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CDC Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years — United States, 2005–2010

Tuesday, September 6, 2011 – 12:00pm ET

KAREN HUNTER: Thank you.  And welcome to today's Vital Signs press briefing.  The Vital Signs report is titled "Current Cigarette Smoking Among Adults Aged 18 and older, United States, 2005 –2010."  And we're going to begin with CDC director, Dr. Thomas Frieden.  Dr. Frieden? 

THOMAS FRIEDEN: Thank you very much, and good afternoon, everyone.  Thanks for joining us.  Also let me apologize for the quality of the connection here.  I′m in a very noisy area related to the rain and travel delays.  Today's information is for the tobacco –– tobacco remains the leading preventable cause of death in the United States.  For 40 years, there was a consistent decline in the number of adults who smoked– from 1964 to around 2005.  Over the past five years, we've seen a virtual stall in the decline in smoking, but today's report shows that that decline did actually continue.  So we have good news which is that there are fewer Americans smoking today than in the past.  The proportion of Americans who smoke decreased slightly from 20.9 percent to 19.3 percent.  That represents three million fewer smokers in 2010 than there would have been had prevalence not declined since 2005.  And three million fewer smokers is a very significant finding, about half of all smokers will be killed by tobacco if they don't quit.  And about one third of all current smokers may die from cigarette use unless they quit promptly.  So we're talking about preventing more than a million deaths because of that decline.  On the other hand, that decline was very gradual.  It was much slower in terms of the rate of decline than previous declines.  So we can certainly do much better. 

There were several other trends that were noteworthy.  A number of people who smoked very heavily, a pack and a half or more per day, fell quite substantially.  And the number of people who smoked less than half a pack a day increased as a proportion of the number of total smokers.  Now, while that is a reflection of fewer cigarettes being smoked, the fact is that the only safe thing to do is to quit smoking entirely.  This has a lot of implications for smokers and for health care systems.  Quitting smoking is the most important thing that a smoker can do to live a longer, healthier life.  Smokers not only die much younger than nonsmokers, but for the years that they're alive, they feel much older.  What we've seen also in different parts of the U.S. is that the states that have continued to implement effective tobacco control interventions have seen much more sustained and rapid declines in the number of adults and youth who smoke.  So tobacco control works.  It's not a question of our tools getting blunter, it's a question of our failing to effectively implement tobacco control measures. 

The study that was –– that is being reported on today is reported from a very systematic evaluation of how many people smoked and is controlled for a number of potential confounders.  So we view this as the most valid information we have.  This was a household interview survey.  One of the challenges that we've had in recent years in accurately describing the proportion of adults who smoke is the dramatic increase in the number of individuals who only have a cell phone and don't have landline coverage.  We know from various studies that those who only have a cell phone have a slightly higher smoking rate than those who don't, or also have a land line or only a land line.  This door–to–door study gives what we believe is the most valid information about smoking.  So we have fewer Americans smoking and smokers who are smoking are smoking less.  If you smoke, there is a lot of hope.  Most Americans who ever smoked have already quit, and most people who continue to smoke can quit either on their own or with assistance. 

There are a few tips that help smokers to quit.  They can think about the reason for quitting.  The health benefits that they'll get.  The people they'll be able to live to see their graduations, how much better they'll feel with exercise, aesthetic and other benefits.  Second is to get support from family and friends to quit with a buddy.  A third is to identify and reduce the things that trigger smoking, whether it's a familiar smoking places or a situation and for people who want to quit, to avoid those places and to prepare to quit by cleaning the house and getting rid of triggers such as ashtrays.  Most people who have ever smoked in this country have already quit, and most smokers want to quit.  So we think that today's information shows continued progress in reducing smoking in the U.S., but slower progress than we would like.  Slower progress than is possible, and slower progress than most smokers want.  I′m going to stop there and ask Dr. McAfee if there are other things that he would like to add.  After that, we'll open it up for questions. 

KAREN HUNTER: This is the moderator.  I forgot to introduce Dr. McAfee. Tim McAfee, he is the director of the Office on Smoking and Health.  His last name is spelled M–c–a–f–e–e.  Do you have any remarks? 

