Small-area estimation and prioritizing communities for tobacco control efforts in Massachusetts

UMMS Affiliation

Department of Medicine, Division of Preventive and Behavioral Medicine; Department of Family Medicine and Community Health

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*Community Health Services; Confidence Intervals; *Health Promotion; Humans; Massachusetts; Odds Ratio; Population Surveillance; Prevalence; *Public Health; Public Health Practice; Risk Factors; Smoking; *Social Marketing; Socioeconomic Factors; Time Factors; *Tobacco; Tobacco Use Disorder


Life Sciences | Medicine and Health Sciences


OBJECTIVES: We developed a method to evaluate geographic and temporal variations in community-level risk factors and prevalence estimates, and used that method to identify communities in Massachusetts that should be considered high priority communities for smoking interventions.

METHODS: We integrated individual-level data from the Behavioral Risk Factor Surveillance System from 1999 to 2005 with community-level data in Massachusetts. We used small-area estimation models to assess the associations of adults' smoking status with both individual- and community-level characteristics and to estimate community-specific smoking prevalence in 398 communities. We classified communities into 8 groups according to their prevalence estimates, the precision of the estimates, and temporal trends.

RESULTS: Community-level prevalence of current cigarette smoking among adults ranged from 5% to 36% in 2005 and declined in all but 16 (4%) communities between 1999 and 2005. However, less than 15% of the communities met the national prevalence goal of 12% or less. High smoking prevalence remained in communities with lower income, higher percentage of blue-collar workers, and higher density of tobacco outlets.

CONCLUSIONS: Prioritizing communities for intervention can be accomplished through the use of small-area estimation models. In Massachusetts, socioeconomically disadvantaged communities have high smoking prevalence rates and should be of high priority to those working to control tobacco use.

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Citation: Am J Public Health. 2009 Mar;99(3):470-9. Epub 2009 Jan 15. Link to article on publisher's site

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American journal of public health

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