27
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 Source	National Health Interview Survey (NHIS), CDC, NCHS.	
State Data Source	Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.	
Healthy People 2000 Objective	3.4 (Tobacco) (also 15.12 and 16.6), age adjusted to the 2000 standard population.	
Leading Health Indicator	Tobacco Use.	
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 Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1998 National Health Interview Survey:	
	•	Have you smoked at least 100 cigarettes in your entire life?	
	[If yes:]
o	Do you now smoke cigarettes everyday, some days, or not at all?	
Expected Periodicity	Annual.	
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 Source	National Health Interview Survey (NHIS), CDC, NCHS.	
State Data Source	Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.	
Healthy People 2000 Objective	Not applicable.	
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 Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1998 National Health Interview Survey:	
	•	Have you used snuff such as Skoal, Skoal Bandits, or Copenhagen at least 20 times in your entire life?	
	[If yes:]
o	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:]
o	Do you now use chewing tobacco everyday, some days, or not at all?	
Expected Periodicity	Periodic.	
Comments	Persons are classified as using either snuff or chewing tobacco if they answer “yes” to either use of snuff or use of chewing tobacco, and 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 Source	National Health Interview Survey (NHIS), CDC, NCHS.	
State Data Source	Not identified—see Comments.	
Healthy People 2000 Objective	Not applicable.	
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 Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1998 National Health Interview Survey:	
	•	Have you ever smoked cigars?	
	[If yes:]
o	Have you smoked at least 50 cigars in your entire life?	
	o	Do you now smoke cigars everyday, some days, or not at all?	
Expected Periodicity	Periodic.	
Comments	Persons are classified as smoking cigars if they answer “yes” to smoking 50 cigars in their lifetime, and 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 Source	Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.	
State Data Source	Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.	
Healthy People 2000 Objective	Adapted from 3.9 (Tobacco) (also 13.17) and 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 Targeted	Students in grades 9 through 12.	
Questions Used To Obtain the National Data	From the 1999 Youth Risk Behavior Surveillance System:	
	•	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 Periodicity	Biennial.	
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 Source	Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.	
State Data Source	Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.	
Healthy People 2000 Objective	Adapted from 4.6 (Substance Abuse: Alcohol and Other Drugs) (also 3.20).	
Leading Health Indicator	Tobacco Use.	
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 Targeted	Students in grades 9 through 12.	
Questions Used To Obtain the National Data	From the 1999 Youth Risk Behavior Survey:	
	•	During the past 30 days, on how many days did you smoke cigarettes?	
Expected Periodicity	Biennial.	
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 Source	Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.	
State Data Source	Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.	
Healthy People 2000 Objective	Adapted from 3.9 (Tobacco) (also 13.17).	
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 Targeted	Students in grades 9 through 12.	
Questions Used To Obtain the National Data	From the 1999 Youth Risk Behavior Surveillance System:	
	•	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 Periodicity	Biennial.	
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 Source	Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.	
State Data Source	Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.	
Healthy People 2000 Objective	Not applicable.	
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 Targeted	Students in grades 9 through 12.	
Questions Used To Obtain the National Data	From the 1999 Youth Risk Behavior Surveillance System:	
	•	During the past 30 days, on how many days did you smoke any cigars, cigarillos, or little cigars? 	
Expected Periodicity	Biennial.	
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 Data Source	National Household Survey on Drug Abuse (NHSDA), SAMHSA.	
State Data Source	Not identified.	
Healthy People 2000 Objective	4.5 (Substance Abuse: Alcohol and Other Drugs) (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 Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1997 National Household Survey on Drug Abuse:	
	•	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 Periodicity	Annual.	
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 Source	National Household Survey on Drug Abuse (NHSDA), SAMHSA.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 4.5 (Substance Abuse: Alcohol and 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 Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	See Questions Used To Obtain the National Data provided with objective 27-4a.	
Expected Periodicity	Annual.	
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 Source	National Health Interview Survey (NHIS), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 3.6 (Tobacco).	
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 Targeted	U.S. civilian noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1998 National Health Interview Survey:	
	•	Have you smoked at least 100 cigarettes in your entire life?	
	[If yes:]
o	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 Periodicity	Annual.	
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 Source	National Health Interview Survey (NHIS), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 3.7 (Tobacco).	
