# 27 {#section .Chapter-# .unnumbered}

# Tobacco Use

#### Tobacco Use in Population Groups

27-1 Adult tobacco use

27-1a Cigarette smoking

27-1b Spit tobacco

27-1c Cigars

27-1d Other products

27-2 Adolescent tobacco use

27-2a Tobacco products

27-2b Cigarettes

27-2c Spit tobacco

27-2d Cigars

27-3 Initiation of tobacco use

27-4 Age at first tobacco use

27-4a Adolescents aged 12 to 17 years

27-4b Young adults aged 18 to 25 years

#### Cessation and Treatment

27-5 Smoking cessation by adults

27-6 Smoking cessation during pregnancy

27-7 Smoking cessation by adolescents

27-8 Insurance coverage of cessation treatment

27-8a Managed care organizations

27-8b Medicaid programs

27-8c All insurance

#### Exposure to Secondhand Smoke

27-9 Exposure to tobacco smoke at home among children

27-10 Exposure to environmental tobacco smoke

27-11 Smoke-free and tobacco-free schools

27-12 Worksite smoking policies

27-13 Smoke-free indoor air laws

27-13a Private workplaces

27-13b Public workplaces

27-13c Restaurants

27-13d Public transportation

27-13e Day care centers

27-13f Retail stores

27-13g Tribes

27-13h Territories

#### Social and Environmental Changes

27-14 Enforcement of illegal tobacco sales to minors laws

27-14a States and District of Columbia

27-14b Territories

27-15 Retail license suspension for sales to minors

27-16 Tobacco advertising and promotion targeting adolescents and young
adults

27-17 Adolescent disapproval of smoking

27-17a 8th graders

27-17b 10th graders

27-17c 12th graders

27-18 Tobacco control programs

27-19 Preemptive tobacco control laws

27-20 Tobacco product regulation

27-21 Tobacco tax

27-21a Cigarettes

27-21b Spit tobacco

### Tobacco Use in Population Groups

27-1. Reduce tobacco use by adults.

+---------------------+------------------------------------------------+
| 27-1a. Cigarette    |                                                |
| smoking.            |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | 3.4 (Tobacco) (also 15.12 and 16.6), age       |
| 2000 Objective**    | adjusted to the 2000 standard population.      |
+---------------------+------------------------------------------------+
| **Leading Health    | Tobacco Use.                                   |
| Indicator**         |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 24 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults aged 18 years and older who   |
|                     | have smoked at least 100 cigarettes in         |
|                     | lifetime and who now report smoking cigarettes |
|                     | everyday or some days.                         |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 18 years and older.      |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Have you smoked at least 100 cigarettes in |
|                     |     your entire life?                          |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Do you now smoke cigarettes everyday, some |
|                     |     days, or not at all?                       |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Persons are considered as using cigarettes if  |
|                     | they report that they smoked at least 100      |
|                     | cigarettes in their lifetime and now report    |
|                     | smoking cigarettes everyday or some days.      |
+---------------------+------------------------------------------------+
|                     | Starting in 1992, NHIS has defined current     |
|                     | smokers as persons who have smoked at least    |
|                     | 100 cigarettes and now smoke either everyday   |
|                     | or some days. The 1992 inclusion of            |
|                     | intermittent smoking increased the prevalence  |
|                     | of smoking by approximately one percent        |
|                     | compared with estimates derived from the       |
|                     | previous smoking definition.                   |
+---------------------+------------------------------------------------+
|                     | For State data, 1996 and later questions from  |
|                     | the BRFSS are the same as those presented for  |
|                     | 1998 NHIS.                                     |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | This objective is one of the measures used to  |
|                     | track the Tobacco Use Leading Health           |
|                     | Indicator. See Appendix H for a complete       |
|                     | listing.                                       |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and BRFSS |
|                     | and Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 27-1b. Spit         |                                                |
| tobacco.            |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 2.6 (1998).                                    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults 18 years and older who report |
|                     | using snuff or chewing tobacco at least 20     |
|                     | times in their lifetime and now use it         |
|                     | everyday or some days.                         |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 18 years and older.      |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Have you used snuff such as Skoal, Skoal   |
|                     |     Bandits, or Copenhagen at least 20 times   |
|                     |     in your entire life?                       |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Do you now use snuff everyday, some days,  |
|                     |     or not at all?                             |
+---------------------+------------------------------------------------+
|                     | -   Have you ever used chewing tobacco such as |
|                     |     Redman, Levi Garrett, or Beechnut at least |
|                     |     20 times in your entire life?              |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Do you now use chewing tobacco everyday,   |
|                     |     some days, or not at all?                  |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Persons are classified as using either snuff   |
|                     | or chewing tobacco if they answer "yes" to     |
|                     | either use of snuff [or]{.underline} use of    |
|                     | chewing tobacco, [and]{.underline} they report |
|                     | using the snuff or chewing tobacco "everyday"  |
|                     | or "some days."                                |
+---------------------+------------------------------------------------+
|                     | For State data, the 1998 BRFSS (Optional       |
|                     | Module) contains questions similar, but not    |
|                     | identical, to NHIS questions.                  |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and BRFSS |
|                     | and Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 27-1c. Cigars.      |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified---see Comments.                 |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 2.5 (1998).                                    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults 18 years and older who report |
|                     | having smoked at least 50 cigars in lifetime   |
|                     | and now smoke cigars everyday or some days.    |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 18 years and older.      |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Have you ever smoked cigars?               |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Have you smoked at least 50 cigars in your |
|                     |     entire life?                               |
+---------------------+------------------------------------------------+
|                     | -   Do you now smoke cigars everyday, some     |
|                     |     days, or not at all?                       |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Persons are classified as smoking cigars if    |
|                     | they answer "yes" to smoking 50 cigars in      |
|                     | their lifetime, [and]{.underline} report       |
|                     | smoking cigars "everyday" or "some days."      |
+---------------------+------------------------------------------------+
|                     | For State data, questions on cigar smoking for |
|                     | the 2001 BRFSS (Optional Module) are proposed. |
|                     | They are not identical to the NHIS questions.  |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and BRFSS |
|                     | and Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  27-1d. (Developmental) 
  Other products.        

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         Other products are expected to include pipes,
                         bidis, and possibly other herbal cigarettes. The
                         proposed national data source is the National
                         Health Interview Survey (NHIS), CDC, NCHS, and
                         the proposed State data source is the Behavioral
                         Risk Factor Surveillance System (BRFSS), CDC,
                         NCCDPHP.

                         The 1998 NHIS asked the following questions to
                         obtain pipe smoking data: Have you ever smoked
                         pipes? (If yes,) Have you smoked at least 50
                         pipes in your entire life? Do you now smoke
                         pipes everyday, some days, or not at all?

                         See Part C for a description of NHIS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

27-2. Reduce tobacco use by adolescents.

