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Surveillance for Selected Tobacco-Use Behaviors -- United States, 1900-1994

Abstract

Problem/Condition: Surveillance of tobacco use is an essential component of any tobacco-control program. The information gathered can be used to guide research initiatives, intervention programs, and policy decisions.

Reporting Periods: This report covers the period 1900-1994 for per capita cigarette consumption; 1965-1991 for trends in cigarette smoking prevalence and cessation; 1974-1991 for trends in the number of cigarettes smoked daily by current smokers; 1987-1991 for recent patterns of tobacco use; 1970, 1987, and 1991 for trends in cigar/pipe smoking and snuff/chewing tobacco use; 1984-1992 for trends in state-specific prevalences of regular cigarette smoking; 1987-1992 for state-specific estimates of smokeless-tobacco use; and 1976-1993 for trends in cigarette smoking among U.S. high school seniors.

Description of Systems: Estimates of cigarette consumption are reported by the U.S. Department of Agriculture, which uses data from the U.S. Department of the Treasury, the U.S. Department of Commerce, the Tobacco Institute, and other sources. The National Health Interview Survey uses household interviews to provide nationally representative estimates (for the civilian, noninstitutionalized population) of cigarette smoking and other behaviors related to tobacco use. The Behavioral Risk Factor Surveillance System uses telephone surveys of civilian, noninstitutionalized adults (greater than or equal to 18 years of age) to provide state-specific estimates of current cigarette smoking and use of smokeless tobacco. The University of Michigan's Institute for Social Research uses school-based, self-administered questionnaires to gather data on cigarette smoking from a representative sample of U.S. high school seniors.

Results: During the period 1900-1963, per capita cigarette consumption increased; after 1964, consumption declined. During the years 1965-1991, current cigarette smoking prevalence among persons ages greater than or equal to 18 years declined overall and in every sociodemographic category examined. Decrease in current smoking prevalence was slow in some groups (e.g., among persons with fewer years of formal education). Both the prevalence of never smoking and the prevalence of cessation increased from 1965 through 1991. The prevalence of current cigarette smoking, any tobacco smoking, and any tobacco use was highest among American Indians/Alaska Natives and non-Hispanic blacks and lowest among Asians/Pacific Islanders. The prevalence of cigar smoking and pipe smoking has declined substantially since 1970. The prevalence of smokeless-tobacco use among white males ages 18-34 years was higher in 1987 and 1991 than in 1970; among persons greater than or equal to 45 years of age, the use of smokeless tobacco was more common among blacks than whites in 1970 and 1987. Cigarette smoking prevalence has decreased in most states. The prevalence of smokeless tobacco use was especially high among men in West Virginia, Montana, and several southern states. From 1984-1993, prevalence of cigarette smoking remained constant among U.S. high school seniors. However, prevalence increased slightly for male seniors and white seniors, decreased slightly for female high school seniors, and decreased sharply for black high school seniors.

Interpretation: With the exceptions of increases in cigarette smoking among white and male high school seniors and in the use of smokeless tobacco among white males ages 18-34 years, reductions in tobacco use occurred in every subgroup examined. This decrease must continue if the national health objectives for the year 2000 are to be reached.

Actions Taken: Surveillance of tobacco use is ongoing. Effective interventions that discourage initiation and encourage cessation are being disseminated throughout the United States.

INTRODUCTION

Knowledge of the historical patterns of tobacco use in the United States aids in understanding patterns of morbidity and mortality, predicting future disease burden, understanding the effects of activities that promote tobacco use, evaluating tobacco-control interventions, identifying groups at high risk for tobacco-attributable diseases, and consulting with officials from other countries that are at earlier stages of the tobacco-use epidemic (1-5). Data gathered from tobacco-use surveillance can be used to guide research initiatives, intervention programs, and policy decisions. This report uses data from several sources to update or expand upon earlier reports (1,4,6-16) of selected tobacco-use behaviors in the United States.

METHODS

Sources of Data

U.S. Department of Agriculture

The Economic Research Service of the U.S. Department of Agriculture makes annual estimates of total and adult (i.e., persons greater than or equal to 18 years of age) per capita consumption of cigarettes (17-19). Their estimates are based on data from the Bureau of Alcohol, Tobacco, and Firearms (BATF) of the U.S. Department of Treasury; the Bureau of Commerce of the U.S. Department of Commerce; the Tobacco Institute; and other private and industry sources. The BATF reports the number of cigarettes on which federal taxes are paid; the U.S. Bureau of Commerce reports the number of cigarettes that are imported into the United States; and the Tobacco Institute reports the number of packs of cigarettes on which state taxes are paid (1).

Estimates of total and per capita consumption are based on both federal and state taxes paid on cigarettes at the time of transfer from the warehouses to the points of sale, as well as on imports; adjustments are made for inventory changes and smuggling. Population data from the U.S. Bureau of the Census are used to calculate the per capita estimates. (1,19).

National Health Interview Survey

Since 1965, CDC has collected data on tobacco use through the National Health Interview Survey (NHIS). The survey uses a probability sample of the civilian, non-institutionalized adult population of the United States (20-22). This report uses data from the surveys conducted since 1965 that included respondents greater than or equal to 18 years of age (i.e., 1965-1966, 1970, 1974, 1978-1980, 1983, 1985, 1987-1988, and 1990-1991). Some of the responses from the 1965, 1966, and 1970 surveys were collected from proxy respondents. Most interviews were conducted in the respondent's home; however, when respondents could not be interviewed in person, they were interviewed by telephone. Overall sample sizes ranged from 10,342 in 1980 to 86,332 in 1966. Data were adjusted for nonresponse and were weighted to provide national estimates. Confidence intervals were calculated by using variance curves for 1965 and 1966 (21) and by using standard errors generated by the Software for Survey Data Analysis (SUDAAN) for more recent years (23).

NHIS respondents are classified as current smokers if they report that they have smoked greater than or equal to 100 cigarettes and that they currently smoke. Former smokers are those who have smoked greater than or equal to 100 cigarettes and who do not currently smoke. Never smokers have either smoked no cigarettes or less than 100 cigarettes. Ever smokers comprise current smokers and former smokers. The prevalence of cessation (i.e., the percentage of ever smokers who no longer smoke) was obtained by dividing the number of former smokers by the number of ever smokers and multiplying by 100 percent. This measure has been referred to previously as the "quit ratio" (1,9,12,13). In the surveys conducted from 1965 through 1990, current smokers were asked to report the average number of cigarettes they smoked daily. In 1991, current smokers who smoked every day were asked the same question; those who reported that they only smoked on some days (occasional smokers) were asked to report the number of days during the previous 30 days they had smoked any cigarettes and the average number that they had smoked on those days; for those occasional smokers, the average number of cigarettes smoked daily was calculated by using a composite of those two reports.

A percentage-point change was calculated for certain trend data by subtracting the percentage-point estimate for the first year in the sequence from the estimate for the last year. A relative percentage change was calculated by dividing the percentage-point change by the percentage-point estimate from the first year in the sequence.

The 1970, 1987, and 1991 NHIS defined current cigar smokers as those who had smoked greater than or equal to 50 cigars and who reported that they currently smoked cigars. The 1970 NHIS defined current pipe users as those who had smoked at least three packages of pipe tobacco and who currently smoked a pipe. The 1987 and 1991 NHIS defined current pipe smokers as those who had smoked a pipe at least 50 times and who currently smoked a pipe.

After answering questions about whether they used cigarettes, cigars, or pipes, respondents (or their proxies) to the 1970 NHIS were asked if they currently used "any other form of tobacco, such as snuff or chewing tobacco." In 1987 and 1991, current snuff users were those who had used snuff greater than or equal to 20 times and were currently using snuff. The same criteria were used to classify users of chewing tobacco.

