In the 2021 Rankings, this measure was age-adjusted and underwent additional methodological changes, further making comparisons with estimates from prior release years difficult. Methodological changes in the Behavioral Risk Factor Surveillance System, which are discussed above and were implemented in the 2016 Rankings, make comparisons with estimates prior to that release year difficult. This measure could be used to measure progress, but only after considering its substantial limitations. Can This Measure Be Used to Track Progress The denominator is the total number of adult respondents in a county. The numerator is the number of adult respondents who reported “Yes” to the following question: Have you smoked at least 100 cigarettes in your entire life? and “Every day or some days” to the question: Do you now smoke cigarettes every day, some days, or not at all? Denominator The simple “current smoker” status question does not capture the thousands of chemical compounds in cigarettes and cigarette smoke nor take into account the effects of secondhand smoke. Additionally, new methods using biomarkers have shown that not all smokers are exposed to the same level of contaminants. BRFSS also currently only asks about the use of cigarettes and not e-cigarettes which have grown in prominence. The Youth Behavioral Risk Factor Survey attempts to fill this gap, but it currently does not provide enough data to estimate county-level smoking prevalence among youth. The BRFSS only surveys adults (age 18 and older), lacking data on adolescent smoking. Finally, there is no perfect model and each model generally has limitations specific to their methods. Models make assumptions about statistical relationships that may not hold in all cases. The smaller the population or sample size of a county, the more the estimates are derived from the model itself and the less they are based on survey responses. There are also drawbacks to using modeled data. For more technical information on PLACES modeling using BRFSS data, please see their methodology. The Adult Smoking estimates are produced from one year of survey data and are created using complex statistical modeling. Modeling generates more stable estimates for places with small numbers of residents or survey responses. Statistical modeling is used to obtain more informed and reliable estimates than survey data alone can provide. Adult Smoking is created using statistical modeling All of these changes were implemented in order to provide users with the most accurate estimates of health in their community as possible. Also in the 2021 Rankings, this measure is now age-adjusted. Beginning with the 2021 Rankings, the CDC has updated their modeling procedure for producing small-area estimates. Beginning with the 2016 Rankings, the CDC provided single-year modeled county-level estimates that included both landline and cell phone users. Prior to the 2016 County Health Rankings, the CDC’s BRFSS provided the Rankings with county-level estimates that were constructed from seven years of responses from participants who used a landline phone. The method for calculating Adult Smoking has changed We report an age-adjusted rate in order to fairly compare counties with differing age structures.
Adult Smoking estimates are age-adjustedĪge is a non-modifiable risk factor, and certain health behaviors may be associated with different age groups in the population.
Adult Smoking is the percentage of the adult population in a county who both report that they currently smoke every day or some days and have smoked at least 100 cigarettes in their lifetime.
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