+---------------------+------------------------------------------------+
| 27-2a. Tobacco      |                                                |
| products (past      |                                                |
| month).             |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Youth Risk Behavior Surveillance System        |
| Source**            | (YRBSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **State Data        | Youth Risk Behavior Surveillance System        |
| Source**            | (YRBSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 3.9 (Tobacco) (also 13.17) and    |
| 2000 Objective**    | 4.6 (Substance Abuse: Alcohol and Other Drugs) |
|                     | (also 3.20).                                   |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 40 (1999).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of students in grades 9 through 12 who  |
|                     | report using cigarettes, spit tobacco, or      |
|                     | cigars on 1 or more of the 30 days preceding   |
|                     | the survey.                                    |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of students in grades 9 through 12.     |
+---------------------+------------------------------------------------+
| **Population        | Students in grades 9 through 12.               |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1999 Youth Risk Behavior Surveillance |
| Obtain the National | System:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   During the past 30 days, on how many days  |
|                     |     did you smoke cigarettes?                  |
+---------------------+------------------------------------------------+
|                     | -   During the past 30 days, on how many days  |
|                     |     did you use chewing tobacco or snuff, such |
|                     |     as Redman, Levi Garrett, Beechnut, Skoal,  |
|                     |     Skoal Bandits, or Copenhagen?              |
+---------------------+------------------------------------------------+
|                     | -   During the past 30 days, on how many days  |
|                     |     did you smoke any cigars, cigarillos, or   |
|                     |     little cigars?                             |
+---------------------+------------------------------------------------+
| **Expected          | Biennial.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Students are classified as using tobacco if    |
|                     | they report using at least one of the tobacco  |
|                     | products on 1 or more of the 30 days preceding |
|                     | the survey.                                    |
+---------------------+------------------------------------------------+
|                     | This objective differs from Healthy People     |
|                     | 2000 objectives 3.9 and 4.6 in two ways. For   |
|                     | the Healthy People 2000 objectives, the        |
|                     | national data source was the National          |
|                     | Household Survey on Drug Abuse (NHSDA),        |
|                     | SAMHSA, and the targeted age group was 12 to   |
|                     | 17 years.                                      |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of YRBSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 27-2b. Cigarettes   |                                                |
| (past month).       |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Youth Risk Behavior Surveillance System        |
| Source**            | (YRBSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **State Data        | Youth Risk Behavior Surveillance System        |
| Source**            | (YRBSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 4.6 (Substance Abuse: Alcohol and |
| 2000 Objective**    | Other Drugs) (also 3.20).                      |
+---------------------+------------------------------------------------+
| **Leading Health    | Tobacco Use.                                   |
| Indicator**         |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 35 (1999).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of students in grades 9 through 12 who  |
|                     | reported having smoked cigarettes on 1 or more |
|                     | of the 30 days preceding the survey.           |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of students in grades 9 through 12.     |
+---------------------+------------------------------------------------+
| **Population        | Students in grades 9 through 12.               |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1999 Youth Risk Behavior Survey:      |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   During the past 30 days, on how many days  |
|                     |     did you smoke cigarettes?                  |
+---------------------+------------------------------------------------+
| **Expected          | Biennial.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | This objective differs from Healthy People     |
|                     | 2000 objective 4.6 in two ways. For the        |
|                     | Healthy People 2000 objective, the national    |
|                     | data source was the National Household Survey  |
|                     | on Drug Abuse (NHSDA), SAMHSA, and the         |
|                     | targeted age group was 12 to 17 years.         |
+---------------------+------------------------------------------------+
|                     | This objective is one of the measures used to  |
|                     | track the Tobacco Use Leading Health           |
|                     | Indicator. See Appendix H for a complete       |
|                     | listing.                                       |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of YRBSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 27-2c. Spit tobacco |                                                |
| (past month).       |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Youth Risk Behavior Surveillance System        |
| Source**            | (YRBSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **State Data        | Youth Risk Behavior Surveillance System        |
| Source**            | (YRBSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 3.9 (Tobacco) (also 13.17).       |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 8 (1999).                                      |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of students in grades 9 through 12 who  |
|                     | reported having used smokeless (chewing        |
|                     | tobacco or snuff) tobacco on 1 or more of the  |
|                     | 30 days preceding the survey.                  |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of students in grades 9 through 12.     |
+---------------------+------------------------------------------------+
| **Population        | Students in grades 9 through 12.               |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1999 Youth Risk Behavior Surveillance |
| Obtain the National | System:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   During the past 30 days, on how many days  |
|                     |     did you use chewing tobacco or snuff, such |
|                     |     as Redman, Levi Garrett, Beechnut, Skoal,  |
|                     |     Skoal Bandits, or Copenhagen?              |
+---------------------+------------------------------------------------+
| **Expected          | Biennial.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | This objective differs from Healthy People     |
|                     | 2000 objective 3.9 in two ways. For the        |
|                     | Healthy People 2000 objective, the national    |
|                     | data source was the National Household Survey  |
|                     | on Drug Abuse (NHSDA), SAMHSA, and the         |
|                     | targeted age group was 12 to 17 years.         |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of YRBSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 27-2d. Cigars (past |                                                |
| month).             |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Youth Risk Behavior Surveillance System        |
| Source**            | (YRBSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **State Data        | Youth Risk Behavior Surveillance System        |
| Source**            | (YRBSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 18 (1999).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of students in grades 9 through 12 who  |
|                     | reported having smoked cigars on 1 or more of  |
|                     | the 30 days preceding the survey.              |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of students in grades 9 through 12.     |
+---------------------+------------------------------------------------+
| **Population        | Students in grades 9 through 12.               |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1999 Youth Risk Behavior Surveillance |
| Obtain the National | System:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   During the past 30 days, on how many days  |
|                     |     did you smoke any cigars, cigarillos, or   |
|                     |     little cigars?                             |
+---------------------+------------------------------------------------+
| **Expected          | Biennial.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Part C for a description of YRBSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+
| 27-3.               |                                                |
| (Developmental)     |                                                |
| Reduce the          |                                                |
| initiation of       |                                                |
| tobacco use among   |                                                |
| children and        |                                                |
| adolescents.        |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | An operational definition could not be         |
|                     | specified at the time of publication. A        |
|                     | proposed data source is the National Household |
|                     | Survey on Drug Abuse (NHSDA), SAMHSA.          |
+---------------------+------------------------------------------------+
|                     | This objective is modified from Healthy People |
|                     | 2000 objective 3.5 (Tobacco).                  |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

27-4. Increase the average age of first use of tobacco products by
adolescents and young adults.

