requirement 58.8% of current smokers believe that retailers should be required to keep tobacco products out of view. (Table 15) 12. Tioga County adults show slight opposition for a local or state policy that would limit the maximum number of tobacco retailers allowed in a neighborhood or area (less than half 41.5% voice support for this type of potential policy, while 53.5% voice opposition). The Tioga County results are not significantly different from current regional average results (Tioga County level of support is 41.5%, regional average is currently 44.3% support). tably, even among current smokers in the county, 19.7% indicate which represents approximately one-infive current smokers who support having a maximum number of tobacco retailers allowed in a neighborhood or area. (Table 16) 13. When asked their opinion about a policy that would limit the number of stores that could sell tobacco in one s community approximately two-in-five Tioga County adults (39.0%) are in favor (22.3% strongly in favor, and 16.7% somewhat in favor). The Tioga County results are not significantly different from current regional average results of 41.9% strongly or somewhat in favor. Even among current smokers in Tioga County, 15.8% are in favor of this limit on the number of stores that could sell tobacco. (Table 17) Tobacco On Screen Findings: 14. When asked how often one sees tobacco use or images on screen (such as: movies, internet, television, video-games), over 82% of Tioga County adults indicate that they see these images on screen at least some of the time that they are watching images on screen (not significantly different from regional average of 85.2%), while only 13.3% respond with Never. (Table 18) 15. Strong agreement is found in Tioga County with the statement: Youth-rated movies should not include tobacco use or images. 78.3% support this potential requirement for youth-rated movies, while only 17.1% oppose (not significantly different from the current regional average of 78.1% agreeing). tably, even among current smokers in the county there is a high level of agreement with the notion of images on screen not including tobacco use 62.8% of current smokers agree that Youth-rated movies should not include tobacco use or images. (Table 19) 16. Strong agreement is found in Tioga County with the statement: Internet sites and TV shows that youth use and watch should not include tobacco use or images. 77.8% support this potential requirement for Internet sites and television, while only 16.8% oppose (not significantly different from the current regional average of 77.2% agreeing). tably, even among current smokers in the county there is a high level of agreement with the notion of images on screen not including tobacco use 60.7% of current smokers agree that Internet sites and TV shows that youth use and watch should not include tobacco use or images. (Table 20) page 6

10 17. Strong support exists in Tioga County for a policy that restricts showing the use of tobacco in media rated for youth viewership 76.9% support this type of policy, while only 19.6% oppose (not significantly different from the current regional average of 75.4% supporting). tably, even among current smokers in the county there is a high level of support for restricting the use of tobacco in media rated for youth viewership 70.9% of current smokers support this potential policy. (Table 21) Secondhand Smoke Exposure Findings In One s Personal Vehicle, At Public Outdoor Locations, At the Workplace, and In One s Home: 18. Very strong support for a law that would prohibit smoking inside a car in New York State when a person under the age of 18 is present has been identified among Tioga County adults 71.0% of the adults would agree with this type of law (among which, 47.0% strongly agree), while only 22.0% disagree. This level of support in Tioga County is not significantly different from the current regional average rate of support (70.1% agree or strongly agree across the studied region). This opinion is strongly illustrated in every demographic subgroup investigated a majority within each subgroup would agree with this law if passed in New York State. In fact, even among current smokers in the county more would agree with this law than disagree 61.4% of current smokers would agree with the law, while only 25.5% of current smokers would disagree. (Table 22) 19. There is a very high level of support among Tioga County residents for reducing secondhand smoke exposure at public outdoor locations, with at least 73% of the residents supporting either restricting or completely eliminating cigarette smoking at each of the four types of outdoor locations studied (public outdoor recreation areas like parks; Municipal pools and public beaches; Public building entryways; and