tobacco progress review may 14, 2003. public health challenges tobacco impact and public health...

Tobacco Progress Review

May 14, 2003

Public Health Challenges

Tobacco Impact and Public Health Challenges

28% of High School Students

11% of Middle School Students

22% of Adults(46 million adults)

Current Smokers Environmental Tobacco Smoke

54% of Nonsmokers Exposed

Annual Impact

~440,000 Premature

Deaths

Lung / Other CancersChronic Respiratory Disease

Cardiovascular Disease

14% of Medicaid ExpendituresDirect and Indirect Costs:

$157 Billion

Smoking-Attributable Mortality, 1995-1999442,398

155,761 148,605

98,007

1,007 966

38,053

3,000

35,053

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

Number of average annual deaths

Sources: CDC. Annual Smoking –Attributable Mortality, Years of Potential Life Lost, and Economic Costs—United States, 1995-1999. MMWR 2002 51;300-3. Burn deaths from: Hall JR. The U.S. smoking-material fire problem. Quincy, Massachusetts: National Fire Protection Association, Fire Analysis and Research Division, 2001. Environmental tobacco smoke deaths from: National Cancer Institute. Health effects of exposure to environmental tobacco smoke: the report of the California Environmental Protection Agency. Smoking and tobacco control monograph 10. Bethesda, Maryland: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 1999. . Total does not equal sum due to rounding.

Neoplasms Cardiovascular diseases

Respiratory disease

Total Perinatal conditions

Burn deaths

Total Lungcancer

Ischemic heart disease

Environmental Tobacco Smoke

3-2. Lung Cancer Death Rates

0

10

20

30

40

50

60

70

80

90

100

110

120

130

1950 1960 1970 1980 1990 2000

Age-adjusted death rate per 100,000 standard population

Black male

Total population

White male

White female

Black female

Notes: Data are age adjusted to the 2000 standard population. The race groups white and black may be of Hispanic or non-Hispanic origin.Source: National Vital Statistics System-Mortality (NVSS-M), NCHS, CDC.

2010 Target

Total male

Total female

27-1a. Current Cigarette Smoking: Adults 18 Years and Older

0

20

40

60

1965 1974 1985 1995 2001

Age-adjusted percent

2010 Target

Black male

19751965 1975 1995 20011985

White male

White femaleBlack female

Notes: Data are age adjusted to the 2000 standard population. Survey redesigned in 1997 and data for 1998 and subsequent years may not be directly comparable to earlier years. Source: National Health Interview Survey (NHIS), NCHS, CDC.

27-1a. Current Cigarette Smoking for Adults

30

13

23 24

36

22

11

22

15

20

2528

0

10

20

30

40Ameri

can In

dian/

Alaska

Nati

ve only

Asian

only

Hispan

ic *

Black,

not

Hispan

ic on

ly*

White, n

ot

Hispan

ic only*

2010 Target1998 Baseline Current Level

*Preliminary data: January-September 2002, current data year for other groups is 2001. Notes: Current smokers report smoking everyday/some days and have smoked at least 100 cigarettes. Data are age adjusted to the 2000 standard population. American Indians/Alaska Natives or Asians/Pacific Islanders may be of Hispanic origin. Hispanics may be of any race. For 1998 and 2002, persons reported only one race or reported more than one race and identified one race as best representing their race. Adults: 18 years and older.

Total*

Source: National Health Interview Survey (NHIS), NCHS, CDC.

Males*

9-11 y

ears

High school

graduate

13-15

years

16 ye

ars

or more

Female

s*

Ag

e-a

dju

ste

d p

erce

nt

Education level

27-5. Percent of Current Adult Smokers Who Attempted to Quit in the Past Year, 2001

4239

50

38

4741

0

25

50

75

American Indian/Alaska Native only

Asian only Hispanic Black, not Hispanic only

White, not Hispanic only

2010 Target

I 95% confidence interval *Current smokers (everyday/some days and have smoked at least 100 cigarettes) who have quit smoking one day or longer in the year prior to interview. Notes: American Indians/Alaska Natives or Asians may be of Hispanic origin. Hispanics may be of any race. Data are age adjusted to the2000 standard population. Adults: 18 years and older.


