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Cigarette Smoking Among Adults -- United States, 1988

In 1964, the first Surgeon General's report on smoking focused on the health hazards associated with cigarette smoking (1). From 1965 through 1987, the overall prevalence of cigarette smoking among adults in the United States declined by approximately 0.5 percentage points per year (1,2). To determine the prevalence of smoking among adults in the United States in 1988, the Occupational Health Supplement (OHS) of CDC's National Health Interview Survey collected information on cigarette smoking from a representative sample of the U.S. civilian, noninstitutionalized population aged greater than or equal to 18 years.

For 1988, the OHS included the following questions on smoking behavior: "Have you smoked at least 100 cigarettes in your entire life?" and "Do you smoke cigarettes now?" Among persons who reported smoking at least 100 cigarettes, current smokers were defined as those who reported being a smoker at the time of the interview, and former smokers, as those who were not current smokers. Both current and former smokers were classified as ever smokers. The proportion of persons who had stopped smoking was defined as the number of former smokers divided by the number of ever smokers. Current smokers were asked, "On the average, about how many cigarettes a day do you smoke?" Data were available on cigarette smoking status for approximately 44,000 persons aged greater than or equal to 18 years and were weighted to provide national estimates. Ninety-five percent confidence intervals (CIs) were calculated using SESUDAAN (3).

Based on the survey, in 1988 an estimated 91.1 million (51.9%) adults in the United States were ever smokers, and 49.4 million (28.1%) were current smokers. Current smokers included 30.8% of all men (25.6 million) and 25.7% of all women (23.7 million). In all age groups except 18-24-year-olds, the prevalence of smoking was higher among men than women; smoking was most prevalent among persons 25-64 years of age (Table 1). The overall prevalence of smoking was higher among blacks (31.7%) than whites (27.8%), and lowest among persons of other races (23.8%). The overall prevalence also was higher among non-Hispanics (28.4%) than Hispanics (23.5%). The prevalence of smoking was highest among persons with less than a high school education (34.0%) and with only a high school education (32.0%) (Table 1).

The prevalence of smoking was significantly higher among separated and divorced persons (42.6% (95% CI=41.3%-44.0%)) than among persons in other marital categories: married (27.4% (95% CI=26.7%-28.1%)), never married (26.5% (95% CI= 25.2%-27.7%)), and widowed (19.5% (95% CI=18.3%-20.6%)).

In 1988, 41.8 million (45.8%) ever smokers were former smokers. The proportion of men (49.0% (95% CI=47.8%-50.1%)) who had stopped smoking was higher than that of women (42.0% (95% CI=40.8%-43.1%)), and the proportion of whites (47.6% (95% CI=46.8%-48.4%)) who had stopped smoking was higher than that of blacks (32.4% (95% CI=30.2%-34.6%)). The proportion of Hispanics who had stopped smoking (44.9% (95% CI=41.7%-48.1%)) was similar to that for non-Hispanics (45.9% (95% CI=45.1%-46.7%)). The proportions of adults with less than a high school education who had stopped smoking (41.1% (95% CI=39.6%-42.7%)) and of adult high school graduates who had stopped smoking (41.3% (95% CI=40.0%-42.6%)) were lower than those for persons with some college education (47.7% (95% CI= 46.1%-49.3%)) and for college graduates (63.1% (95% CI=61.3%-64.9%)).

Overall, the mean number of cigarettes smoked per day by current smokers in 1988 was 21.3 (Table 2). In general, the mean number of cigarettes smoked by men was higher than the number smoked by women. Whites smoked more cigarettes per day than did blacks and persons of other races, and non-Hispanics smoked more cigarettes per day than did Hispanics. In 1988, 27.0% (95% CI=26.0%-27.9%) of smokers smoked 25 or more cigarettes per day. Reported by: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion; Div of Health Interview Statistics, National Center for Health Statistics; Surveillance Br, Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that, from 1987 to 1988, the overall prevalence of smoking among adults greater than or equal to 18 years of age declined from 28.8% (2) to 28.1%--approximately 0.7 percentage points. In addition, in 1988, the proportion of ever smokers who were former smokers was 45.8%, compared with 44.2% in 1987 (4).

The higher rates of cigarette smoking among separated and divorced persons appear to reflect higher rates of smoking initiation before the usual age of marriage (5). In addition, separated and divorced persons were less likely to have quit smoking than married persons (5). Social support provided in marriage may increase the probability of cessation (5), while stress (which has been associated with difficulty in quitting (6)) from marital discord may decrease the likelihood of quitting.

Cigarette smoking is the single most important preventable cause of death in the United States (7). One of the national health objectives for the year 2000 (objective 3.4) is to reduce the prevalence of cigarette smoking among adults to no more than 15% (8). To achieve this goal, the current rate of decline must be doubled.

Health-care providers and public health agencies must increase efforts to prevent the initiation of smoking and, for smokers, to support attempts to quit and maintain cessation. Persons with less than a high school education and in low socioeconomic groups are at especially high risk for becoming smokers (1,9). In addition to directing interventions toward these groups, smoking control and prevention efforts will require intensified public health education, increased emphasis on school health education, and enactment and enforcement of effective health-promoting policies and laws.

References

  1. CDC. Reducing the health consequences of smoking: 25 years of progress--a report of the Surgeon General, 1989. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411.

  2. CDC. Tobacco use by adults--United States, 1987. MMWR 1989;38:685-7.

  3. Shah BV. SESUDAAN: standard errors program for computing of standardized rates from sample survey data. Research Triangle Park, North Carolina: Research Triangle Institute, 1981.

  4. NCHS, Schoenborn CA, Boyd GM. Smoking and other tobacco use--United States, 1987. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (PHS)89-1597. (Vital and health statistics; series 10, no. 169).

  5. Waldron I, Lye D. Family roles and smoking. Am J Prev Med 1989;5:136-41.

  6. DiClemente CC, Prochaska JO. Processes and stages of self-change: coping and competence in smoking behavior change. In: Shiffman S, Wills TA, eds. Coping and substance use. New York: Academic Press, Inc., 1985.

  7. CDC. The health benefits of smoking cessation: a report of the Surgeon General, 1990. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1990; DHHS publication no. (CDC)90-8416.

  8. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives--full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

  9. CDC. Cigarette smoking among youth--United States, 1989. MMWR 1991;40:712-5.

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