Behavioral Risk Factor Surveillance System

CDC coordinates state surveillance of behavioral risk factors through the Behavioral Risk Factor Surveillance System (BRFSS) (24,25). States that participate in the BRFSS provide estimates of several risk behaviors for the adult (i.e., persons greater than or equal to 18 years of age) population in each state. Data are collected through random-digit-dialed telephone interviews. This report provides data collected from 15 states in 1984 and from 49 states (including the District of Columbia) in 1992. (Beginning in 1994, all 50 states and the District of Columbia regularly collected data as part of the BRFSS.) Sample sizes ranged from 476 (Indiana, 1984) to 3,988 (California, 1992). Since 1991, at least 1,178 persons have been included in the sample in each state. The data are weighted to provide state-specific estimates. Ninety-five percent confidence intervals have been calculated by using SESUDAAN (26).

The BRFSS has routinely reported estimates of "regular" cigarette smoking. Current regular smokers are defined as those a) who report that they have smoked greater than or equal to 100 cigarettes and that they currently smoke and b) who do not respond that they are occasional smokers when asked to report the average number of cigarettes they smoke daily. The use of a measure of current regular smoking generally results in median prevalence estimates that are about 0.7 to 1.0 percentage points lower than those estimates that include current occasional smokers (CDC, unpublished data).

Thirty-three states in 1987 and 37 states in 1988 added (to the BRFSS core questionnaire) questions assessing smokeless-tobacco use. During the period 1989-1992, fewer states, ranging from 8 to 17, assessed smokeless-tobacco use. Smokeless-tobacco users were defined as those who said that they had ever used or tried any smokeless-tobacco products (such as chewing tobacco or snuff) and who currently used any smokeless-tobacco products.

Monitoring the Future Project (Surveys of High School Seniors)

Each spring since 1975, the University of Michigan's Institute for Social Research, under grants from the National Institute on Drug Abuse, has surveyed nationally representative samples of high school seniors as part of the Monitoring the Future Project. This report includes data from published reports for 1976-1992 (27-43) and unpublished data for 1993 (University of Michigan, Institute for Social Research). (The year 1975 was not included because the response rate was lower and the sample size was smaller than in subsequent years {44}.) Sample sizes ranged from 15,850 to 18,448. The data were weighted to provide national estimates. Responses to the question "How frequently have you smoked cigarettes during the last 30 days?" were used to estimate the percentage of seniors who smoked an average of one or more cigarettes per day during the previous 30 days. Although this measure is referred to as a measure of daily smoking, it does not technically measure smoking every day because some adolescents will average one or more cigarettes per day and still not smoke on every day (15).

Racial/Ethnic Comparisons

Whenever possible, persons who classified themselves as being of Hispanic origin were classified as Hispanic (rather than white, black, Asian/Pacific Islander, or American Indian/Alaska Native). Differences in tobacco-use behaviors among racial/ethnic groups may be influenced by differences in both educational levels and socioeconomic status, as well as by social and cultural phenomena that require further explanation. For example, tobacco-product marketing that appeals to certain populations may play a role in maintaining or increasing prevalence among those groups (1). Healthy People 2000's national health objectives for reducing smoking prevalence by the year 2000 have targeted special populations including blacks, Hispanics, American Indians/Alaska Natives, and Southeast Asian men (16).

RESULTS

Cigarette Consumption

Total annual consumption of cigarettes in the United States was 2.5 billion cigarettes in 1900, peaked at 640 billion in 1981, and will be approximately 480 billion cigarettes in 1994 Table_1. Total consumption in 1994 will be approximately equal to that of 1960. Per capita (i.e., adults greater than or equal to 18 years of age) annual consumption was 54 cigarettes in 1900, peaked at 4,345 in 1963, and is estimated to fall to 2,493 in 1994. With the exceptions of 1901, 1920, 1930-1932, 1938, 1946-1947, 1949, 1953- 1954, and 1962, per capita consumption increased steadily from 1900 through 1963. Since 1963, however, consumption has declined with rebounds being observed only in 1965-1966 and 1971-1973. Per capita consumption in 1994 will approximately equal that of 1942.

Cigarette Smoking Prevalence

In 1965, the year the NHIS first assessed cigarette smoking, an estimated 42% of U.S. adults were current smokers -- 52% of men and 34% of women Table_2. In 1991, cigarette smoking prevalence was 26% overall (28% for men and 24% for women). Generally, blacks were more likely to smoke than whites. Hispanics were less likely to smoke than non-Hispanics. Prevalence by age was highest among persons ages 25-44 years (30%) and lowest for those greater than or equal to 65 years of age (13%). Prevalence decreased with increasing education: 31% of persons with less than 12 years of formal education and 14% of persons with greater than or equal to 16 years of formal education were current smokers in 1991.

During the 27-year study period, current cigarette smoking prevalence greatly declined for all sociodemographic groups examined. From 1965-1991, the prevalence of cigarette smoking decreased 46% among men and 31% among women; from 1983-1991, prevalence decline approximately 20% for both sexes. The decrease in current smoking prevalence from 1965 through 1991 was similar for whites and blacks and more pronounced among Hispanics than non-Hispanics (from 1978 through 1991), among younger than older persons, and among persons with more education. The largest percentage change from 1965 through 1991 was for persons with greater than or equal to 16 years of education (-61%).

Among U.S. adults, the prevalence of never smoking increased from 44% in 1965 to 50% in 1991. Although women were consistently more likely than men to have never smoked, men demonstrated a more promising trend. The prevalence of never smoking among men increased steadily, from 28% in 1965 to 42% in 1991 -- a 49% increase. Among women, the trend was opposite: the prevalence of never smoking decreased steadily from 58% in 1965 to 54% in 1985. Although this trend increased thereafter, in 1991 the prevalence of women who had never smoked (57.6%) remained half a percentage point lower than the 1965 figure. Throughout the study period, blacks were more likely to have never smoked than whites, and the percentage increase in this behavior was greater for blacks (23%) than for whites (12%). Similarly, during the period for which data were available (1978-1991), U.S. residents of Hispanic origin were more likely to have never smoked than persons of non-Hispanic origin, and the percentage increase was greater for Hispanics (19%) than for non-Hispanics (10%). Large increases were observed in the prevalence of never smoking during the period 1965-1991 among persons less than or equal to 44 years of age, and a substantial decline was observed among persons greater than or equal to 65 years of age. The prevalence of never smoking increased directly with increasing education, and the relative percentage change between 1966 and 1991 also increased with higher levels of education.

Number of Smokers

The number of cigarette smokers in the United States was 50.1 million in 1965, 53.5 million in 1983, and 46.3 million in 1991 Table_3. The actual number of smokers was slightly higher at the end of the observation period than at the beginning for women, blacks, Hispanics, persons 25-44 and greater than or equal to 65 years of age, and persons with greater than or equal to 12 years of education. The number of former and never smokers increased substantially over the observation period for every group examined.

Intensity of Smoking

Among current cigarette smokers, the percentage who reported that they smoked less than 15 cigarettes per day was approximately 32% in 1974, 29% in 1980, and 37% in 1991 Table_4. The percentage of smokers who were heavier smokers (i.e., who reported that they smoked greater than or equal to 25 cigarettes per day) was about 25% in 1974, 29% in 1980, and 22% in 1991. The average self-reported number of cigarettes smoked daily by current smokers was 20 in 1974, 21 in 1980, and 18 in 1991. The percentage of current smokers who were heavier smokers declined across all subgroups after 1980 (except among persons greater than or equal to 65 years of age for whom this behavior peaked in 1987 and among U.S. residents of Hispanic origins for whom this behavior peaked in 1985). Heavier smoking was more prevalent among men than women, among whites than blacks, among non-Hispanics than Hispanics, and among persons ages 25-64 years than persons ages 18-24 and greater than or equal to 65 years of age.