Total


27-1a, 27-2b. Current Cigarette Smoking

0

10

20

30

40

50

Percent

2010 Target: Students

Students (grades 9-12)

Adults (18 and older)

2010 Target: Adults

1970 1975 1980 20001965 1985 1990 1995*Preliminary data, January-September 2002.Notes: Adults, age adjusted to the 2000 standard population. Current Smoking: Adults-every/some days (and have smoked at least 100 cigarettes), Students-1+ day/past month.

2002*

Sources: Adults, National Health Interview Survey (NHIS), NCHS, CDC. Students, Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC.

Healthy People 2010 Objectives Past Month* Tobacco Users: Students (Grades 9-12), 2001

Tobacco Product

Any

Tobacco

Product

Cigarettes Spit Tobacco

Cigars

Current

Rate

34% (total)

30% (females)

39% (males)

28% (total)

28% (females)

29% (males)

8% (total)

2% (females)

15% (males)

15% (total)

9% (females)

22% (males)

2010

Target 21% 16% 1% 8%

Objective Number

27-2a. 27-2b. 27-2c. 27-2d.

*Tobacco use on one or more days in the 30 days preceding the survey.Note: Tobacco users may have used more than one tobacco product.

Source: Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC.

27-2b. Cigarette Use in Past Month*:Students (grades 9-12)

35

28

33

27

20

15

39

3235

28

35

29

0

5

10

15

20

25

30

35

40

45

MalesHispanic Black, not Hispanic

White, not Hispanic

2010 Target1999 Baseline 2001Percent

Total Females

Sources: Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC and **National Youth Tobacco Survey, OSH, CDC and The American Legacy Foundation.

I 95% confidence interval *Smoked cigarette(s) on one or more days of the 30 days preceding the survey.Note: Data for American Indians, Alaska Natives, and Pacific Islanders are unreliable.

In 2000, 11% of students in grades 6-8 smoked**

Current Cigarette Smoking, Price and Tax: Students (12th Grade)

$0.00

$0.50

$1.00

$1.50

$2.00

$2.50

$3.00

$3.50

1975 1980 1985 1990 1995 2000

0

5

10

15

20

25

30

35

40Dollars

Mean excise tax on a pack of cigarettes

Current smoking

Real price per pack

Cu

rren

t sm

oki

ng

Percent

*Current cigarette smoking: Have smoked at least once in the past 30 days. ** Real price is Consumer Price Index-adjusted national average retail price.Real price and mean excise tax per pack of cigarettes adjusted for inflation. Sources: Original analysis/slide prepared by the ImpacTeen Project. Estimated prices for the period covered by the survey data are based on the 11/01 price for each year reported by Orzechowski and Walker, adjusted for changes in state and federal cigarette taxes and trends in the non-tax component of price. Price data from: Orzechowski W, Walker RC. The tax burden on tobacco: historical compilation 2001. Arlington, Virginia: Orzechowski and Walker, 2002.Smoking prevalence data from: Monitoring the Future Study, NIH, NIDA. Tax data from: The Tax Burden on Tobacco, The Tobacco Institute.

$1.25$1.50$1.75$2.00$2.25$2.50$2.75$3.00$3.25$3.50

1975 1980 1985 1990 1995 2000

Year

Rea

l P

rice

Per

Pac

k**

26

28

30

32

34

36

38

40

Cu

rren

t S

mo

kin

g

(per

cen

t)

Current Smoking* and Price: Students (12th Grade), 1975-2002

*Current cigarette smoking: Have smoked at least once in the past 30 days. ** Real price is Consumer Price Index-adjusted national average retail price.Sources: Original analysis/slide prepared by the ImpacTeen Project. Estimated prices for the period covered by the survey data are based on the 11/01 price for each year reported by Orzechowski and Walker, adjusted for changes in state and federal cigarette taxes and trends in the non-tax component of price. Price data from: Orzechowski W, Walker RC. The tax burden on tobacco: historical compilation 2001. Arlington, Virginia: Orzechowski and Walker, 2002.Smoking prevalence data from: Monitoring the Future Study, NIH, NIDA.