TIMOTHY MCAFEE: I would add a couple of things to what Dr. Frieden had gone over.  One is that particularly in these economic times it's important to remember that in addition to the terrible cost of human life, there's also a significant financial burden that smoking places on all of us.  And that smoking costs the U.S. about $193 billion annually, which is about equally comprised of direct medical costs and lost productivity.  And in terms of this issue as us as a society really having the tools at hand to be able to solve the –– and really ultimately drive down the pain and suffering and economic costs that smoking causes to us, one of the areas that needs more attention particularly is the importance of sustaining our comprehensive state tobacco control programs which have had so much success over the past two decades.  The tobacco industry continues to spend almost $10 billion each year, $27 million every day on cigarette advertising and promotion, with about 72 percent of that now spent on discounting to offset the price increases that were brought about by the higher excise taxes.  But this year alone, out of the $25 billion–plus in tobacco–generated state revenues that come from the sale of tobacco products, currently only about 2 percent or less is being dedicated to state programs to reduce tobacco use.  And if states were to dedicate more like the 10 percent to 15 percent that is recommended of these tobacco revenues to tobacco control, they'd be fully funding these programs, and we would see a much more rapid decline in tobacco use in our society. 

KAREN HUNTER: Thank you, Dr. McAfee.  I think we can open it up for questions now. 

Operator:  Thank you, we will now begin the question–and–answer session.  If you would like to ask a question, please press star–one.  You will be prompted to record your name.  Again, press star–one to ask a question.  And one moment for our first question.  Thank you, our first question comes from Timothy Martin with Wall Street Journal.  You may ask your question. 

TIMOTHY MARTIN: Hi, thanks for taking my call, and good morning.  Could you guys talk about –– smokers are smoking less.  Could you dive into maybe the reasons why the proportion of smokers who are taking in nine or fewer cigarettes per day on the decline 30 or more falling, is there a reason for that? 

TIMOTHY MCAFEE: And this is Tim McAfee.  Dr. Frieden, you want me to take that?  I′ll take that.  Well, I think we've seen a steady decline in consumption over the last 40 years, 45 years, since the first surgeon general's report in the mid–1960s.  So there are two things that –– ways that happened.  One is that people –– some people quit, and then the other is that people cut down.  And so I think people –– people are doing this because of the changes that have happened in society.  We've seen a de–normalization of smoking, we've seen the increase in clean indoor air laws that have happened so aggressively in the last ten years.  So people, it's a little harder for people to smoke, but it's also people feel –– feel like they want to cut down.  We've seen the increases in cigarette tax that went up on average.  Both there was a federal increase a couple years ago, and then the state –– most of the states have actually increased their taxes over the last decade which drives down consumption even more than it drives down people quitting.  I think the thing that we want to emphasize about this trend is to the extent to which people are cutting back for health benefits, not for pure economic benefits.  We just want to be sure that people understand that probably more so now than we saw ten years ago, we are considerably less impressed with the benefit that people will accrue themselves by cutting down as a harm reduction strategy.  Far and away the best thing that people can do is to quit for which they will get very clear, some of them immediate, almost immediate benefits, and where we have a much more definite sense of the dramatic benefits that they'll get. 

TIMOTHY MARTIN:  Yeah.  And one follow up, thank you ––

THOMAS FRIEDEN: This is Dr. Frieden.  I′ll just add to that, that we really do know what works in tobacco control.  Our comprehensive tobacco control program is highly effective at reducing smoking rates.  And the key components of that are smoke free so that people don't have to breathe cigarette smoke at their work or in other public places.  Offering help to people who want to quit.  We know that evidence–based tobacco cessation measures can double or triple the chances of someone who wants to quit will quit.  Warning about the harms of tobacco through media coverage and through effective mass media.  Reducing the efforts of industry to mislead the public about smoking, something which they have been doing for decades.  And raising taxes which is the single most effective way to reduce tobacco use.  In parts of the country where those policies have continued to deal with and progressively implement we've seen rates of tobacco use that are far below the national average and that would be possible anywhere.  In contrast, in parts of the country where those measures are not being implemented, we see rates of tobacco use that are significantly higher than the national average.  There is a misperception or misconception among some that we have reached an irreducible minimum of smoking and this is going to be at 20 percent or 18 percent.  And that is very far from the truth.  We know that it's possible in different parts this country and around the world to drive down tobacco use substantially more than they've been driven down already.  And most smokers want that to happen. 

