Methods of a Multi-State Rapid-Response Survey Designed to Close Evidence Gaps in Tobacco Use and Related Disparities in the U.S.

Abstract

Tobacco use remains a significant public health challenge in the U.S., particularly in high-tobacco-burden states in the Midwest and South (Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, South Carolina, Tennessee, and West Virginia). Despite higher smoking prevalence and tobacco-related health disparities, little up-to-date information on correlates of tobacco use and emerging issues specific to this region is available for advocates and policymakers. Therefore, an online rapid-response survey was developed to provide timely and cost-effective information. A total of 12,300 adults (aged 18-65 years) were surveyed from April to May 2023 and 2024 on tobacco use behaviors, harm perceptions, attitudes toward tobacco control policies, and access and use of cessation resources in high- versus 4 low-tobacco-burden states (California, Illinois, Maryland, and Virginia). Data were weighted to each state's population, enabling comprehensive analysis of regional and subpopulation differences. Weighted pooled data from both waves in high-tobacco-burden states revealed the highest prevalence of current tobacco use in Arkansas (42.8%) and the lowest in Missouri (29.7%). Cigarette use was most common in West Virginia (25.8%) and least common in South Carolina (17.6%), notably higher than the 10.9%-14.3% rates in low-tobacco-burden states. The use of other tobacco products, including E-cigarettes (16.6%) and oral nicotine pouches (3.5%), was also relatively high in high-tobacco-burden states. This rapid-response survey provides timely data to inform tobacco control policies in high-tobacco-burden states. Tobacco use and related data can aid in developing more effective interventions and clinical guidelines.