Public playgrounds). More strikingly, at public playgrounds 66.3% of the interviewed adults in Tioga County support complete elimination of smoking, and at public building entryways 47.2% of the interviewed adults in Tioga County support complete elimination of smoking. In general, current support for restriction or elimination of smoking at public outdoor locations in Tioga County is not significantly different from the current regional average levels of support (except at Public beaches and Municipal pools, where Tioga rate of support is higher), and has increased significantly in the county between 2006 and Results for the four types of public outdoor locations are summarized in the following table. (Tables 23-26) Type of Outdoor Location Among all surveyed residents, % who support either restricting or entirely eliminating smoking 2011 Tioga County Tioga County Tioga County Regional Average Rest. Elim. R+E Rest. Elim. R+E Rest. Elim. R+E Restrict + Eliminate Public Playground 27.9% 55.8% 83.7% 22.4% 65.6% 88.0% 24.9% 66.3% 91.2% 88.8% Public Building Entryways 33.8% 46.1% 79.9% 31.7% 55.0% 86.7% 37.1% 47.2% 84.3% 83.4% Public Beach or Municipal Pool NA NA NA NA NA NA 43.0% 36.7% 79.7% 72.5% Public Park or Outdoor Recreation Area 44.4% 28.6% 73.0% 45.1% 32.2% 77.3% 40.7% 32.8% 73.5% 72.7% 20. 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 four studied public outdoor locations, at least 56% of Tioga County current cigarette smokers believe that smoking should be restricted or not allowed at all. te the high level of support among current cigarette smokers in Tioga County for reducing secondhand smoke exposure at public playgrounds 57.2% of the smokers support complete elimination of smoking at public playgrounds. Results for current cigarette smokers are summarized in the following table. (Tables 23-26) Type of Outdoor Location Among surveyed Current Cigarette Smokers, % who support either restricting or entirely eliminating smoking Tioga County 2011 Restrict Eliminate Restrict + Eliminate Public Playground 28.7% 57.2% 85.9% Public Building Entryways 34.8% 31.9% 66.7% Public Beach or Municipal Pool 40.5% 25.0% 65.5% Public Park or Outdoor Recreation Area 40.7% 16.0% 56.7% 21. Less than 10% of the participants (6.0%) in this study are residents of a multi-unit dwelling or apartment, not significantly different from the current regional average of 8.8%. It is increasingly common among residents in page 7

11 Tioga County who live in multiple-unit dwellings (apartments) to indicate that there is a policy in their building that prohibits indoor smoking in residential units 46.7% of these MUD-dwellers report this to be true (increased significantly from the 2008 findings in the county of 26.2%, and not significantly different from the current regional average rate of 29.3%). (Tables 27-28) 22. Strong support for policies that prohibit indoor smoking everywhere inside the building, including living areas has been found in Tioga County 64.1% of the adults who currently live in MUDs indicate that they are in favor of not allowing smoking anywhere in their building (not significantly changed from 55.8% in the county in 2008). Level of support for prohibiting smoking in MUDs among Tioga County residents is not significantly different from the current regional average support level (average=61.7% support prohibit indoors ). (Table 29) Tobacco Use Findings: 23. The current cigarette smoking rate found in Tioga County is: a total estimate of 15.3% current smokers, with 13.9% smoking every day and 1.5% smoking on only some days (rounding is what causes the 13.9% + 1.5% 15.3%). This cigarette smoking rate has not changed significantly from the rates found in Tioga County in 2006 and 2008 (20.7% and 17.9%, respectively). The current 15.3% smoking rate in Tioga County is not significantly different from the current regional average rate of 18.4% current cigarette smokers found among the twenty rthern, Central, and Western New York counties studied between December 2010 and December The New York State Department of Health published the results for the Expanded Behavioral Risk Factor Surveillance System (BRFSS) in December This overall health study includes an estimate of adult current cigarette smoking prevalence. The methodology utilized in the BRFSS is very similar to that used in this current December 2011 Tioga County adult tobacco community assessment (both studies used a random telephone survey, sample sizes were n=658 vs. n=394, weighting algorithms were similar while not identical, the BRFSS interviews spanned July 2008-December 2009; for more details regarding this BRFSS study, visit: The adult smoking prevalence rate reported for Tioga County in the 2009 Expanded BRFSS was 21.6%. The 15.3% smoking rate found in