August 2002 volume 18 number 08 Division of Public Health http://health.state.ga.us Kathleen E. Toomey, M.D., M.P.H. Director State Health Officer Epidemiology Branch http://health.state.ga.us/epi Paul A. Blake, M.D., M.P.H. Director State Epidemiologist Mel Ralston Public Health Advisor Georgia Epidemiology Report Editorial Board Carol A. Hoban, M.S., M.P.H. - Editor Kathryn E. Arnold, M.D. Paul A. Blake, M.D., M.P.H. Susan Lance-Parker, D.V.M., Ph.D. Kathleen E. Toomey, M.D., M.P.H. Angela Alexander - Mailing List Jimmy Clanton, Jr. - Graphic Designer Georgia Department of Human Resources Division of Public Health Epidemiology Branch Two Peachtree St., N.W. Atlanta, GA 30303-3186 Phone: (404) 657-2588 Fax: (404) 657-7517 Please send comments to: Gaepinfo@dhr.state.ga.us The Georgia Epidemiology Report is a publication of the Epidemiology Branch, Division of Public Health, Georgia Department of Human Resources Georgia Youth Tobacco Survey, 2001 Introduction Tobacco use is the leading preventable cause of death in Georgia, accounting for more than 10,000 deaths and $1.8 billion in health care expenditures annually (1). Approximately 80% of adult smokers began smoking during adolescence. The earlier tobacco use begins, the more likely that tobacco use will persist, resulting in increased risk for tobacco-related illnesses (2). Physicians and other health care providers can play an important role in reducing the prevalence of smoking among all age groups, including adolescents. To establish baseline data on adolescent tobacco use in Georgia we conducted a statewide Youth Tobacco Survey (YTS) in the fall of 2001. This report presents the main findings from this survey. Methods A school-based survey of a representative sample of middle (n=2,848) and high (n=2,975) school students in Georgia was conducted in the fall of 2001. Using a paper-and-pencil questionnaire, students were asked about tobacco use (cigarettes, cigars, pipes, bidi cigarettes, and smokeless tobacco), exposure to secondhand smoke, smoking cessation, school curriculum, their ability to purchase or obtain tobacco products, knowledge and attitudes about tobacco, peer influences, media and advertising influences, and demographic information. Weighted estimates and 95% confidence intervals were calculated using SUDAAN software package to account for the complex sample design. Where available, Georgia data are compared to the National Youth Tobacco Survey (NYTS)(3). Results Tobacco Use Prevalence In Georgia, 14.5% of middle school and 31.7% of high school students use one or more tobacco product(s) (Table 1). These rates are comparable to national rates. Among Georgia's middle school students 8.9% smoke cigarettes, 5.4% smoke cigars, 4.5% use smokeless tobacco (such as chewing tobacco, snuff or dip), and 2.8% smoke bidis (small brown cigarettes from India consisting of tobacco wrapped in a leaf tied with a thread). In high school, 23.7% of Georgia's students currently smoke cigarettes, 14.5% smoke cigars, 9.5% use smokeless tobacco, and 5.5% smoke bidis. The rate of cigarette smoking among high school students is lower than the national rate whereas the rate of smokeless tobacco use is higher. The use of tobacco products increases from 6th through 12th grades (Figure 1). Cigarette smoking in the 12th grade is six times higher than the rate in the 6th grade. Exposure to Environmental Tobacco Smoke (Secondhand Smoke) Smokers in middle and high school are significantly more likely than nonsmokers to live with someone who smokes. Nearly three-fourths of middle school smokers (70.2%) and over a half of high school smokers (56.5%) live with a smoker, compared with about one third of middle school non smokers (33.9%) and high school non-smokers (31.4%) (Figure 2). Cessation Approximately half of Georgia's middle school and high school students who smoke cigarettes would like to quit smoking (54.2% and 47.7%, respectively). The proportion of Georgia high school students who smoke and would like to quit is significantly lower than the proportion of high school smokers nationally (61.0%). About three-fourths of middle school smokers (73.6%) and high school smokers (78.5%) think they would be able to quit smoking, if they wanted to quit. More than half of Georgia's middle (54.4%) and high (53.2%) school smokers have attempted to quit smoking within the past 12 months. However, few middle (12.1%) and high (5.9%) school smokers have participated in a program to help them quit using tobacco. Editorial Note The results of the Georgia Youth Tobacco Survey confirm that tobacco use