+---------------------+------------------------------------------------+
| **27-4a.            |                                                |
| Adolescents aged 12 |                                                |
| to 17 years.**      |                                                |
+---------------------+------------------------------------------------+
| ######              | National Household Survey on Drug Abuse        |
| National Data Sourc | (NHSDA), SAMHSA.                               |
| e {#national-data-s |                                                |
| ource .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | 4.5 (Substance Abuse: Alcohol and Other Drugs) |
| 2000 Objective**    | (also 3.19).                                   |
+---------------------+------------------------------------------------+
| **Measure**         | Mean.                                          |
+---------------------+------------------------------------------------+
| **Baseline**        | 12 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Sum of the ages of first cigarette use of      |
|                     | adolescents aged 12 to 17 years who ever       |
|                     | smoked, including those who ever smoked one or |
|                     | two puffs in their lifetime.                   |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adolescents aged 12 to 17 years who  |
|                     | ever smoked, including those who ever smoked   |
|                     | one or two puffs in their lifetime.            |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Household Survey on     |
| Obtain the National | Drug Abuse:                                    |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   How old were you the first time you smoked |
|                     |     a cigarette, even one or two puffs?        |
|                     |                                                |
|                     |     The first time I smoked a cigarette I was  |
|                     |     \_\_\_\_\_ years old.\                     |
|                     |     I have never smoked a cigarette in my      |
|                     |     life.                                      |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Part C for a description of NHSDA and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  27-4b. Young adults    
  aged 18 to 25 years.   

  **National Data        National Household Survey on Drug Abuse (NHSDA),
  Source**               SAMHSA.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 4.5 (Substance Abuse: Alcohol and
  Objective**            Other Drugs) (also 3.19).

  **Measure**            Mean.

  **Baseline**           15 (1997).

  **Numerator**          Sum of the ages of first cigarette use of young
                         adults aged 18 to 25 years who ever smoked,
                         including those who ever smoked one or two puffs
                         in their lifetime.

  **Denominator**        Number of young adults aged 18 to 25 years who
                         ever smoked cigarettes, including those who ever
                         smoked one or two puffs in their lifetime.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    See Questions Used To Obtain the National Data
  Obtain the National    provided with objective 27-4a.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           This objective differs from Healthy People 2000
                         objective 4.5, which did not target the age
                         group of 18 to 25 years.

                         See Part C for a description of NHSDA and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

### Cessation and Treatment

+---------------------+------------------------------------------------+
| 27-5. Increase      |                                                |
| smoking cessation   |                                                |
| attempts by adult   |                                                |
| smokers.            |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 3.6 (Tobacco).                    |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 41 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of current, everyday cigarette smokers  |
|                     | aged 18 years and older who quit smoking for 1 |
|                     | day or longer during the 12 months prior to    |
|                     | the interview.                                 |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults in the survey population aged |
|                     | 18 years and older who are current, everyday   |
|                     | cigarette smokers.                             |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian noninstitutionalized population. |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Have you smoked at least 100 cigarettes in |
|                     |     your entire life?                          |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Do you now smoke cigarettes everyday, some |
|                     |     days, or not at all?                       |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   During the past 12 months, have you        |
|                     |     stopped smoking for 1 day or longer        |
|                     |     BECAUSE YOU WERE TRYING TO QUIT SMOKING?   |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Adults are classified as current smokers if    |
|                     | they report currently smoking cigarettes       |
|                     | "everyday" or "some days."                     |
+---------------------+------------------------------------------------+
|                     | This objective is measured differently than    |
|                     | Healthy People 2000 objective 3.6. For         |
|                     | objective 3.6, the question asked, "During the |
|                     | past 12 months, have you quit smoking for 1    |
|                     | day or longer?" Beginning in 1997, the         |
|                     | question on quitting smoking was modified by   |
|                     | adding "because you were trying to quit        |
|                     | smoking," and may affect trends.               |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 27-6. Increase      |                                                |
| smoking cessation   |                                                |
| during pregnancy.   |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 3.7 (Tobacco).                    |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 14 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of females aged 18 to 49 years who      |
|                     | reported having a live birth in the past 5     |
|                     | years and smoking at any time during their     |
|                     | pregnancy with their last child and who quit   |
|                     | smoking in their first trimester and stayed    |
|                     | off cigarettes for the rest of their           |
|                     | pregnancy.                                     |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of females aged 18 to 49 years who      |
|                     | reported having a live birth in the past 5     |
|                     | years and smoking at any time during their     |
|                     | pregnancy with their last child.               |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   (Has/have) (you/[Person]{.underline})      |
|                     |     given birth to a liveborn infant in the    |
|                     |     past 5 years?                              |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Were you smoking cigarettes when you       |
|                     |     became pregnant with your last child?      |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Did you smoke cigarettes at any time       |
|                     |     during your pregnancy with your last       |
|                     |     child?                                     |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Did you quit smoking for 7 days or longer  |
|                     |     during your pregnancy with your last       |
|                     |     child?                                     |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   In what month of your pregnancy did you    |
|                     |     first quit for 7 days or longer?           |
+---------------------+------------------------------------------------+
|                     | -   Did you start smoking again during that    |
|                     |     pregnancy or did you stay off cigarettes   |
|                     |     for the rest of the pregnancy?             |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Females classified as smoking during pregnancy |
|                     | and quitting are those who answered "Yes" to   |
|                     | smoking at any time during their pregnancy     |
|                     | with their last child, "Yes" to quitting       |
|                     | smoking for 7 days or longer, reported that    |
|                     | the month they quit was the first through the  |
|                     | third, and answered "No" to starting smoking   |
|                     | again during the pregnancy.                    |
+---------------------+------------------------------------------------+
|                     | This objective is measured differently than    |
|                     | Healthy People 2000 objective 3.7. For         |
|                     | objective 3.7, the numerator was the number of |
|                     | females who quit smoking for 7 days or longer  |
|                     | during their most recent pregnancy in the past |
|                     | 5 years. Quitting in the first trimester was   |
|                     | not measured. Healthy People 2010 objective    |
|                     | 27-6 specifies quitting in the first trimester |
|                     | (months 1 through 3), and adds a specific      |
|                     | question about smoking cigarettes at any time  |
|                     | during pregnancy with the last child.          |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 27-7. Increase      |                                                |
| tobacco use         |                                                |
| cessation attempts  |                                                |
| among adolescent    |                                                |
| smokers.            |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Youth Risk Behavior Surveillance System        |
| Source**            | (YRBSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **State Data        | Youth Risk Behavior Surveillance System        |
| Source**            | (YRBSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 76 (1999).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of students in grades 9 through 12 who  |
|                     | ever smoked at least one cigarette everyday    |
|                     | for 30 days and ever tried to quit smoking     |
|                     | cigarettes.                                    |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of students in grades 9 through 12 who  |
|                     | ever smoked at least one cigarette everyday    |
|                     | for 30 days.                                   |
+---------------------+------------------------------------------------+
| **Population        | Students in grades 9 through 12.               |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1999 Youth Risk Behavior Surveillance |
| Obtain the National | System:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Have you ever tried cigarette smoking,     |
|                     |     even one or two puffs?                     |
|                     |                                                |
|                     |     \[If yes:\]                                |
|                     |                                                |
|                     |     -   During the past 30 days, on how many   |
|                     |         days did you smoke cigarettes?         |
|                     |                                                |
|                     |         0 days\                                |
|                     |         1 or 2 days\                           |
|                     |         3 to 5 days\                           |
|                     |         6 to 9 days\                           |
|                     |         10 to 19 days\                         |
|                     |         20 to 29 days\                         |
|                     |         All 30 days                            |
+---------------------+------------------------------------------------+
|                     | -   Have you ever tried to quit smoking        |
|                     |     cigarettes?                                |
+---------------------+------------------------------------------------+
| **Expected          | Biennial.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Part C for a description of YRBSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

27-8. Increase insurance coverage of evidence-based treatment for
nicotine dependency.

