This webpage contains links to new tobacco disparities reports prepared by the University of Maryland School of Public Health for the Maryland Department of Health and Mental Hygiene’s Center for Health Promotion, Education & Tobacco Use Prevention with Cigarette Restitution Funds (Contract Number OPASS 8-9738G, Principal Investigator Dr. Carter-Pokras). Information from these reports are crucial to understanding differences among certain groups (racial/ethnic groups, groups according to socioeconomic status, etc) in our state that remain at high risk and suffer disproportionately from tobacco-related illness and death in spite of the progress in reducing tobacco use.  The information provided is based on the latest available data sources: the 2006 Maryland Youth Tobacco Survey (MYTS) and the 2006 Maryland Adult Tobacco Survey.

• Report on Disparities in Tobacco Use Behaviors by Middle and High School Minority Youth in Maryland, 2006
• Report on Disparities in Tobacco Use Behaviors by Adult Minority Populations in Maryland, 2006
• Maryland Tobacco Use Prevention and Cessation Logic Models
• Use of Flavored Cigarettes Fact Sheet
• Use of Menthol Cigarettes Fact Sheet

This presents qualitative information on the use of tobacco products among minority adult populations. The information provided is based on a series of focus groups aimed at exploring cultural, psychosocial, and environmental factors influencing tobacco use among Asian Americans, Hispanics, African Americans and American Indians in Maryland.

• Exploring cultural, psychosocial, and environmental factors influencing tobacco use among Asian Americans, Hispanics, African Americans and American Indians in Maryland

If you want additional information about Maryland’s efforts to reduce the use of tobacco, please call your local health department about activities in your community, or the Center for Health Promotion, Education and Tobacco Prevention (410-767-1362) for information on statewide initiatives.

Additional information on tobacco disparities in Maryland has been presented at national conferences:

• Carter-Pokras O, Feldman RH, Ye C, Valliant R, Kanamori M, Zhang G, Fiedler R. Disparities In Tobacco Use Behaviors By Adult Minority Populations In Maryland. NIH SUMMIT: The science of Eliminating Health Disparities. National Harbor, Maryland. December, 2008.
  Abstract: Smoking harms nearly every organ of the body, and is the leading preventable cause of disease and death in Maryland. Persistent disparities in tobacco-related disease and mortality remain despite declines in cigarette smoking. This paper presents data from the 2006 Maryland Adult Tobacco Survey, one of the largest tobacco surveys in the nation (n=21,799), administered using Computer-Assisted Telephone Interviewing technology in English and Spanish. Detailed information on the use of tobacco products among minority adult populations in Maryland from this survey data analysis can be used to identify and address determinants influencing a relatively higher tobacco use among certain adult minority populations and adults of low socioeconomic status. Findings show notable ethnic disparities in tobacco use behaviors, attitudes, knowledge and tobacco cessation among adult minority populations: 17.6% of Maryland adults were current tobacco users, with Asians having significantly lower rates than any other racial/ethnic group (5.4%) and American Indians having the highest rates (23.6%). Among 18-29 year old former and never smokers, 8.6% reported an intention to smoke in the next year with Hispanics having the highest (15%) intention to start smoking and Blacks the least (4.2%). Fifteen percent (15.3%) of Maryland adults believed that light cigarettes are safer than regular cigarettes, ranging from 14.8% for Hispanics to 19.5% for Asians. Consistent with their higher tobacco use, American Indians are the most likely to be exposed to secondhand smoke in the car (29.6%), and highest rate of smokers living in households with minors (41.5%). Hispanic males were the least likely to have been advised by their children to quit (33.6%). Results can be used to improve understanding of tobacco use among minority populations who are at high risk and suffer disproportionately from tobacco-related illness and death. Findings will be helpful in designing minority tobacco use prevention and cessation programs.
• Carter-Pokras O, Voorhees C, Kanamori M, Ye C, Valliant R, Zhang G, Fiedler R. Disparities In Tobacco Use Behaviors By Adult Minority Populations In Maryland. NIH SUMMIT: The science of Eliminating Health Disparities. National Harbor, Maryland. December, 2008.