Prevalence of Cigarette Smoking Among Young Adults

Current prevalence of cigarette smoking among persons ages 18-24 years was approximately half as high in 1991 (23%) as in 1965 (46%) Table_5. Among these young adults, the rate of decline in prevalence was greater for men than women. In 1965, the prevalence among men 18-24 years of age was 16 percentage points higher than among women; by 1991, the prevalence of smoking was only 1.1 percentage points higher among men than women. Current smoking prevalence among young black adults declined more rapidly than among young white adults, especially after 1980. Blacks ages 18-24 years were substantially less likely than whites to be current smokers in 1991. Current prevalence of cigarette smoking among persons ages 20-24 years declined more rapidly among those with greater than or equal to 13 years of education than among those with less than or equal to 12 years of education. Among women ages 20-24 years with less than or equal to 12 years of education, current smoking prevalence was approximately equal in 1965 and 1985. By 1991, however, prevalence in this group had declined substantially.

Among 18- through 24-year-olds, prevalence of never smoking increased more rapidly both among men than women and among blacks than whites. In every year, never smoking was more common among young adults with greater than or equal to 13 years of education than among those with less than or equal to 12 years of education. The rate of increase in never smoking was higher among women ages 20-24 years with greater than or equal to 13 years of education than among women with less than or equal to 12 years of education; among men, however, the rate of increase was higher among persons with less than or equal to 12 years of formal education.

With the exception of young adult men (in particular those with greater than or equal to 13 years of education), the declines in current smoking and the increases in never smoking among young adults leveled off during the period 1978-1983.

Prevalence of Cessation

The prevalence of smoking cessation almost doubled between 1965 and 1991 Table_6. In 1991, nearly half of the U.S. population who had smoked at least 100 cigarettes no longer smoked (i.e., were former cigarette smokers). By 1990, more than half of U.S. men and more than half of U.S. white adults who had ever smoked cigarettes had quit. The prevalence of quitting was higher for men than women, for whites than blacks, and for non-Hispanics than Hispanics. Prevalence of cessation increased as both age and education increased.

Prevalence of Tobacco Use, 1987-1991

For the combined years of 1987, 1988, 1990, and 1991, current cigarette smoking prevalence among men was highest among American Indians/Alaska Natives (AI/ANs) and non-Hispanic blacks, intermediate among non-Hispanic whites and Hispanics, and lowest among Asians/Pacific Islanders (A/PIs) Table_7. The prevalence of never smoking was highest among A/PIs and lowest among AI/ANs, regardless of sex. The prevalences of both current and never smoking were higher among non-Hispanic black men than among non-Hispanic white men. Current cigarette smoking prevalence was approximately equal among non-Hispanic white women and non-Hispanic black women; non-Hispanic black women were more likely than non-Hispanic white women to have never smoked. Current cigarette smoking prevalence among women was estimated to be about 36% for AI/ANs, 26% for non-Hispanic whites, 25% for non-Hispanic blacks, 17% for Hispanics, and 8% for A/PIs. For both sexes combined, current smoking prevalence was 37.1% (95% confidence interval {CI}=+/-5.8%) among AI/ANs, 30.1% (CI=+/-0.8%) among non-Hispanic blacks, 27.3% (CI=+/-0.4%) among non-Hispanic whites, 22.5% (CI=+/- 1.0%) among all Hispanics, and 16.0% (CI=+/-1.7%) among A/PIs. For both sexes, the percentage of current smokers who had smoked greater than or equal to 25 cigarettes per day was highest among non-Hispanic whites, intermediate among AI/ANs, and lowest among non-Hispanic blacks, A/PIs, and Hispanics.

The prevalence of current use of cigars or pipes was highest among AI/AN men and for both sexes of this race combined Table_8; use was intermediate among non-Hispanic whites and non-Hispanic blacks and lowest among Hispanics (with slightly higher use among Cuban Americans and the population of other Hispanics) and A/PIs. Neither of these types of tobacco use was prevalent among women of any of the racial/ethnic groups. Overall, AI/ANs were most likely to use chewing tobacco or snuff; prevalence of use was intermediate among non-Hispanic whites and non-Hispanic blacks and lowest among A/PIs and Hispanics. Approximately 8% of AI/AN males and 7% of white males used either chewing tobacco or snuff. Approximately 3% of non-Hispanic black women and 1% of AI/AN women used smokeless tobacco (i.e., chewing tobacco or snuff). The prevalence of use of any tobacco product was 40.2% (CI= +/-6.4%) among AI/ANs, 35.2% (CI=+1.4%) among non-Hispanic blacks, 32.2% (CI=+0.5%) among non-Hispanic whites, 23.4% (CI=+1.4%) among all Hispanics, and 16.8% (CI=+2.6%) among A/PIs. The sex-specific rank order of tobacco-use prevalence was the same among these five groups.

Data from the 1970, 1987, and 1991 NHIS indicated that the prevalence of cigar smoking and of pipe smoking among U.S. men declined substantially during the years 1970-1991 for whites, blacks, and the total adult male population Table_9. The difference between 1970 and 1991 prevalence data was greater among men ages less than or equal to 34 years than it was among older men. With the exception of black women greater than or equal to 65 years of age in 1970, the prevalence of cigar and pipe smoking was less than 1% among all subgroups of U.S. women examined.

The prevalence of chewing tobacco use and of snuff use increased substantially between 1970 and 1987 among white men less than or equal to 34 years of age. This trend was not observed among black men, black women, or white women. Among white men in 1970, chewing tobacco and snuff use was most prevalent among those greater than or equal to 65 years of age; in 1987 and 1991, use was most prevalent among white males ages 18-24 years. The use of chewing tobacco and snuff has been higher among older than younger black men, regardless of the survey year. In 1970 and 1987, black men greater than or equal to 45 years of age were more likely than white men greater than or equal to 45 years of age to use chewing tobacco or snuff. In 1970, white women greater than or equal to 45 years of age were more likely to use snuff than were white women less than or equal to 44 years of age; this difference was much smaller in 1987. The use of chewing tobacco and snuff among black women tended to increase with increasing age, regardless of survey year. Use was substantially more common among black than among white women. Nearly one fourth of black men and women greater than or equal to 65 years of age used either form of smokeless tobacco in 1970.

State-Level Prevalences of Regular Cigarette Smoking

The median prevalence of regular cigarette smoking was 27.4% within the 15 states participating in the BRFSS in 1984 and 22.2% within the 49 states participating in 1992 Table_10. The prevalence of cigarette smoking has declined consistently in some states and has remained fairly constant in others. In 1992, cigarette smoking prevalence was highest in Nevada (30.5%) and lowest in Utah (15.6%). In 1992, the prevalences in 11 states and the District of Columbia (Arizona, California, the District of Columbia, Georgia, Hawaii, Idaho, Iowa, Maryland, Montana, Nebraska, New Mexico, and Utah) were less than 20%.

The prevalence of smokeless-tobacco use was especially high among men in West Virginia, Montana, and several southern states. Table_11. Smokeless-tobacco use was reported by at least 2% of women in Alabama, Georgia, Mississippi, and North Carolina.