Tioga County in this December 2011 Tioga County adult tobacco community assessment is not significantly different from the finding in the Expanded BRFSS. (Tables 31-32) 24. Significant correlations with cigarette smoking potential explanatory factors that are related with the likelihood that a Tioga County adult resident will be a current cigarette smoker that were discovered include that residents between the ages of (19.4% are smokers), residents with an educational background of less than a 4-year degree ( 18% are smokers), and those from lower income households ( 23% of those from households with annual income of $50,000 or less are smokers) are most likely to be current cigarette smokers. (Table 32) 25. Less than one-half of the adults in Tioga County (47.3%) have smoked at least 100 cigarettes in their lifetime, a rate that has not changed significantly from the rates found in the county in earlier studies (40.5% in 2006 and 47.5% in 2008), and a rate that is not significantly different from the current regional average rate of 48.8%. This 47.3% who have smoked at least 100 cigarettes in their lifetime is not equally distributed between former and current smokers 32.0% of the adult population in Tioga County are former smokers, and 15.3% are current smokers. (Tables 30 and 32) 26. Use of other tobacco products (those other than cigarettes) among Tioga County residents is much less common than use of cigarettes and has not changed significantly throughout in 2006, 4.1% used some non-cigarette tobacco product(s), the rate was 3.7% in 2008, and the current rate is 3.9%. The current noncigarette tobacco product use rate in Tioga County is not significantly different from the current regional average of 5.1%. Use of non-cigarette types of tobacco products is strongly related to gender 7.9% of males use noncigarette tobacco while 0.0% of females do so; strongly related to age 8.2% of those age use noncigarette tobacco while only 0.7% of those age 65+ do so; and strongly related to cigarette smoking 9.4% of current cigarette smokers also use at least one type of other tobacco product, while only 2.9% of non-smokers do so. (Table 33) 27. The current overall tobacco-use rate among Tioga County residents is 17.8% (use at least one type of tobacco product), which is not significantly different from the results in any of the two preceding community tobacco assessments completed in the county (tobacco use rate has been 21.9% in 2006, and 19.5% in 2008). The current 17.8% overall tobacco use rate among Tioga County residents is not significantly different from the current regional average of 21.0% using at least one type of tobacco product. Males (20.9% of males use tobacco), younger adults (23.5% of those age use tobacco), those with lower education levels ( 22% of those with less than a 4-year degree use tobacco), and those from households with lower annual incomes ( 25% of those page 8

12 from households with annual income of less than $50,000 use tobacco) are most likely to be users of tobacco products in Tioga County. (Table 34) Further Attitudes, Behaviors, Interests, and Familiarity among Current Smokers 28. Over one-half (55.4%) of the current smokers in Tioga County have attempted to quit smoking by stopping for one day or longer in the past twelve months. This rate has not changed significantly in Tioga County between 2006 and 2011, and is not significantly different from the current regional average rate of 52.6%. (Table 35) 29. Approximately three-fourths of the current cigarette smokers (74.9%) in Tioga County have purchased their cigarettes from another state to avoid the New York State cigarette excise tax in the past year, not significantly different from the current regional average rate of 61.9%. Smokers in the Tioga County are less likely to purchase their cigarettes from a website or on the Internet, with only 6.4% reporting to do so in the past year, again not significantly different from the current regional average rate of 4.8%. (Tables 36-37) 30. The price of tobacco is cited by 43.4% of current Tioga County smokers as having caused them to smoke fewer cigarettes, with 20.7% indicating that the price of tobacco is causing them to plan to quit smoking. Approximately one-half of smokers 46.3% - reported at least one of these two positive impacts (reducing smoking and/or planning to quit), a rate that is not significantly different from the current regional average rate of 48.9% having at least one positive impact. (Table 38) 31. Approximately one-half of Tioga County current smokers indicate that they want to quit smoking now (50.3%). The interest-in-quitting rate in Tioga County is not significantly different from the current regional average rate of 50.0%, and has not changed significantly from the 2006 and 2008 Tioga County rates found (38.4% in 2006, and 49.1% in 2008). (Table 39) page 9

