Georgia Tobacco Use Surveillance Report 
2009 
 
 Acknowledgements 
 
Georgia Department of Human Resources B.J. Walker, Commissioner 
 
Division of Public Health S. Elizabeth Ford, MD, MBA, Acting Director 
 
  
 
Health Information, Policy, Strategy, and Accountability Martha N. Okafor, Ph.D., Deputy Director 
 
 
 
Office of Epidemiology, Evaluation and Health Information Dafna Kanny, Ph.D., Senior Director 
 
Epidemiology Section 
 
 
 
John Horan, MD, MPH, Director 
 
 
 
Office of Healthy Behavior 
 
 
 
Kimberly Redding, MD, MPH, Senior Director 
 
  
 
Health Promotion Section Shonta Chambers, MPH, Director 
 
  
 
Tobacco Use Prevention Program Kenneth Ray, MPH, Program Manager 
 
 
 
Graphic Design: Jimmy Clanton, Jr. 
Suggested citation: Figueroa A. 2009 Georgia Tobacco Surveillance Report. Georgia Department of Human Resources, Division of Public Health, Office of Epidemiology, Evaluation and Health Information, March 2009. Publication Number: DPH 09.345 HW. 
This publication was supported by Cooperative Agreement Number UC58/CCU422885-03022 from the Centers for Disease Control and Prevention (CDC), State Tobacco Prevention and Control Program. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. 
 
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2009 Georgia Tobacco Use Surveillance Report 
 
 Table of Contents 
Executive Summary............................................................................................................................. 4 
Introduction.......................................................................................................................................... 6 
Burden of Tobacco Use in Georgia...................................................................................................... 7 Mortality..................................................................................................................................... 7 Years of potential life lost.......................................................................................................... 8 Economic costs......................................................................................................................... 8 
Tobacco Use in Georgia....................................................................................................................... 9 Tobacco use among youth........................................................................................................ 9 Tobacco use among adults....................................................................................................... 11 Tobacco use among pregnant women..................................................................................... 13 
Secondhand Smoke and Asthma........................................................................................................ 14 
Reducing Tobacco Use in Georgia...................................................................................................... 15 Former smokers....................................................................................................................... 15 Smoking cessation................................................................................................................... 16 
Policy................................................................................................................................................... 17 Home and worksite policies...................................................................................................... 17 School policies......................................................................................................................... 18 Support of smoke-free laws and taxation................................................................................. 19 
Summary and Implications for Prevention.......................................................................................... 20 
Methodology and Limitations.............................................................................................................. 22 
Glossary.............................................................................................................................................. 27 
References.......................................................................................................................................... 29 
Appendices......................................................................................................................................... 31 
 
2009 Georgia Tobacco Use Surveillance Report 
 
3 
 
 Executive Summary 
Cigarette smoking remains a leading preventable cause of illness and death in Georgia. Mortality 
 Over 10,000 adult Georgians die from smoking-related illnesses annually.  About 4,400 die from cancer  About 3,300 die from cardiovascular diseases  About 2,700 die from respiratory diseases 
 About 35 infants die every year because their mothers smoked during pregnancy. Economic Costs 
 $3.4 billion in lost productivity costs in Georgia for adults are attributed to smoking annually.  $1.8 billion in healthcare costs in Georgia for adults are attributed to smoking annually. Tobacco Use in Georgia  Approximately 23,000 (6%) middle school students and 81,000 (19%) high school students in 
Georgia smoke cigarettes.  Approximately 1,400 (6%) middle school smokers and 24,000 (30%) high school smokers buy their 
cigarettes at gas stations or convenience stores.  Approximately 1.3 million (19%) adult Georgians smoke cigarettes.  The prevalence of current smoking among adults is significantly higher among younger age groups 
and those with fewer years of education.  10% of pregnant women in Georgia smoked during the last three months of their pregnancy. Secondhand Smoke and Asthma  Approximately 41,000 (11%) middle school students, 44,000 (10%) high school students, and 
524,000 (8%) adults in Georgia have asthma.  Among persons with asthma, approximately 3,000 (8%) middle school students, 8,000 (19%) high 
school students, and 126,000 (24%) adults smoke cigarettes. 
 
4 
 
2009 Georgia Tobacco Use Surveillance Report 
 
 Executive Summary (continued) 
Reducing Tobacco Use in Georgia 
 Approximately 1.5 million (54%) adult Georgians who had ever smoked report having quit smoking. 
 Approximately 760,000 (57%) adult smokers in Georgia have ever stopped smoking cigarettes for one day or longer in an attempt to quit. 
 Approximately 151,000 (25%) adult smokers who made a quit attempt used medication such as nicotine patch or gum on their last quit attempt. 
 Approximately 673,000 (59%) adult smokers are seriously considering stopping smoking. 
 Approximately 485,000 (67%) adult smokers who visited their health care provider in the past year indicated their health care provider advised them not to smoke. 
 Of all current adult smokers who were advised not to smoke when they visited their health care provider in the past year, approximately 144,000 (30%) of them were given a prescription for medication to help them quit and approximately 80,000 (17%) of them were advised to participate in a smoking cessation class or program. 
Policy 
 A majority (81%) of adults in Georgia do not allow smoking anywhere inside their homes. 
 A majority (85%) of employed adults in Georgia indicate their worksite has a policy that prohibits smoking at work. 
 Almost all public middle (99%) and high schools (99%) have a policy prohibiting tobacco use. 
 Most middle schools and high schools have procedures to inform students (99% MS, 100% HS), and faculty and staff (88% MS, 93% HS) of the actions taken when someone is non-compliant with the school policy; however, the procedures were applicable to visitors in only 69% of middle schools and 65% of high schools. 
 Half of adult smokers and a majority (82%) of adult non-smokers support laws making restaurants smoke-free. 
 Nearly half (46%) of adult smokers and three-fourths (75%) of adult non-smokers would support an additional tax on cigarettes. 
 
2009 Georgia Tobacco Use Surveillance Report 
 
5 
 
 Introduction 
 
The effect of tobacco use on health has been a topic of research since the beginning of the 20th century (1). There is ample scientific literature providing evidence of a causal relationship between tobacco use and disease, disability, and death. Tobacco use is related to many health conditions (Table 1) and is recognized as one of the most common preventable causes of death in the United States (2). Smoking is not only harmful to smokers but also to children and non-smokers who are exposed to secondhand smoke. Exposure to secondhand smoke is associated with decreased lung function and development, bronchitis, respiratory infections, asthma severity, lung cancer, and heart disease (3). 
 
Table 1. Causes of death for which tobacco use is a contributing cause 
 
Causes of death 
 
Cancer 
 
Cardiovascular diseases 
 
Respiratory diseases 
 
Lip, oral cavity, pharynx Esophagus Stomach Pancreas Larynx Trachea, lung, bronchus Cervix Kidney and renal pelvis Bladder Acute myeloid leukemia 
 
Ischemic heart disease Other heart disease Stroke Atherosclerosis Aortic aneurysm Other diseases of the circulatory system 
 
Pneumonia Influenza Bronchitis Emphysema Chronic airway obstruction 
 
Perinatal conditions 
Short gestation Low birth weight Respiratory distress syndrome Respiratory conditions of newborrns Sudden infant death syndrome (SIDS) 
 
Over the past 40 years, the nationwide percentage of smokers has declined, falling from 40% in 1965 to 20% in 2007 (4, 5, 6); still many people continue to smoke. Cigarette smoking is responsible for over 10,000 deaths, more than 170,000 years of potential life lost, and approximately $3.4 billion in productivity losses in Georgia every year. 
The 2009 Georgia Tobacco Use Surveillance Report presents data on smoking-related deaths and costs, tobacco use prevalence, and policies affecting tobacco use. It also indicates the status of the tobacco use goals for Georgia as they relate to the Healthy People 2010 Objectives (Appendix Table I). This is the second comprehensive surveillance report describing the burden of tobacco use in Georgia. Data from this report will be used by the Georgia Department of Human Resources and partner organizations to evaluate, redesign, and enhance program activities and strategies focusing on tobacco use prevention in Georgia. 
 
6 
 
2009 Georgia Tobacco Use Surveillance Report 
 
 Burden of Tobacco Use in Georgia 
Mortality Cigarette smoking is a leading cause of preventable illness and death in Georgia. From 2002 to 2006, an estimated annual average of 10,359 deaths -or 17% of the annual average of 61,762 deaths due to all causes- among Georgians ages 35 years and older were attributed to cigarette smoking. Of these estimated deaths, 4,360 (42%) were due to cancer, 3,289 (32%) were due to cardiovascular diseases, and 2,710 (26%) were due to respiratory diseases (Figure 1). The most common causes of death attributed to smoking in Georgia were lung cancer (3,464 deaths), chronic obstructive pulmonary disease (COPD) (2,253 deaths), ischemic heart disease (1,686 deaths), and stroke (496 deaths). 
Figure 1. Average annual smoking-attributable deaths among adults ages 35 and older, Georgia, 2002-2006 
 
Attributed to smoking 17% 
Average annual adult deaths, all causes = 61,762 
Sources: Georgia Vital Statistics; CDC SAMMEC 
 
32% 
 
Cardiovascular 
 
diseases 
 
26% 
 
Respiratory 
 
42% 
 
diseases 
 
Cancer 
 
Average annual adult deaths attributed to smoking = 10,359 
 
From 2002 to 2006, cigarette smoking caused an estimated annual average of 6,463 deaths among adult males and 3,896 deaths among adult females in Georgia (Appendix Table A). 
From 2002 to 2006, cigarette smoking during pregnancy resulted in an estimated annual average of 17 infant deaths due to short gestation or low birth weight and 15 infant deaths due to sudden infant death syndrome (SIDS) (Appendix Table A). 
From 2002 to 2006, the average annual estimates of adult deaths attributed to smoking for each of the 18 public health districts ranged from 202 to 887 deaths (Appendix Table B). 
 