Cigarette priceCurrent smoking

27-10. Exposure to Environmental Tobacco Smoke: Nonsmokers* with Detectable Cotinine Levels**,

Ages 4 and Older

88.1

53.9

83.4

93.9

72.0

52.0

44.1

87.8

0

10

20

30

40

50

60

70

80

90

100

2010 Target

1988-94 Baseline Percent with detectable serum cotinine 1999-2000

Mexican American Total White, not Hispanic Black, not Hispanic

Source: National Health and Nutrition Examination Survey (NHANES), NCHS, CDC.

I 95% confidence interval* Nonsmokers defined by serum cotinine levels < 11 ng/mL. **Detectable serum cotinine levels: > .05 ng/mL and < 10 ng/mL. Notes: Age adjusted to the 2000 standard population. Data for other Hispanics, American Indians, Alaska Natives, Asians and Pacific Islanders are unreliable.

27-13. Smoke-Free Indoor Air Laws*

0

25

50

Private Public Restaurants Public Day Care Retail Store

2010 TargetTotal number of States with laws (including D.C.)

Workplace Transportation

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

*Indoor air laws: smoking bans or limited to separately ventilated areas.

3 5

18

24

6

17

1998 Baseline 2002

1

13

3

16

22

4

2010 Target: 51 (50 States + D.C.)

25

34 35

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

27-8b. States With Medicaid Coverage for Treatment of Nicotine Dependency

2515 16

Complete Coverage Partial Coverage No Coverage

1998 1999 2000

1 1 1

Progress review data and slidescan be found on the web at:

http://www.cdc.gov/nchs/hphome.htmhttp://www.cdc.gov/nchs/hphome.htm

Healthy People 2010 ObjectivesCurrent Regular* Tobacco Users: Adults

Tobacco Product

(Year)

Cigarettes(2002, Jan.-Sept.,

preliminary)

Spit Tobacco

(2000)

Cigars

(2000)

Pipes

(2000)

Bidis

(2000)

Number of Users

46,155,000persons

4,444,000persons

4,386,000persons

973,000persons

167,000persons

Current

Rate

22% (total)

20% (females)

25% (males)

2.3% (total)

0.3% (females)

4.4% (males)

2.2% (total)

0.2% (females)

4.4% (males)

0.5% (total)

0.06% (females0.06% (females)**

1.0% (males)

0.09% (total)

0.08% (females)

0.09% (males)

2010

Target

12% 0.4% 1.2% Targets: to be determined

Objective Number

27-1a 27-1b 27-1c 27-1d 27-1e

Notes: Data are age adjusted to the 2000 standard population. Estimated number of users are rounded to the nearest thousand. Users may regularly use more than one tobacco product. Adults: 18 years and older. *Everyday or somedays.**Unreliable estimate, relative standard error >30%.


(2001)

27-1a. Current Cigarette Smoking for Adults 18 years and older: 1998, 2001, and 2002

24 23 22

30

16 15

23 24

35

13 13

19

2522

25 24

0

5

10

15

20

25

30

35

40

45




2010 Target1998 Baseline 2001

I 95% confidence interval *Preliminary data: January-September 2002. Notes: Current smokers report smoking everyday/some days and have smoked at least 100 cigarettes. Data are age adjusted to the 2000 standard population. American Indians/Alaska Natives or Asians/Pacific Islanders may be of Hispanic origin. Hispanics may be of any race. For 1998 and 2002, persons reported only one race or reported more than one race and identified one race as best representing their race.


Total

2002*


27-1a. Current Cigarette Smoking for Adults18 years and older: 1998, 2001, and 2002

24 23 22 22 21 20

26 25 25

3836

29 28

2422

11 11

0

10

20

30

40


I 95% confidence interval. * Preliminary data: January-September 2002. Note: Data are age adjusted to the 2000 standard population.

Education Level

1998 Baseline 2010 Target

9-11 yrs.All adults HS graduate 13-15 years 16 years or moreFemales Males

2001


2002*

27-5. Percent of Current Adult Smokers Who Attempted to Quit in the Past Year

41 42 4239 38

50

38 38

45 47

40 41

0

25

50

75





I 95% confidence interval *Current smokers (everyday/some days who have smoked at least 100 cigarettes) who have quit smoking one day or longer in the year prior to interview. Notes: American Indians/Alaska Natives or Asians may be of Hispanic origin. Hispanics may be of any race. For 1998, persons reported only one race or reported more than one race and identified one race as best representing their race. Data are age adjusted to the 2000 standard population. Adults: 18 years and older.


