Research paper
 
CC-BY-NC 4.0
 
 

Tobacco Program Budget Cuts: Could these Influence Future North Carolina County Mortality Rates?

 
1
Wake Forest School of Medicine
Tob. Prev. Cessation 2016;2(November):75
Publish date: 2016-11-03
KEYWORDS:
TOPICS:
 
ABSTRACT:
Introduction:
North Carolina has a high rate of smoking, yet legislators cut the state’s budget for tobacco control in 2011 from $18 million to $1 million. To inform legislators and others about effects of this cut, this ecological study uses county-level data to predict mortality rate reduction by reducing smoking prevalence in North Carolina’s 100 counties.

Methods:
County-level smoking data for 1996 were reported as percent of the county population who smoked. County level demographic data were taken from the 2010 US Census and the North Carolina Office of State Budget Management. Selected disease specific mortality rates for were reported per 100,000 county population. Linear regression analysis evaluated how a one-percent reduction in county smoking prevalence could reduce county mortality rates.

Results:
The 1996 percent county-level smokers correlated with 2010 rates for mortality from all-causes, total cancer, lung cancer, heart disease and diabetes (regression coefficients = 5.92; 4.84; 5.57; 4.12 and 1.80, respectively). The regression coefficient (5.93) for 1996 county level smoking rates was greatest for all-cause mortality. This coefficient implies that for each one percent change in county smoking rates in 1996, there would be a corresponding change in county all-cause mortality of 5.92 deaths per 100,000 population.

Conclusions:
This study found correlations between 1996 county-level smoking rates and disease-specific 2010 mortality in North Carolina’s 100 counties. Informing legislators and other stakeholders about these findings might influence an increase in tobacco control funding statewide as well as in legislators’ home counties. Other states could follow this approach.



CORRESPONDING AUTHOR:
John Spangler   
Wake Forest School of Medicine, Department of Family Medicine, Medical Center BLVD, 27157 Winston Salem, United States
 