+---------------------+------------------------------------------------+
| 27-8a. Managed care |                                                |
| organizations.      |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Addressing Tobacco in Managed Care: 1997--98   |
| Source**            | Health Plan Survey (ATMC), Robert Wood Johnson |
|                     | Foundation.                                    |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 3.24 (Tobacco).                   |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 75 (1997--98).                                 |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of managed care organizations with      |
|                     | health plans that partially or fully covered   |
|                     | one or more smoking cessation interventions.   |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of managed care organizations.          |
+---------------------+------------------------------------------------+
| **Population        | Managed care organizations.                    |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the Addressing Tobacco in Managed Care:   |
| Obtain the National | 1997--98 Health Plan Survey:                   |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Which of the following cessation           |
|                     |     interventions are available in your plan   |
|                     |     and which are included in your plan's      |
|                     |     formulary?                                 |
|                     |                                                |
|                     |     Nicotine Replacement therapy:              |
|                     |                                                |
|                     |     Over-the-counter\                          |
|                     |     Prescription\                              |
|                     |     Only w/ enrollment in cessation program    |
|                     |                                                |
|                     |     Bupropion (for example, Zyban)\            |
|                     |     Telephone counseling\                      |
|                     |     Face-to-face counseling\                   |
|                     |     Classes or group meeting\                  |
|                     |     Self-help materials                        |
|                     |                                                |
|                     |     \[Response categories: mark all that       |
|                     |     apply:\]\                                  |
|                     |     Unavailable;\                              |
|                     |     Full coverage;\                            |
|                     |     Partial coverage;\                         |
|                     |     In formulary                               |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The ATMC survey will not be repeated. However, |
|                     | the American Association of Health Plans will  |
|                     | be surveying managed care organizations        |
|                     | annually, with selected tobacco-related        |
|                     | questions every 2 or 3 years.                  |
+---------------------+------------------------------------------------+
|                     | This objective is measured by a different data |
|                     | source than Healthy People 2000 objective      |
|                     | 3.24, which had no updates to the 1985         |
|                     | baseline during the decade.                    |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  27-8b. Medicaid        
  programs in States and 
  the District of        
  Columbia.              

  **National Data        Health Policy Tracking Service, National
  Source**               Conference of State Legislators.

  **State Data Source**  Health Policy Tracking Service, National
                         Conference of State Legislators.

  **Healthy People 2000  Adapted from 3.24 (Tobacco).
  Objective**            

  **Measure**            Number.

  **Baseline**           24 (1998).

  **Numerator**          Number of Medicaid programs in States and the
                         District of Columbia that cover smoking
                         cessation services, including counseling and
                         nicotine replacement therapies.

  **Denominator**        Number of Medicaid programs in States and the
                         District of Columbia.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Periodic.
  Periodicity**          

  **Comments**           See Appendix A for focus area contact
                         information.

                         

  27-8c. (Developmental) 
  All insurance.         

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         This objective is modified from Healthy People
                         objective 3.24 (Tobacco).

