Technical Appendix

US State-level Human Development Index (SHDI):

The national human development index (HDI) introduced by the United Nations Development Program (UNDP) in 1990 is used widely across the globe to assess the well-being of people and their quality of life reflected in average values of three dimensions of socio-economic and demographic characteristics of human capital: education, health, and standard of living.¹ Since countries may have wide regional variation in these indicators, the Subnational Human Development Index (SHDI) improves upon the national-level index by measuring HDI at the subnational levels.²

We constructed the HDI in the United States (US) at the state level (50 states and District of Columbia). Overlaying state-level tobacco-related data on SHDI in the US map shows the within-country correspondence between tobacco-related geographic disparities and state of human capital. It can help identify where resources are needed most from a broader perspective of socio-economic equity while mitigating the adverse consequences of the tobacco epidemic and improving overall well-being of US population.

Methods

Table 1 shows the characteristics of four indicators corresponding to the three dimensions of SHDI at state level in the US For computing the dimension indices from corresponding indicators, the following formula was used:

Indexing actual value in relation to the minimum and the maximum values ensures that the values of the dimension indices fall between 0 and 1. For the education and health dimensions, the minimum and maximum set by UNDP have been used. For standard of living, the minimum and maximum values of per capita gross national income were adjusted to state-level minimum and maximum values rounded off to the closest thousand in US dollars to avoid zeros in the numerator or the denominator in the right-hand side of equation (1).

The educational dimension is measured with two indicators—(i) mean years of schooling of the adult (25+) population that indicates the current level of educational attainment of the population, and (ii) expected years of schooling of children aged 5 years that reflects the prospective level of educational attainment of the population. The dimension index for education was calculated using the geometric mean of the separate indices for the two indicators of educational attainment based on the formula in equation (1). 

The state-specific SHDI is then computed as the geometric mean of the three indices of education, health and income:

The state-specific SHDI is used to categorize states into four quartiles. The aggregate SHDI values for quartiles are calculated by applying the SHDI formula to the weighted group averages of component indicators. Health and income indicators are weighted by total population, expected years of schooling is weighted by population ages 5–24 and mean years of schooling is weighted by population ages 25 and older. Age group wise state-level population estimates were obtained from the 2017-2021 American Community Survey (ACS).

Table 1. Summary of indicators included in the SHDI.