2009 Georgia Tobacco Use Surveillance Report 
 
7 
 
 Burden of Tobacco Use in Georgia 
 
Years of Potential Life Lost 
Years of potential life lost (YPLL), a calculation used to measure premature mortality, is the sum of the years of life lost annually by all persons who die before their expected age of death. From 2002 to 2006, an estimated 173,302 years of life were lost on average annually in Georgia from smoking. Adult male and female smokers lost an average of 16.5 years of potential life because they smoked. Adults who died from cancer, particularly lung cancer attributed to smoking, lost an average of 17.7 years of potential life. Adults who died from cardiovascular diseases and respiratory diseases attributed to smoking lost an average of 17.6 years and 13.1 years, 
respectively (Table 2). 
 
Table 2. Average annual years of potential life lost (YPLL), number of deaths, and average YPLL attributed to smoking by disease category and sex, Georgia, 2002-2006 
 
Cancer Male Female Total Cancer 
 
YPLL attributed to Deaths attributed 
 
smoking 
 
to smoking 
 
50,325 26,731 77,056 
 
2,945 1,415 4,360 
 
Average YPLL per death from smoking 
17.1 18.9 17.7 
 
Cardiovascular Diseases 
 
Male 
 
38,088 
 
2,091 
 
18.2 
 
Female 
 
19,827 
 
1,198 
 
16.6 
 
Total Cardiovascular Diseases 
 
57,915 
 
3,289 
 
17.6 
 
Respiratory Diseases 
 
Male 
 
17,954 
 
1,427 
 
12.6 
 
Female 
 
17,661 
 
1,283 
 
13.8 
 
Total Respiratory Diseases 
 
35,615 
 
2,710 
 
13.1 
 
Total Adult (35+ years) 
 
170,586 
 
10,359 
 
16.5* 
 
Perinatal Conditions 
 
Male 
 
1,477 
 
20 
 
Female 
 
1,239 
 
15 
 
Total Perinatal Conditions 
 
2,716 
 
35 
 
73.9 82.6 77.6 
 
Overall Total 
 
173,302 
 
10,394 
 
16.7 
 
* Indicates the average years of potential life lost attributed to smoking per adult smoker  Indicates the average years of potential life lost attributed to smoking per child born of a woman who smoked during pregnancy Source: Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) application 
 
Table 3. Average annual smoking-attributable economic costs, Georgia, 2002-2006 
 
Economic Costs 
 
Cost component 
 
The average annual smokingrelated productivity losses in Georgia during 2002-2006 were estimated at almost $2.3 billion for men and $1.2 billion for women. In 1998, the smoking-related adult healthcare costs were estimated at almost $1.8 billion. These healthcare costs plus the average annual productivity losses exceeded $5.2 billion per year (Table 3). 
 
Smoking-attributable productivity losses Men Women Total 
Smoking-attributable adult healthcare costs, 1998* Ambulatory care Hospital care Prescription drugs Nursing home Other care Total 
Total adult (35+ years) costs 
 
Total 
$2,278,000,000 $1,169,000,000 $3,447,000,000 
$742,000,000 $421,000,000 $149,000,000 $311,000,000 $135,000,000 $1,758,000,000 
$5,205,000,000 
 
Infant costs 
 
Smoking-attributable neonatal healthcare costs 
 
$9,000,000 
 
Total costs 
 
$5,214,000,000 
 
* Expenditure smoking-attributable fractions obtained from Miller, et.al and 1998 personal healthcare expenditure data obtained from Centers for Medicare and Medicaid Services.  Neonatal expenditures are based on the reimbursement levels used by a sample of private insurers in 1996. Smoking-attributable neonatal expenditures are based on data from 1999 Georgia Birth Certificate and Natality Reports. 
 
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2009 Georgia Tobacco Use Surveillance Report 
 
 Tobacco Use in Georgia 
 
Figure 2. Percentage of youth tobacco users, by school type and tobacco product, Georgia, 2007 
 
Percent 
 
50 
 
40 
 
30 
 
20 
 
10 
 
10 
 
6 
 
4 
 
0 Middle School 
 
26 19 8 
High School 
 
Any Tobacco Product* Cigarettes Smokeless Tobacco 
* Combined variable that includes use of cigarettes, cigars, smokeless tobacco, pipe, or bidis. 
Source: Georgia Student Health Survey (YRBS) 
 
Tobacco Use among Youth 
In 2007, approximately 36,000 (10%) middle school students and 113,000 (26%) high school students in Georgia used some form of tobacco; 23,000 (6%) middle school students and 81,000 (19%) high school students smoked cigarettes, while 15,000 (4%) middle school students and 39,000 (8%) high school students used smokeless tobacco (Figure 2). 
 
Figure 3. Percentage of youth smokers, by school type and sex, Georgia, 2007 
 
Male and female students smoked cigarettes at comparable rates (Figure 3). 
 
Percent 
 
50 
 
40 
 
30 
 
20 
 
10 
 
8 
 
5 
 
0 Middle School 
 
Male 
 
Source: Georgia Student Health Survey (YRBS) 
 
21 17 
High School Female 
 
Figure 4. Percentage of youth smokers, by school grade, Georgia, 2007 
 
50 
 
40 
 
30 
 
24 
 
20 
 
15 
 
17 
 
19 
 
10 
 
4 
 
6 
 
9 
 
0 
 
6th 
 
7th 
 
8th 
 
9th 10th 11th 12th 
 
Percent 
 
Among middle school students, 8th graders (9%) were significantly more likely than 6th graders (4%) to smoke cigarettes. Among high school students, 12th graders (24%) were significantly more likely than 9th graders (15%) to smoke cigarettes (Figure 4). 
 
Source: Georgia Student Health Survey (YRBS) 
 
2009 Georgia Tobacco Use Surveillance Report 
 
9 
 
 Tobacco Use in Georgia 
 
In both middle and high school, the smoking prevalence was significantly higher among non-Hispanic whites than among nonHispanic blacks (Figure 5). 
In 2007, approximately 22,000 (6.1%) middle school students smoked a whole cigarette before age 11 and approximately 68,000 (14.5%) high school students smoked a whole cigarette before age 13 (Appendix Table C). 
 
Figure 5. Percentage of youth smokers, by school type and race/ethnicity, Georgia, 2007 
 
50 
 
40 
 
Percent 
 
30 
 
20 
 
10 
 
9 
 
4 
 
6 
 
0 Middle School 
 
White 
 
Black 
 
* Data not presented, n<100 respondents 
 
Source: Georgia Student Health Survey (YRBS) 
 
25 20 
10 
High School Hispanic 
 
In 2007, approximately 1,400 (6%) middle school smokers and 24,000 (30%) high school smokers bought cigarettes at gas stations or convenience stores. Male and female middle school smokers were similarly likely to purchase cigarettes at gas stations or convenience stores; however, in high school, cigarettes purchases at gas stations or convenience stores were more common among male smokers than among female smokers (Figure 6). 
 
Figure 6. Percentage of youth who purchased cigarettes at gas stations or convenience stores, 
by school type and sex, Georgia, 2007 
 
Percent 
 
50 
 
40 
 
30 
 
20 
 
10 
 
8 
 
5 
 
0 Middle School 
 
Male 
 
Source: Georgia Student Health Survey (YRBS) 
 
34 24 
High School Female 
 
10 
 
2009 Georgia Tobacco Use Surveillance Report 
 
 Tobacco Use in Georgia 
 
Tobacco Use among Adults 
Cigarette use among adult Georgians has remained stable during the past decade. From 1985 through 1995 the prevalence of adult smokers declined by an average of 3% per year. From 1996 through 2007, however, the prevalence did not change significantly, declining by an average of 0.2% per year (Figure 7). 
 
Source: Georgia Behavioral Risk Factor Surveillance System (BRFSS) 
 
Figure 8. Percentage of adult smokers, Georgia, 2007 
 
50 
 
40 
 
Percent 
 
30 
 
20 
 
19 
 
10 
 
21 18 
 
19 20 15 
 
0 Total 
 
MF Sex 
 
Source: Georgia Behavioral Risk Factor Surveillance System (BRFSS) 
 
WB H Race/Ethnicity 
 
In 2007, approximately 1.3 million (19%) adult Georgians were current smokers, 23% were former smokers, and 58% were never smokers. More males (21%) than females (18%) smoked cigarettes. Non-Hispanic black adults (20%) were equally likely as nonHispanic white adults (19%) to smoke (Figure 8). 
 
Figure 9. Percentage of adult smokers, by age, 
Georgia, 2007 
 
50 
 
40 
 
30 
 
23 
 
22 
 
23 
 
20 
 
19 
 
18 
 
10 
 
8 
 
0 
 
18-24 
 
25-34 
 
35-44 
 
45-54 
 
55-64 
 
65+ 
 
The overall adult smoking prevalence was significantly higher among adults ages 18-64 than among adults ages 65 and older (Figure 9). 
 
Percent 
 
Source: Georgia Behavioral Risk Factor Surveillance System (BRFSS) 
 
2009 Georgia Tobacco Use Surveillance Report 
 
11 
 
 Tobacco Use in Georgia 
 
The smoking prevalence among adults in Georgia decreased with increasing education level. Adults who did not finish high school have the highest smoking prevalence (35%) among all educational attainment groups (Figure 10). 
The annual average adult smoking prevalence varied by public health district (Map 1). Table D in the Appendix lists the smoking prevalence for each of the public health districts. 
 