Total



12.99- 21.73

22.16- 23.45

23.68- 25.30

25.32- 31.11Data are age adjusted to the 2000 standard population. Ages 18 and older.Source: Behavioral Risk Factor Surveillance Survey, NCCDPHP, CDC.

Current Cigarette Smoking Among Adults: 2001

27-2a. Tobacco Use in Past month*:Students (grades 9-12)

40

34 35

2925

45

38 37

30

44

39

0

5

10

15

20

25

30

35

40

45

50

MalesHispanic Black, not Hispanic

White, not Hispanic


I 95% confidence interval *Smoked cigarettes or cigars or used chewing tobacco, snuff, or dip on one or more of the 30 days preceding the survey.Note: Data for American Indians, Alaska Natives, and Pacific Islanders are unreliable.

Percent

Total Females


19

All tobaccoproducts

Cigarettes Spit tobacco Cigars

Tobacco Use in the Past Month:

Students (Grades 9-12)Direction of change

desired2010 Target2001

21%

8%

1%

16%

34%

28%

8%

15%


(27-2a.) (27-2c.) (27-2d.)(27-2b.)

27-3a,b. Persons Who First Used Any Cigarettes During 1965 to 2000

0

25

50

75

100

125

150

Ages 12-17 Ages 18-25

Age-specific rate per 1,000 person-years exposure

Targets: to be determined.

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999-2001.

Percent of Mothers Who Reported Smoking During Pregnancy*, 2001

12.0

14.4

19.0

17.0

10.3

7.68.6 9.3

0

5

10

15

20

15-17 years 20-24 years

Notes: *Total of 49 reporting States and D.C., excludes data for California, which did not require reporting of tobacco use during pregnancy on birth certificates. **14% quit during their first trimester (age adjusted to the 2000 standard population - objective 27-6).

18-19 years 25-29 years 40-54 years30-34 years 35-39 years

Age of Mother

In 1998, 20% of mothers 18-49 years who smoked quit smoking

during their pregnancy**

Percent

Sources: *National Vital Statistics System-Natality (NVSS-N), and **National Health Interview Survey (NHIS), NCHS, CDC.

10-54 years

Percent of Mothers Who Reported Smoking During Pregnancy by Race/Ethnicity, 2001

0

5

10

15

20

25

30

35

Total*

Notes: Persons of Hispanic origin may be of any race.Total of 49 reporting States and D.C., excludes data for California, which did not require reporting of tobacco use during pregnancy on birth certificates.

Hispanic Black, notHispanic

White, notHispanic

Mother’s Age 15-19

Total* Hispanic White, not Hispanic

Black, not Hispanic

11.3

3.1

14.2

9.6

17.5

4.0

30.5

7.2

Percent

Mother’s Age 20-54

Source: National Vital Statistics System-Natality (NVSS-N), NCHS, CDC.

*Totals include origin not stated.

27-9. Reported Exposure to Tobacco Smoke at Home:Children ages 6 and under, 1998

20

29

34

26

1411

27

22

0

10

20

30

40

50

Hispanic Black, not Hispanic

White, not Hispanic

2010 Target

I 95% confidence interval. ##Unreliable estimate, relative standard error >30%.Notes: Exposure is defined as anyone smoking inside the home at least 4 days a week. Hispanics may be of any race. American Indians, Alaska Natives, Asians, and Pacific Islanders may be of Hispanic origin.

Percent

Total Poor Middle/High


Near poor

American Indian /Alaska Native

Asian/PacificIslander

##

##6

Family Income Level

Rode in Car with Someone Who Was Smoking on at Least One of the Preceding Seven Days:

Middle School Students: 34.3%**(range of 26 States: 21.7% in DC, to 45.5% in WV)

High School Students: 29.2%**(range of 24 States: 19.9% in CO, to 43.3% in KY)

Were in Same Room with Someone Who Was Smoking on at Least One of the Preceding Seven Days:

Middle School Students: 49.1%** (range of 26 States: 36.4% in CA, to 63.7% in WV)

High School Students: 56.5%**(range of 24 States: 39.7% in DC, to 71.5% in KY)

.