REFERENCES:
1. Tobacco data and statistics. Atlanta (GA): Centers for Disease Control and Prevention; 2014. Avalilable from: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/ (accessed May 2014).
2. County health rankings and roadmaps. Princeton (NJ): Robert Wood Johnson Foundation; 2014.Available from: http://www.rwjf.org/en/research-publications/research-features/rwjf-datahub/national.html#q/scope/national/ind/59/dist/0/char/0/time/23/viz/map/cmp/brkdwn (accessed May 2014).
3. Census of Agriculture—State Data: Table 45: Farms by North American Industry Classification System. Washington (DC): U. S. Department of Agriculture, National Agricultural Statistics Service; 2007.
4. Spangler JG, Bell RA, Knick S, Michielutte R, Dignan MB, Summerson JH. Church-related correlates of tobacco use among Lumbee Indians in North Carolina. Ethn Dis 1997; 8: 73-80.
5. Spangler JG, Bell RA, Dignan MB, Michielutte R. Prevalence and predictors of tobacco use among Lumbee Indian women in Robeson County, North Carolina. J Community Health 22: 115-125. doi: 10.1023/A:1025112822200
6. Bell RA, Spangler JG, Quandt SA. Smokeless tobacco use among adults in the Southeast. South Med J 2000; 93: 456-462.
7. State of Tobacco Control. Funding for prevention programs slashed. Chicago (IL): American Lung Association; 2011. Available from: http://www.stateoftobaccocontrol.org/at-a-glance/state-governments/funding-for-prevention-slashed.html (accessed May 2014).
8. Kurtz KT. Legislatures and Citizens: Communications Between Representatives and Their Constituents. Albany (NY): Produced for USAID G/DG by the National Conference of State Legislatures and the Research Foundation of the State University of New York; 1997.
9. Butler DM., Nickerson DW. Can Learning Constituency Opinion Affect How Legislators Vote? Results from a Field Experiment. Quart J Polit Sci 2011; 6: 55-83. doi: 10.1561/100.00011019.
10. Little TH, Ogle DB. The Legislative Branch of State Government: People, Process and Politics. Santa Barbara (CA): ABC-CLIO, 2006.
11. Gordis L. Epidemiology. 2nd Edition. Philadelphia (PA): W.B. Saunders, 2000; p. 185-187.
12. Dwyer-Lindgren L, Mokdad AH, Srebotnjak T, Flaxman AD, Hansen GM, Murray CJ. Cigarette smoking prevalence in US counties: 1996-2012. Popul Health Metr 2014; 12(1):5.
13. State and County Quick Facts, North Carolina. Washington (DC): US Census Bureau; 2010. Available from: http://quickfacts.census.gov/qfd/states/37000.html. (accessed May 2014).
14. Population Figures by race and total by county. Raleigh (NC): North Carolina Office of State Budget and Management; 2010. Available from: http://www.osbm.state.nc.us/ncosbm/facts_and_figures/socioeconomic_data/population_estimates/county_estimates.shtm. (accessed May 2014).
15. Statistics and Reports, County Level. Raleigh (NC): North Carolina State Center for Health Statistics; 2010. Available from: http://www.schs.state.nc.us/data/county.cfm (accessed May 2014).
16. Richmond JB, Kotelchuck M. Political influences: rethinking national health policy. In: Mcquire C, Foley R, Gorr A, Richards R, editors. Handbook of Health Professions Education. San Francisco (CA): Jossey Bass Publishers, 1983; p. 993.
17. Atwood K, Colditz GA, Kawachi I. From public health science to prevention policy: placing science in its social and political contexts. AJPH 1997; 87: 1603-1603.
18. Tolbert CJ, Grummel JA. Revisiting the Racial Threat Hypothesis: White Voter Support for California's Proposition 209. State Politics & Policy Quarterly 2003; 3: 183-202.
19. Citrin J, Reingold B, Walters E, Green D. The “Official English” movement and the symbolic politics of language in the United States. West Polit Q 1990; 43: 535-60. doi: 10.2307/448703
20. Stein R, Post S, Rinden A. Reconciling Context and Contact Effects on Racial Attitudes. Polit Res Q 2000; 53: 285-303. doi:10.1177/106591290005300204
21. Tolbert C, Hero R. Race/Ethnicity and Direct Democracy: An Analysis of California's Illegal Immigration Initiative. J Polit 1996; 58: 806-18. doi: 10.2307/2960447
22. Tolbert C Hero R. Facing Diversity: Racial/Ethnic Context and Social Policy Change. Polit Res Q 2001; 54: 571-604. doi: 10.1177/106591290105400305
23. Voss S, Miller P. Following a False Trail: The Hunt for White Backlash in Kentucky's 1996 Desegregation Vote. State Politics and Policy Quarterly 2001; 1: 62-80. doi: 10.1177/153244000100100105
24. Roch CH, Rushton MJ. Social Context and Voting Over Taxes: Evidence from a Referendum in Alabama. Andrew Young School Research Paper No. 06-06; 2007. Available from: http://dx.doi.org/10.2139/ssrn.890715. (accessed May 2014).
25. Epperson MW, Wolff N, Morgan RD, Fisher WH, Frueh BC, Huening J. Envisioning the next generation of behavioral health and criminal justice interventions. Int J Law Psychiatry 2014; Epub ahead of print. doi: 10.1016/j.ijlp.2014.02.015
26. Peto R, Boreham J, Lopez AD, Thun M, Heath C. Mortality from tobacco in developed countries: indirect estimation from national vital statistics. The Lancet. 1992 May 23;339(8804):1268-78. doi: 10.1016/0140-6736(92)91600-d
27. 2009 North Carolina Youth Tobacco Survey. Raleigh (NC): North Carolina Department of Health and Human Serivces, Tobacco Prevention and Control Branch; 2009. Available from: http://www.tobaccopreventionandcontrol.ncdhhs.gov/data/yts/index.htm. (accessed May 2014).
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