The findings in this report are subject to at least fivelimitations. First, the estimates of cigarette smoking wereself-reported and were not validated by biochemical tests.However, research has indicated that self-reported smokingstatus correlates highly with measured serum cotinine levels(10). Second, questionnaires were administered only in Englishand Spanish, which might have resulted in nonresponse amongpersons who speak neither of those languages. Third, becauseNHIS does not include institutionalized populations and personsin the military, these results might not be generalizable tothese groups. Fourth, the NHIS response rate of 66.3% mighthave resulted in nonresponse bias, even after adjustment for nonresponse. Finally, small samples sizes resulted in impreciseannual estimates for certain population groups (e.g., AmericanIndians/Alaska Natives).Although comprehensive tobacco control programs¶¶ havebeen effective in decreasing tobacco use in the United States,they remain underfunded. In fiscal year 2011, CDC recommendedappropriate annual funding levels for each statecomprehensive tobacco control program. However, only twostates funded tobacco control programs at CDC-recommendedlevels, whereas 27 states funded at <25% of these levels (CDC,unpublished data, 2012). Despite increases in excise tax revenue,state funding for tobacco control programs has actuallydecreased during the past 5 years. Full implementation of comprehensivetobacco control programs at CDC-recommended
funding levels might result in a substantial reduction in
tobacco-related disease and death and billions of dollars in
savings from averted medical costs and lost productivity (3).
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