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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention

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Research Articles

Multilevel Small-Area Estimation of Multiple Cigarette Smoking Status Categories Using the 2012 Behavioral Risk Factor Surveillance System

Zahava Berkowitz, Xingyou Zhang, Thomas B. Richards, Lucy Peipins, S. Jane Henley and James Holt
Zahava Berkowitz
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Chamblee, Georgia.
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  • For correspondence: zab3@cdc.gov
Xingyou Zhang
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Chamblee, Georgia.
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Thomas B. Richards
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Chamblee, Georgia.
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Lucy Peipins
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Chamblee, Georgia.
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S. Jane Henley
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Chamblee, Georgia.
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James Holt
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Chamblee, Georgia.
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DOI: 10.1158/1055-9965.EPI-16-0244 Published October 2016
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Abstract

Background: Smoking is the leading preventable cause of death; however, small-area estimates for detailed smoking status are limited. We developed multilevel small-area estimate mixed models to generate county-level estimates for six smoking status categories: current, some days, every day, former, ever, and never.

Method: Using 2012 Behavioral Risk Factor Surveillance System (BRFSS) data (our sample size = 405,233 persons), we constructed and fitted a series of multilevel logistic regression models and applied them to the U.S. Census population to generate county-level prevalence estimates. We mapped the estimates by sex and aggregated them into state and national estimates. We conducted comparisons for internal consistency with BRFSS states' estimates using Pearson correlation coefficients, and external validation with the 2012 National Health Interview Survey current smoking prevalence.

Results: Correlation coefficients ranged from 0.908 to 0.982, indicating high internal consistency. External validation indicated complete agreement (prevalence = 18.06%). We found large variations in current and former smoking status between and within states and by sex. County prevalence of former smokers was highest among men in the Northeast, North, and West. Utah consistently had the lowest smoking prevalence.

Conclusions: Our models, which include demographic and geographic characteristics, provide reliable estimates that can be applied to multiple category outcomes and any demographic group. County and state estimates may help understand the variation in smoking prevalence in the United States and provide information for control and prevention.

Impact: Detailed county and state smoking category estimates can help identify areas in need of tobacco control and prevention and potentially allow planning for health care. Cancer Epidemiol Biomarkers Prev; 25(10); 1402–10. ©2016 AACR.

This article is featured in Highlights of This Issue, p. 1367

Footnotes

  • Dr. Zhang was employed by CDC during the time of the project. He is currently employed by the Social, Economic, and Housing Statistics Division, U.S. Census Bureau.

  • Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).

  • Received March 25, 2016.
  • Revision received July 1, 2016.
  • Accepted July 17, 2016.
  • ©2016 American Association for Cancer Research.
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Cancer Epidemiology Biomarkers & Prevention: 25 (10)
October 2016
Volume 25, Issue 10
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Multilevel Small-Area Estimation of Multiple Cigarette Smoking Status Categories Using the 2012 Behavioral Risk Factor Surveillance System
Zahava Berkowitz, Xingyou Zhang, Thomas B. Richards, Lucy Peipins, S. Jane Henley and James Holt
Cancer Epidemiol Biomarkers Prev October 1 2016 (25) (10) 1402-1410; DOI: 10.1158/1055-9965.EPI-16-0244

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Multilevel Small-Area Estimation of Multiple Cigarette Smoking Status Categories Using the 2012 Behavioral Risk Factor Surveillance System
Zahava Berkowitz, Xingyou Zhang, Thomas B. Richards, Lucy Peipins, S. Jane Henley and James Holt
Cancer Epidemiol Biomarkers Prev October 1 2016 (25) (10) 1402-1410; DOI: 10.1158/1055-9965.EPI-16-0244
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