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Juan Carlos Zevallos, MD, Philip Huang, MD, MPH, Monica Smoot, MPH, Kenneth Condon, BS and Celan Alo, MD, MPH

Juan Carlos Zevallos is with the Texas Tech University Health Sciences Center at El Paso. Philip Huang, Monica Smoot, Kenneth Condon, and Celan Alo are with the Texas Department of Health, Austin.

Correspondence: Requests for reprints should be sent to Juan Carlos Zevallos, MD, Texas Tech University Health Sciences Center at El Paso, 1100 N Stanton, Suite 105, El Paso TX 79902 (e-mail: zevallos{at}elp.rr.com).

Objectives. We compared reports of deaths in which tobacco use was a contributing factor ("tobacco-associated deaths") before and after the addition to death certificates in Texas of a check-box question asking whether tobacco use contributed to an individual’s death.

Methods. We examined Texas vital statistics files from 1987 to 1998. We calculated differences in percentages of reported tobacco-associated deaths (and 95% confidence intervals [CIs]) for the periods 1987 to 1992, before the addition of the check-box question, and 1993 to 1998, after the additon of the check-box.

Results. Reports of tobacco-associated deaths were significantly less frequent before addition of the check-box question (0.7%; 95% CI = 0.4%, 1.0%) than after addition of the question (13.9%; 95% CI = 13.0%, 14.7%). From 1993 to 1998, percentages of tobacco-associated deaths reported on the check-box question increased steadily.

Conclusions. The addition of a tobacco-associated-death check box on Texas death certificates significantly increased reporting of tobacco use contributions to mortality.