Figure 10. Percentage of adult smokers, by educational attainment, Georgia, 2007 
 
50 
 
40 
 
35 
 
30 
 
25 
 
23 
 
20 
 
10 
 
0 < High school High school Some College 
 
8 
College Graduate 
 
Percent 
 
Source: Georgia Behavioral Risk Factor Surveillance System (BRFSS) 
 
Map 1. Percent of Adults Who Smoke Cigarettes by Health District, Georgia 
 
2000 - 2003 
 
2004 - 2007 
 
Significantly above the state prevalence Same as the state prevalence Significantly below the state prevalence 
 
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2009 Georgia Tobacco Use Surveillance Report 
 
 Tobacco Use in Georgia 
 
Figure 11. Percentage of women who smoked during the last 3 months of their pregnancy, by educational attainment, Georgia, 2006 
50 
 
40 
 
Percent 
 
30 23 
 
20 
 
11 
 
10 
 
7 
 
0 <High School High School Some College 
 
2 
College Graduate 
 
Source: Georgia Pregnancy Risk Assessment and Monitoring System (PRAMS) 
 
Tobacco Use among Pregnant Women 
In 2006, 9.5% of women who delivered babies in Georgia smoked cigarettes during the last three months of pregnancy. Women with less than a high school education (23%) were significantly more likely than women with at least some college education to have smoked cigarettes in the last three months of pregnancy (Figure 11). Women with annual household incomes of less than $15,000 (15%) and women with annual household incomes between $15,000 and $24,999 (12%) were significantly more likely than women with annual household incomes of $50,000 or more (3.5%) to have smoked cigarettes in the last three months of pregnancy (Appendix Table E). 
 
2009 Georgia Tobacco Use Surveillance Report 
 
13 
 
 Secondhand Smoke and Asthma 
 
Figure 12. Percentage of youth and adults with asthma who smoke, Georgia, 2007 
 
Percent 
 
100 80 60 
40 20 
8 0 
Middle School 
 
19 High School 
 
24 Adults 
 
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Figure 13. Percentage of youth and adults who live with a smoker, by smoking status, Georgia, 2004 and 2005 
 
100 
 
80 
 
70 
 
60 
 
56 
 
59 
 
Percent 
 
40 
 
29 
 
31 
 
20 
 
16 
 
0 Middle School 
 
High School 
 
Adults 
 
Smokers 
 
Non-smokers 
 
Sources: 2004 Georgia Adult Tobacco Survey and 2005 Georgia Youth Tobacco Survey 
 
Figure 14. Percentage of youth exposed to SHS* at home, room, or car, 
by school type and asthma status, Georgia, 2005 
 
Percent 
 
100 
 
80 
 
66 
 
59 
 
60 
 
40 
 
20 
 
0 Middle School 
 
73 
 
69 
 
High School 
 
* Secondhand smoke (SHS) 
 
Asthma 
 
Source: Georgia Youth Tobacco Survey 
 
No Asthma 
 
Secondhand smoke is a known environmental trigger for asthma. Persons with asthma may experience severe asthma episodes or attacks as a result of being exposed to secondhand smoke. Despite this fact, many people with asthma choose to smoke. 
Approximately 41,000 (11%) middle school students, 44,000 (10%) high school students, and 524,000 (8%) adults in Georgia have asthma. Among these, approximately 3,000 (8%) middle school students, 8,000 (19%) high school students, and 126,000 (24%) adults smoke (Figure 12). 
The 2006 Surgeon General's report (3) concluded that exposure to secondhand smoke poses a health risk in children and non-smoking adults. Much progress has been achieved in the adoption of smokefree policies in public places during the past decade. Despite these efforts, many persons are exposed to secondhand smoke at home. Nearly three-fourths of middle school smokers (70%) and over half of high school smokers (56%) live with a smoker. Nearly one-third of middle school non-smokers (29%) and high school non-smokers (31%) live with a smoker. Nearly three in five (59%) adult smokers and one in six (16%) adult non-smokers in Georgia live with a smoker (Figure 13). 
Among youth with asthma, approximately twothirds (66%) of middle school students and three-fourths (73%) of high school students are exposed to secondhand smoke at home or from being in the same room or car with a smoker (Figure 14). 
 
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2009 Georgia Tobacco Use Surveillance Report 
 
 Reducing Tobacco Use in Georgia 
 
Former Smokers 
The quit ratio, defined as the number of former smokers in a given population divided by the number of ever smokers in that same population, is used as an indicator of quitting behavior among people who have ever smoked. In 2007, approximately 1.5 million (54%) adults in Georgia who had ever smoked reported that they were not currently smoking (Figure 15). 
 
Percent 
 
Figure 15. Proportion of former smokers among ever smokers, Georgia, 1996-2007 
60 50 40 30 20 10 
0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year 
 
The quit ratio was significantly higher among adults ages 55 and older than among adults ages 18-54 (Figure 16). 
The quit ratio was significantly higher among adults with a college education (73%) than among adults with fewer years of education (Figure 17). 
 
Source: Georgia Behavioral Risk Factor Surveillance System (BRFSS) 
 
Figure 16. Percentage of adult former smokers among adult ever smokers, 
by age, Georgia, 2007 
 
100 
 
81 80 
66 
 
60 
 
49 
 
51 
 
40 40 
 
20 
 
15 
 
0 
 
18-24 
 
25-34 
 
35-44 
 
45-54 
 
55-64 
 
65+ 
 
Percent 
 
Source: Georgia Behavioral Risk Factor Surveillance System (BRFSS) 
 
Figure 17. Percentage of adult former smokers among adult ever smokers, by educational attainment, Georgia, 2007 
100 
 
80 
 
73 
 
Percent 
 
60 43 
 
45 
 
50 
 
40 
 
20 
 
0 <High School High School Some College 
 
College Graduate 
 
Source: Georgia Behavioral Risk Factor Surveillance System (BRFSS) 
 
2009 Georgia Tobacco Use Surveillance Report 
 
15 
 
 Reducing Tobacco Use in Georgia 
 
* Adults who stopped smoking for one day or longer during the past 12 months because they were trying to quit smoking. Source: Georgia Behavioral Risk Factor Surveillance System (BRFSS) 
 
Smoking Cessation 
Approximately 760,000 (57%) adult smokers in Georgia stopped smoking for one day or longer during the past 12 months because they were trying to quit. More females than males made an attempt to quit smoking. NonHispanic black smokers were more likely than non-Hispanic white smokers to have stopped smoking for one day or longer in an attempt to quit. More smokers ages 18-24 made a quit attempt in 2007 than their older counterparts (Figure 18). 
 
Figure 2109. Percentage of adult smokers whose health care providers advised to quit, 
by type of assistance given, Georgia, 2004 
100 
 
80 
 
Percent 
 
60 
 
40 
 
30 
 
23 
 
20 
 
17 
 
0 
 
Prescribed medication 
 
Suggested setting a Suggested taking a 
 
specific date for cessation class or 
 
quitting 
 
program 
 
Source: Georgia Adult Tobacco Survey 
 
Approximately 151,000 (25%) adult smokers who made a quit attempt used medication such as nicotine patch or gum on their last quit attempt. Approximately 673,000 (59%) adult smokers are seriously considering stopping smoking. 
Approximately 485,000 (67%) adult smokers who visited their health care provider in the past year indicated their health care provider advised them not to smoke. Among them, approximately 144,000 (30%) were given a prescription for medication to help them quit and approximately 80,000 (17%) were advised to participate in a smoking cessation class or program (Figure 19). 
 
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2009 Georgia Tobacco Use Surveillance Report 
 
 Policy 
Policies that restrict or prohibit smoking prevent some people from starting to smoke, help current smokers quit, and reduce exposure to secondhand smoke. 
 
Home and Worksite Policies 
Over half (53%) of adult smokers and a majority (88%) of adult non-smokers do not allow smoking anywhere inside their home (Figure 20). 
 
Figure 201. Percentage of adults who live in smoke-free* homes, 
by smoking status and sex, Georgia, 2006 
 
100 
 
80 
 
60 
 
55 
 
50 
 
88 
 
88 
 
Percent 
 
40 
 
20 
 
0 Smokers 
 
Non-smokers 
 
Male 
*Smoking is not allowed anywhere inside the home. 
 
Female 
 
Source: Georgia Behavioral Risk Factor Surveillance System (BRFSS) 
 
Three-fourths (78%) of adult smokers and a majority (87%) of adult non-smokers indicated that their worksite does not allow smoking anywhere in the workplace. Females were more likely than males to indicate their worksite does not allow smoking (Figure 21). 
 
FFigure 221. Percentage of adults who work in smoke-free* workplaces, 
by smoking status and sex, Georgia, 2006 
 
100 
 
80 
 
76 
 
80 
 
85 
 
90 
 
Percent 
 
60 
 
40 
 
20 
 
0 Smokers 
 
Non-smokers 
 
Male 
*Worksite's official policy prohibits smoking in all work areas. 
 
Female 
 
Source: Georgia Behavioral Risk Factor Surveillance System (BRFSS) 
 
2009 Georgia Tobacco Use Surveillance Report 
 
17 
 
 Policy 
School Policies The School Health Profiles (Profiles) was conducted in the spring of 2006 to assess existing health-related school policies and to monitor characteristics of health education programs in public middle and high schools in Georgia. 
 
FFiigguurree2223aa.. Percentage of middle schools that have a policy prohibiting tobacco use, 
by group and time, Georgia, 2006 
 
Percent 
 
99 
 
100 
 
86 
 
80 
 
60 
 
40 
 
20 
 
0 Students 
 
98 81 
Faculty/staff 
 
96 76 
Visitors 
 
During school hours During non-school hours 
Source: Georgia School Health Profiles Survey 
 
Findings from Profiles indicate that almost all public schools in Georgia (99%) had a policy prohibiting tobacco use (i.e., cigarettes, smokeless tobacco, cigars, and pipes) (Figures 22a, 22b, Appendix Table F). Most schools (95%) had a policy prohibiting tobacco use by students, faculty, and staff during school hours and in school buildings, grounds and property (Appendix Table G). 
 