among adolescents continues to be an important public health problem in Georgia, with 14.5% of middle school and 31.7% of high school students currently using some form of tobacco. Physicians and other health care providers can play a dual role in efforts to reduce the prevalence of smoking among persons of all ages in Georgia. Physician guidance and counseling can, first, prevent onset and encourage cessation among youth and, second, foster smoking cessation among adults. The AAP recommends that discussion and guidance about avoiding smoking and tobacco use should begin by age 5 years, with particular emphasis on resisting the influence of advertising and peer influence. The AAP also recommends that pediatricians be knowledgeable about tobacco cessation therapies such as patches, and routinely offer help and referral to those who are nicotine-dependent (6). More information from and about the 2001 Georgia Youth Tobacco Survey report (7) are available on the web at http://www.ph.dhr. state.ga.us/pdfs/chronic/tobacco/youthtobaccosurvey.01.pdf. Copies of the report can be obtained by calling (404) 657-6646. Encouraging smoking cessation among adults is important because youths who live with a smoker are significantly more likely to smoke and because all persons living with a smoker are more likely to suffer from various respiratory conditions such as asthma and respiratory infections. Counseling by physicians and other smoking cessation services administered through physicians' offices do help and are recommended by the Task Force on Clinical Preventive Services (4). Counseling adults can occur either when the adult comes for care or when the adult brings a child for care. A recent survey of pediatricians shows that only half (51%) regularly talk with the caregivers of 13-18 year old children about the smoking practices of adults in the household (5). For children 6-12 years of age, only 39% counseled about smoking by adults in the home. Encouraging children and youth not to begin smoking and encouraging those who have already begun to stop is also important. Responses to the Georgia Youth Tobacco Survey reflect both the ambivalence of many youth about their smoking and their lack of knowledge about the difficulties of breaking the addiction. Three fourths of the smokers reported that they could quit if they desired to, yet 55% of middle school smokers and 61% of high school smokers said they wanted to quit smoking and more than half had attempted to quit in the past 12 months but were still smoking. Because attitudes and behaviors about smoking begin early, physician counseling and guidance also should begin early. Nationally, only 29% of pediatricians regularly counsel 6-12 year children about smoking and 69% regularly counsel 13-18 year old children (5). The American Academy of Pediatrics (AAP) states that it is critical for pediatricians to routinely inquire about tobacco use and smoke exposure. This article was written by: Dafna Kanny, Ph.D. and Kenneth E. Powell, M.D., M.P.H. References: 1. Miller VP, Ernest C, Collin F. Smoking-attributable medical care costs in the USA. Social Science & Medicine 1999;48:447-458. 2. Centers for Disease Control and Prevention. Tobacco Information and Prevention Sources (TIPS). (http://www.cdc.gov/tobacco/ issue.htm) 3. Centers for Disease Control and Prevention. CDC Surveillance Summaries, November 2, 2001. MMWR 2001;50(No.SS-4). 4. U.S. Preventive Services Task Force. Guide to clinical preventive services, 2nd edition. Baltimore: Williams & Wilkins, 1996. 5. Galuska DA, Fulton JE, Powell KE, Burgeson CR, Pratt M, Elster A, Griesemer BA. Pediatrician Counseling About Preventive Health Topics: Results From the Physicians' Practices Survey, 19981999. Pediatrics 2002 May;109(5):E83-3. (http://www.pediatrics.org/cgi/reprint/109/ 5/e83.pdf) 6. American Academy of Pediatrics, Committee on Substance Abuse. Tobacco's Toll: Implications for the Pediatrician. Pediatrics 2001; 107: 794-798. 