Daily Smoking Among U.S. High School Seniors

Among U.S. high school seniors, the overall prevalence of daily smoking was approximately 35% lower in 1984 than in 1976 but approximately 2% higher in 1993 than in 1984 Table_12. In contrast, among adults Table_2, current smoking prevalence in 1991 was about 20% lower than in 1983. Similarly, the percentage changes between 1984 and 1993 for daily smoking among white (+14%) and male (+21%) high school seniors were substantially different from the changes observed between 1983 and 1991 for current smoking among white (-20%) and male (-20%) adults. Among female high school seniors, on the other hand, the prevalence of daily smoking was 11% lower in 1993 than in 1984; among adult women between 1983 and 1991, the decrease in current smoking was even more pronounced (20%). The most notable reduction in daily smoking among high school seniors was among blacks: their self-reported prevalence was 51% lower in 1993 than in 1984. Between 1983 and 1991, the reduction in current smoking was less pronounced among black adults (19%).

DISCUSSION

Cigarette Consumption

U.S. Department of Agriculture data on per capita cigarette consumption present an objective measure of cigarette smoking in the United States. With the exceptions of 1920, the first few years of the Great Depression, and the end of World War II, per capita consumption of cigarettes in the United States increased steadily from 1901 through 1952. This period was characterized by a marked increase in the advertising of cigarette products (15,45), by the glamorization of smoking in Hollywood-produced movies (45), and by the paucity of health warnings about the dangers of cigarette smoking (1). When reports (and subsequent articles in the popular press) from the first medical studies on the dangers of smoking were published in the early 1950s (1,46), per capita consumption declined substantially (1). The tobacco industry responded to these concerns with claims that their products were safe, with promises to conduct research on the relationship between cigarette smoking and health, and with the introduction of filter cigarettes (1,47). These activities likely resulted in renewed increases in per capita consumption in the mid-1950s.

Per capita consumption continued to increase until 1963. In 1964, the publication year of the landmark report of the Surgeon General's Advisory Committee on Smoking and Health (48), consumption decreased. After that year, however, consumption slowly increased again until 1967, which ushered in a 4-year period of reduced consumption. The period 1967-1970 marked the last years that tobacco manufacturers were permitted to advertise their products on radio and television; yet it was also the period when the Federal Communications Commission applied the Fairness Doctrine to cigarette advertising. This doctrine required television and radio stations to donate air time for health-promoting messages. When the advertising ban on tobacco products went into effect on January 2, 1971, the free spots for anti-smoking messages vanished along with the paid spots for cigarette advertisements.

Per capita consumption of cigarettes rose during the next 2 years but has declined every year since. Much of this decline is attributable to an increased public awareness of a) the health hazards associated with smoking, involuntary smoking, and use of smokeless tobacco; b) the benefits of smoking cessation; c) the addictive properties of tobacco products; and d) the risk of premature death due to tobacco use (1,2,8,9,49-52). Also instrumental in reducing tobacco consumption have been the increased availability of interventions that both prevent and treat nicotine addiction and the increased presence of laws and policies to prevent the initiation of tobacco use, encourage cessation, and protect nonsmokers (1,2,8,15). Declines in consumption may also be attributed to the effects of the nonsmokers' rights movement and to increases since 1981 in the real price (i.e., the price adjusted for inflation) of cigarettes (1,15).

The overall effect of these various components of the antismoking campaign that began with the release of the 1964 Surgeon General's report has been a substantial decline in per capita consumption. Results from one analysis have suggested that the level of per capita cigarette consumption observed in 1987 was from 53% to 56% of what would have been expected in the absence of the antismoking campaign (1).

In 1900, 7.4 total pounds of tobacco were consumed per capita (ages greater than or equal to 15 years) in the United States: 2% as cigarettes, 4% as snuff, 27% as cigars, 19% as smoking tobacco (pipe and roll-your-own), and 48% as chewing tobacco (53). By 1952, 12.9 pounds of tobacco were consumed per capita: 81% as cigarettes, 3% as snuff, 10% as cigars, 4% as smoking tobacco, and 3% as chewing tobacco (53). The per capita consumption of cigarettes in 1952 (10.41 pounds) was 10.25 pounds greater than in 1900 (0.16 pounds) (53). The per capita consumption of all other forms of tobacco was 4.76 pounds less in 1952 (2.51 pounds) than in 1900 (7.27 pounds). Thus, 5.49 pounds, or 54% of the increase in per capita consumption of cigarettes since 1900, can be considered as additional tobacco consumption. The other 46% of the increase may be regarded as a shift from other tobacco products to cigarettes. In 1991, 5.1 pounds of tobacco were consumed per capita (19,54): * 87% as cigarettes, 4% as snuff, 4% as cigars, 1% as smoking tobacco, and 5% as chewing tobacco. **

Cigarette Smoking Prevalence

Birth cohort analyses demonstrate that for U.S. males, smoking prevalence peaked in the 1940s and 1950s at approximately 67% for the cohort born during the period 1911-1930 (2). For females, smoking prevalence peaked in the 1960s at about 44% for the 1931- 1940 birth cohort. In the absence of the antismoking campaign, the peak prevalences observed for U.S. males would likely have declined less rapidly after the 1940s, and the peak prevalences among females would likely have risen to a higher level (1).

Prevalence data collected since 1965 indicate that the gap between men and women has decreased markedly in the past 25 years. This trend seems more pronounced when data from the 1955 Current Population Survey are considered (6,8). In 1955, 54% of men and 24% of women were cigarette smokers; in contrast, the 1991 NHIS Table_2 found that 28% of men and 24% of women were smokers. In 1989, researchers used data from the 1974-1985 NHIS and predicted that if trends observed at that time continued, more women than men would be smoking by 1995 (55). A more recent analysis, based on data from 1974 through 1991, suggested that cigarette-smoking prevalence among U.S. women would likely exceed that of men only after the year 2000 (56). But if the recent parallel rate of decline observed from 1983 through 1991 continues (Table 2), the prevalences may not cross at all.

The major reason for the different projections from more recent surveys is the marked decline in smoking prevalence among women ages 20-24 years with less than or equal to 12 years of education (from 46% in 1983 to 31% in 1991) (Table 5). This finding is consistent with data from other surveys that indicate that the prevalence of cigarette smoking among adolescent females, which since at least the 1970s has been higher than the prevalence among adolescent males, has continued to decline in recent years and is now similar to that among adolescent males (15) (Table 12). Further research, including separate analyses of high school dropouts, should be conducted to determine the reason for this trend.

For years, the differences in prevalence of cigarette smoking observed among black and white adults (Table 2) generally have been seen only in males, with both black and white males being substantially more likely to smoke than black and white females (10) (Table 7). Data show that although blacks are more likely to be current smokers, they are also more likely to have never smoked. Thus, although a smaller proportion of blacks have ever smoked, those who do take up smoking are less likely to quit (9) (Tables 2,6). Also, blacks who try to quit are more likely to resume smoking (57,58).

The year 1991 was the first in more than 25 years of observations when more than half of the U.S. adult population had either smoked no cigarettes or had smoked less than 100 cigarettes (Table 2). Specifically, most women, blacks, Hispanics, persons ages 18-44 years and greater than or equal to 65 years of age, and persons with greater than or equal to 16 years of education had never smoked. Continuing this trend is important because preventing smoking initiation is an important way to reduce smoking-attributable mortality (15).

Number of Smokers

The finding that the actual number of cigarette smokers is not declining in some groups, even though prevalence is declining, is a result of population increases. For example, the population of civilian, noninstitutionalized adults (for whom smoking status was known) increased from approximately 118 million persons in 1965 to approximately 180 million persons in 1991 (Table 3).