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

### Exposure to Secondhand Smoke

+---------------------+------------------------------------------------+
| 27-9. Reduce the    |                                                |
| proportion of       |                                                |
| children who are    |                                                |
| regularly exposed   |                                                |
| to tobacco smoke at |                                                |
| home.               |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | 3.8 (Tobacco).                                 |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 27 (1994).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of children aged 6 years and under      |
|                     | living in households where a household         |
|                     | resident smoked inside the home at least 4     |
|                     | days a week.                                   |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of households with children aged 6      |
|                     | years and under.                               |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1994 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Does ANYONE who lives here smoke           |
|                     |     cigarettes, cigars, or pipes ANYWHERE      |
|                     |     INSIDE this home?                          |
+---------------------+------------------------------------------------+
|                     | -   On the average, about how many days per    |
|                     |     week do people who live here smoke         |
|                     |     ANYWHERE INSIDE this home?                 |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Only households with children aged 6 years and |
|                     | under are used in the calculation.             |
+---------------------+------------------------------------------------+
|                     | The first update for this objective will not   |
|                     | be comparable to the baseline. In the 1998     |
|                     | NHIS questionnaire, the wording of the second  |
|                     | question in the two-question series was        |
|                     | changed to: On the average, about how many     |
|                     | DAYS PER WEEK is there smoking ANYWHERE INSIDE |
|                     | this home?                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 27-10. Reduce the   |                                                |
| proportion of       |                                                |
| nonsmokers exposed  |                                                |
| to environmental    |                                                |
| tobacco smoke.      |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health and Nutrition Examination      |
| Source**            | Survey (NHANES), CDC, NCHS.                    |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Leading Health    | Environmental Quality.                         |
| Indicator**         |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 65 (1988--94).                                 |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of nonsmokers aged 4 years and older    |
|                     | who had a serum cotinine level above 0.10      |
|                     | ng/mL.                                         |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of nonsmokers aged 4 years and older.   |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1988--94 National Health and          |
| Obtain the National | Nutrition Examination Survey:                  |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[For ages 8 years and older:\]                |
|                     |                                                |
|                     | -   How many cigarettes have you smoked in the |
|                     |     past 5 days?                               |
+---------------------+------------------------------------------------+
|                     | -   How many pipes and how many cigars have    |
|                     |     you smoked in the past 5 days?             |
+---------------------+------------------------------------------------+
|                     | -   How many containers of chewing tobacco or  |
|                     |     snuff have you used in the past 5 days?    |
+---------------------+------------------------------------------------+
|                     | -   How many pieces of nicotine gum have you   |
|                     |     chewed in the past 5 days? (Nicotine gum   |
|                     |     is a sugar-free flavored chewing gum       |
|                     |     prescribed by a doctor to help people stop |
|                     |     smoking or chewing tobacco.)               |
+---------------------+------------------------------------------------+
| **Expected          | Annual, beginning with 1999 data.              |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Children aged 4 to 7 years are classified as   |
|                     | nonsmokers. Children aged 8 years and older    |
|                     | are classified as nonsmokers if the responses  |
|                     | to all four types of nicotine exposure were    |
|                     | "0" or "None." Only responses to the questions |
|                     | asked of persons who participated in the       |
|                     | examination component of the survey were used, |
|                     | so that serum levels of cotinine could be      |
|                     | available for analysis.                        |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | This objective is one of the measures used to  |
|                     | track the Environmental Quality Leading Health |
|                     | Indicator. See Appendix H for a complete       |
|                     | listing.                                       |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHANES and     |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 27-11. Increase     |                                                |
| smoke-free and      |                                                |
| tobacco-free        |                                                |
| environments in     |                                                |
| schools, including  |                                                |
| all school          |                                                |
| facilities,         |                                                |
| property, vehicles, |                                                |
| and school events.  |                                                |
+---------------------+------------------------------------------------+
| **National Data     | School Health Policies and Programs Study      |
| Source**            | (SHPPS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **State Data        | School Health Policies and Programs Study      |
| Source**            | (SHPPS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 3.10 (Tobacco).                   |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 37 (1994).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of junior high, middle, and senior high |
|                     | schools that reported that no smoking or no    |
|                     | smokeless tobacco use was allowed by students, |
|                     | staff, or visitors on school facilities,       |
|                     | property, vehicles, and school events.         |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of junior high, middle, and senior high |
|                     | schools.                                       |
+---------------------+------------------------------------------------+
| **Population        | Public and private junior high, middle, and    |
| Targeted**          | senior high schools.                           |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1994 School Health Policies and       |
| Obtain the National | Programs Study:                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | Handcard #1:                                   |
|                     |                                                |
|                     | School building\                               |
|                     | School grounds\                                |
|                     | School-sponsored events off-campus\            |
|                     | School vehicles                                |
+---------------------+------------------------------------------------+
|                     | \[Show Handcard #1\]                           |
|                     |                                                |
|                     | -   I'm going to ask you a series of questions |
|                     |     about [student smoking                     |
|                     |     policies]{.underline}. By smoking, I mean  |
|                     |     all forms of smoking tobacco, including    |
|                     |     cigarettes, pipes, and cigars. Looking at  |
|                     |     [Handcard #1]{.underline}, are students    |
|                     |     permitted to smoke in any of these places  |
|                     |     during regular school hours?               |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Where are students permitted to smoke      |
|                     |     during regular school hours?               |
+---------------------+------------------------------------------------+
|                     | -   Are students permitted to smoke in any of  |
|                     |     these places during [non-school            |
|                     |     hours]{.underline}?                        |
+---------------------+------------------------------------------------+
|                     | \[Show Handcard #1\]                           |
|                     |                                                |
|                     | -   I'm going to ask you the same series of    |
|                     |     questions about [student smokeless tobacco |
|                     |     use policies]{.underline}. By smokeless    |
|                     |     tobacco, I mean snuff or chewing tobacco.  |
|                     |     Looking at [Handcard #1]{.underline}, are  |
|                     |     students permitted to use smokeless        |
|                     |     tobacco in any of these places during      |
|                     |     [regular school hours]{.underline}?        |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Where are students permitted to use        |
|                     |     smokeless tobacco during regular school    |
|                     |     hours?                                     |
+---------------------+------------------------------------------------+
|                     | -   Are students permitted to use smokeless    |
|                     |     tobacco in any of these places during      |
|                     |     [non-school hours]{.underline}?            |
+---------------------+------------------------------------------------+
|                     | \[Show Handcard #1\]                           |
|                     |                                                |
|                     | -   Looking at [Handcard #1]{.underline}, are  |
|                     |     school staff permitted to smoke in any of  |
|                     |     these places during [regular school        |
|                     |     hours]{.underline}?                        |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Where are school staff permitted to smoke  |
|                     |     during regular school hours?               |
+---------------------+------------------------------------------------+
|                     | -   Are school staff permitted to smoke in any |
|                     |     of these places during [non-school         |
|                     |     hours]{.underline}?                        |
+---------------------+------------------------------------------------+
|                     | \[Show Handcard #1\]                           |
|                     |                                                |
|                     | -   Looking at [Handcard #1]{.underline}, are  |
|                     |     school staff permitted to use smokeless    |
|                     |     tobacco in any of these places during      |
|                     |     [regular school hours]{.underline}?        |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Where are school staff permitted to use    |
|                     |     smokeless tobacco during regular school    |
|                     |     hours?                                     |
+---------------------+------------------------------------------------+
|                     | -   Are school staff permitted to use          |
|                     |     smokeless tobacco in any of these places   |
|                     |     during [non-school hours]{.underline}?     |
+---------------------+------------------------------------------------+
|                     | -   Do your smoking and smokeless tobacco      |
|                     |     policies apply to [visitors]{.underline}   |
|                     |     at your school?                            |
|                     |                                                |
|                     |     No\                                        |
|                     |     Yes, smoking policies apply\               |
|                     |     Yes, smokeless tobacco policies apply      |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | SHPPS 2000 tobacco use prevention questions,   |
|                     | which will provide the first update for this   |
|                     | objective, are different from those used in    |
|                     | the 1994 SHPPS. The updated questions,         |
|                     | summarized, will include:                      |
+---------------------+------------------------------------------------+
|                     | -   Has this school adopted a policy           |
|                     |     prohibiting \[cigarette smoking/cigar and  |
|                     |     pipe smoking/smokeless tobacco use\] by    |
|                     |     \[students/faculty and staff/school        |
|                     |     visitors\]?                                |
+---------------------+------------------------------------------------+
|                     | -   Does that policy specifically prohibit     |
|                     |     \[cigarette smoking/smokeless tobacco      |
|                     |     use\] by \[students/faculty and            |
|                     |     staff/school visitors\]\...                |
|                     |                                                |
|                     |     In school buildings?\                      |
|                     |     Outside, on school grounds?\               |
|                     |     In school buses or other vehicles used to  |
|                     |     transport students?\                       |
|                     |     At off-campus, school-sponsored events?    |
+---------------------+------------------------------------------------+
|                     | This objective differs from Healthy People     |
|                     | 2000 objective 3.10, which not only tracked    |
|                     | school districts providing tobacco-free        |
|                     | environments, but also the proportion of       |
|                     | school districts providing antismoking         |
|                     | education. This objective focuses on smoke-    |
|                     | and tobacco-free environments only.            |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of SHPPS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 27-12. Increase the |                                                |
| proportion of       |                                                |
| worksites with      |                                                |
| formal smoking      |                                                |
| policies that       |                                                |
| prohibit smoking or |                                                |
| limit it to         |                                                |
| separately          |                                                |
| ventilated areas.   |                                                |
+=====================+================================================+
| **National Data     | 1999 National Worksite Health Promotion Survey |
| Sources**           | (NWHPS), Association for Worksite Health       |
|                     | Promotion (AWHP) and OPHS, ODPHP.              |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 3.11 (Tobacco) (also 10.18).      |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 79 (1998--99).                                 |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of nongovernmental worksites with 50 or |
|                     | more employees that have a formal smoking      |
|                     | policy that prohibits or severely restricts    |
|                     | smoking at the worksite or on the job.         |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of nongovernmental worksites with 50 or |
|                     | more employees.                                |
+---------------------+------------------------------------------------+
| **Population        | Nongovernmental worksites with 50 or more      |
| Targeted**          | employees.                                     |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1999 National Worksite Health         |
| Obtain the National | Promotion Survey:                              |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Does your worksite have a formal smoking   |
|                     |     policy that prohibits or severely          |
|                     |     restricts smoking at the worksite/on the   |
|                     |     job?                                       |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Data for this objective are not comparable to  |
|                     | the data for Healthy People 2000 objective     |
|                     | 3.11 from the 1992 National Survey of Worksite |
|                     | Health Promotion Activities. The 1992          |
|                     | questionnaire had a more explicit list of      |
|                     | questions to determine the type of formal      |
|                     | smoking policy.                                |
+---------------------+------------------------------------------------+
|                     | The 1999 question was similar to the 1992      |
|                     | question: Does your worksite have a formal     |
|                     | smoking policy that prohibits or severely      |
|                     | restricts smoking at the workplace? In 1992,   |
|                     | if the answer was "yes," the respondent was    |
|                     | asked: "How would you describe the rules on    |
|                     | smoking at the worksite? Possible responses    |
|                     | were: (a) Smoking not allowed anywhere         |
|                     | inside/smoke-free environment, (b) Smoking not |
|                     | allowed except in separately ventilated        |
|                     | smoking areas, (c) Smoking not allowed except  |
|                     | in designated areas without separate           |
|                     | ventilation, (d) Smoking allowed everywhere    |
|                     | except in a few no smoking areas, (e) Each     |
|                     | area decides on its own policy, (f) Smoking    |
|                     | permitted everywhere/no rules, (g) Designated  |
|                     | areas, ventilation unknown, (h) Other.         |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NWHPS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

