The findings in this report are subject to at least five
limitations. First, the estimates of cigarette smoking were
self-reported and were not validated by biochemical tests.
However, research has indicated that self-reported smoking
status correlates highly with measured serum cotinine levels
(10). Second, questionnaires were administered only in English
and Spanish, which might have resulted in nonresponse among
persons who speak neither of those languages. Third, because
NHIS does not include institutionalized populations and persons
in the military, these results might not be generalizable to
these groups. Fourth, the NHIS response rate of 66.3% might
have resulted in nonresponse bias, even after adjustment for nonresponse. Finally, small samples sizes resulted in imprecise
annual estimates for certain population groups (e.g., American
Indians/Alaska Natives).
Although comprehensive tobacco control programs¶¶ have
been effective in decreasing tobacco use in the United States,
they remain underfunded. In fiscal year 2011, CDC recommended
appropriate annual funding levels for each state
comprehensive tobacco control program. However, only two
states funded tobacco control programs at CDC-recommended
levels, whereas 27 states funded at