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 Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1998 National Health Interview Survey:	
	•	(Has/have) (you/Person) given birth to a liveborn infant in the past 5 years?	
	[If yes:]
o	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:]
o	In what month of your pregnancy did you first quit for 7 days or longer?	
	o	Did you start smoking again during that pregnancy or did you stay off cigarettes for the rest of the pregnancy?	
Expected Periodicity	Periodic.	
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 Source	Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.	
State Data Source	Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.	
Healthy People 2000 Objective	Not applicable.	
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 Targeted	Students in grades 9 through 12.	
Questions Used To Obtain the National Data	From the 1999 Youth Risk Behavior Surveillance System:	
	•	Have you ever tried cigarette smoking, even one or two puffs?
[If yes:]
o	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 Periodicity	Biennial.	
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 Source	Addressing Tobacco in Managed Care: 1997–98 Health Plan Survey (ATMC), Robert Wood Johnson Foundation.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 3.24 (Tobacco).	
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 Targeted	Managed care organizations.	
Questions Used To Obtain the National Data	From the Addressing Tobacco in Managed Care: 1997–98 Health Plan Survey:	
	•	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 Periodicity	Periodic.	
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 Source	Health Policy Tracking Service, National Conference of State Legislators.	
State Data Source	Health Policy Tracking Service, National Conference of State Legislators.	
Healthy People 2000 Objective	Adapted from 3.24 (Tobacco).	
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 Obtain the National Data	Not applicable.	
Expected Periodicity	Periodic.	
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 Source	National Health Interview Survey (NHIS), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	3.8 (Tobacco).	
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 Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1994 National Health Interview Survey:	
	•	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 Periodicity	Periodic.	
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 Source	National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Not applicable.	
Leading Health Indicator	Environmental Quality.	
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 Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1988–94 National Health and Nutrition Examination Survey:	
	[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 Periodicity	Annual, beginning with 1999 data.	
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 Source	School Health Policies and Programs Study (SHPPS), CDC, NCCDPHP.	
State Data Source	School Health Policies and Programs Study (SHPPS), CDC, NCCDPHP.	
Healthy People 2000 Objective	Adapted from 3.10 (Tobacco).	
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 Targeted	Public and private junior high, middle, and senior high schools.	
Questions Used To Obtain the National Data	From the 1994 School Health Policies and Programs Study:	
	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. By smoking, I mean all forms of smoking tobacco, including cigarettes, pipes, and cigars. Looking at Handcard #1, are students permitted to smoke in any of these places during regular school hours?	
	[If yes:]
o	Where are students permitted to smoke during regular school hours?	
	o	Are students permitted to smoke in any of these places during non-school hours?	
	[Show Handcard #1]
•	I’m going to ask you the same series of questions about student smokeless tobacco use policies. By smokeless tobacco, I mean snuff or chewing tobacco. Looking at Handcard #1, are students permitted to use smokeless tobacco in any of these places during regular school hours?	
	[If yes:]
o	Where are students permitted to use smokeless tobacco during regular school hours?	
	o	Are students permitted to use smokeless tobacco in any of these places during non-school hours?	
	[Show Handcard #1]
•	Looking at Handcard #1, are school staff permitted to smoke in any of these places during regular school hours?	
	[If yes:]
o	Where are school staff permitted to smoke during regular school hours?	
	o	Are school staff permitted to smoke in any of these places during non-school hours?	
	[Show Handcard #1]
•	Looking at Handcard #1, are school staff permitted to use smokeless tobacco in any of these places during regular school hours?	
	[If yes:]
o	Where are school staff permitted to use smokeless tobacco during regular school hours?	
	o	Are school staff permitted to use smokeless tobacco in any of these places during non-school hours?	
	o	Do your smoking and smokeless tobacco policies apply to visitors at your school?
No
Yes, smoking policies apply
Yes, smokeless tobacco policies apply	
Expected Periodicity	Periodic.	
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 Sources	1999 National Worksite Health Promotion Survey (NWHPS), Association for Worksite Health Promotion (AWHP) and OPHS, ODPHP.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 3.11 (Tobacco) (also 10.18).	
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 Targeted	Nongovernmental worksites with 50 or more employees.	
Questions Used To Obtain the National Data	From the 1999 National Worksite Health Promotion Survey:	
	•	Does your worksite have a formal smoking policy that prohibits or severely restricts smoking at the worksite/on the job? 	