Intensity of Smoking

The percentage of current heavy smokers (those who reported that they smoke greater than or equal to 25 cigarettes a day) increased slightly from 1974 to 1980 but has decreased since. This measure has been used to monitor the proportion of current smokers who are hard-core smokers (i.e., persons who are less able to quit and less interested in quitting) (1). However, the increasing spread of restrictions on where persons can smoke has probably contributed to a decline in the average number of cigarettes smoked per day (1,59), independent of the proportion of hard-core smokers. Also, the nicotine yield of cigarettes smoked in the United States declined from the 1950s to the early 1980s and subsequently increased slightly (1). Smokers may have compensated for the reduced nicotine of cigarettes before the early 1980s by smoking more cigarettes per day (1,8). The need for this compensation may have declined after the nicotine yield of cigarettes stopped declining in the 1980s. Also, increases in the real price (i.e., the price adjusted for inflation) of cigarettes since 1981 (15) may have also contributed to the decline in the proportion of smokers who are heavy smokers.

Trends in both interest in cessation and diseases or conditions related to tobacco use (e.g., the prevalences of depression, other psychiatric conditions, heavy alcohol use, and drug abuse among smokers) should also be monitored to better assess the proportion of smokers who are hard-core smokers (56,60).

An alternative method for estimating the average number of cigarettes smoked each day by U.S. smokers has been described (61). This methodology divides the U.S. Department of Agriculture's estimate for yearly per capita consumption by 365 (to obtain an estimate of daily per capita consumption), and divides the result by the proportion of the population greater than or equal to 18 years of age that currently smokes. For example, dividing the 1990 estimate of per capita consumption (2,817) by 365 yields a U.S. per capita estimate of 7.7 cigarettes smoked per day. Dividing this estimate by the proportion of the population greater than or equal to 18 years of age that currently smoked in 1990 (e.g., 0.255 {Table 2}) yields a consumption/prevalence-based estimate of 30.3 cigarettes smoked daily by current smokers (versus 19.1 cigarettes per day based on self-report {Table 4}).

The consumption/prevalence-based estimate does not include the cigarettes smoked by persons ages less than 18 years and by former smokers who have quit within the previous year. It also does not incorporate the slight underreporting of current smoking prevalence that occurs in population-based surveys (9). These three factors will artifactually increase slightly the consumption/prevalence-based estimate of the number of cigarettes smoked daily by current smokers. The self-reported estimates are probably lowered substantially by a tendency to round down to a preferred digit (1).

Regardless of these limitations, the estimates obtained by using self-report and those obtained by using a consumption/prevalence approach both increased by 1.3 to 1.4 cigarettes per day from 1974 through 1978-80 and decreased by 2.7 to 3.0 cigarettes per day from 1980 through 1994 (Table 4) (61).

Prevalence of Cigarette Smoking Among Young Adults

The prevalence of self-reported cigarette smoking among black adolescents and young adults (i.e., persons ages 18-24 years) has been decreasing much more rapidly than among their white counterparts (10,15,62) (Tables 5,12). This finding is true for both sexes (10,62). Both in-school and out-of-school (i.e., drop outs) black adolescents are less likely to report current smoking than are their white counterparts (15); the differences appear to hold after controlling for various sociodemographic differences (63). One explanation for some of the difference may be differential misclassification of smoking behavior, with black adolescent smokers being more likely than white adolescent smokers to misclassify themselves as nonsmokers (64). Further research on this topic, including studies of whether misclassification has changed by race over time, is warranted.

The decreasing prevalence among blacks ages 18-24 years suggests that the trends seen among black adolescents are continuing into young adulthood and that the later age of initiation generally seen in black populations does not account for the large decline observed among black adolescents (65).

Prevalence of Cessation

This report updates earlier findings that the prevalence of cessation among men and women has increased at about the same rate (1,9,12). Although this proportion has remained higher for men, the absolute differences would be within two percentage points if this estimate were adjusted for the finding that U.S. male smokers are more likely to either switch to or continue using cigars, pipes, chewing tobacco, or snuff after quitting cigarette smoking (9). In addition, men started quitting earlier in the century than did women. Recent reports also support the conclusion that women are as likely to quit as are men (57,66). Our knowledge of the patterns and predictors of smoking cessation (whether for men or women) would benefit from a prospective study that used a probability sample of the U.S. population of smokers to analyze the natural history of quitting smoking.

Prevalence of Tobacco Use, 1987-1991

Among racial/ethnic groups, the pronounced prevalence of tobacco use among AI/ANs strongly suggests these groups' need for targeted interventions for the prevention and cessation of tobacco use. Although the prevalence of cigarette smoking is notably low among A/PI women, this population should be monitored to determine if recent immigrants tend to adopt smoking patterns similar to women in the United States.

Between 1970 and 1987, substantial increases in the prevalence of chewing tobacco and snuff use were observed among young white males (Table 9). This pattern suggests that the coincident, extensive marketing of smokeless tobacco products through advertising and promotional campaigns that appeal to young white males had had some effect (1,15). In 1986, however, advertising for smokeless tobacco products on radio and television was banned, and smokeless tobacco has since received increased public health and media attention (1,15). The prevalence of smokeless tobacco use among male adolescents and young adults appeared to have stabilized by the early 1990s. The finding that black men and women have higher mortality rates from oral cancer than white men and women (67) can partially be accounted for by the higher prevalences, during the past two decades, of smokeless tobacco use among older black men and women than among older white men and women. Race-specific differences in cigarette smoking prevalence, alcohol consumption, and dietary intake may also explain some of the observed differences (67).

State-level Prevalences of Tobacco Use

Further analyses are needed to assess the lack of progress in reducing smoking prevalence in some states (Table 10). Trends in prevalence should be assessed by sex, race, age, and levels of education to provide a more complete picture of this phenomenon.

State-specific prevalence estimates for cigarette smoking and other forms of tobacco use from the 1985 and 1989 Current Population Surveys have also been published (68-70).

Daily Smoking Among U.S. High School Seniors

Data from the Monitoring the Future Project (Table 12) are consistent with other data from high school seniors that demonstrate a lack of progress in preventing white and male adolescents from starting smoking (15). Cigarette advertising and promotion campaigns could have influenced initiation among these groups (15).

Actions Taken

CDC will continue to conduct surveys to monitor tobacco use among adults and adolescents. The NHIS will measure tobacco-use behaviors throughout the 1990s to monitor progress in achieving the national health objectives for the year 2000 (16). If current trends continue, the overall objective of reducing adult cigarette smoking prevalence to 15% will not be achieved (56).

Recent data indicate that approximately 15% of current U.S. smokers do not smoke cigarettes every day. Thus, CDC has expanded the NHIS definition of a current smoker to include this more occasional pattern of smoking. This more comprehensive measure may raise the estimated prevalence by approximately one percentage point (71).

In 1989, the Teenage Attitudes and Practices Survey (TAPS) provided in-depth information on patterns of tobacco use among U.S. adolescents (15). In 1993 follow-up interviews of the 1989 sample monitored possible factors influencing the initiation of tobacco use.

Existing programmatic activities focus on the prevention of nicotine addiction, the cessation of tobacco use, and the protection of nonsmokers from exposure to environmental tobacco smoke (ETS) (72). The national health objectives for the year 2000 call for dissemination of effective school health education programs (Healthy People 2000 objective 3.10), the provision of tobacco-free schools (objective 3.10), more states enacting laws (objective 3.12) and worksite policies (objective 3.11) that protect nonsmokers from ETS, the restriction or elimination of tobacco-product advertising and promotion to which youth are likely to be exposed (objective 3.15), the effective prohibition of tobacco sales to young people (objective 3.13), the implementation of tobacco-control plans in every state (objective 3.14), and the increased use of cessation strategies by health-care providers for their patients who use tobacco (objective 3.16) (16). In addition, the potential increase in the excise taxes on tobacco products is likely to reduce consumption and subsequent mortality (73).

