title: Small-area estimation and prioritizing communities for tobacco control efforts in Massachusetts.
abstract: 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.
authors.affiliation: 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
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.forename: Thomas
authors.initials: T
authors.lastname: Land
authors.forename: Zi
authors.initials: Z
authors.lastname: Zhang
authors.forename: Lois
authors.initials: L
authors.lastname: Keithly
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kelsey
mesh_terms: 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