Figure 232b. Percentage of high schools that 
 
have a policy prohibiting tobacco use, 
 
by group and time, 
 
Georgia, 2006 
 
99 
 
100 
 
88 
 
80 
 
96 80 
 
94 71 
 
Percent 
 
60 
 
40 
 
20 
 
0 Students 
 
Faculty/staff 
 
Visitors 
 
During school hours During non-school hours 
Source: Georgia School Health Profiles Survey 
 
Most middle schools and high schools had procedures to inform students (99% MS, 100% HS) and school faculty and staff (88% MS, 93% HS) about compliance with the school's policy on tobacco use; however, only about two-thirds of middle schools and high schools had procedures to inform visitors about compliance (Appendix Table H). 
 
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2009 Georgia Tobacco Use Surveillance Report 
 
 Policy 
Support of Smoke-free Laws and Taxation The Adult Tobacco Survey (ATS) was conducted in 2004 to obtain information about knowledge, attitudes, and beliefs on tobacco use and to assess the level of support of tobacco-related policies among the adult population in Georgia. The survey was conducted prior to the enactment of the Georgia Smokefree Air Act of 2005. It included a question on the level of support of laws making restaurants smoke-free. 
 
Survey findings indicate that 50% of smokers and 82% of non-smokers supported laws making restaurants smoke-free. Black smokers (70%) were more likely than white smokers (41%) to support smoke-free laws (Figure 23). 
 
Figure 243. Percentage of adults who support laws making restaurants smoke-free*, by smoking status and race, Georgia, 2004 
 
100 
 
80 
 
70 
 
60 
 
50 
 
41 
 
40 
 
82 82 84 
 
Percent 
 
20 
 
0 Smokers 
 
Non-smokers 
 
Total 
 
White 
 
Black 
 
* Responses were obtained prior to the enactment of the Georgia Smokefree Air Act of 2005 
 
Source: Georgia Adult Tobacco Survey 
 
The ATS also included a question on the level of support of an additional tax on cigarettes if the money raised was used to support tobacco use prevention programs. Survey findings indicate that 46% of smokers and 75% of non-smokers were willing to support an additional tax on cigarettes. The proportion of non-smoking adults who support a cigarette tax increased with increasing educational attainment (Figure 24). 
 
FFiigguurree 2245.. Percentage of adults who support an additional tax on cigarettes, 
by smoking status and educational attainment, Georgia, 2004 
 
100 
 
80 
 
60 
 
51 43 48 44 
 
40 
 
70 77 81 58 
 
Percent 
 
20 
 
0 Smokers 
 
Non-smokers 
 
<High School High School 
Source: Georgia Adult Tobacco Survey 
 
Some College 
 
College Graduate 
 
2009 Georgia Tobacco Use Surveillance Report 
 
19 
 
 Summary and Implications for Prevention 
Data described in this report provide information about the burden and prevention of tobacco-related illness in Georgia. 
 Over 10,000 adult Georgians die from smoking-related illnesses annually, about one death out of every 6. Implications for prevention: o The burden of smoking-related illness in Georgia is high. Health promotion messages educating the public about the dangers of tobacco use should continue to be provided at all levels of patient care. o Stopping smoking is beneficial to all smokers, regardless how long they have smoked (8). Tobacco users should be encouraged to kick the habit and referred to cessation professionals for assistance in quitting. o Maintaining and supporting statewide comprehensive tobacco use prevention programs is necessary to reduce the burden. 
 About 35 infants die every year in Georgia because their mothers smoked during pregnancy. Implications for prevention: 
o Smoking cessation programs for pregnant women have been shown to be cost effective and to double the rates for quitting, thus reducing the prevalence of smoking during pregnancy (9). 
o Although many women voluntarily quit smoking during pregnancy, about two-thirds of them are smoking again a year after delivery. Smoking cessation and prevention efforts tailored to these women should resume post partum (10, 11). 
 Tobacco use costs over $3 billion in productivity losses alone annually in Georgia. Implications for prevention: 
o Reducing tobacco use in Georgia saves money for individuals, businesses, and government. 
 Approximately one out of five (19%) adult Georgians smoke cigarettes. This percentage has remained stable in recent years. More males than females smoke cigarettes. Younger adults and adults with fewer years of education are more likely to smoke than older adults or adults with more years of education. Implications for prevention: o Although smoking is prevalent among all segments of society, some groups are more likely to smoke than others. Smoking cessation and prevention activities should include efforts targeting groups in which smoking is most prevalent, namely, males, younger people and people with fewer years of education. o Youth and lower income smokers are more likely to quit or smoke less than other smokers because of an increase in the cost of cigarettes. A 10 percent increase in the cost of cigarettes reduces consumption of cigarettes by 3  5% (12). 
 
20 
 
2009 Georgia Tobacco Use Surveillance Report 
 
 Summary and Implications for Prevention 
 6% of middle school students and 19% of high school students in Georgia smoke cigarettes. Youth usually purchase their cigarettes at gas stations or convenience stores. Implications for prevention: o Establishing comprehensive school policies restricting tobacco use may help reduce the prevalence of smoking among students (13). o Strict enforcement of laws and regulations that prohibit the sale of tobacco products to individuals younger than 18 years of age have been shown to hinder youth purchases of tobacco, which may reduce the youth smoking prevalence (14). 
 One in three non-smokers in both middle and high schools live with a smoker. Implications for prevention: 
o Establishing voluntary home rules that prohibit smoking anywhere inside the home protects non-smokers from secondhand smoke exposure while at home. 
o Reducing and eliminating secondhand smoke at home helps minimize complications from asthma and other respiratory conditions in children and adults. 
 The prevalence of cigarette smoking among persons with asthma in Georgia is as high as among the general population. Many youth living with asthma are exposed to secondhand smoke. o Stopping smoking and avoiding exposure to secondhand smoke help persons with asthma manage their condition by reducing the frequency and severity of asthma attacks. o Eliminating indoor smoking in public places helps reduce potential environmental triggers for asthma (3). 
 More than half (57%) of current adult smokers tried to quit smoking during the past year. Implications for prevention: 
o Raising the cost of tobacco products is helpful to many smokers who are trying to stop smoking (12). Low-income smokers may be more likely to benefit than high-income smokers from a higher cost of tobacco. 
o Comprehensive health education interventions or clinical counseling helps smokers quit (15). 
 Most public schools (99%) in Georgia have policies limiting or prohibiting tobacco use on the premises. Many employed adults (85%) indicate their worksite has a policy that does not allow smoking at work. Implications for prevention: o Compliance with and enforcement of the state law restricting smoking in public places promote clean livable environments and make public smoking less acceptable. o County and local governments should be encouraged to establish strong smoking regulations within their borders. Smoking restrictions in public places (e.g., restaurants) help smokers stop or reduce smoking (12). In areas where smoking restrictions in restaurants and bars have been enacted, the establishments are not financially hurt (16). 
 
2009 Georgia Tobacco Use Surveillance Report 
 
21 
 
 Methodology and Limitations 
Methodology 
This report compiles tobacco-related information from a variety of available data sources in Georgia. Mortality data Mortality data in Georgia were obtained from Georgia Vital Statistics. Deaths for 23 conditions for which smoking is a contributing cause were counted and categorized using the ICD-10 codes listed in appendix table A. Smoking-Attributable Mortality Estimates 
The Smoking Attributable Morbidity, Mortality, and Economic Costs (SAMMEC) application developed by the Centers for Disease Control and Prevention (CDC) derives smoking-attributable mortality (SAM) using an attributable-fraction formula (17). The smoking-attributable fractions (SAF) of adult deaths for 19 smoking-related diseases are calculated using sex-specific smoking prevalence and relative risk (RR) of death for adult current and former smokers aged 35. Infant mortality SAFs are calculated using maternal smoking prevalence and RR of death for four infant conditions caused by smoking. SAFs for each disease and sex are derived using the following formula: 
SAF = [(p0 + p1(RR1) + p2(RR2)) - 1] / [p0 + p1(RR1) + p2(RR2)] For adults: 
p0 = Percentage of adult never smokers in study group p1 = Percentage of adult current smokers in study group p2 = Percentage of adult former smokers in study group RR1 = Relative risk of death for adult current smokers relative to adult never smokers RR2 = Relative risk of death for adult former smokers relative to adult never smokers 
For infants: p0 = Percentage of maternal non-smokers in study group p1 = Percentage of maternal smokers in study group p2 = Not applicable RR1 = Relative risk of death for infants of maternal smokers relative to infants of maternal nonsmokers RR2 = Not applicable 
Data for former smokers are not included in the SAF for infants because it calculates the impact of maternal smoking during pregnancy. Prevalence Data 
SAMMEC uses separate prevalence data for adult smokers aged 35-64 and 65 years. The adult smoking prevalence estimates for 2000-2006 were obtained from the Georgia Behavioral Risk Factor Surveillance System (BRFSS). Maternal smoking prevalence estimates for 2000-2006 were obtained from Georgia Vital Statistics as noted on birth certificates. 
Relative Risk Data 
SAMMEC uses age-adjusted RR estimates for adults aged 35 years from the second wave of the American Cancer Society's Cancer Prevention Study (CPS-II) six year follow-up. Separate RR data are used for smokers aged 35-64 and 65 years for ischemic (or coronary) heart disease and cerebrovascular disease (stroke). The RR of death from smoking drops dramatically after age 65 for these two conditions. 
 
