This article first appeared in the St. Louis Beacon, Jan. 20, 2011 - Which Missouri location has the highest percentage of adults who smoke cigarettes? St. Louis? Kansas City? Actually, the answer is Taney County, where Branson is located.
This finding was uncovered in a statewide tobacco study done in 2007 by the Missouri Foundation for Health. The foundation embarked this month on an even more ambitious study: a year-long comparison of progress on tobacco and three other health issues within each county across the state.
Surveyors will call an estimated 52,000 people and ask them to answer 148 questions. In addition to tobacco use, the respondents will be asked about access to health services and healthy food, such as fresh fruits and vegetables, and the viability of engaging in physical activity in their neighborhoods.
Policymakers and researchers will use the findings from the latest survey to help pzero in on communities where health-related issues aren't being addressed, says Matthew Kuhlenbeck, a program officer at the foundation.
"It's the most comprehensive study we've ever been able to implement to date in Missouri," he says. "The 2007 study was huge. We got a lot of great information. We will build off that and even go further to learn more about our community. It will guide health policy funding decisions and health priorities in communities."
The foundation expects interviewers to complete all their work by the end of December; it hopes to make the data available by next spring.
"You could argue that the 2007 data is out of date, especially when you think about the many activities that have happened in the past four years," Kuhlenbeck said. "If you look at clean indoor air policies, for example, there were maybe five across the state then. Now there are 20, almost 25."
Other changes, he said, include policies to make some communities more bicycle- and pedestrian-friendly. The goal is to see what impact such changes have had on the well-being of Missourians.
"We want to make sure we're investing in the right ways and the right places. We have to follow up to make sure that we are seeing change. The data will show where the highest needs are. If, for example, the tobacco use rate in St. Louis County is less than 10 percent, which we know it is not, it wouldn't make sense to put a huge amount of money into tobacco cessation there when the rate might be three times" higher in another county.
Kuhlenbeck doesn't underestimate the challenges of conducting the largest adult health survey ever undertaken in Missouri and one of the largest in the nation. "This is telephone-based and we're in a world of caller ID and screening of phone calls. Getting folks to respond is very important. Without hearing from the community, it's very difficult for this data to be collected as well as used in the best ways possible."
Lung Association Report
The new foundation study began weeks before the American Lung Association issued a report that gave Missouri grades of F in four key tobacco policy areas: spending on tobacco prevention programs, promoting smoke-free air, raising the tobacco tax and funding cessation programs.
The Lung Association notes that none of the money Missouri received last spring from tobacco settlement funds went to smoking prevention and cessation programs. However, new tobacco prevention programs are being planned. St. Louis County received a two-year, $7.6 million federal stimulus grant to develop a campaign to support its new smoke-free ordinance. Missouri has $8.3 million in federal and state allocations for tobacco cessation programming.
The new evidence-based cessation program represents a wise investment for tackling smoking in Missouri, said Sarah Shelton, a senior data analyst at the Center for Tobacco Policy Research at Washington University's Brown School of Social Work.
She noted that the state project, once it gets under way, will give Medicaid recipients access to cessation services.
"That's going to be a huge benefit," she said, noting that the center released a report last year showing that Medicaid recipients had the highest smoking prevalence. "Also, people with less than high school educations had very high smoking prevalence, as well as people who are uninsured."
Another interesting finding of that study, she said, was that Medicare recipients had the highest percentage of smokers who "lacked confidence to quit. They do not feel they can be successful in quitting smoking."
The bigger picture, she says, is the lack of policies to address the problem overall. "The best and most effective way to use our resources is with policy changes," Shelton says. "These could be anything from a complete smoke-free policy, to a higher tobacco tax. There is evidence that increasing the tax reduces the number of people who smoke. It reduces the number of teens who begin smoking in the first place. It's really about prevention."
Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.