CDC has recently funded tobacco-control efforts in 32 states and the District of Columbia as part of its state Initiatives to Mobilize for the Prevention and Control of Tobacco Use (State IMPACT) program. The National Cancer Institute has funded 17 states as part of the American Stop Smoking Intervention Study for Cancer Prevention (Project ASSIST). California helps fund its antismoking programs by using monies from its excise tax initiative. These programs are designed to disseminate effective tobacco-control interventions (1,2,15,52). For the first time, every state and the District of Columbia have a dedicated tobacco-control program.

The most recent Surgeon General's report, Preventing Tobacco Use Among Young People, contains information that can further guide prevention activities (15). This report has been supplemented by a special publication, SGR4KIDS, which summarizes the findings of the report in a magazine-style format that is targeted to adolescents (74). In addition, CDC recently published Guidelines for School Health Programs to Prevent Tobacco Use and Addiction (75), which should facilitate the dissemination of effective tobacco-prevention education programs and tobacco-free policies for schools. CDC is also working with the Center for Substance Abuse Prevention to assess the effectiveness of Federal legislation (PL 102-321) designed to prohibit the sale and distribution of tobacco products to minors. In addition, the Agency for Health Care Policy and Research is developing clinical practice guidelines on smoking cessation (76).

Acknowledgments

We thank the following state BRFSS coordinators for their contributions to this report: Scott Jackson, Alabama; Patricia Owen, Alaska; Brian Bender, Arizona; John Senner, Arkansas; Laura Lund, California; Marilyn Leff, Colorado; Mary Adams, Connecticut; Fred Breukelman, Delaware; Cynthia Mitchell, District Of Columbia; Doris McTague, Florida; Ed Pledger, Georgia; Faye Newfield, Hawaii; Christopher Johnson, Idaho; Bruce Steiner, Illinois; Ray Guest, Indiana; Patricia Busick, Iowa; Karen Pippert, Kansas; Karen Bramblett, Kentucky; Diane Hargrove-Roberson, Louisiana; Dorean Maines, Maine; Alyse Weinstein, Maryland; Ruth Lederman, Massachusetts; Harry McGee, Michigan; Nagi Salem, Minnesota; Ellen Jones, Mississippi; Jeannette Jackson-Thompson, Missouri; Patrick Smith, Montana; Sue Huffman, Nebraska; Martin Atherton, Nevada; Kay Zaso, New Hampshire; Georgette Boeselager, New Jersey; Patrice Jaramillo, New Mexico; Chris Maylahn, New York; Chanetta Washington, North Carolina; David Young, North Dakota; Ellen Capwell, Ohio; Neil Hann, Oklahoma; Joyce Grant-Worley, Oregon; Cathy Becker, Pennsylvania; Jay Buechner, Rhode Island; Marcia Lane, South Carolina; Barbara Miller, South Dakota; David Ridings, Tennessee; Roger Diamond, Texas; Rebecca Giles, Utah; Robert McIntyre, Vermont; Scott Carswell, Virginia; Kirsten Holm, Washington; Fred King, West Virginia; and Eleanor Cautley, Wisconsin.

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* The USDA published an estimate of 5.4 pounds per capita (ages greater than or equal to 18 years) total tobacco consumption for 1991 (19). The 1991 estimate of 5.1 pounds per capita presented here was calculated, for comparison purposes, for persons ages greater than or equal to 15 years. 

** These calculations multiply the published number of pounds of snuff, smoking tobacco, and chewing tobacco by 0.68 to obtain the unstemmed processing weight.


Table_1
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TABLE 1. Total and per capita yearly consumption * of manufactured
cigarettes and percentage changes in per capita consumption
-- United States, 1900-1994
===========================================================================
                Total                       Percentage changes in
              cigarettes    Cigarettes      per capita consumption
Year          (billions)    per capita +     from previous year
---------------------------------------------------------------------------
1900             2.5            54
1901             2.5            53               - 1.9
1902             2.8            60               +13.2
1903             3.1            64               + 6.7
1904             3.3            66               + 3.1
1905             3.6            70               + 6.1
1906             4.5            86               +22.9
1907             5.3            99               +15.1
1908             5.7           105               + 6.1
1909             7.0           125               +19.0
1910             8.6           151               +20.8
1911            10.1           173               +14.6
1912            13.2           223               +28.9
1913            15.8           260               +16.6
1914            16.5           267               + 2.7
1915            17.9           285               + 6.7
1916            25.2           395               +38.6
1917            35.7           551               +39.5
1918            45.6           697               +26.5
1919            48.0           727               + 4.3
1920            44.6           665               - 8.5
1921            50.7           742               +11.6
1922            53.4           770               + 3.8
1923            64.4           911               +18.3
1924            71.0           982               + 7.8
1925            79.8         1,085               +10.5
1926            89.1         1,191               + 9.8
1927            97.5         1,279               + 7.4
1928           106.0         1,366               + 6.8
1929           118.6         1,504               +10.1
1930           119.3         1,485               - 1.3
1931           114.0         1,399               - 5.8
1932           102.8         1,245               -11.0
1933           111.6         1,334               + 7.1
1934           125.7         1,483               +11.2
1935           134.4         1,564               + 5.5
1936           152.7         1,754               +12.1
1937           162.8         1,847               + 5.3
1938           163.4         1,830               - 0.9
1939           172.1         1,900               + 3.8
1940           181.9         1,976               + 4.0
1941           208.9         2,236               +13.2
1942           245.0         2,585               +15.6
1943           284.3         2,956               +14.4
1944           296.3         3,039               + 2.8
1945           340.6         3,449               +13.5
1946           344.3         3,446               - 0.1
1947           345.4         3,416               - 0.9
1948           358.9         3,505               + 2.6
1949           360.9         3,480               - 0.7
1950           369.8         3,552               + 2.1
1951           397.1         3,744               + 5.4
1952           416.0         3,886               + 3.8
1953           408.2         3,778               - 2.8
1954           387.0         3,546               - 6.1
1955           396.4         3,597               + 1.4
1956           406.5         3,650               + 1.5
1957           422.5         3,755               + 2.9
1958           448.9         3,953               + 5.3
1959           467.5         4,073               + 3.0
1960           484.4         4,171               + 2.4
1961           502.5         4,266               + 2.3
1962           508.4         4,266                 0.0
1963           523.9         4,345               + 1.9
1964           511.3         4,194               - 3.5
1965           528.8         4,258               + 1.5
1966           541.3         4,287               + 0.7
1967           549.3         4,280               - 0.2
1968           545.6         4,186               - 2.2
1969           528.9         3,993               - 4.6
1970           536.5         3,985               - 0.2
1971           555.1         4,037               + 1.3
1972           566.8         4,043               + 0.1
1973           589.7         4,148               + 2.6
1974           599.0         4,141               - 0.2
1975           607.2         4,122               - 0.5
1976           613.5         4,091               - 0.8
1977           617.0         4,043               - 1.2
1978           616.0         3,970               - 1.8
1979           621.5         3,861               - 2.7
1980           631.5         3,849               - 0.3
1981           640.0         3,836               - 0.3
1982           634.0         3,739               - 2.5
1983           600.0         3,488               - 6.7
1984           600.4         3,446               - 1.2
1985           594.0         3,370               - 2.2
1986           583.8         3,274               - 2.8
1987           575.0         3,197               - 2.4
1988           562.5         3,096               - 3.3
1989           540.0         2,926               - 5.5
1990           525.0         2,817               - 3.7
1991           510.0         2,713               - 3.7
1992           500.0         2,640               - 2.7
1993 @         485.0         2,539               - 3.8
1994 &         480.0         2,493               - 1.8
---------------------------------------------------------------------------
* U.S. military forces overseas are included in the estimated total
  consumption for the periods 1917-1919 and 1940-1994 and in the
  estimated per capita consumption for 1930-1994.
+ Among persons 318 years of age.
@ Subject to revision.
& Estimated, based on projection for entire year.