22 
 
2009 Georgia Tobacco Use Surveillance Report 
 
 Methodology and Limitations 
For infants, SAMMEC uses RR estimates for short gestation/low birth weight, Sudden Infant Death Syndrome (SIDS), Respiratory Distress Syndrome (RDS), and other respiratory infant conditions of the newborn from a meta analysis of epidemiological literature conducted by Gavin et al. (2001). 
Estimation of the Average Annual Smoking-Attributable Mortality 
SAMMEC applies the age- and sex-specific adult SAFs to adult mortality data for each smoking-related disease in the population under study. Mortality data by cause of death in Georgia for 2002-2006 were obtained from Georgia Vital Statistics. The average annual number of deaths is multiplied by the relevant SAF for each smoking-related cause of death. 
SAMMEC applies the infant SAF to infant mortality data derived from Georgia Vital Statistics' infant birth and death records. The following formula is used to calculate the SAM: 
SAM =Number of deaths x SAF 
Summing across age categories provides the sex-specific estimate of SAM for each cause of death. The average annual SAM is the sum of smoking-attributable deaths across age groups, and across causes of death for both sexes combined. 
Estimation of Average Annual Years of Potential Life Lost 
SAMMEC estimates the annual average impact of premature deaths on the life expectancy of adult smokers and infants of maternal smokers. Smoking-attributable years of potential life lost (YPLL) are the sum of years of life lost from premature deaths caused by smoking. 
SAMMEC multiplies the number of smoking-attributable adult deaths by the midpoint estimate of remaining life expectancy (RLE) for each smoking-related cause of death, sex, and 5-year age group, while for infants it uses the RLE at birth for both sexes to calculate adult and infant YPLL through the following formula: 
Smoking-attributable YPLL = SAM x RLE 
Age- and sex-specific remaining life expectancy data for the nation for 2002-2006 were obtained from National Center for Health Statistics (18). Average annual YPLL estimates are generated for each disease, major disease category, and all diseases combined, by sex and both sexes combined. 
Estimation of Years of Potential Life Lost per Smoker 
The average annual smoking-attributable YPLL per smoker was calculated using the following formula: 
 
Average annual smoking -attributable YPLL per smoker 
 
= 
 
Average annual smoking-attributable YPLL due to a cause of death 
SAM due to a cause of death 
 
2009 Georgia Tobacco Use Surveillance Report 
 
23 
 
 Methodology and Limitations 
 
Smoking-attributable Death Estimates at the Health District Level 
Proportions were used to calculate estimates of smoking-attributable deaths for each health district. Presuming that the risk of dying from tobacco use in each district was similar to the risk in the state, the smoking-attributable deaths for each disease category were divided by the total number of deaths for each disease category during 2002-2006, and this resulting rate was in turn multiplied times the district's average annual number of deaths for each disease category: 
 
District SAM = 
 
State SAM for each disease category State deaths for each disease category 
 
X 
 
District deaths for each disease category 
 
Calculation of the Quit Ratio 
 
The quit ratio was calculated to obtain the percent of former adult smokers using the following formula: 
 
Quit ratio = 
 
Former smokers X 100 Ever smokers 
 
Behavioral Risk Factor Surveillance System 
Georgia Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed to obtain the adult smoking prevalence and quit ratios. The BRFSS is a survey conducted annually by the Division of Public Health, Georgia Department of Human Resources. The survey is administered by telephone to the noninstitutionalized, civilian population ages 18 years and older in Georgia using standardized methods and questionnaires. The BRFSS covers a wide range of modifiable health behaviors related primarily to chronic diseases, including high blood pressure, obesity, binge drinking, and cigarette smoking. Data have been collected in Georgia annually since 1984. 
All estimates presented in this report are based on 2007 survey findings. 
Youth Surveys 
Data on tobacco use among youth and purchasing ability were obtained from the 2007 Georgia Student Health Survey (Georgia's Youth Risk Behavior Survey). Data on exposure to secondhand smoke were obtained from the 2005 Georgia Youth Tobacco Survey. Both are school-based surveys administered to a representative sample of middle and high school students in the state (19, 20). 
 
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2009 Georgia Tobacco Use Surveillance Report 
 
 Methodology and Limitations 
Adult Surveys Data on support of tobacco-related laws and taxation were obtained from the 2004 Georgia Adult Tobacco Survey. The survey provided data on knowledge, attitudes and beliefs related to tobacco use among the adult Georgian population (21). 
School Health Profiles The School Health Profiles (Profiles) was administered to principals and lead health education teachers of a representative sample of randomly selected public middle and high schools in Georgia. Survey topics included health education requirements, health education coordination, physical education and physical activity programs, tobacco prevention policies, nutrition-related policies and practices, violence prevention, asthma management, and HIV prevention programs and policies (22). The questionnaires answered by principals assessed school policies prohibiting tobacco use, advertising, sponsorship of school events, actions taken when students are caught smoking, and school referrals to cessation programs for students, faculty, and staff. The teacher questionnaire assessed topics covered in the school's health education curriculum and the grades at which those topics were taught. 
Limitations 
Smoking-Attributable Morbidity, Mortality, and Economic Costs (SAMMEC) 
The methodology used to calculate the smoking-attributable deaths is subject to several limitations. The smoking-attributable mortality figures in this report were estimated by using smoking prevalence and mortality data for 2002-2006, whereas actual smoking-attributable deaths are the result of cumulative exposure to tobacco at higher rates from previous decades. Relative risks were adjusted for the effects of age but not for other potential confounders, although studies have shown that these confounders have little impact on the relative risk of death from smoking. Mortality estimates do not include deaths from smoking cigars or pipes, from using smokeless tobacco, or from secondhand smoke. Smoking-attributable expenditures were derived by applying 1993 smoking-attributable fractions of expenditures to 1998 personal health care expenditure data. Changes in the health care system, economic and demographic characteristics, and risk behaviors between 1993 and 1998 may have influenced the smoking-attributable fractions. Productivity loss estimates do not include the value of lost work time from smoking-related illness, absenteeism, excess work breaks, and secondhand smoke-related disease morbidity and mortality. The medical costs of maternal smoking may be underestimated because the future medical costs of children born to women who smoked during pregnancy and the costs of treating conditions related to secondhand smoke are not taken into account. SAMMEC does not provide smoking-attributed morbidity estimates. 
Youth Risk Behavior Survey (YRBS) and Youth Tobacco Survey (YTS) 
Youth prevalence data apply only to middle school and high school students enrolled in Georgia's public education system, and, therefore, are not representative of all persons in this age group. All data are selfreported and, for certain behaviors, the reported estimates may be subject to recall bias. 
 
2009 Georgia Tobacco Use Surveillance Report 
 
25 
 
 Methodology and Limitations 
PRAMS 
PRAMS data are representative only of pregnant women who delivered live-born infants. Smoking estimates during pregnancy are based on self-reported data and may be subject to recall bias. Because PRAMS does not collect data on alcohol or tobacco use during the first or second trimesters of pregnancy, the prevalence of use of these substances in early pregnancy could be underestimated. PRAMS may not accurately obtain the prevalence of folic acid intake in the form of multivitamin use. The prevalence of unintended pregnancies is probably underestimated because PRAMS reports only unintended pregnancies resulting in a live birth. 
Behavioral Risk Factor Surveillance System (BRFSS) and Adult Tobacco Survey (ATS) 
Both BRFSS and ATS are telephone-based surveys. The survey sample includes only persons residing in households with telephone land lines. It excludes persons living in institutions such as assisted living facilities and the military. Prevalence data may not be representative of all adults in Georgia. All data are self-reported and, for certain behaviors, the reported estimates may be subject to recall bias. 
Profiles 
Policy data from the School Health Profiles are self-reported by school principals and lead health education teachers and may be subject to bias. Private and alternative schools are not included in the survey sample. 
 
26 
 
2009 Georgia Tobacco Use Surveillance Report 
 
 Glossary 
Acute myeloid leukemia: a cancer of the blood and bone marrow that affects the normal development of white blood cells necessary for fighting off infections and that can spread to other parts of the body. 
Aortic aneurysm: a bulge in the wall of the aorta (a large blood vessel that carries blood from the heart to the rest of the body) that has become stretched out and thin, and in which blood clots may form. 
Asthma: a chronic inflammatory disorder of the airways characterized by periodic attacks of wheezing, shortness of breath, chest tightness, and coughing. 
Atherosclerosis: thickening and hardening of artery walls. 
Bronchitis, chronic: a form of chronic obstructive pulmonary disease characterized by persistent cough that brings up mucus from the lungs. 
Cancer: a group of diseases characterized by uncontrolled growth and spread of abnormal cells that can result in death. 
Cardiovascular disease: includes a wide variety of diseases of the heart and blood vessels, such as ischemic heart disease, stroke, congestive heart failure, hypertensive disease, and atherosclerosis. 
Cerebrovascular disease: also known as stroke, occurs when a blood vessel (artery) that supplies blood to the brain bursts or becomes blocked by a blood clot resulting in damage and death of nerve cells in the affected area of the brain. 
Chronic Obstructive Pulmonary Disease (COPD): a group of chronic lung conditions characterized by obstruction of the airways in the lungs, which traps air in the lungs, making it difficult for an individual to breathe in and out normally. 
Current adult smokers: adults who have smoked at least 100 cigarettes in their lifetime and now smoke every day or some days. 
Current youth smokers: middle and high school students who have smoked cigarettes on one or more days in the 30 days preceding the survey. 
Emphysema: a form of chronic obstructive pulmonary disease characterized by irreversible damage to the air sacs in the lungs. The air sacs are unable to completely deflate and are therefore unable to fill with fresh air to ensure adequate oxygen supply to the body. 
Ever adult smokers: adults who have smoked 100 cigarettes in their lifetime. 
Ever youth smokers: middle and high school students who have ever tried cigarette smoking, even one or two puffs. 
Former adult smokers: adults who have smoked 100 or more cigarettes in their lifetime but who do not currently smoke. 
 