13 Presentation of Results Tobacco Free Broome and Tioga Tioga County Adult Tobacco Survey December 2011 The structure of the interviews for this study was organized into seven sections. Information concerning attitudes and behavior regarding tobacco was collected in the following seven groups of questions: 1. Spreading the Message About the Dangers of Tobacco 2. Tobacco Advertising 3. Tobacco Sales 4. Tobacco On Screen 5. Secondhand Smoke Exposure In One s Personal Vehicle, At Public Outdoor Locations, At the Workplace, and In One s Home 6. Tobacco Use 7. Further Attitudes, Behaviors, Interests, and Familiarity among Current Smokers The results for each survey question, in each of these seven sections of the survey, are presented in the following portion of the report with consistent structure. Typically, one page is devoted to the results for each survey question, using the following organization: (1) The results of the current study (December 2011), are presented in a table for each survey question that was included in this study including sample percentages, sample frequencies or counts, and the sample size (all weighted by Gender, Age and Education Level). (2) When possible, directly below each of the 2011 Results tables, a trend analysis comparison of the current study results to the results from the 2006 and 2008 Tioga County tobacco studies is provided. These comparison for a trend tables are only possible when the same survey questions have been asked in 2006, and/or 2008, and in the current 2011 study. If the question phrasing and/or possible response distribution (choices, or answers) have been altered between earlier studies and the 2011 study, to an extent that it is likely that the actual variable or phenomena being measured has changed between years, then no trend table is presented. These trend analysis tables provide information for an analysis of changes over the past five years an opportunity to attempt to identify Tobacco Free Broome and Tioga, and Tioga-Broome Reality Check, impact. Statistically significant changes or trends are highlighted throughout (above each trend table). (3) Regional Comparative results are provided, reporting the summarized outcomes for each survey question for a group of twenty Central, rthern, and Western New York tobacco-related studies completed in December 2010 December Each of these twenty studies had adults as the target population, investigated tobacco-related issues, used telephone methodology, and used similar sample sizes. The summarized results include the minimum, maximum, and average result among the twenty studied counties. The twenty participating counties are: Allegany, Broome, Cattaraugus, Cayuga, Chemung, Cortland, Jefferson, Lewis, Livingston, Madison, Monroe, Orleans, Oswego, Schuyler, Seneca, Steuben, St. Lawrence, Tioga, Wayne, and Wyoming Counties. To ease the interpretation of regional comparison results (as well as to satisfy requirements of statistical tests of significance that are applied), responses to survey questions that have a multinomial response distribution have typically been collapsed. For example, a survey question with possible responses of: Use Every Day, Use Some Days, Do t Use, and Don t Know would typically be collapsed to: Use at least some (Every Day + Some Days) versus Do not indicate use (Do t Use + Don t Know) before displaying regional comparison data and applying statistical tests of significance. These tables provide information for an analysis of the current relative magnitude of the result found in Tioga County. Statistically significant results, when any Tioga County current result differs significantly from the current regional average, are highlighted throughout (again, above each regional comparison table). (4) Finally, the Tioga County 2011 results for each of the survey questions have been crosstabulated by each of the demographic factors of Gender, Age, Education Level, and Household Income Level, as well as by Cigarette Smoking Status (this report includes approximately 200 cross-tabulation tables of results). The results for these correlational investigations have been provided in tables along with the current, trend, and regional comparison tables for each survey item. te that at times, for survey questions that were only posed to smaller subgroups, such as those for current cigarette smokers or those participants who reside in multi-unit dwellings, the sample sizes are not sufficiently large to complete crosstabulations the resulting sample sizes within demographic subgroups would at times be well less than 50 (minimum cell size required by NYSDOH standards). page 10

