Small-area estimation and prioritizing communities for tobacco control efforts in Massachusetts.
OBJECTIVE
We developed a method to evaluate geographic and temporal variations in community-level risk factors and prevalence estimates, and used that method to identify communities in Massachusetts that should be considered high priority communities for smoking interventions.


METHODS
We integrated individual-level data from the Behavioral Risk Factor Surveillance System from 1999 to 2005 with community-level data in Massachusetts. We used small-area estimation models to assess the associations of adults' smoking status with both individual- and community-level characteristics and to estimate community-specific smoking prevalence in 398 communities. We classified communities into 8 groups according to their prevalence estimates, the precision of the estimates, and temporal trends.


RESULTS
Community-level prevalence of current cigarette smoking among adults ranged from 5% to 36% in 2005 and declined in all but 16 (4%) communities between 1999 and 2005. However, less than 15% of the communities met the national prevalence goal of 12% or less. High smoking prevalence remained in communities with lower income, higher percentage of blue-collar workers, and higher density of tobacco outlets.


CONCLUSIONS
Prioritizing communities for intervention can be accomplished through the use of small-area estimation models. In Massachusetts, socioeconomically disadvantaged communities have high smoking prevalence rates and should be of high priority to those working to control tobacco use.
Li
Wenjun
W
Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Shaw Building, SH2-230, 55 Lake Ave N, Worcester, MA 01655, USA. wenjun.li@umassmed.edu
Land
Thomas
T
Zhang
Zi
Z
Keithly
Lois
L
Kelsey
Jennifer L
JL
D003153:Community Health Services; D016001:Confidence Intervals; D006293:Health Promotion; D006801:Humans; D008404:Massachusetts / Q000453:epidemiology; D016017:Odds Ratio; D011159:Population Surveillance; D015995:Prevalence; D011634:Public Health; D015980:Public Health Practice / Q000706:statistics & numerical data*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D000074606:Smoking Prevention; D040241:Social Marketing; D012959:Socioeconomic Factors; D013997:Time Factors; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000517:prevention & control*; D014026:Nicotiana