27-13. Establish laws on smoke-free indoor air that prohibit smoking or
limit it to separately ventilated areas in public places and worksites.

  ---------------------- ------------------------------------------------
  27-13a. Private        
  workplaces.            

  **National Data        State Tobacco Activities Tracking and Evaluation
  Source**               System (STATE System), CDC, NCCDPHP, OSH.

  **State Data Source**  State Tobacco Activities Tracking and Evaluation
                         System (STATE System), CDC, NCCDPHP, OSH.

  **Healthy People 2000  3.12 (Tobacco) (also 10.19).
  Objective**            

  **Measure**            Number.

  **Baseline**           1 (1998).

  **Numerator**          Number of States and the District of Columbia
                         with comprehensive laws for private workplaces
                         prohibiting smoking or limiting it to separately
                         ventilated areas.

  **Denominator**        Not applicable.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Quarterly.
  Periodicity**          

  **Comments**           Every 3 months (March 31, June 30, September 30,
                         December 31), newly enacted State
                         tobacco-control legislation is downloaded from
                         Lexis-Nexis, an on-line legal database. CDC, OSH
                         searches two Lexis-Nexis subfiles: the
                         StateTrack System and the Advanced Legislative
                         Services System. The downloads are coded
                         according to variables identified by CDC, OSH,
                         which include the comprehensiveness of the law,
                         includes smoking areas permitted or required,
                         separately ventilated smoking areas required,
                         and no smoking allowed. In some cases, data on
                         enforcement authority, penalty for violation,
                         and signage required are also collected.

                         See Part C for a description of the STATE System
                         and Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

+---------------------+------------------------------------------------+
| **27-13b. Public    |                                                |
| workplaces.**       |                                                |
+---------------------+------------------------------------------------+
| ###### Na           | State Tobacco Activities Tracking and          |
| tional Data Source  | Evaluation System (STATE System), CDC,         |
| {#national-data-sou | NCCDPHP, OSH.                                  |
| rce-1 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **State Data        | State Tobacco Activities Tracking and          |
| Source**            | Evaluation System (STATE System), CDC,         |
|                     | NCCDPHP, OSH.                                  |
+---------------------+------------------------------------------------+
| **Healthy People    | 3.12 (Tobacco) (also 10.19).                   |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Number.                                        |
+---------------------+------------------------------------------------+
| **Baseline**        | 13 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of States and the District of Columbia  |
|                     | with comprehensive laws for public workplaces  |
|                     | prohibiting smoking or limiting it to          |
|                     | separately ventilated areas.                   |
+---------------------+------------------------------------------------+
| **Denominator**     | Not applicable.                                |
+---------------------+------------------------------------------------+
| **Questions Used To | Not applicable.                                |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Quarterly.                                     |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 27-13a    |
|                     | for more information.                          |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  27-13c. Restaurants.   

  **National Data        State Tobacco Activities Tracking and Evaluation
  Source**               System (STATE System), CDC, NCCDPHP, OSH.

  **State Data Source**  State Tobacco Activities Tracking and Evaluation
                         System (STATE System), CDC, NCCDPHP, OSH.

  **Healthy People 2000  3.12 (Tobacco) (also 10.19).
  Objective**            

  **Measure**            Number.

  **Baseline**           3 (1998).

  **Numerator**          Number of States and the District of Columbia
                         with comprehensive laws for restaurants
                         prohibiting smoking or limiting it to separately
                         ventilated areas.

  **Denominator**        Not applicable.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Quarterly.
  Periodicity**          

  **Comments**           See Comments provided with objective 27-13a for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  27-13d. Public         
  transportation.        

  **National Data        State Tobacco Activities Tracking and Evaluation
  Source**               System (STATE System), CDC, NCCDPHP, OSH.

  **State Data Source**  State Tobacco Activities Tracking and Evaluation
                         System (STATE System), CDC, NCCDPHP, OSH.

  **Healthy People 2000  3.12 (Tobacco) (also 10.19).
  Objective**            

  **Measure**            Number.

  **Baseline**           16 (1998).

  **Numerator**          Number of States and the District of Columbia
                         with comprehensive laws for public
                         transportation prohibiting smoking or limiting
                         it to separately ventilated areas.

  **Denominator**        Not applicable.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Quarterly.
  Periodicity**          

  **Comments**           For this objective, data on enforcement
                         authority, penalty for violation, and signage
                         required are not currently included in the STATE
                         System. See Comments provided with objective
                         27-13a for more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  27-13e. Day care       
  centers.               

  **National Data        State Tobacco Activities Tracking and Evaluation
  Source**               System (STATE System), CDC, NCCDPHP, OSH.

  **State Data Source**  State Tobacco Activities Tracking and Evaluation
                         System (STATE System), CDC, NCCDPHP, OSH.

  **Healthy People 2000  3.12 (Tobacco) (also 10.19).
  Objective**            

  **Measure**            Number.

  **Baseline**           22 (1998).

  **Numerator**          Number of States and the District of Columbia
                         with comprehensive laws for day care centers
                         (commercial or home-based) prohibiting smoking
                         or limiting it to separately ventilated areas.

  **Denominator**        Not applicable.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Quarterly.
  Periodicity**          

  **Comments**           Commercial and home-based day care centers are
                         tracked separately; this objective combines
                         them. See Comments provided with objective
                         27-13a for more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  27-13f. Retail stores. 

  **National Data        State Tobacco Activities Tracking and Evaluation
  Source**               System (STATE System), CDC, NCCDPHP, OSH.

