title: Usefulness of tobacco check boxes on death certificates: Texas, 1987-1998.
abstract: OBJECTIVE
  We compared reports of deaths in which tobacco use was a contributing factor ("tobacco-associated deaths") before and after the addition to death certificates in Texas of a check-box question asking whether tobacco use contributed to an individual's death.
  
  
  METHODS
  We examined Texas vital statistics files from 1987 to 1998. We calculated differences in percentages of reported tobacco-associated deaths (and 95% confidence intervals [CIs]) for the periods 1987 to 1992, before the addition of the check-box question, and 1993 to 1998, after the addition of the check-box.
  
  
  RESULTS
  Reports of tobacco-associated deaths were significantly less frequent before addition of the check-box question (0.7%; 95% CI = 0.4%, 1.0%) than after addition of the question (13.9%; 95% CI = 13.0%, 14.7%). From 1993 to 1998, percentages of tobacco-associated deaths reported on the check-box question increased steadily.
  
  
  CONCLUSIONS
  The addition of a tobacco-associated-death check box on Texas death certificates significantly increased reporting of tobacco use contributions to mortality.
authors.affiliation: Texas Tech University Health Sciences Center at El Paso, 79902, USA. zevallos@elp.rr.com
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Zevallos
authors.forename: Philip
authors.initials: P
authors.lastname: Huang
authors.forename: Monica
authors.initials: M
authors.lastname: Smoot
authors.forename: Kenneth
authors.initials: K
authors.lastname: Condon
authors.forename: Celan
authors.initials: C
authors.lastname: Alo
mesh_terms: D002423:Cause of Death; D016001:Confidence Intervals; D003644:Death Certificates; D005568:Forms and Records Control / Q000379:methods / Q000592:standards*; D006801:Humans; D008499:Medical Records / Q000592:standards* / Q000706:statistics & numerical data; D011159:Population Surveillance / Q000379:methods*; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality*; D013781:Texas / Q000453:epidemiology; D014029:Tobacco Use Disorder / Q000401:mortality*