  Abstract: Each day in the U.S. approximately 4,000 12-17 year olds initiate cigarette smoking, 1,140 young people become daily cigarette smokers, and one third of these smokers are expected to die from a smoking-related disease. This paper presents data from the 2006 Maryland Youth Tobacco Survey, one of the largest tobacco surveys in the nation (308 schools, n= 82,500). The questionnaire was administered in paper-and-pencil format either in individual classrooms or in alternative locations using CDC protocols for administration and analysis of the Youth Tobacco Survey. Findings show notable ethnic disparities in tobacco use behaviors, attitudes, knowledge and tobacco cessation among adolescent minority populations (1969 American Indian/Alaskan Natives (AI), 3226 Asians, 20739 Blacks, 3898 Hispanics, 1015 Native Hawaiian/Pacific Islanders (NHPI), 49937 Whites, 1716 Missing race/ethnicity). NHPI had the highest current tobacco use followed by AIs and Hispanics (34.5%, 22.7% and 18.2%). Male rates were higher (17.9%) than females (12.8%). Current tobacco use was higher with greater grade level, and overall patterns differ by ethnicity. NHPIs, AIs and Asian smokers had the highest prevalence of friends who smoke more than 4 cigarettes (70.6%, 67.2% and 65.5%). NHPI, Hispanic and AI smokers were more likely to live with an adult smoker (32.4%, 20.2% and 19.0%). Car secondhand smoke exposure was highest among NHPI and AI (46% and 39.6%). NHPI were least likely (37%) to have been asked for age and refused purchase, and Hispanics (70%) the most likely. Understanding differing patterns of initiation, access issues and second hand smoke exposure between diverse ethnic and gender groups can result in targeted interventions that are more likely to be effective in preventing initiation, reducing exposure and access as well as targeting groups that are most in need of cessation services.
• Carter-Pokras O, Ye C, Fiedler R. Lost opportunities for tobacco cessation: diabetics in the Maryland Adult Tobacco Survey. Cultivating Healthy Communities: 20th national Conference on Chronic Disease Prevention and Control. National Harbor, Maryland. February, 2009.
  Abstract: This paper presents data from the 2006 Maryland Adult Tobacco Survey, one of the largest tobacco surveys in the nation (n=21,799). The Maryland Adult Tobacco Survey is administered in English and Spanish using Computer-Assisted Telephone Interviewing technology. Previous diabetes diagnosis, and smoking status, are based on self-report. Analytic sample sizes were sufficient to provide detailed analysis for Whites and Blacks with diabetes, but, not other racial/ethnic groups. All analyses took into account the sample design and weights. The Maryland Adult Tobacco Survey is administered in English and Spanish using Computer-Assisted Telephone Interviewing technology. Previous diabetes diagnosis, and smoking status, are based on self-report. Analytic sample sizes were sufficient to provide detailed analysis for Whites and Blacks with diabetes, but, not other racial/ethnic groups. All analyses took into account the sample design and weights. Smoking harms nearly every organ of the body, and is the leading preventable cause of disease and death in Maryland. Analyses of the 2006 Maryland Adult Tobacco Survey show notable racial/ethnic disparities in tobacco use behaviors, attitudes, knowledge and tobacco cessation among adult minority populations. Eleven percent of Blacks and 7.7% of Whites reported previous diagnosis of diabetes. Former smokers (12.9%) were more likely to have diabetes than current smokers (7.2%) or nonsmokers (6.9%), with Black former smokers having the highest rate of diabetes (21.3%). Current/former smokers who smoked everyday for more than 10 years were almost three times as likely to have diabetes than those who smoked fewer years (14.5% vs 5.6%). One out of five Black current/former adult smokers (21.4%) who smoked more than 10 years had diabetes. Only eight out of ten Black current smokers, and nine out of ten White current smokers had health insurance. Almost all diabetics, regardless of smoking status, had seen a doctor or other health professional in the previous year; less than half of current smokers had seen a dentist during the previous year. Among diabetics, 23.7% of Black current smokers and 16.4% of White current smokers had not received advice to quit smoking by a doctor/dentist/other health professional. Two-thirds of diabetics who were current smokers had not been advised to quit smoking by a dentist. This paper further discusses exposure to smoking cessation programs and messages. Results from our analyses can be used to identify key areas for intervention to reduce smoking-related disease and diabetes complications.
• Carter-Pokras O, Feldman RH, Kanamori M, Rivera I. Understanding Latino Barriers to Access and Use of Community Resources to Promote Smoking Cessation. American Academy of Health Behavior. Hilton Head, South Carolina. March, 2009.