2009 Georgia Tobacco Use Surveillance Report 
 
27 
 
 Glossary 
 
Former youth smokers: middle and high school students who have smoked 100 or more cigarettes in their lifetime but who have not smoked in the last 30 days. 
Hypertension: also known as high blood pressure, occurs when the systolic pressure is consistently over 140 mmHg, or the diastolic blood pressure is consistently over 90 mmHg. 
Influenza: a viral illness that comes on suddenly, causing fever, shaking chills, body aches, headache, and fatigue, which usually last for 3 to 4 days, followed by a dry cough, runny nose, and sore or scratchy throat for another week or so. 
International Classification of Diseases, 10th Revision (ICD-10): an alphanumeric coding scheme developed by the World Health Organization, used for mortality data since 1999, that arranges diseases and injuries into groups according to established criteria. It is used to improve comparability of cause of death statistics reported by different governmental entities. 
Ischemic heart disease: also known as coronary heart disease, is the term given to heart problems caused by a narrowing of the coronary arteries and includes heart attacks. 
Low birth weight: a live birth with a weight of less than 2500 grams (5lbs. 8oz.). 
Non-smokers, adults: persons who have not smoked 100 cigarettes in their lifetime. 
Non-smokers, youth: middle and high school students who have not smoked cigarettes on one or more days in the 30 days preceding the survey. 
Prevalence: an estimate of how many people in a defined population have a specific disease at a given time. 
 
Pneumonia: a bacterial or viral infection of the lungs that may cause fevers, coughing, chills, shallow breathing, chest pains, rapid heartbeat, and weakness or fatigue. 
Quit ratio: the percentage of ever smokers who have quit. 
Respiratory distress syndrome: respiratory difficulty in newborn infants, common in babies born prematurely. 
Secondhand smoke: tobacco smoke that is generated from the burning end of a cigarette, pipe or cigar and the smoke that is exhaled by smokers of these tobacco products. It is also known as environmental tobacco smoke (ETS). 
 
Short gestation: a fetus born before 37 weeks after conception. 
 
Sudden infant death syndrome: the sudden and unexpected death of a baby with no known illnesses, typically affecting sleeping infants between the ages of two weeks to six months. 
 
Years of potential life lost: a measure of the impact of premature mortality on a population, calculated as the sum of the differences between some predetermined minimum or desired life span and the age of death for individuals who died earlier than that predetermined age. 
 
28 
 
2009 Georgia Tobacco Use Surveillance Report 
 
 References 
1. U.S. Public Health Service. Smoking and Health Report of the Advisory Committee to the Surgeon General of the Public Health Service. US Department of Health, Education and Welfare, Public Health Service, Centers for Disease Control. PHS Publication No. 1103, 1964. 
2. Centers for Disease Control and Prevention. Smoking and Tobacco Use. http://www.cdc.gov/tobacco/ basic_information/index.htm 
3. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. 
4. U.S. Department of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 89-8411, Prepublication version, January 11, 1989. 
5. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System (BRFSS), Nationwide Prevalence Data, 2007. http://www.apps.nccd.cdc.gov/brfss/index.asp 
6. Centers for Disease Control and Prevention. Tobacco Use Among Adults  United States, 2005. MMWR 2006; 55(42);1145-1148. 
7. Centers for Disease Control and Prevention. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses  United States, 1997-2001. MMWR 2005; 54(25);625-628. 
8. U.S. Department of Health and Human Services. The Health Benefits of Smoking Cessation. US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 90-8416. 1990. 
9. U.S. Department of Health and Human Services. Women and Smoking. A Report of the Surgeon General. Rockville (MD): US Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2001. 
10. Wall MA, Severson HH, Andrews JA, Lichtenstein E, Zoref L. Pediatric Office-based Smoking Intervention: Impact on Maternal Smoking and Relapse. Pediatrics 1995; 96(4): 622-628. 
11. Mullen PD, DiClemente CC, Bartholomew LK. Theory and Context and Project PANDA: a Program to Help Post-partum Women Stay Off Cigarettes. In Bartholomew LK, Parcel GS, Kok G, Gottlieb H. Designing Theory- and Evidence-based Health Promotion Programs. Mountain View, California: Mayfield Publishers, 2000; 453-477. 
12. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000. 
 
2009 Georgia Tobacco Use Surveillance Report 
 
29 
 
 References 
13. Moore L, Roberts C, Tudor-Smith C. School smoking policies and smoking prevalence among adolescents: multilevel analysis of cross-sectional data from Wales. Tobacco Control 2001;10:117-123 (Summer). 
14. National Cancer Institute. State and Local Legislative Action to Reduce Tobacco Use. Smoking and Tobacco Control Monograph No. 11. Bethesda, MD. US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, NIH Pub. No. 00-4804, 2000. 
15. Centers for Disease Control and Prevention. Strategies for Reducing Exposure to Environmental Tobacco Smoke, Increasing Tobacco-Use Cessation, and Reducing Initiation in Communities and Health-Care Systems. MMWR 2000;49:RR-12. 
16. Bartosch WJ, Pope GC. The Economic Effect of Smoke-free Restaurant Policies on Restaurant Businesses in Massachusetts. Journal of the Public Health Management Practice. 1999; 5(1): 53-62. 
17. Centers for Disease Control and Prevention. Smoking-attributable mortality, morbidity, and economic costs (SAMMEC): adult SAMMEC and maternal and child health (MCH) SAMMEC application, 2002. http://apps.nccd.cdc.gov/sammec/ 
18. National Center for Health Statistics. United States Life Tables, 2003. National Vital Statistics reports; vol. 54 no. 14. Hyattsville, MD, Revised March 28, 2007. 
19. Kanny D, Horan J, Figueroa A. 2007 Georgia Student Health Survey Report. Georgia Department of Human Resources, Division of Public Health, July 2008. Publication Number: DPH08/190HW. http://health.state.ga.us/pdfs/epi/cdiee/2003-2005-2007_GaStudentHealthSurveyReport.pdf. 
20. Kanny D and Figueroa A. 2005 Georgia Youth Tobacco Survey Report. Georgia Department of Human Resources, Division of Public Health, September 2006. Publication Number: DPH06/143HW. http://health.state.ga.us/pdfs/epi/cdiee/2005%20Georgia%20Youth%20Tobacco%20Survey%20Report.pdf. 
21. Figueroa A and Kanny D. 2004 Georgia Adult Tobacco Survey Report. Georgia Department of Human Resources, Division of Public Health, Chronic Disease, Injury, and Environmental Epidemiology Section, October 2006. Publication Number: DPH07/005HW. http://health.state.ga.us/pdfs/epi/cdiee/Adult%20Tobacco%20Survey%20Report,%20Georgia,%202004.pdf. 
22. Falb M, Figueroa A, Kanny D. 2006 Georgia School Health Profiles Report. Georgia Department of Human Resources, Division of Public Health, Chronic Disease, Injury, and Environmental Epidemiology Section, March 2007. Publication Number: DPH07/027HW. http://health.state.ga.us/pdfs/epi/cdiee/2006GASchoolHealthProfiles.pdf. 
 
30 
 
2009 Georgia Tobacco Use Surveillance Report 
 
 Table A. Average annual smoking-attributable mortality (SAM) and years of potential life lost (YPLL) by cause of death and sex, adults 35 and older and TablienfAa.nStsmoonkeinyge-aatrtraibnudtayboluenmgoerrt,aGliteyo(rSgAiaM, )2a0n0d2 y- e2a0r0s6of potential life lost (YPLL) by cause of death and sex, adults 35 and older and infants one year and younger, Georgia, 2002-2006 
 
Appendices | Table A 
 
2009 Georgia Tobacco Use Surveillance Report 
 
Disease Category Neoplasms Lip, Oral cavity, Pharynx Esophagus Stomach Pancreas Larynx Trachea, Lung, Bronchus Cervix Kidney and Renal Pelvis Bladder Acute myeloid leukemia 
 
ICD-10* 
C00-C14 C15 C16 C25 C32 
C33-C34 C53 
C64-C65 C67 
C92.0 
 
Deaths 144 248 161 377 83 
2,610 0 
185 177 
87 
 
Male SAM 
106 178 
44 83 69 2,292 
0 71 83 20 
 
YPLL 2,112 3,386 778 1,523 1,267 
38,556 0 
1,279 1,091 
333 
 
Deaths 69 79 
119 387 
22 1,672 
114 118 
89 75 
 
Female SAM 32 45 13 87 16 1,172 13 6 24 7 
 
YPLL 614 881 241 
1,518 334 
22,190 373 140 299 140 
 
Both sexes 
 
Deaths SAM 
 
213 
 
138 
 
327 
 
223 
 
280 
 
57 
 
764 
 
170 
 
105 
 
84 
 
4,282 
 
3,464 
 
114 
 
13 
 
303 
 
77 
 
266 
 
107 
 
162 
 
27 
 
YPLL 2,726 4,267 1,019 3,040 1,601 
60,746 373 
1,419 1,391 
473 
 
Total Neoplasms 
 
4,072 
 
2,945 50,325 
 
2,744 
 
1,415 26,731 
 
6,816 
 
4,360 77,055 
 
Cardiovascular Diseases: Ischemic Heart Disease 
Aged 35-64 years Aged 65+ years Other Heart Disease 
Cerebrovascular Disease Aged 35-64 years Aged 65+ years 
Atherosclerosis Aortic Aneurysm Other diseases of circulatory system 
 
I20-I25 
I00-I09, I26I51 
I60-I69 
I70 I71 I72-I78 
 
1,661 3,219 
2,905 
412 1,169 
108 199 109 
 
648 17,308 
 
483 
 
4,767 
 
536 
 
8,315 
 
152 
 
4,096 
 
98 
 
910 
 
29 
 
373 
 
128 
 
2,078 
 
15 
 
240 
 
626 3,495 
3,634 
341 2,081 
174 126 147 
 
206 
 
6,094 
 
2,287 
 
350 
 
3,175 
 
6,714 
 
303 
 
4,078 
 
6,539 
 
137 
 
4,278 
 
753 
 
108 
 
953 
 
3,250 
 
14 
 
140 
 
282 
 
61 
 
868 
 
325 
 
20 
 
242 
 
256 
 
854 23,401 
 
833 
 
7,942 
 
840 12,393 
 
290 
 
8,374 
 
206 
 
1,863 
 
43 
 
513 
 
190 
 
2,946 
 
35 
 
482 
 
Total Cardiovascular Diseases 
 
9,782 
 
2,091 38,088 10,624 
 
1,198 19,827 20,406 
 
3,289 57,915 
 
Respiratory Diseases: Pneumonia, Influenza Bronchitis, Emphysema Chronic Airway Obstruction 
 