Expected Periodicity	Periodic.	
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 Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
State Data Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
Healthy People 2000 Objective	3.12 (Tobacco) (also 10.19).	
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 Obtain the National Data	Not applicable.	
Expected Periodicity	Quarterly.	
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.	
National Data Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
State Data Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
Healthy People 2000 Objective	3.12 (Tobacco) (also 10.19).	
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 Obtain the National Data	Not applicable.	
Expected Periodicity	Quarterly.	
Comments	See Comments provided with objective 27-13a for more information.	
    
27-13c. 	Restaurants.	
National Data Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
State Data Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
Healthy People 2000 Objective	3.12 (Tobacco) (also 10.19).	
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 Obtain the National Data	Not applicable.	
Expected Periodicity	Quarterly.	
Comments	See Comments provided with objective 27-13a for more information.	
    
27-13d. 	Public transportation.	
National Data Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
State Data Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
Healthy People 2000 Objective	3.12 (Tobacco) (also 10.19).	
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 Obtain the National Data	Not applicable.	
Expected Periodicity	Quarterly.	
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 Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
State Data Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
Healthy People 2000 Objective	3.12 (Tobacco) (also 10.19).	
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 Obtain the National Data	Not applicable.	
Expected Periodicity	Quarterly.	
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 Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
State Data Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
Healthy People 2000 Objective	Adapted from 3.12 (Tobacco) (also 10.19).	
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 Obtain the National Data	Not applicable.	
Expected Periodicity	Quarterly.	
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 Source	State Synar Enforcement Reporting, SAMHSA, CSAP.	
State Data Source	State Synar Enforcement Reporting, SAMHSA, CSAP.	
Healthy People 2000 Objective	Adapted from 3.13 (Tobacco).	
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 Obtain the National Data	Not applicable.	
Expected Periodicity	Annual.	
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 Source	State Synar Enforcement Reporting, SAMHSA, CSAP.	
State Data Source	State Synar Enforcement Reporting, SAMHSA, CSAP.	
Healthy People 2000 Objective	Adapted from 3.13 (Tobacco).	
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 Obtain the National Data	Not applicable.	
Expected Periodicity	Annual.	
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 Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
State Data Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
Healthy People 2000 Objective	Not applicable.	
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 Obtain the National Data	Not applicable.	
Expected Periodicity	Quarterly.	
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 Source	Monitoring the Future Study (MTF), NIH, NIDA.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 4.9 (Substance Abuse: Alcohol and Other Drugs) (also 3.21).	
Measure	Percent.	
Baseline	80 (1998).	
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 Targeted	Public and private schools in the coterminous United States.	
Questions Used To Obtain the National Data	From the 1998 Monitoring the Future Study:	
	•	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 Periodicity	Annual.	
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 Source	Monitoring the Future Study (MTF), NIH, NIDA.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 4.9 (Substance Abuse: Alcohol and Other Drugs) (also 3.21).	
Measure	Percent.	
Baseline	75 (1998).	
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 Targeted	Public and private schools in the coterminous United States.	
Questions Used To Obtain the National Data	From the 1998 Monitoring the Future Study:	
	•	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 Periodicity	Annual.	
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 Source	Monitoring the Future Study (MTF), NIH, NIDA.	
State Data Source	Not identified.	
Healthy People 2000 Objective	4.9 (Substance Abuse: Alcohol and Other Drugs) (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 Targeted	Public and private schools in the coterminous United States.	
Questions Used To Obtain the National Data	From the 1998 Monitoring the Future Study:	
	•	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 Periodicity	Annual.	
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.	
National Data Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
State Data Source	State Tobacco Activities Tracking and Evaluation System (STATE System), CDC, NCCDPHP, OSH.	
Healthy People 2000 Objective	Adapted from 10.20 (Occupational Safety and 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 Obtain the National Data	Not applicable.	
Expected Periodicity	Quarterly.	
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 Source	The Tax Burden on Tobacco,1 The Tobacco Institute.	
State Data Source	The Tax Burden on Tobacco,1 The Tobacco Institute.	
Healthy People 2000 Objective	Adapted from 3.23 (Tobacco).	
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 Obtain the National Data	Not applicable.	
Expected Periodicity	Quarterly.	
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.