14 Technical Comments for Interpretation of the Presented Results Margin of Error Using this Data to Estimate for Entire Tioga County Adult Populations The results of this study should be presented to a very wide array of readers who, no doubt, have a very wide variety of statistical backgrounds. The following comments are provided to give guidance for interpretation of the presented findings so that readers with less-than-current statistical training might maximize the use of the information contained in this community tobacco study. Recall that the margin of error for this survey has been stated as approximately ±5.6 percentage points (on page 4). Therefore, when a percentage is observed in one of the following Tioga County 2011 Results tables, the appropriate interpretation is that we are 95% confident that if all adult residents of Tioga County were surveyed (rather than just the 394 that were actually surveyed), the percentage that would result for all residents would be within ±5.6 percentage points of the sample percentage that has been calculated and reported in this study. For example, since 68.0% of the sample of Tioga County adults in December 2011 reported that they believe that tobacco products should not be sold in pharmacies (please refer to Table 12 later in this report to verify this statistic), with this sample result, one can infer with 95% confidence (only a 5% chance that it will not be true) that if all Tioga County adults were asked, somewhere between 62.4% and 73.6% of the population of approximately 39,000 adults over the age of 18 in Tioga County would indicate that they believe that tobacco products should not be sold in pharmacies (using a margin of error of ±5.6%). This resulting interval (62.4%-73.6%) is known as a 95% Confidence Interval. The consumer of this report should use this pattern, or approach, when attempting to generalize any of the 2011 Tioga County overall survey findings to the entire adult population of the county. The preceding example used a margin of error of ±5.6%. However, the margin of error when using the sample results in this study to construct a confidence interval to estimate a population percentage will not always be ±5.6%. There is not one universal value of a margin of error that can be precisely calculated and used for the results for every question included in this survey, or for that matter, any multiple-question survey. Calculation methods used in this study for generating the margin of error depend upon the following four factors: 1. The sample size is the number of adults who validly answered the survey question. The sample size will not always be n=394 since individuals have a right to omit any question. Additionally, some survey questions were only posed after screening questions, such as questions asked only to current smokers. In general, the smaller the sample size then the larger the margin of error, and conversely, the larger the sample size then the smaller the margin of error. 2. The sample proportion or percentage is the calculated percentage of the sample who responded with the answer or category of interest (i.e. responded Agree ). This percentage can vary from 0%-100%, and, of course, will change from question to question throughout the survey. In general, the further that a sample percentage varies from 50% in either direction (approaching either 0% or 100%), the smaller the margin of error, and conversely, the closer that the actual sample percentage is to 50% then the larger the resulting margin of error. 3. The confidence level used in generalizing the results of the sample to the population that the sample represented. In this study, the standard confidence level used in survey research, 95% confidence level, will be used for all survey questions. 4. The design effect is a factor that compensates for the impact that having a sample whose gender, age, and formal education level distributions do not parallel the gender, age, and formal education level distributions of the entire adult population of Tioga County will have upon the size of the margin of error. In general, the further that the sample deviates from the actual gender, age, and formal education level distributions of the entire county adult population, the larger the resulting margin of error. In mathematical notation, the margin of error for each sample result for this study would be represented as: p(100 p) ME = 1.96 Deff n Where n=sample size = # valid responses to the survey question p=sample percentage for the survey question (between 0%-100%) 1.96 = the standard normal score associated with the 95% confidence level Deff = the design effect 2 n And wi Deff = w ( ) 2 i With w i =the poststratification weight associated with i th of the 394 sampled individuals For this Tioga County study, the design effect (Deff) equals 1.4. page 11