Sources: References 17-19.
===========================================================================

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Table_2
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 TABLE  2. Percentage of adults * who were current, former, or never smokers,+ overall and by  sex, race,
 Hispanic origin, age, and education, National Health  Interview Surveys, selected years -- United States, 1965-1991
 =====================================================================================================================================
                                                                                                                Percentage
                                                                                                                  point     Percentage
                    1965    1966   1970   1974   1978   1979   1980   1983   1985   1987   1988   1990   1991   Difference &   Change @
 -------------------------------------------------------------------------------------------------------------------------------------
Smoking status
 Total population
  Current           42.4    42.6   37.4   37.1   34.1   33.5   33.2   32.1   30.1   28.8   28.1   25.5   25.7     - 16.7     - 39.4
  Former            13.6    13.6   18.5   19.5   20.8   21.3   21.3   21.8   24.2   22.8   23.8   24.6   24.1     + 10.5     + 77.2
  Never             44.0    43.7   44.2   43.4   45.0   45.2   45.5   46.1   45.8   48.4   48.1   49.9   50.2     +  6.2     + 14.1

Sex
 Male
  Current           51.9    52.5   44.1   43.1   38.1   37.5   37.6   35.1   32.6   31.2   30.8   28.4   28.1     - 23.8     - 45.9
  Former            19.8    20.1   26.3   27.7   28.3   28.4   28.1   28.3   30.9   28.9   29.6   30.3   29.9     + 10.1     + 51.0
  Never             28.3    27.4   29.6   29.2   33.6   34.1   34.4   36.6   36.5   39.9   39.6   41.3   42.1     + 13.8     + 48.8
 Female
  Current           33.9    33.9   31.5   32.1   30.7   29.9   29.3   29.5   27.9   26.5   25.7   22.8   23.5     - 10.4     - 30.7
  Former             8.0     7.9   11.6   12.7   14.2   15.0   15.1   15.9   18.1   17.4   18.6   19.5   19.0     + 11.0     +137.5
  Never             58.1    58.2   56.9   55.2   55.2   55.1   55.5   54.6   54.0   56.0   55.8   57.7   57.6     -  0.5     -  0.9

Race
 White
  Current           42.1    42.4   37.0   36.4   33.9   33.3   32.9   31.8   29.6   28.5   27.8   25.6   25.5     - 16.6     - 39.4
  Former            14.2    14.3   19.4   20.5   21.9   22.3   22.2   22.8   25.5   24.2   25.3   25.9   25.7     + 11.5     + 81.0
  Never             43.8    43.3   43.6   43.1   44.3   44.4   44.9   45.3   44.9   47.3   47.0   48.5   48.9     +  5.1     + 11.6
 Black
  Current           45.8    45.9   41.4   44.0   37.7   36.9   36.9   35.9   34.9   32.9   31.7   26.2   29.1     - 16.7     - 36.5
  Former             8.4     7.6   10.7   10.8   13.3   13.8   13.8   14.2   15.9   14.8   15.2   16.7   14.6     +  6.2     + 73.8
  Never             45.8    46.5   47.8   45.3   49.0   49.4   49.4   49.9   49.2   52.3   53.1   57.1   56.2     + 10.4     + 22.7

Hispanic origin
 Hispanic
  Current            NA      NA     NA     NA    31.6   29.5   30.0   25.3   25.9   23.6   23.6   23.0   20.2     - 11.4 **  - 36.1 **
  Former             NA      NA     NA     NA    15.6   16.9   15.1   15.7   17.2   16.1   19.2   17.0   16.9     +  1.3 **  +  8.3 **
  Never              NA      NA     NA     NA    52.9   53.6   54.9   59.0   56.9   60.4   57.3   60.0   63.0     + 10.1 **  + 19.1 **
 Non-Hispanic
  Current            NA      NA     NA     NA    34.3   33.7   33.4   32.6   30.3   29.2   28.4   25.7   26.1     -  8.2 **  + 23.9 **
  Former             NA      NA     NA     NA    21.1   21.6   21.6   22.2   24.6   23.4   24.1   25.3   24.8     +  3.7 **  + 17.5 **
  Never              NA      NA     NA     NA    44.6   44.6   45.0   45.3   45.1   47.5   47.4   49.0   49.0     +  4.4 **  +  9.9 **

Age (years)
 18-24
  Current           45.5    44.6   38.0   37.8   34.4   34.4   33.3   34.2   29.3   27.1   25.9   24.5   22.9     - 22.6     - 49.7
  Former             6.9     6.0    9.2    9.5    9.2   10.6   10.5    9.3   10.1    8.0    9.3    9.5    7.7     +  0.8     + 11.6
  Never             47.6    49.4   52.8   52.7   56.4   55.0   56.2   56.5   60.6   64.9   64.8   66.0   69.3     + 21.7     + 45.6
 25-44
  Current           51.2    51.4   44.6   44.5   39.3   38.9   37.8   36.3   34.8   33.2   32.9   29.7   30.4     - 20.8     - 40.6
  Former            13.6    13.5   18.8   18.4   19.5   19.6   19.8   19.0   21.4   19.6   19.2   20.0   19.4     +  5.8     + 42.7
  Never             35.3    35.1   36.6   37.1   41.2   41.5   42.5   44.7   43.8   47.2   47.9   50.3   50.2     + 14.9     + 42.2
 45-64
  Current           41.6    42.7   38.6   37.7   36.7   34.8   35.6   33.3   31.6   30.9   29.4   27.0   26.9     - 14.7     - 35.3
  Former            16.1    16.4   21.7   24.8   26.1   27.2   26.6   28.8   31.2   29.9   32.9   32.9   32.9     + 16.8     +104.4
  Never             42.3    41.0   39.7   37.5   37.3   38.0   37.9   37.9   37.3   39.3   37.6   40.1   40.2     -  2.1     -  5.0
 >=65
  Current           17.9    17.9   16.1   17.3   16.3   16.4   17.2   16.7   16.0   15.2   14.9   12.8   13.3     -  4.6     - 25.7
  Former            15.0    16.0   21.3   23.3   28.1   27.5   27.9   30.7   34.0   34.1   34.5   36.6   36.4     + 21.4     +142.7
  Never             67.2    66.1   62.6   59.4   55.6   56.2   54.9   52.6   50.0   50.7   50.6   50.6   50.3     - 16.9     - 25.2