  **State Data Source**  State Tobacco Activities Tracking and Evaluation
                         System (STATE System), CDC, NCCDPHP, OSH.

  **Healthy People 2000  Adapted from 3.12 (Tobacco) (also 10.19).
  Objective**            

  **Measure**            Number.

  **Baseline**           4 (1998).

  **Numerator**          Number of States and the District of Columbia
                         with comprehensive laws for malls and grocery
                         stores prohibiting smoking or limiting it to
                         separately ventilated areas.

  **Denominator**        Not applicable.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Quarterly.
  Periodicity**          

  **Comments**           Retail stores, as a general category, are not
                         tracked. Measures are only available for malls
                         and grocery stores. Data on enforcement
                         authority, penalty for violation, and signage
                         required are not currently included in the STATE
                         System for this objective.

                         This objective differs from Healthy People 2000
                         objective 3.12, which did not specifically track
                         retail stores.

                         See Comments provided with objective 27-13a for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  27-13g.                
  (Developmental)        
  Tribes.                

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  27-13h.                
  (Developmental)        
  Territories.           

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed data source is Lexis-Nexis, an online
                         legal database. CDC searches two Lexis-Nexis
                         subfiles: the StateTrack system and the Advanced
                         Legislative Services system. As data become
                         available, some U.S. territories may also be
                         tracked.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

### Social and Environmental Changes

27-14. Reduce the illegal sales rate to minors through enforcement of
laws that prohibit such sales.

  ---------------------- ------------------------------------------------
  27-14a. States and the 
  District of Columbia.  

  **National Data        State Synar Enforcement Reporting, SAMHSA, CSAP.
  Source**               

  **State Data Source**  State Synar Enforcement Reporting, SAMHSA, CSAP.

  **Healthy People 2000  Adapted from 3.13 (Tobacco).
  Objective**            

  **Measure**            Number.

  **Baseline**           0 (1998).

  **Numerator**          Number of States and the District of Columbia
                         with a 5 percent or less illegal sales rate to
                         minors in compliance checks.

  **Denominator**        Not applicable.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           As required by the Synar Amendment, all 50
                         States and the District of Columbia submit their
                         baseline sales rates in compliance checks to
                         SAMHSA as part of their annual Substance Abuse
                         Prevention and Treatment (SAPT) block grant
                         applications.

                         This objective is defined differently from
                         Healthy People 2000 objective 3.13, which
                         targets States and the District of Columbia that
                         have a 20 percent or less illegal buy rate among
                         minors.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  27-14b. Territories.   

  **National Data        State Synar Enforcement Reporting, SAMHSA, CSAP.
  Source**               

  **State Data Source**  State Synar Enforcement Reporting, SAMHSA, CSAP.

  **Healthy People 2000  Adapted from 3.13 (Tobacco).
  Objective**            

  **Measure**            Number.

  **Baseline**           0 (1998).

  **Numerator**          Number of U.S. territories with a 5-percent or
                         less illegal buy rate among minors in compliance
                         checks.

  **Denominator**        Not applicable.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           U.S. territories eligible for inclusion are:
                         American Samoa, Guam, Marshall Islands,
                         Federated States of Micronesia, Commonwealth of
                         the Northern Mariana Islands, Republic of Palau,
                         Puerto Rico, and the Virgin Islands.

                         This objective differs from Healthy People 2000
                         objective 3.13, which did not target U.S.
                         territories.

                         See Comments provided with objective 27-14a for
                         more information.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  27-15. Increase the    
  number of States and   
  the District of        
  Columbia that suspend  
  or revoke State retail 
  licenses for           
  violations of laws     
  prohibiting the sale   
  of tobacco to minors.  

  **National Data        State Tobacco Activities Tracking and Evaluation
  Source**               System (STATE System), CDC, NCCDPHP, OSH.

  **State Data Source**  State Tobacco Activities Tracking and Evaluation
                         System (STATE System), CDC, NCCDPHP, OSH.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Number.

  **Baseline**           34 (1998).

  **Numerator**          Number of States and the District of Columbia
                         with minors' access laws with provisions for
                         license suspension and/or revocation for
                         violation.

  **Denominator**        Not applicable.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Quarterly.
  Periodicity**          

  **Comments**           Every 3 months (March 31, June 30, September 30,
                         December 31), newly enacted State
                         tobacco-control legislation is downloaded from
                         Lexis-Nexis, an on-line legal database. CDC, OSH
                         searches two Lexis-Nexis subfiles: the State
                         Track System and the Advanced Legislative
                         Services System. The downloads are coded
                         according to variables identified by CDC, OSH,
                         which include the comprehensiveness of the law,
                         that is, minimum age for legal sale, inclusion
                         of chewing tobacco and/or snuff, enforcement
                         authority, penalty for violation, prohibition of
                         purchase, possession and/or use by minors, etc.

                         See Part C for a description of the STATE System
                         and Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  27-16. (Developmental) 
  Eliminate tobacco      
  advertising and        
  promotions that        
  influence adolescents  
  and young adults.      

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         Proposed national data sources are the American
                         Legacy Foundation and the National Association
                         of Attorneys General.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

27-17. Increase adolescents' disapproval of smoking.

