Methods of a Multi-State Rapid-Response Survey Designed to Close Evidence Gaps in Tobacco Use and Related Disparities in the U.S.

INTRODUCTION

Tobacco use remains a significant public health challenge in the U.S., particularly in high-tobacco-burden states in the Midwest and South (Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, South Carolina, Tennessee, and West Virginia). Despite higher smoking prevalence and tobacco-related health disparities, little up-to-date information on correlates of tobacco use and emerging issues specific to this region is available for advocates and policymakers. Therefore, an online rapid-response survey was developed to provide timely and cost-effective information.

METHODS

A total of 12,300 adults (aged 18-65 years) were surveyed from April to May 2023 and 2024 on tobacco use behaviors, harm perceptions, attitudes toward tobacco control policies, and access and use of cessation resources in high- versus 4 low-tobacco-burden states (California, Illinois, Maryland, and Virginia). Data were weighted to each state's population, enabling comprehensive analysis of regional and subpopulation differences.

RESULTS

Weighted pooled data from both waves in high-tobacco-burden states revealed the highest prevalence of current tobacco use in Arkansas (42.8%) and the lowest in Missouri (29.7%). Cigarette use was most common in West Virginia (25.8%) and least common in South Carolina (17.6%), notably higher than the 10.9%-14.3% rates in low-tobacco-burden states. The use of other tobacco products, including E-cigarettes (16.6%) and oral nicotine pouches (3.5%), was also relatively high in high-tobacco-burden states.

CONCLUSIONS

This rapid-response survey provides timely data to inform tobacco control policies in high-tobacco-burden states. Tobacco use and related data can aid in developing more effective interventions and clinical guidelines.