TIMOTHY MARTIN:  Yeah.  One quick follow up –– thank you for your answers.  You had mentioned –– I think Dr. Frieden had mentioned that the rate of reduction of smoking had stagnated after about 40 years of consistent declines and maybe in the last five years or so, it's declined again.  Anything policy–wise, maybe this is retread from the previous question and answer, but anything policy–wise or anything different in recent years that might account for the 1.5 percent drop since 2005 to 2010? 

THOMAS FRIEDEN: I′ll begin and ask Dr. McAfee to continue.  There are a couple of things that can see–– one is the unfortunate substantial decline in state level funding for tobacco control.  And Dr. McAfee can give you members on that.  We've seen a decrease in investments in tobacco control and, therefore, we're having more tobacco–related disease as a result.  Second and something that we are not yet fully able to analyze or understand may have been changes in tobacco product.  The laboratory at the Centers for Disease Control which analyzes the tobacco industry and cigarettes has found that the industry has been able to often change the way nicotine –or affect I should say– the way nicotine is inhaled or absorbed.  So it is possible that the cigarettes today may be somewhat even more addictive than they were 10 or 20 years ago.  We've seen an increase in what is called free nicotine for essentially crack nicotine available for very rapid absorption through the lungs on smoking.  But I′ll ask Dr. McAfee to expand on those ideas. 

TIMOTHY MCAFEE: Yeah, the only thing I would add, to flip it –– actually one thing I wanted to clarify, I don't think we would use the word "stagnate" to describe the last five years.  In many ways, the findings that we're releasing today are good news relative to what we were concerned might have happened over the last five years because the thing that's different about the last five years from the previous five years is that the rate of decline is slower, and it's been less stable.  There was a couple of periods between –– between 2006 and 2007 where it didn't go down at all.  Whereas in other years it was solid each year.  But so stagnation fortunately is an overstatement.  It's a slowing down the rate of decline.  But we are still moving in the right direction.  

I would just add, I think to answer the part of your question that was asking about positive things that have helped to make this happen, first of all, it's the price increases that have happened, both in the states and at the federal level that resulted from the –– from the tax increases.  We do think that this –– we got perhaps less of an impact from this than we would have expected in large measure because of the strategies that the tobacco industry has used where they've shifted a lot of their promotional efforts into discounting at the point of sale.  In the retail environment, as well as through their couponing campaign that they do direct to consumers.  These have been executed to the point that they have diminished the effects we would have gotten otherwise. 

We also think that the –– we've seen this incredible, positive epidemic spread of clean indoor air ordinances, both at the state level where we went in 2000 from zero states having comprehensive clean indoor air laws to half of the states having comprehensive clean indoor laws, plus a whole host of local communities that also moved forward on this.  We think that made a big difference.  There was actually some move in the private sector where over the last five years we had three out of six of the major Hollywood studios essentially self–imposed standards relating to PG–13 movies not depicting smoking, which had been a major issue earlier in the decade.  And we think that may have also contributed particularly toward decreasing youth initiation. 

Operator: Our next question is from Julie Steenhuysen with Reuters.  You may ask your question. 

JULIE STEENHUYSEN: I′m just wondering if you can quantify for me the rate of –– you know, how the rate of smoking decline has slowed.  And I don't know if you can do that or not. 

TIMOTHY MCAFEE: We would be –– we can't –– I′m not sure we can do it immediately off the tip of our tongues, but we could certainly get back to you with a more quantitative mathematical description of it. 

JULIE STEENHUYSEN: Okay.  Thanks a lot. 