J10-J18 J40-J43 
J44 
 
677 238 1,304 
 
152 216 1,059 
 
1,780 2,913 13,261 
 
897 215 1,346 
 
116 
 
1,337 
 
172 
 
2,622 
 
994 13,702 
 
1,574 453 
2,650 
 
269 388 2,053 
 
3,116 5,535 26,963 
 
Total Respiratory Diseases 
 
2,219 
 
1,427 17,954 
 
2,458 
 
1,283 17,661 
 
4,677 
 
2,710 35,615 
 
Total Adult 
 
16,073 
 
6,463 106,366 15,826 
 
3,896 64,219 31,899 10,359 170,585 
 
Perinatal Conditions: Short Gestation / Low Birth Weight Respiratory Distress Syndrome Respiratory Conditions - Newborn Sudden Infant Death Syndrome 
 
P07 P22 P23-P28 R95 
 
125 
 
10 
 
713 
 
101 
 
26 
 
1 
 
56 
 
23 
 
30 
 
1 
 
88 
 
16 
 
73 
 
8 
 
621 
 
57 
 
8 
 
616 
 
226 
 
1 
 
53 
 
49 
 
1 
 
50 
 
46 
 
6 
 
519 
 
130 
 
17 
 
1,329 
 
1 
 
110 
 
2 
 
138 
 
15 
 
1,139 
 
Total Perinatal Conditions 
 
254 
 
20 
 
1,477 
 
197 
 
15 
 
1,239 
 
451 
 
35 
 
2,716 
 
Overall Total 
 
16,327 
 
6,483 107,844 
 
* International Classification of Diseases, Tenth Revision used since 1999 for specifying cause of death. * InternationaTloCtalalsmsifaicyatnioont oafdDdisuepaseexsa, cTtelyntbheRceavuissioenouf sroedunsdinicneg1t9o9n9efoarrespset cinifyteinggecr.ause of death. Mortality daMtaosrotaulrictye:dGaetaorgsioauVrcitael:SGtaetiosrtigcisa. Vital Statistics. 
 
16,023 
 
3,912 65,458 32,350 10,394 173,301 
 
31 
 
 Appendices | Table B & C 
 
Table B. AveTraabglee Ba.nAnvuearlasgme oankninuga-lastmtriobkuintagb-alettrmibourttaablilteym(SoArtaMli)t,y b(SyAcMa)u,sbeyocfaduesaethofadnedatphuabnldicphuebalilcthhdeaisltthricdti,stardicut,lts ages 35 andadouldltesraGgesor3g5iaa,n2d0o0l2d-e2r0G06eorgia, 2002-2006 
 
Cancer 
 
Cardiovascular Disease 
 
Respiratory Disease 
 
Total smokingrelated diseases 
 
Deaths SAM Deaths SAM Deaths SAM Deaths SAM 
 
Georgia 
 
6,186 4,360 20,406 3,289 4,677 2,710 31,899 10,359 
 
Northwest Health District (Rome) 
 
570 
 
365 1,644 
 
265 
 
403 
 
234 2,617 
 
864 
 
North Georgia Health District (Dalton) 
 
311 
 
199 
 
836 
 
135 
 
228 
 
132 1,375 
 
466 
 
North Health District (Gainesville) 
 
452 
 
289 1,312 
 
211 
 
349 
 
202 2,113 
 
702 
 
Cobb/Douglas Health District 
 
397 
 
254 1,236 
 
199 
 
277 
 
161 1,910 
 
614 
 
Fulton Health District 
 
528 
 
338 1,505 
 
243 
 
315 
 
183 2,348 
 
764 
 
Clayton County Health District (Morrow) 
 
145 
 
93 
 
374 
 
60 
 
84 
 
49 
 
603 
 
202 
 
East Metro Health District (Lawrenceville) 
 
423 
 
271 1,058 
 
171 
 
259 
 
150 1,740 
 
592 
 
DeKalb Health District 
 
386 
 
247 1,028 
 
166 
 
205 
 
119 1,619 
 
532 
 
LaGrange Health District 
 
561 
 
359 1,793 
 
289 
 
412 
 
239 2,766 
 
887 
 
South Central Health District (Dublin) 
 
141 
 
90 
 
574 
 
93 
 
110 
 
64 
 
825 
 
247 
 
North Central Health District (Macon) 
 
462 
 
296 1,391 
 
224 
 
316 
 
183 2,169 
 
703 
 
East Central Health District (Augusta) 
 
423 
 
271 1,240 
 
200 
 
292 
 
169 1,955 
 
640 
 
West Central Health District (Columbus) 
 
343 
 
219 1,169 
 
188 
 
246 
 
143 1,758 
 
550 
 
South Health District (Valdosta) 
 
216 
 
138 
 
688 
 
111 
 
178 
 
103 1,082 
 
352 
 
Southwest Health District (Albany) 
 
377 
 
241 1,139 
 
184 
 
232 
 
134 1,748 
 
559 
 
Southeast Health District (Waycross) 
 
440 
 
281 1,311 
 
211 
 
290 
 
168 2,041 
 
660 
 
Coastal Health District (Savannah) 
 
327 
 
209 1,066 
 
172 
 
261 
 
151 1,654 
 
532 
 
Northeast Health District (Athens) 
 
314 
 
201 1,040 
 
168 
 
216 
 
125 1,570 
 
494 
 
 SAM is an average annual total that does not include burn or secondhand smoke deaths. 
 
TaanbdleseCx.,PGeerocTbreaegnbfitoaleo,re2fC0ma.0gPi7deesdrlc1ee1snactanhgdoeo1lo3af*-nmbdyidhgdirglaehdsseccahhnoodoollsasentxud-Gdheeingothrsgsiwach-h2oo0o0sl7msotukdedenatsciwgharoesttme obkeefodrea acgigeasre1t1teand 13*, by grade 
 
Grade Smoked before age 11 
6th 7th 8th 
 
Males 
 
% 
 
95% CI 
 
7.07.0 (5.3-9.1) 
 
8.4 (5.5-12.7) 
 
4.0 (2.2-7.3) 
 
8.4 (5.8-11.9) 
 
Females 
 
% 
 
95% CI 
 
5.25.2 (3.6-7.4) 
 
3.1 (1.7-5.4) 
 
6.2 (3.5-10.9) 
 
6.2 (3.5-10.8) 
 
Total 
 
% 
 
95% CI 
 
6.16.1 (4.9-7.6) 
 
5.8 (3.8-8.8) 
 
5.1 (3.3-7.7) 
 
7.3 (5.3-10.0) 
 
Smoked before age 13 181.82.2 (15.7-21.0) 101.07.7 (8.8-13.0) 141.45.5 
 
9th 
 
22.1 (18.1-26.7) 
 
9.9 (7.2-13.4) 
 
16.4 
 
10th 
 
20.7 (14.0-29.6) 
 
10.3 (7.0-14.8) 
 
15.7 
 
11th 
 
13.1 (9.9-17.2) 
 
14.3 (9.9-20.2) 
 
13.7 
 
12th 
 
12.3 (7.9-18.6) 
 
8.1 (5.0-12.8) 
 
10.1 
 
*Ages of initiation are defined as 11 years for middle school students and 13 years for high school students. 
 
(12.6-16.7) (13.5-19.7) (12.5-19.6) (11.0-17.0) (6.8-14.7) 
 
*Ages of initiation are defined as 11 years for middle school students and 13 years for high school students. 
 
32 
 
2009 Georgia Tobacco Use Surveillance Report 
 
 Appendices | Table D 
 
Table D. Percent of adult smokers by public health district, Georgia, 2000-2007 
 
District 
 
2000-2003 % 95% CI 
 
2004-2007 % 95% CI 
 
Northwest Health District (Rome) North Georgia Health District (Dalton) North Health District (Gainesville) Cobb/Douglas Health District Fulton Health District Clayton County Health District (Morrow) East Metro Health District (Lawrenceville) DeKalb Health District LaGrange Health District South Central Health District (Dublin) North Central Health District (Macon) East Central Health District (Augusta) West Central Health District (Columbus) South Health District (Valdosta) Southwest Health District (Albany) Coastal Health District (Savannah) Southeast Health District (Waycross) Northeast Health District (Athens) 
 
31.7 (28.3-35.3) 29.9 (26.4-33.7) 24.0 (20.9-27.3) 19.5 (16.5-22.8) 18.6 (15.7-21.8) 26.8 (23.0-30.9) 24.5 (21.3-27.9) 18.9 (15.7-22.5) 23.7 (20.7-27.0) 22.1 (19.3-25.3) 27.8 (24.5-31.5) 25.2 (22.4-28.3) 22.7 (19.6-26.1) 25.6 (22.1-29.5) 24.3 (21.3-27.5) 26.6 (24.3-29.1) 27.8 (24.7-31.1) 24.5 (21.4-27.8) 
 
27.2 (24.0-30.6) 24.4 (20.9-28.2) 21.6 (19.1-24.3) 14.9 (12.6-17.7) 15.3 (12.6-18.5) 23.4 (18.5-29.1) 16.5 (13.8-19.6) 13.7 (11.1-16.9) 20.2 (17.3-23.5) 21.9 (19.3-24.9) 24.9 (21.7-28.5) 22.9 (20.3-25.7) 22.8 (19.7-26.2) 25.4 (22.2-29.0) 21.7 (19.1-24.7) 24.8 (22.2-27.6) 25.8 (23.1-28.7) 20.2 (17.4-23.4) 
 
