Small-area estimation and prioritizing communities for tobacco control efforts in Massachusetts

Am J Public Health. 2009 Mar;99(3):470-9. doi: 10.2105/AJPH.2007.130112. Epub 2009 Jan 15.


Objectives: 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.

MeSH terms

  • Community Health Services*
  • Confidence Intervals
  • Health Promotion*
  • Humans
  • Massachusetts / epidemiology
  • Odds Ratio
  • Population Surveillance
  • Prevalence
  • Public Health Practice / statistics & numerical data*
  • Public Health*
  • Risk Factors
  • Smoking / epidemiology
  • Smoking Prevention*
  • Social Marketing*
  • Socioeconomic Factors
  • Time Factors
  • Tobacco Use Disorder / epidemiology
  • Tobacco Use Disorder / prevention & control*
  • Tobacco*