  Abstract: This poster will describe an ongoing qualitative project, funded by the Maryland Department of Health and Mental Hygiene, to assess barriers to access and use of smoking cessation services experienced by Latinos in Maryland. Our analyses of data from the 2006 Maryland Adult Tobacco Survey suggest that the Latino population in Maryland is more knowledgeable than other ethnic groups that smoking is physically addictive, that there are dangers to smoking while pregnant, and that second hand smoking causes lung cancer and heart disease in adults and respiratory problems in children., Maryland Latinos are less likely than other ethnic groups to obtain information about quitting from all sources with the exception of radio . In addition, former and current Latino smokers report that the top reasons that influence their intentions to quit are physical fitness, health problems, and to be an example (role model).To further explore these findings, five focus groups were conducted of 18-65 year old Latino smokers and ex-smokers (two focus groups with current smokers, two focus groups with former smokers, and one focus group with social smokers). Focus groups were conducted in Montgomery County (Silver Spring/Wheaton) and in Prince George County, MD (Langley Park/Bladensburg) in September 2008. Topics covered included: 1) barriers and difficulties Hispanics face in trying to quit and what they think will help them, 2) underlying characteristics that make some smoking cessation services more/less appealing to the Hispanic community, and 3) configuration of Hispanic social networks and sources of information and how they can be used to promote available smoking cessation services as well as to disseminate smoking prevention and cessation messages. Findings will be used to inform state and local tobacco programs on how best to incorporate cultural, linguistic, literacy and social elements into effective smoking prevention and cessation services for Hispanics.
• Feldman R, Carter-Pokras O, Kanamori M, Rivera I. Understanding the barriers to the access and use of community resources to promote smoking cessation among Latinos. American Academy of Health Behavior, Hilton Head, South Carolina. March, 2009.
  Abstract: Purpose: Our analysis of the 2006 Maryland Adult Tobacco Survey suggests that Maryland Latinos are less likely than other ethnic groups to obtain information about quitting from all sources with the exception of radio. In addition, former and current Latino smokers report that the top reasons that influence their intentions to quit are physical fitness, health problems, and to be a good example. Methods: To further identify the barriers and facilitators to smoking cessation for Maryland Latinos five focus groups (n=55) were conducted of 21-60 year old Latino regular smokers, social smokers and ex-smokers. Results: The majority of participants were unaware of smoking cessation services available to Latinos in Maryland. The top two barriers for quitting smoking were: 1) seeing/smelling other smokers, socially or at work, and 2) anxiety, depression or stress. Male regular smokers used oral alternatives (e.g., gum) in their attempts to quit smoking while male ex-smokers reported turning to God to help them quit and female ex-smokers mentioned using natural remedies in quitting. Social factors/friends were very important in perpetuating the cycle of smoking. Most ex-smokers stated that family members were influential in persuading them to quit smoking. Participants recommended Spanish-speaking ex-smokers as lay health promoters as the best way to reach the community to promote smoking cessation. Conclusions: Cultural, linguistic, and social elements play an important role in smoking prevention and cessation services for Latinos. The findings will be used to inform state and local tobacco programs on how best to incorporate these elements into effective programs.
• Gottlieb J, MacPherson L, Carter-Pokras1 O, Voorhees C, Kanamori M, Ye C, Valliant R, Zhang G, Fiedler R. Disparities in Flavored and Smokeless Tobacco Use Behaviors by Youth Minority Populations in Maryland. 2009 Joint Conference of SRNT and SRNT-Europe. Dublin, Ireland. April, 2009.