2009 Georgia Tobacco Use Surveillance Report 
 
33 
 
 Appendices | Table E & F 
 
Table E. Percentage of women who smoked during the last three months of pregnancy by race, age, and educational attainment, Georgia, 2006 
% Smokers 95% CI 
 
Total 
 
9.5 (8.2-10.8) 
 
Race 
 
White 
 
13.9 (11.7-16.2) 
 
Black 
 
5.7 (4.3-7.1) 
 
Age 
 
0-17 
 
9.1 (3.4-14.8) 
 
18-24 
 
12.0 (9.6-14.4) 
 
25-34 
 
7.9 (6.2-9.6) 
 
35-44 
 
8.9 (5.5-12.4) 
 
45+ 
 
0.0 
 
Education 
 
<High school 
 
23.4 (17.9-28.8) 
 
High school/GED 
 
10.6 (8.2-12.9) 
 
Some college 
 
6.7 (4.4-8.9) 
 
College graduate 
 
1.8 (0.6-3.0) 
 
Household income 
 
<$15,000 
 
14.8 (12.1-17.6) 
 
$15,000 - $24,999 
 
12.0 (7.9-16.1) 
 
$25,000-$49,999 
 
7.1 (4.3-10.0) 
 
Table F. Percentage of schools that had a p$o5li0c,y00p0r+ohibiting tobacc3o.5us(e1.b8y- 5to.2b)acco product, 
 
Table gF.roPueprc, eanntdagsechoofoslcthyopoel,sGtehoartghiaa,d2a00p6olicy prohibiting tobacco use by tobacco product, group, and school type, 
 
Georgia, 2006 
 
Middle School 
 
High School 
 
% 
 
95% CI 
 
% 
 
95% CI 
 
Had a policy prohibiting cigarettes Students Faculty/staff Visitors 
 
98.2 (96.2-100) 98.2 (96.1-100) 93.9 (90.4-97.3) 
 
97.7 (95.1-100) 94.8 (90.9-98.7) 90.1 (85.2-95.1) 
 
Had a policy prohibiting smokeless Students Faculty/staff Visitors 
 
97.6 (95.2-99.9) 96.3 (93.4-99.2) 88.9 (84.4-93.3) 
 
96.9 (93.8-100) 94.8 (90.8-98.7) 87.0 (81.1-92.8) 
 
Had a policy prohibiting cigars Students Faculty/staff Visitors 
 
98.2 (96.2-100) 98.2 (96.1-100) 94.5 (91.2-97.7) 
 
97.7 (95.1-100) 95.6 (92.1-99.2) 90.1 (85.2-95.1) 
 
Had a policy prohibiting pipes Students Faculty/staff Visitors 
 
98.2 (96.2-100) 98.2 (96.1-100) 94.5 (91.2-97.7) 
 
97.7 (95.1-100) 95.6 (92.1-99.2) 89.4 (84.2-94.5) 
 
34 
 
2009 Georgia Tobacco Use Surveillance Report 
 
 Appendices | Table G & H 
 
Table G. Georgia, 
 
P2e0r0c6entageTanoabdf lsesccGhho.ooPolelsrtctyhepanett,ahGgaeedooargfpisaoc,lhi2co0yo0pl6srothhaibtihtiandg 
 
atopboalciccyopursoehibbyitcinogvetorabgaec,cgoruosuep,bayncdosvcehraogoel ,tygproe,up, 
 
Middle School 
 
% 
 
95% CI 
 
High School 
 
% 
 
95% CI 
 
Policy prohibits tobacco use during school hours 
Students Faculty/staff Visitors 
 
99.4 (98.2-100) 98.0 (95.8-100) 96.2 (94.3-98.0) 
 
98.5 (96.4-100) 95.6 (92.0-99.1) 93.9 (90.4-97.5) 
 
Policy prohibits tobacco use during nonschool hours 
Students Faculty/staff Visitors 
 
86.1 (80.5-91.6) 81.0 (74.9-87.1) 76.2 (69.5-82.9) 
 
88.4 (82.3-94.5) 79.9 (72.4-87.5) 71.3 (62.3-80.2) 
 
Policy prohibits tobacco use in school buildings 
Students Faculty/staff Visitors 
 
98.8 (97.2-100) 98.8 (97.2-100) 96.3 (93.4-99.3) 
 
98.3 (96.0-100) 97.6 (94.9-100) 96.0 (92.5-99.5) 
 
Policy prohibits tobacco use outside onf school grounds* 
Students 
Faculty/staff 
Visitors 
 
98.8 (97.2-100) 95.6 (92.3-98.9) 86.3 (80.8-91.8) 
 
98.3 (96.0-100) 93.9 (89.7-98.2) 87.7 (82.0-99.3) 
 
Policy prohibits tobacco use on school buses 
Students Faculty/staff Visitors 
 
98.8 (97.2-100) 98.8 (97.2-100) 95.0 (91.5-98.5) 
 
98.3 (96.0-100) 97.6 (94.9-100) 94.6 (90.5-98.6) 
 
* School grounds include school parking lots and playing fields. 
 
Table H. Percentage of schools that had procedures to inform specific groups about compliance with their tobacco use policy by group TanabdlescHh.oPoelrtcyepnet,aGgeeoorfgsiac,h2o0o0l6s that had procedures to inform specific groups about compliance 
with their tobacco use policy by group and school type, Georgia, 2006 
 
Middle School 
 
% 
 
95% CI 
 
High School 
 
% 
 
95% CI 
 
Had procedures to inform students 
 
98.7 (96.8-100) 
 
100 
 
Had procedures to inform faculty/staff 
 
87.9 (83.3-92.5) 
 
93.2 (88.7-97.7) 
 
Had procedures to inform visitors 
 
69.3 (62.4-76.2) 
 
64.9 (56.6-73.2) 
 
2009 Georgia Tobacco Use Surveillance Report 
 
35 
 
 Appendices | Table 1 
 
Table I. Tobacco-related Healthy People 2010 objectives and current status in Georgia Table I. Tobacco-related Healthy People 2010 objectives and current status in Georgia 
 
Obj. # Objective 
 
HP 2010 Target 
 
Status in Georgia 
 
27-1a Reduce the proportion of adults who currently smoke cigarettes. 
 
12% 
 
19% 
 
27-2a Reduce the proportion of students in grades 9 through 12 who are current users of any tobacco products. 
 
21% 
 
26% 
 
27-2b Reduce the proportion of students in grades 9 through 12 who are current cigarette smokers. 
 
16% 
 
19% 
 
27-2c Reduce the proportion of students in grades 9 through 12 who are 
 
current smokeless tobacco users. 
 
1% 
 
8% 
 
27-2d Reduce the proportion of students in grades 9 through 12 who are 
 
current cigar smokers. 
 
8% 
 
16% 
 
27-3 Reduce the proportion of children and adolescents who begin using tobacco products.(in development) 
 
In deNv/eAlopment 
 
N/A 
 
27-4a Increase the average age of first use of tobacco products by adolescents angdedyo1u2ntgo a1d7uyltesars. 
 
1144%years 
 
Ag1e3-g1r4oup y1e3a-r1s4 
 
27-4b Increase the average age of first use of tobacco products by young adults aged 18 to 25 years. 
 
17% 
 
Data not collected 
 
27-5 Increase the proportion of adult smokers who have attempted to quit smoking. 
 
75% 
 
56% 
 
27-6 Increase the proportion of pregnant women who quit smoking during the first trimester of their pregnancy. 
 
30% 
 
Data not colNle/cAted 
 
27-7 Increase the proportion of smokers in grades 9 through 12 who have attempted to quit smoking. 
 
84% 
 
58% 
 
27-8 Increase in insurance coverage of evidence-based treatment for nicotine dependency. 
 
100% 
 
Data not colNle/cAted 
 
27-9 Reduce the proportion of children 6 years and under who are regularly exposed to tobacco smoke at home. 
 
10% 
 
Data not colNle/cAted 
 
27-10 Reduce the proportion of non-smokers aged 4 years and older who are exposed to environmental tobacco smoke. 
Increase the proportion of schools that are smoke-free and tobacco27-11 free, to include all school facilities, property, vehicles, and school 
events. 
 
45% 100% 
 
Data not colNle/cAted 
N2/0A% 
 
36 
 
2009 Georgia Tobacco Use Surveillance Report 
 
 27-12 27-13 27-14 27-15 
 
Increase the proportion of worksites with formal policies prohibiting or limiting smoking to separately ventilated areas. 
 
100% 
 
Increase or establish laws on smoke-free indoor air that prohibit or limit smoking to separately ventilated areas in public places and worksites. 
 
51% 
 
Increase the number of States and Territories that reduce the proportion of illegal sales of tobacco products to minors through the enforcement of laws prohibiting the sale of tobacco products to minors. 
 
50 States, DC, and all US territories 
 
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 products to minors. 
 
50 States and DC 
 
27-16 Eliminate tobacco advertising and promotions that influence adolescents and young adults 
 
In development 
 
27-17 27-18 
 
Increase the proportion of students in 8th, 10th and 12th grades who disapprove smoking. Increase the number of Tribes, Territories and States and the District of Columbia with comprehensive, evidence-based tobacco control programs. 
 
95% 
In development 
 
27-19 Eliminate the number of States with laws that preempt stronger tobacco control laws. 
 
No States 
 
27-20 Reduce the toxicity of tobacco products by establishing a regulatory 
 
In 
 
structure to monitor toxicity. 
 
development 
 
Data not collNe/cAted Data not collNec/Ated 
Met 
Met 
N/A Data not collected 
Met 
Met 
N/A 
 
27-21a Increase the average Federal and State tax on cigarettes. 
 
$2 
 
$0.37- GSetaotregia