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

Publication Date


Document Type



*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.

DOI of Published Version



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

Journal/Book/Conference Title

American journal of public health

Related Resources

Link to Article in PubMed

PubMed ID