  Abstract: The popularity of flavored cigarettes, called "bidis" or "beedies," and smokeless tobacco among youth in the U.S. has grown recently. Flavored cigarettes are perceived as candy-like, less expensive, and safer and more natural than regular cigarettes. Bidi smokers have much higher risks of heart attacks, chronic bronchitis, and some cancers than non-smokers. This paper presents data from the 2006 Maryland Youth Tobacco Survey, one of the largest tobacco surveys in the nation (308 schools, n= 82,500, 6th grade-12th grade). Findings show notable racial/ethnic disparities (sample included 1969 American Indian/Alaskan Natives, 3226 Asians, 20739 Blacks, 3898 Hispanics, 1015 Native Hawaiian/Pacific Islanders, 49937 Whites, and 1716 Missing race/ethnicity). Flavored cigarette use was highest among Asian smokers (56.8%) followed by Native Hawaiian/Pacific Islander smokers (NHPI) (55.5%) and American Indians (AI) (54.6%); with males (42.2%) greater than females (34.3%). NHPI males (25.5%) and AI males (13.7%) in high school were the most likely to use bidis with much higher rates in 12th than 11th grade. NHPI (11.5%) and AI (7.9%) were most likely to be smokeless tobacco users, with males (5.2%) more likely than females (1.7%). High school youth were also the most likely to use smokeless tobacco. Results can be used to improve understanding of flavored and smokeless tobacco use among minority populations who are at high risk and suffer disproportionately from tobacco-related illness and death. Findings will be helpful in designing minority tobacco use prevention and cessation programs.
• Ye C, Valliant R, Zhang G, Kreuter F, Carter-Pokras O, Fiedler R. Item Nonresponse and Weighting Adjustments in a Telephone Survey of Tobacco Use, 63rd Annual AAPOR Conference. May, 2009.
  Abstract: The 2006 Maryland Adult Tobacco Survey, one of the largest tobacco surveys in the nation (n=21,799), was administered using Computer-Assisted Telephone Interviewing technology. It yielded 272 items with missing data. Among the 21,799 respondents, 19.3% refused to answer at least one question, and 77.9% answered “don’t know” to at least one question. On average, the missing rate per item was 3.4%, and nearly 16% of respondents (15.9%) did not answer the question asking about income. Although item nonresponse is common, universal unit weights that do not consider this fact are usually used for estimation. A possible solution would be to create individual weights for each variable of interest. However, individual weight construction is rarely done in practice because it poses tremendous burden on both data preparation and analysis. To examine the impact of item nonresponse on estimation, we instead compared the estimates of interest for imputed (multiple imputation) and unimputed data. In this survey, item missing rates varied among respondents with different demographic characteristics. For example, in general, college graduates were less likely to have item missing data. Therefore, we took a step further to develop a weighting adjustment for unimputed data in an effort to reduce the potential bias due to item nonresponse. We used a logistic regression model to describe a sample member’s propensity for having overall item nonresponse, and weight adjustments are based on the propensity scores. We thus assessed estimates of interest using weighted, weighted imputed, and adjusted weighted data, with the first as a baseline for comparison.
• Feldman R, Carter-Pokras O, Kanamori, M, Roth S, Gryczynski J. Social and cultural factors associated with high tobacco use among American Indians in Maryland. National Conference on Tobacco or Health. Phoenix, AZ. June, 2009.
  Abstract: Introduction: Data from the 2006 Maryland Adult Tobacco Survey (n=21,799) suggest that American Indian adults are more likely to use tobacco (23.6%) and cigarettes (20.1%), and to be exposed to secondary smoke in the car (29.6%) and in the workplace (29.6%) than other ethnic groups. American Indians also smoke more cigarettes (mean=19.9 cigarettes) and have longer smoking histories (mean=18.6 years) than other adults. To contextualize these quantitative findings, four focus groups (n = 35) explored attitudes towards tobacco among American Indian former smokers and current smokers who were thinking about quitting. Keypoints: Participants emphasized willpower as an essential component of smoking cessation, an idea tied to the cultural value of self-reliance. Smoking cessation interventions were seen as having the most potential when framed as helping to motivate and empower individuals to make healthy changes for themselves. Participants felt that smoking cessation interventions could have increased reach and impact if disseminated through existing structures in the community, such as churches, community centers or pow-wow celebrations. While some noted that cultural traditions were being lost by American Indians in Maryland, there was broad interest in strategies that included cultural components. Benefits: Findings will be used to inform state and local tobacco programs on how best to incorporate cultural and social elements into effective smoking prevention and cessation services for American Indians. Conclusions: Social and cultural factors play an important role in tobacco use and smoking cessation. Input from the target population can provide valuable insights in understanding behavioral health issues and developing interventions.
• Feldman RH, Carter-Pokras O, Kanamori M, Ye C, Valliant R, Zhang G, Fiedler R. What motivates former smokers and current smokers to quit in Maryland. American Public Health Association 137th annual meeting. Philadelphia, Pennsylvania. November, 2009.
