Tobacco control indicators and lung cancer rates in young adults by state in the United States

Abstract

Objective: To determine the association between a tobacco control index (TCI) for 1992-93 for each US state and lung and bronchus cancer mortality and incidence rates by state for younger adults, as the best indicator of the effects of recent progress in tobacco control on lung cancer control.

Design: For all 51 US areas (50 states and the District of Columbia), correlation coefficients between the state's TCI and lung cancer rate were analysed. Multiple linear regression models (MLR) predicting cancer rates included sociodemographic variables by state (from the 2000 census). In addition, the 51 areas also were divided into tertiles, from highest to lowest TCI, and means for lung cancer rates were compared.

Subjects and settings: All areas with available data on lung cancer mortality and incidence rates.

Main outcome measures: Age-standardised mortality rates were available for all 51 areas (50 states and the District of Columbia) for 1989-93, 1994-98 and 1999-2003 for lung cancer at age 15-44 years. Lung cancer incidence rates for 1999-2002 were available for age 20-44 years for 44 states.

Results: The correlation between the TCI and lung cancer mortality rate increased in magnitude from 1989-93 to 1999-2003, and the association was statistically significant in MLR models for 1994-98 and 1999-2003 (but not 1989-93). The TCI was statistically significantly correlated with the lung cancer incidence rate in 1999-2002 by state, and the association persisted in an MLR model.

Conclusions: Within the limitations of ecologic analyses, findings are consistent with effects of state tobacco control efforts on reducing state-wide lung cancer rates in younger adults.