+---------------------+------------------------------------------------+
| 27-17a. 8th grade.  |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Monitoring the Future Study (MTF), NIH, NIDA.  |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 4.9 (Substance Abuse: Alcohol and |
| 2000 Objective**    | Other Drugs) (also 3.21).                      |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| ##                  | 80 (1998).                                     |
| #### Baseline {#bas |                                                |
| eline .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of students in the 8th grade who        |
|                     | disapprove or strongly disapprove of people    |
|                     | smoking one or more packs of cigarettes per    |
|                     | day.                                           |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of students in the 8th grade.           |
+---------------------+------------------------------------------------+
| **Population        | Public and private schools in the coterminous  |
| Targeted**          | United States.                                 |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 Monitoring the Future Study:     |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Individuals differ in whether or not they  |
|                     |     disapprove of people doing certain things. |
|                     |     Do YOU disapprove of people doing each of  |
|                     |     the following:                             |
|                     |                                                |
|                     |     \[Response categories include:\]\          |
|                     |     Smoking one or more packs of cigarettes    |
|                     |     per day?                                   |
|                     |                                                |
|                     |     Don't disapprove\                          |
|                     |     Disapprove\                                |
|                     |     Strongly disapprove\                       |
|                     |     Can't say, Drug Unfamiliar                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | This objective differs from Healthy People     |
|                     | 2000 objective 4.9, which tracked high school  |
|                     | seniors only.                                  |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of the MTF and    |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 27-17b. 10th grade. |                                                |
+=====================+================================================+
| **National Data     | Monitoring the Future Study (MTF), NIH, NIDA.  |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 4.9 (Substance Abuse: Alcohol and |
| 2000 Objective**    | Other Drugs) (also 3.21).                      |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| ####                | 75 (1998).                                     |
| ## Baseline {#basel |                                                |
| ine-1 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of students in the 10th grade who       |
|                     | disapprove or strongly disapprove of people    |
|                     | smoking one or more packs of cigarettes per    |
|                     | day.                                           |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of students in the 10th grade.          |
+---------------------+------------------------------------------------+
| **Population        | Public and private schools in the coterminous  |
| Targeted**          | United States.                                 |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 Monitoring the Future Study:     |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Individuals differ in whether or not they  |
|                     |     disapprove of people doing certain things. |
|                     |     Do YOU disapprove of people doing each of  |
|                     |     the following:                             |
|                     |                                                |
|                     |     \[Response categories include:\]\          |
|                     |     Smoking one or more packs of cigarettes    |
|                     |     per day?                                   |
|                     |                                                |
|                     |     Don't disapprove\                          |
|                     |     Disapprove\                                |
|                     |     Strongly disapprove\                       |
|                     |     Can't say, drug unfamiliar                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | This objective differs from Healthy People     |
|                     | 2000 objective 4.9, which tracked high school  |
|                     | seniors only.                                  |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of MTF and        |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 27-17c. 12th grade. |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Monitoring the Future Study (MTF), NIH, NIDA.  |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | 4.9 (Substance Abuse: Alcohol and Other Drugs) |
| 2000 Objective**    | (also 3.21).                                   |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 69 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of students in the 12th grade who       |
|                     | disapprove or strongly disapprove of people    |
|                     | smoking one or more packs of cigarettes per    |
|                     | day.                                           |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of students in the 12th grade.          |
+---------------------+------------------------------------------------+
| **Population        | Public and private schools in the coterminous  |
| Targeted**          | United States.                                 |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 Monitoring the Future Study:     |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Individuals differ in whether or not they  |
|                     |     disapprove of people doing certain things. |
|                     |     Do YOU disapprove of people (who are 18 or |
|                     |     older) doing each of the following? (Mark  |
|                     |     one circle for each line.)                 |
|                     |                                                |
|                     |     \[Response categories include:\]\          |
|                     |     Smoking one or more packs of cigarettes    |
|                     |     per day?                                   |
|                     |                                                |
|                     |     Don't disapprove\                          |
|                     |     Disapprove\                                |
|                     |     Strongly disapprove                        |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Refer to Part for a description of MTF and     |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  27-18. (Developmental) 
  Increase the number of 
  Tribes, territories,   
  and States and the     
  District of Columbia   
  with comprehensive,    
  evidence-based tobacco 
  control programs.      

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed data source is the State Tobacco
                         Activities Tracking and Evaluation System (STATE
                         System), CDC, NCCDPHP, OSH; for Tribes, a
                         proposed data source is the IHS.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

+---------------------+------------------------------------------------+
| 27-19. Eliminate    |                                                |
| laws that preempt   |                                                |
| stronger tobacco    |                                                |
| control laws.       |                                                |
+---------------------+------------------------------------------------+
| ###### Na           | State Tobacco Activities Tracking and          |
| tional Data Source  | Evaluation System (STATE System), CDC,         |
| {#national-data-sou | NCCDPHP, OSH.                                  |
| rce-2 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| #                   | State Tobacco Activities Tracking and          |
| ##### State Data So | Evaluation System (STATE System), CDC,         |
| urce {#state-data-s | NCCDPHP, OSH.                                  |
| ource .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 10.20 (Occupational Safety and    |
| 2000 Objective**    | Health) (also 3.25).                           |
+---------------------+------------------------------------------------+
| **Measure**         | Number.                                        |
+---------------------+------------------------------------------------+
| **Baseline**        | 30 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of States and the District of Columbia  |
|                     | with preemptive laws in the areas of clean     |
|                     | indoor air, minors' access, or marketing.      |
+---------------------+------------------------------------------------+
| **Denominator**     | Not applicable.                                |
+---------------------+------------------------------------------------+
| **Questions Used To | Not applicable.                                |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Quarterly.                                     |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Every 3 months (March 31, June 30, September   |
|                     | 30, December 31), newly enacted State          |
|                     | tobacco-control legislation is downloaded from |
|                     | Lexis-Nexis, an on-line legal database. CDC,   |
|                     | OSH searches two Lexis-Nexis subfiles: the     |
|                     | StateTrack System and the Advanced Legislative |
|                     | Services System. The downloads are coded       |
|                     | according to variables identified by CDC, OSH, |
|                     | which include preemption related to smoke-free |
|                     | indoor air, minors' access, and marketing. As  |
|                     | data become available, some U.S. territories   |
|                     | may also be tracked.                           |
+---------------------+------------------------------------------------+
|                     | This objective differs from Healthy People     |
|                     | 2000 objective 3.25, which tracked States and  |
|                     | the District of Columbia that had preemptive   |
|                     | laws regarding smoke-free indoor air only.     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of the STATE      |
|                     | System and Appendix A for focus area contact   |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  27-20. (Developmental) 
  Reduce the toxicity of 
  tobacco products by    
  establishing a         
  regulatory structure   
  to monitor toxicity.   

  **Comments**           An operational definition could not be specified
                         at the time of publication. A proposed national
                         data source is the Food and Drug Administration.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

27-21. Increase the average Federal and State tax on tobacco products.

  ----------------------- -----------------------------------------------
  27-21a. Cigarettes.     

  **National Data         The Tax Burden on Tobacco,**^1^** The Tobacco
  Source**                Institute.

  **State Data Source**   The Tax Burden on Tobacco,**^1^** The Tobacco
                          Institute.

  **Healthy People 2000   Adapted from 3.23 (Tobacco).
  Objective**             

  **Measure**             Mean.

  **Baseline**            \$0.63 (1998).

  **Numerator**           Sum of the State excise taxes on the retail
                          price of a package of 20 cigarettes
                          (full-priced brands) in all 50 States and the
                          District of Columbia.

  **Denominator**         All 50 States and the District of Columbia.

  **Questions Used To     Not applicable.
  Obtain the National     
  Data**                  

  **Expected              Quarterly.
  Periodicity**           

  **Comments**            The State Tobacco Activities Tracking and
                          Evaluation System (STATE System), CDC, NCCDPHP,
                          OSH, is proposed as a future data source for
                          this objective.

                          This objective is modified from Healthy People
                          2000 objective 3.23, which tracks tobacco
                          excise tax by percent of the retail price.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  ----------------------- -----------------------------------------------
  27-21b. (Developmental) 
  Spit tobacco.           

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          Federal tax in 1999 was 2.7 cents; 7 States and
                          the District of Columbia did not tax smokeless
                          tobacco products.

                          A proposed data source is the State Tobacco
                          Activities Tracking and Evaluation System
                          (STATE System), CDC, NCCDPHP, OSH.

                          This objective is modified from Healthy People
                          2000 objective 3.23 (Tobacco).

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

## Reference

1\. The Tobacco Institute. *The Tax Burden on Tobacco.* Vol. 33.
Washington, DC: the Institute, 1998.