Reported Environmental Tobacco Smoke Exposure in Nonsmokers*, 2000

Source: National Youth Tobacco Survey (NYTS), OSH, NCCDPHP, CDC and American Legacy Foundation.

*Never cigarette smokers. ** Median of State rates.

27-10. Exposure to Environmental Tobacco Smoke (ETS):Nonsmokers* with Detectable Serum Cotinine Levels**

88.1

53.9

87.4 88.3

51.0

64.2

0

10

20

30

40

50

60

70

80

90

100

2010 Target

1988-94 Baseline

I 95% confidence interval* Nonsmokers defined by serum cotinine levels < 11 ng/mL. **Detectable serum cotinine levels: > .05 ng/mL and < 10 ng/mL. ***Age adjusted to the 2000 standard population. Source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

Percent with detectable serum cotinine 1999-2000

Ages 4-17 Ages 4 and older*** Ages 18+***


Annually, ETS causes about 3,000 lung cancer deaths and 35,000 deaths from ischemic heart disease

in adult nonsmokers


Ages 4 to 17

87.4

64.2

83.4

94.5

83.1

63.0

48.2

86.7

0

10

20

30

40

50

60

70

80

90

100

2010 Target




I 95% confidence interval * Nonsmokers defined by serum cotinine levels < 11 ng/mL.**Detectable serum cotinine levels: > .05 ng/mL and < 10 ng/mL. ), Note: Data for other Hispanics, American Indians, Alaska Natives, Asians and Pacific Islanders are unreliable.


Ages 18 and older

88.3

51.0

83.5

93.8

68.3

48.943.2

88.2

0

10

20

30

40

50

60

70

80

90

100

2010 Target

1988-94 Baseline

Note: Age adjusted to the 2000 standard population. Data for other Hispanics, American Indians, Alaska Natives, Asians and Pacific Islanders are unreliable.

Percent with detectable serum cotinine 1999-2000



I 95% confidence interval*Nonsmokers defined by serum cotinine levels < 11 ng/mL. **Detectable serum cotinine levels: > .05 ng/mL and < 10 ng/mL.

27-10. Exposure to Environmental Tobacco Smoke: Nonsmokers* with Detectable Cotinine Levels**

88.3

51.0

92.7 90.5

52.547.2

80.1

68.4

87.9

0

10

20

30

40

50

60

70

80

90

100

2010 Target


18-24 25-44 45-64 AdultsAges 18 and older***

65+

40.7


I 95% confidence interval* Nonsmokers defined by serum cotinine levels < 11 ng/mL. **Detectable serum cotinine levels: > .05 ng/mL and < 10 ng/mL. Note: ***Age adjusted to the 2000 standard population. ), CDC, NCHS.

27-13. Smoke-Free Indoor Air Laws*: 2002

3

17

5

18

24

6

0

25

50

Private Public Restaurants Public Day Care Retail Store

2010 TargetNumber of States with laws (including D.C.)

Workplace Transportation

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

*Indoor air laws: smoking bans or limited to separately ventilated areas.

24-2a,b,c. Hospitalizations for Asthma: 1998, 1999, and 2000

45.6

64.0

33.1

41.646.4

57.665.1

80.9

12.115.9 15.5

9.0 9.5 8.6

17.7 19.623.7

8.513.314.1

53.6

12.5

21.224.626.7

0

25

50

75

100

125

1502010 Target1998 Baseline

I 95% confidence intervalNote: *Data are age adjusted to the 2000 standard population.

Hospitalizations per 10,000 population 1999

Children under 5 years Persons 5 to 64 years* Adults 65 and older*

Total Female Male Total Female Male MaleFemaleTotal

Source: National Hospital Discharge Survey (NHDS), NCHS, CDC.

13.6

2000

17.5

24-2a,b,c. Hospitalizations for Asthma: 1998, 1999, and 2000

45.6

64.0

82.4

114.4

31.939.3

12.1

28.423.6

7.8 8.0 7.3

17.7 19.6

32.1

12.414.313.4

53.6

29.5

12.5

27.3

45.6

0

25

50

75

100

125

150

1752010 Target1998 Baseline

I 95% confidence intervalNotes: *Data are age adjusted to the 2000 standard population. Data for Hispanics, American Indians, Alaska Natives, Asians and Pacific Islanders are unreliable.