KAREN HUNTER: Thank you, next question. 

Operator: Thank you, next question comes from Debra Kotz with Boston Globe. You may ask your question. 

DEBRA KOTZ: Hi, thank you very much for taking my phone call.  I′m just curious if when you had mentioned before about the states that you said that the states are sort of not using large percentage of their –– the profits that they make from tobacco toward tobacco reduction strategies, you wanted to get that 10 percent to 15 percent that's recommended.  Are any states reaching that benchmark?  And if so, have you seen a parallel decline in the smoking rates that are greater than the average in over the last few years? 

TIMOTHY MCAFEE: Well, it's both an issue of how much states are spending, but it's also an issue of how they're spending it and the continuity of spending, and the classic example of this is actually California where –– which began the nation's longest running tobacco control all the way back in 1988.  And it has continuously –– its funding level is still lower than we would recommend, but they have been sort of like the little engine that could in that they've kept doing this year after year after year, and evolved to their situation so that the adult smoking rate in California has actually dropped 50 percent from when they started with the number of cigarette smoke decreasing two thirds.  And in its –– they've now analyzed on some of the first analyses of really the cost benefit of this and found that for a little less than $2 billion that they invested over this period of time, they've saved $86 billion in health care costs.  And there are similar examples from other states, Arizona which was one of the earliest programs, spent about a quarter of a billion dollars between 1996 and 2004, and saw a savings of $2.3 billion in health care costs.  So we are beginning to get now particularly as we're getting into an era where we're starting to see lung cancer rates begin to decline particularly dramatically in states that have had these kind of longstanding programs, we're starting to see the benefits that they are accruing, and both these expenditures of resources as well as the policies relating to clean indoor air and price are bearing fruit. 

DEBRA KOTZ:  Do you happen to have any specific stats like you had on Massachusetts? 

TIMOTHY MCAFEE: We can definitely get those to you.  Would you like us to follow up? 

DEBRA KOTZ:  Yes, definitely. 

TIMOTHY MCAFEE: Will do. We'll get back to you with specifics on Massachusetts. 

KAREN HUNTER: Thank you. Next question, please. 

Operator: Thank you, our next question comes from Robert Macpherson with AFP. You may ask your question. 

ROBERT MACPHERSON: Hey, good afternoon, how you doing?  A couple of questions. First of all, I guess to follow up on my colleague from Boston, have you got a bit of a regional picture?  Are there places in the country that is more likely to be smoking and parts of the country where they're less likely?  And also economic indicators or sort of higher income families more likely to quit, lower incomes more likely to keep on smoking?  And yeah, that's my first question.  I′ll have a quick follow up, as well. 

TIMOTHY MCAFEE: Well, this is Tim McAfee.  I′ll take a first stab at that. Yes, absolutely. I′m glad you asked this question because that was another one of the findings in –– in our –– the study.  And unfortunately, many of the disparities in smoking levels and, thus, morbidity and mortality are continuing.  Everybody has been going down.  But the –– in 2010, the prevalence of current cigarette smoking is higher among men, about 21.5 percent, than women, which is about 17.3 percent. It's higher in adults from 25 to 64, and there's a dramatic disparity between the highest racial ethnic group was American Indians and Alaskan Natives were at 31.4 percent. And that goes down with non–Hispanic whites and non–Hispanic blacks being almost identical. Twenty–one percent for whites and 20.6 percent for blacks. Hispanic are about 12.5 percent.  And Asian, non–Hispanic Asians are at 9.2 percent.  So there's more than a threefold difference between Asians and American Indian, Alaskan Natives, and similarly for education level.  We see a dramatic difference between those with a high level of education with those with a post graduate degree just at 6 percent, those with an undergraduate degree at about 10 percent.  Whereas people that have a GED have a rate of smoking of 45 percent.  This is also true with income, with people above the poverty level, at or above it at about 18 percent, and people below it at almost 29 percent.  Now the other thing you asked about geography, there's also –– there is geographic variation with smoking being the highest in the midwest at almost 22 percent, and the south at 21 percent, and lowest at the west at about 16 percent.  And if you look at individual states, the two states that are the lowest which are both in the west are Utah at 9.1 percent and California at 12.1 percent.  And it's the highest in West Virginia at about 26.8 percent and Kentucky at 24.8 percent. 