  Abstract: Smoking is the leading cause of disease and death in Maryland. To better understand the quitting process in Maryland we examined data from the 2006 Maryland Adult Tobacco Survey (MATS), one of the largest tobacco surveys in the U.S. (n=21,799). Ex-smokers and smokers were given a list of 14 reasons why people quit smoking. The top reason among both ex-smokers (34.5%) and smokers (40.7%) was physical fitness. In examining ethnic minorities, the MATS found that Latino ex-smokers (22.3%) and smokers (23.0%) were significantly less likely than White ex-smokers (36.6%) and smokers (41.7%) to state that physical fitness was a reason. The second most reported reason for ex-smokers (33.3%) was concern about health hazards, with Latinos (22.8%) less likely to report health hazards than Whites (35.5%). The second most reported reason to quit for smokers was personal health problems (38.5%) with Latinos (32.4%) being the least likely to report this reason compared to other ethnic groups (nonsignificant). To further understand the quitting process among Maryland Latinos, we conducted a series of focus groups among Latino ex-smokers and smokers. We found that social influences—health of children/family and role model pressures--were important motivators to quit for both Latino ex-smokers and smokers. These quantitative and qualitative data provide a better understanding of ethnic differences among ex-smokers and smokers, and support improved design of smoking cessation programs tailored to the motivators of specific groups.
• Kanamori M, Beck K, Carter-Pokras O, Fiedler R. Association of Social Networks and Mass Media with Cigarette Smoking Among Asthmatic Adolescents. American Public Health Association 137th annual meeting. Philadelphia, Pennsylvania. November, 2009.
  Abstract: Introduction: Asthma is a common chronic disease for youth. Tobacco companies are spending around $37 million per day on media advertisement. This study analyzes whether social actors and mass media are associated with cigarette smoking among asthmatic youth. Methods: Data from the 2006 Maryland Youth Tobacco Survey for 10,481 asthmatic youth (< 18 years old) were analyzed by smoking status, social network, media exposure and sociodemographic variables using bivariate statistics, and logistic regression. Results: Overall, the odds of being a smoker were greater for asthmatic youth (OR = 1.33) compared to non-asthmatic youth. It was also greater regardless of gender, race/ethnicity (with exception of Hispanics and Native Hawaiian/Pacific Islanders), education, weekly income and self perceived health status. Current smoking was associated with cigarette offers from best friends (females OR=114.48, males OR=38.88), having a friend who was a smoker (females OR=7.80, males OR=4.35), and exposure to second-hand smoke in rooms (females OR=4.63) or cars (females OR=1.77, males OR=3.17). Smoking allowed inside the home (OR=1.73), and receipt of advice from a dentist not to smoke was associated with current smoking among females (OR=2.16). Cigarette smoking was associated with media exposure to smoker actors for females (OR=1.43) and with smoker athletes for males (OR=2.35). Exposure to tobacco promotional objects (females OR=2.92, males OR=2.96) was also associated with smoking. Conclusions: Tobacco prevention and control policies, regulations and programs should address asthmatic smoker friends, second-hand smoke and exposure to tobacco promotional objects. Educational campaigns should capitalize on athletes, actors and peer leader as role models.
• Kanamori M, Beck K, Carter-Pokras O. Understanding the Relationship between Social Networks and Mass Media with Cigarette Smoking Among Asthmatic Latino Adolescents. American Public Health Association 137th annual meeting. Philadelphia, Pennsylvania. November, 2009.
  Abstract: Context: Asthma is the most common chronic disease among youth. Tobacco companies spend around $37 million per day on mass media advertisement. Latino cultural values, such as familialismo and simpatia, could potentially favor the dissemination of pro-tobacco messages in Latino social networks. We analyzed the association between social networks and mass media messages on asthmatic Latino youth current cigarette smoking. Methods: Data from the 2006 Maryland Youth Tobacco Survey for 388 asthmatic Latino youth (< 18 years old) were analyzed by smoking status, social network and media exposure variables using bivariate statistics, and logistic regression controlling for demographic variables. Analytic weights accounting for jurisdiction and high school/middle school were used. Results: The percentage of smokers among asthmatic Latino youth was higher compared to Latino non-asthmatic youth (14.5% vs. 11.9% respectively). Social Networks: asthmatic Latino youth smoking was associated with cigarette offers from best friends (OR=161.22), having a friend who was a smoker (OR=18.78), and exposure to second hand smoke in cars (OR=7.17). Mass Media: Lack of knowing about the smoking quitline “1-800-QUIT-NOW” (OR=7.82), exposure to smoker athletes on TV (OR=2.86), exposure to tobacco promotional objects (OR=7.16) and intention to use/buy tobacco promotional products (OR=3.30) were also associated with cigarette smoking. Conclusions: Tobacco prevention and control strategies should capitalize on friends and athletes as positive role models. Regulations targeting youth should prohibit broadcasting smoker athletes on TV, distributing pro-tobacco marketing products, cigarettes access, and second hand smoke in cars. The quitline service should continue to be promoted in the Latino community.