Hospitalizations per 10,000 population 1999

Children under 5 years Persons 5 to 64 years* Adults 65 and older*

Total Black White Total Black White WhiteBlackTotal

103.0

13.6

27.921.2

2000

Source: National Hospital Discharge Survey (NHDS), NCHS, CDC.


0

20

40

60

80

100

1950 1960 1970 1980 1990 2000


2010 Target

Female

Male

Total

Note: Data are age adjusted to the 2000 standard population.

Source: National Vital Statistics System-Mortality (NVSS-M), NCHS, CDC.


0

10

20

30

40

50

60

70

80

90

100

110

120

130

1950 1960 1970 1980 1990 2000


Black male

Total population

White male

White female Black female

Notes: Data are age adjusted to the 2000 standard population. The race groups white and black may be of Hispanic or non-Hispanic origin.Source: National Vital Statistics System-Mortality (NVSS-M), NCHS, CDC.

2010 Target

3-2. Lung Cancer Death Rates, 2000

56.5

32.728.9

22

66.1

58.9

0

10

20

30

40

50

60

70


Notes: American Indians/Alaska Natives or Asians/Pacific Islanders may be of Hispanic origin. Hispanics may be of any race. Malignant neoplasms of trachea, bronchus and lung: ICD-10 codes C33-C34. Data are age adjusted to the 2000 standard population.Source: National Vital Statistics System-Mortality (NVSS-M), NCHS, CDC.

2010 Target

American Indian/Alaska Native

Asian/ Pacific Islander

Hispanic Black, not Hispanic

White, not Hispanic

Total

Source: National Vital Statistics System-Mortality (NVSS-M), NCHS, CDC.

Group 1990 1999

Estimated Annual

Percent Change

1990-99

Male 95.4 76.3 -2.4*

White 94.7 74.4 -2.5* Black / African American 134.6 109.8 -2.4*

Asian or Pacific Islander 64.4 62.7 -0.4

Hispanic or Latino 58.2 35.9 -4.1*

Female 47.4 48.2 +0.3

White 48.7 49.9 +0.4 Black / African American 53.2 55.7 +0.2

Asian or Pacific Islander 28.2 28.6 +0.5

Hispanic or Latino 24.6 20.6 -1.8*

Age-Adjusted Lung Cancer Incidence RatesNew Cases per 100,000 population

*Estimated annual percent change (EAPC) is significantly different from 0 (p<0.05). EAPC has been calculated by fitting a linear regression model to the natural logarithm of the yearly rates from 1990-99. Notes: Estimates for American Indians or Alaska Natives are not shown because of the small number of cases. The race groups, white, black and Asian or Pacific Islander include persons of Hispanic and non-Hispanic origin. ICD-9-CM codes: 162.2-162.9. Source: National Institutes of Health, National Cancer Institute, Surveillance, Epidemiology, and End Results (SEER) Program.

27-21a. Average Federal and State Tax on Cigarettes:Mean Excise Tax on a Pack of Cigarettes

$0.0

$0.1

$0.2

$0.3

$0.4

$0.5

$0.6

$0.7

$0.8

$0.9

$1.0Dollars

Source: The Tax Burden on Tobacco, The Tobacco Institute.

196

124135

249

195

246

115

0

50

100

150

200

250

Total

12-1. Coronary Heart Disease Death Rates, 2000

Black

, Not

Hispan

ic

Hispan

ic

Asian

or

Pac

ific

Isla

nder

Amer

ican

India

n

or Ala

ska

Nativ

e

White

, Not

Hispan

icM

ale

Femal

e

Source: National Vital Statistics System – Mortality (NVSS-M), NCHS, CDC.

NOTE: Coronary heart disease: ICD-10 codes I11, I20-I25. American Indian or Alaska Natives, Asian or Pacific Islanders may be of Hispanic origin. Hispanics may be of any race.

2010 target

Total

156


tobacco progress review may 14, 2003. public health challenges tobacco impact and public health...

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