KAREN HUNTER: Thank you, next question, please. 

TIMOTHY MCAFEE: I would add one other thing that we think there is a relationship, as Dr. Frieden mentioned, between the aggressiveness with which the states have pursued both policies and funding of tobacco–control programs and the rate of smoking in the state. 

ROBERT MACPHERSON: Right. Okay. Thanks. Quick follow up on that note also is, did I understand correctly you're seeing that those public campaigns and a personal concern for one's health seem to be the motivating factor and not the fact that we're in economic hard times now and maybe people are giving up smoking or making the effort to give up smoking because it's simply become too much of a burden on the household budget? 

TIMOTHY MCAFEE: It's sometimes a mixed picture related to economic hardship. On the one hand, it does make it more expensive or makes it more difficult for people to make purchases which drives down –– may help drive down consumption.  But in terms of prevalence, it –– somewhat paradoxically may slow it down because people are under markedly increased stress, and particularly in the groups that I was discussing.  People that are at or below the poverty that smoke more.  They are under obviously much more stress in a current economic environment.  So we think –– we haven't teased out exactly the effect, but it certainly has not had a dramatic effect on people quitting. 

KARE N HUNTER: Thank you.  Are there any additional questions? 

OPERATOR: At this time I′m showing no additional questions. 

KAREN HUNTER: Okay, I will turn it over to Dr. Frieden and/or Dr. McAfee to see if they have any closing remarks. 

TIMOTHY MCAFEE: Well, if Dr. Frieden is not on the line, I would just close by saying that our goal at CDC is to help the tobacco users quit and prevent youth from starting to use tobacco. We know that we have the tools at our disposal that could virtually eliminate the harm caused by tobacco in a really, relatively rapid period.  And that we remain committed to promoting changes in the social norms around tobacco use, including the use of national campaigns to prevent and reduce tobacco use and to make tobacco products less accessible, affordable, attractive, and accepted.  We are looking forward to continuing to collaborate with our colleagues at the Food and Drug Administration that have taken a number of very critical steps over the past two years and will be, for instance, in the next year instituting the new, much more graphic, effective warning labels on cigarette packs and that are looking at other options to help affect the accessibility and attractiveness of tobacco –– of tobacco products, especially cigarettes.  And we look forward to also collaborating with our colleagues at the National Institutes of Health to increase the evidence base for treatment options that are effective at helping people quit.  We've got to continue to support increases in price of tobacco products, restricting tobacco advertising and marketing directed to youth, and work for comprehensive smoke–free laws to protect all nonsmokers across the nation from secondhand smoke.  Thank you. 

KAREN HUNTER: Thank you for joining us today for today's telebriefing.  And that will conclude the telebriefing. Thank you. 

THOMAS FRIEDEN: If I can just –– sorry, this is Dr. Frieden.  Before you conclude, I just want to reiterate the key points that we've talked about. This is good news that tobacco use has gone down.  There are three million fewer smokers in America than there were five years ago.  People who are continuing to smoke are smoking less, but we can do much better by continuing to invest in tobacco–control programs at all levels. And the states that have done that have seen very substantial decreases in tobacco use, not only saving millions of lives but also preventing literally billions of dollars in health care cost. And we know how important both of those things are these days, not only helping people live longer and healthier lives, but also driving down the Medicare and Medicaid costs that are so challenging for all of our budgets.  Tobacco control is a best buy, and we're encouraged by the results today, and that should emphasize the need to continue and intensify our results, our efforts help smokers quit as most smokers want to do.  I want to thank you all very much for your interest, and I′ll look forward to continuing to discuss emerging issues with you in this and other formats. Thank you. 

Operator: That does conclude today's conference.  We thank you for your participation.  At this time, you may disconnect your lines. 

###
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