7. Kanny D, Powell KE, Copes K. Georgia Youth Tobacco Survey, 2001. Georgia Department of Human Resources, division of Public Health, Tobacco Use Prevention Section, June 2002. Publication Table 1. Prevalence of current* tobacco use by school type, location, sex, and race/ethnicity Category Any** Tobacco Use % (95% CI) Cigarette Use % (95% CI) Cigar Use % (95% CI) Smokeless Tobacco Use % (95% CI) Middle School Location Georgia 14.5 (2.9) 8.9 (2.1) 5.4 (1.3) U.S. 15.1 (1.5) 11.0 (1.2) 7.1 (1.0) Sex Female 10.7 (2.9) 7.1 (2.6) 3.4 (1.4) Male 18.1 (3.6) 10.5 (2.6) 7.1 (1.6) Race/Ethnicity White 14.7 (4.2) 9.7 (3.3) 4.3 (1.3) Black 13.2 (2.7) 6.0 (1.8) 6.0 (2.2) Hispanic 18.5 (6.0) 15.1 (5.8) 10.3 (4.4) Other 14.9 (4.9) 9.7 (5.1) 5.6 (3.0) High School Location Georgia 31.7 (2.7) 23.7 (2.3) 14.5 (1.6) U.S. 34.5 (1.9) 28.0 (1.7) 14.8 (1.1) Sex Female 24.3 (2.8) 19.9 (3.2) 9.0 (1.5) Male 38.6 (3.1) 27.4 (2.9) 19.7 (2.5) Race/Ethnicity White 37.8 (3.3) 30.5 (2.3) 15.9 (1.6) Black 20.7 (2.8) 10.4 (2.6) 11.3 (2.4) Hispanic 27.8 (6.5) 20.8 (5.7) 16.2 (4.8) Other 23.2 (7.0) 18.6 (7.6) 12.1 (5.0) * Smoked cigarettes on > 1 of the 30 days preceding the survey ** Composite variable: includes use of cigarettes, cigars, smokeless tobacco, pipes or bidis on > 1 of the 30 days preceding the survey -2 - 4.5 (1.3) 3.6 (0.9) 1.1 (0.5) 7.5 (2.1) 5.8 (2.0) 2.3 (0.8) 2.4 (2.3) 5.9 (4.5) 9.5 (1.9) 6.6 (0.9) 2.2 (0.9) 16.3 (3.4) 12.7 (2.8) 3.4 (1.5) 5.3 (4.7) 8.4 (5.4) Bidis Use % (95% CI) 2.8 (0.9) 2.4 (0.4) 1.9 (0.8) 3.6 (1.2) 2.2 (0.8) 3.7 (1.7) 3.2 (2.6) 2.3 (1.9) 5.5 (1.1) 4.1 (0.4) 3.4 (1.0) 7.6 (1.7) 5.2 (1.5) 5.6 (1.7) 6.7 (3.5) 6.8 (4.4) Figure 1. Tobacco Use Prevalence by Grade, Georgia, 2001 Figure 1. Tobacco Use Prevalence by Grade, Georgia, 2001 40 Any Tobacco Product 35 30 Ciga re tte s 25 20 Cigars 15 10 Smokeless Tobacco 5 Bidis 0 6 1 27 38 49 150 161 712 Grade Figure 2. Environmental Tobacco Smoke in the Home by School Type and Student Smoking Status, Georgia, 2001 Figure 2. Environmental Tobacco Smoke in the Home by School Type and Student Smoking Status, Georgia, 2001 80 70 60 50 40 30 20 10 0 Non-smokers Smokers Middle School Non-smokers Smokers High School Percent Percent Editor's Note: The following graph was incorrectly displayed in the June 2002 issue of the GER, Georgia's West Nile Virus Surveillance During 2001 and Plans for 2002. The following counties (Fulton, Macon, Pierce, Richmond, and Wayne) were improperly represented as white boxes. These are the correct and only counties having WNV positive humans and animals (birds and/or horses). We apologize for any confusion this error may have caused. Figure 1. Distribution of WNV activity in Georgia, 2001. Information is based on laboratory-confirmed cases reported the Georgia Division of Public Health (GDPH). Rome Atlanta Athens LaGrange Columbus Macon Dublin WNV Positive Animals (Birds and/ WNV Positive Humans and Anima Augusta Albany Tifton Valdosta Savanna Waycross Brunswick -3 - The Georgia Epidemiology Report Epidemiology Branch Two Peachtree St., NW Atlanta, GA 30303-3186 PRESORTED STANDARD U.S. POSTAGE PAID ATLANTA, GA PERMIT NO. 4528 August 2002 Volume 18 Number 08 Reported Cases of Selected Notifiable Diseases in Georgia Profile* for March 2002 Selected Notifiable Diseases Campylobacteriosis Chlamydia trachomatis Cryptosporidiosis E. coli O157:H7 Giardiasis Gonorrhea Haemophilus influenzae (invasive) Hepatitis A (acute) Hepatitis B (acute) Legionellosis Lyme Disease Meningococcal Disease (invasive) Mumps Pertussis Rubella Salmonellosis Shigellosis Syphilis - Primary Syphilis - Secondary Syphilis - Early Latent Syphilis - Other** Syphilis - Congenital Tuberculosis Total Reported for May 2002 2002 63 2168 4 4 73 1209 9 48 28 1 0 3 0 3 0 133 112 6 9 14 8 0 51 Previous 3 Months Total Ending in May 2000 2001 2002 158 147 153 7294 7779 7490 31 25 12 7 4 9 258 232 203 4422 4004 4029 24 35 24 69 239 144 68 87 98 3 3 4 0 0 0 13 14 12 1 5 2 11 7 5 0 0 0 262 236 299 78 70 291 34 18 17 68 74 47 159 175 89 175 246 81 5 7 0 172 122 133 Previous 12 Months Total Ending in May 2000 2001 2002 637 611 636 28363 30740 32813 148 176 147 46 42 53 1366 1143 894 19555 19012 18377 83 96 101 352 608 830 266 409 423 9 11 13 0 0 1 65 53 42 5 7 4 63 35 21 0 1 0 1886 1668 1766 296 323 1106 149 104 92 286 284 257 587 558 573 721 818 650 20 23 11 668 638 544 * The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state office, and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia. ** Other syphilis includes latent (unknown duration), late latent, late with symptomatic manifestations, and neurosyphilis. AIDS Profile Update Report Period Latest 12 Months: 07/01-06/02 Five Years Ago: 07/97-06/98 Cumulative: 07/81-06/02 Total Cases Reported* <13yrs >=13yrs Total 2 2018 2020 5 1335 1340 211 25034 25245 Percent Female 25.3 19.0 17.6 Risk Group Distribution (%) MSM IDU MSM&IDU HS Blood 38.4 7.6 2.4 13.5 2.1 43.1 19.0 5.5 17.2 1.1 47.7 17.5 5.4 13.4 1.9 Unknown 36.0 14.2 14.1 Race Distribution (%) White Black Other 19.1 76.4 4.5 23.1 74.3 2.5 34.2 63.4 2.4 MSM - Men having sex with men IDU - Injection drug users HS - Heterosexual * Case totals are accumulated by date of report to the Epidemiology Section - 4 -