• Lee S, Lok JK, Sharma E, Wang Y, Ulpe R, Carter-Pokras O. Psychosocial, cultural, and environmental predictors of tobacco use among Asian Americans in Maryland. American Public Health Association 137th annual meeting. Philadelphia, Pennsylvania. November, 2009.
  Abstract: Background: Few data exist that thoroughly examine smoking behaviors of Asian American (AA) subgroups in Maryland. Existing survey data on tobacco use among aggregated AAs in Maryland are too general and lack specificity. Objective: To investigate cultural, psychosocial, and environmental factors influencing tobacco use among four major AA communities in Maryland. Methods: Four focus groups (total of 43 participants) were conducted in Asian Indian, Chinese, Korean, and Vietnamese communities to collect qualitative data on cultural, psychosocial, and environmental factors that influence tobacco use behaviors. Recommendations for the development of community-specific smoking cessation programs were discussed. We used MAXQDA to code emergent themes and analyze data. Results: Social smoking was described as an essential cultural component among all communities. There was a remarkable pattern of gender differences, where smoking among females was perceived to be a stigma. Military participation and war significantly influenced smoking behavior in Korean and Vietnamese communities. The knowledge and use of other tobacco products such as bidis and hookahs was more prevalent among Asian Indians and younger generations. In the Chinese community, respondents revealed the significance of cigarettes as a tradition and status symbol. In general, participants were unaware of available smoking cessation programs through the state or other providers. Most smokers in these communities did not seek external help for smoking cessation and preferred quitting independently. Recommendations: Community- and faith-based organizations and other community specific media were recommended as ideal communication channels. Participants suggested future smoking cessation programs be more linguistically appropriate and culturally sensitive.
• Voorhees C, Ye C, Carter-Pokras O, Zhang G, Kanamori K, MacPherson L, Fiedler R. Social and Environmental Predictors of Smoking Initiation in Diverse Maryland Adolescents. American Public Health Association 137th annual meeting. Philadelphia, Pennsylvania. November, 2009.
  Abstract: Background: Little is known regarding social and environmental factors that may be associated with smoking onset. Further understanding may aid in prevention efforts consistent with HP 2010 objectives. Methods: This study investigates multiple factors associated with adolescent initiation in the Maryland Youth Tobacco Survey, one of the largest and most diverse school-based surveys in the U.S.(308 middle and high schools; n=82,500) including 1,969 American Indians, 3,226 Asians, 20,739 Blacks, 3,898 Hispanics, and 1,015 Native Hawaiian/Pacific Islanders. The questionnaire was administered in paper-and-pencil format either in individual classrooms or in alternative locations using CDC protocols. Results: Black youth were less likely to initiate smoking during the past year compared to White or Hispanic youth. Bivariate analyses show that youth living with current smokers were significantly more likely to initiate smoking as were youth reporting second hand smoke exposure in rooms or car, reporting exposure to Internet or other advertisements for commercial tobacco products, having more friends that smoke, having friends offer tobacco products, or using other tobacco products such as smokeless tobacco and cigars. Multivariate analyses results show that composite measures for peer influence, advertising exposure and home exposure to second hand smoke were significantly related to smoking initiation in this diverse sample. Differences stratified by racial ethnic group will also be reported. Conclusions: Many social and environmental factors influence smoking initiation, are common to all racial/ethnic groups in this study, and need to be addressed by a combination of targeted public awareness, education and media campaigns directed at parents/guardians.

More information on tobacco disparities

• MDQuit.org: The MDQuit website offers cessation tools, advice, and help to those trying to overcome their addiction to tobacco.