Education (years) &&
 <12
  Current            NA     41.7   37.5   37.8   35.7   35.1   35.1   34.7   34.2   34.2   32.9   30.8   31.4     - 10.3++   - 24.7++
  Former             NA     14.1   18.6   19.8   21.0   22.6   21.7   23.2   26.3   24.8   25.8   26.3   25.3     + 11.2++   + 79.4++
  Never              NA     44.2   43.9   42.4   43.4   42.3   43.2   42.2   39.6   41.0   41.3   42.9   43.3     -  0.9++   -  2.0++
 12
  Current            NA     44.7   39.3   38.8   37.0   35.3   35.4   34.9   33.4   32.9   32.7   30.1   30.6     - 14.1++   - 31.5++
  Former             NA     14.3   19.9   20.9   23.0   22.7   22.8   23.7   25.1   24.7   25.0   26.2   26.1     + 11.8++   + 82.5++
  Never              NA     41.0   40.8   40.4   40.0   42.0   41.8   41.4   41.5   42.5   42.3   43.7   43.3     +  2.3++   +  5.6++
 13-15
  Current            NA     44.8   38.7   37.9   34.3   35.2   33.9   32.1   30.6   28.2   28.1   24.6   25.5     - 19.3++   - 43.1++
  Former             NA     17.0   22.1   24.1   26.9   24.7   24.9   25.1   27.5   26.1   27.2   27.5   28.1     + 11.1++   + 65.3++
  Never              NA     38.2   39.2   38.0   38.8   40.0   41.2   42.8   42.0   45.7   44.7   47.9   46.4     +  8.2++   + 21.5++
 >=16
  Current            NA     35.3   28.8   28.8   24.2   23.7   24.5   20.6   19.0   16.6   16.3   13.9   13.9     - 21.4++   - 60.6++
  Former             NA     21.5   27.7   27.8   26.6   27.9   27.6   26.5   30.3   27.2   28.2   28.7   27.6     +  6.1++   + 28.4++
  Never              NA     43.2   43.5   43.4   49.2   48.4   47.9   52.9   50.7   56.2   55.5   57.4   58.5     + 15.3++   + 35.4++
---------------------------------------------------------------------------------------------------------------------------------------
 * Persons >=18 years of age.
 + Current smokers reported smoking >=100 cigarettes and currently  smoked. Former smokers reported
   smoking >=100 cigarettes and did not currently smoke. Never smokers reported that they had smoked <100 cigarettes.
 &  Percentage point difference from 1965 through 1991, except where noted.
 @ Percentage change from 1965 through  1991, except where noted.
** From 1978 through 1991.
++ From 1966 through 1991.
&& Data on education are presented for persons >=25 years of age.
NA=Data not available.
Source:  National Health Interview Surveys: 1965, 1966, 1970, 1974, 1978, 1979, 1980, 1983, 1985,  1987,  1988,  1990,  1991.
Note:  For any year, 95% confidence  intervals  do  not  exceed   1.2% for the total  population,   1.8% for men,  1.4%  for women,
 1.2% for whites,  3.9% for blacks,   4.7% for Hispanics,  1.2% for non-Hispanics,   2.4% for persons  ages  18-24 years,   1.8%
for persons ages 25-44 years,  1.8% for persons  ages 45-64 years,   2.5% for persons  ages  365 years,   2.1%  for <12  years of
education,   1.9% for  12 years  of education,  3.2% for 13-15  years  of  education, and   2.9% for 316  years  of  education.
=======================================================================================================================================


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Table_3
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TABLE 3. Number * of adults + who were current, former, or never smokers, @ overall and by sex, race, Hispanic origin, age, and education,
National Health Interview Surveys, selected years -- United States, 1965-1991
===========================================================================================================================================
                     1965     1966     1970     1974     1978     1979     1980     1983     1985     1987     1988     1990     1991
-------------------------------------------------------------------------------------------------------------------------------------------
Smoking status
 Total population
  Current            50.1     51.1     48.1     48.9     51.3     51.1     51.6     53.5     50.4     48.9     49.4     45.8     46.3
  Former             16.0     16.3     23.8     25.8     31.3     32.5     33.0     36.2     40.5     38.8     41.8     44.1     43.5
  Never              52.0     52.4     56.8     57.3     67.7     68.9     70.8     76.8     76.6     82.2     84.5     89.6     90.6
Sex
 Male
  Current            28.9     29.6     26.4     25.8     26.9     26.9     27.5     27.6     25.7     25.1     25.6     24.2     24.0
  Former             11.0     11.3     15.8     16.6     20.0     20.4     20.6     22.2     24.4     23.2     24.6     25.8     25.6
  Never              15.8     15.4     17.8     17.5     23.8     24.5     25.2     28.8     28.8     32.1     33.0     35.1     36.0
 Female
  Current            21.1     21.5     21.6     23.1     24.4     24.1     24.1     25.9     24.7     23.8     23.7     21.6     22.2
  Former              5.0      5.0      8.0      9.1     11.3     12.1     12.4     14.0     16.1     15.6     17.1     18.4     18.0
  Never              36.2     37.0     39.0     39.8     43.9     44.4     45.6     48.0     47.8     50.1     51.5     54.4     54.6
Race
 White
  Current            44.6     45.5     42.6     42.7     44.8     44.6     45.2     46.2     43.1     41.7     41.9     39.3     39.1
  Former             15.0     15.4     22.3     24.1     28.9     29.9     30.6     33.1     37.0     35.3     38.1     39.8     39.4
  Never              46.4     46.6     50.1     50.5     58.6     59.5     61.7     65.8     65.3     69.2     70.8     74.6     75.0
 Black
  Current             5.0      5.2      5.1      5.8      5.9      5.8      5.8      6.4      6.3      6.1      6.1      5.2      5.9
  Former              0.9      0.9      1.3      1.4      2.1      2.2      2.2      2.5      2.9      2.8      2.9      3.3      2.9
  Never               5.0      5.2      5.9      6.0      7.7      7.8      7.8      8.9      8.9      9.8     10.3     11.4     11.3
Hispanic origin
 Hispanic
  Current              NA       NA       NA       NA      2.5      2.7      2.6      2.6      2.5      2.9      2.8      3.2      3.0
  Former               NA       NA       NA       NA      1.2      1.6      1.3      1.6      1.7      2.0      2.3      2.4      2.5
  Never                NA       NA       NA       NA      4.2      4.9      4.8      6.0      5.6      7.4      6.8      8.4      9.3
 Non-Hispanic
  Current              NA       NA       NA       NA     48.5     48.1     48.8     50.6     47.7     45.8     46.4     42.4     43.1
  Former               NA       NA       NA       NA     30.0     30.8     31.6     34.5     38.7     36.7     39.4     41.6     41.0
  Never                NA       NA       NA       NA     63.2     63.6     65.7     70.4     70.8     74.6     77.4     80.8     80.9
Age (years)
 18-24
  Current             8.0      8.4      8.3      8.8      9.4      9.6      9.2      9.8      7.8      6.9      6.6      6.1      5.5
  Former              1.2      1.1      2.0      2.2      2.5      2.9      2.9      2.6      2.7      2.0      2.4      2.4      1.9
  Never               8.4      9.2     11.6     12.3     15.4     15.3     15.6     16.1     16.2     16.5     16.5     16.3     16.8
 25-44
  Current            23.1     23.2     20.8     21.5     22.4     22.7     22.9     24.7     24.6     24.5     25.3     23.5     24.2
  Former              6.1      6.1      8.8      8.9     11.1     11.4     12.0     12.9     15.1     14.5     14.7     15.8     15.4
  Never              15.9     15.8     17.1     17.9     23.5     24.2     25.8     30.4     30.9     34.9     36.7     39.9     40.0
 45-64
  Current            15.9     16.5     15.9     15.2     15.8     15.0     15.3     14.7     13.8     13.3     13.3     12.4     12.5
  Former              6.1      6.3      8.9     10.0     11.3     11.7     11.5     12.7     13.6     12.9     14.9     15.2     15.3
  Never              16.1     15.8     16.3     15.1     16.1     16.4     16.3     16.7     16.3     17.0     17.0     18.5     18.8
 >=65
  Current             3.1      3.1      3.0      3.5      3.7      3.8      4.1      4.3      4.2      4.2      4.2      3.8      4.0
  Former              2.6      2.8      4.0      4.7      6.4      6.4      6.7      7.9      9.0      9.4      9.8     10.8     10.9
  Never              11.6     11.6     11.8     12.0     12.7     13.1     13.1     13.6     13.2     14.9     14.3     14.9     15.1
Education & (years)
 <12
  Current              NA     21.1     17.8     16.4     14.2     14.0     13.6     13.2     12.1     11.6     11.1     10.1     10.2
  Former               NA      7.1      8.8      8.6      8.4      9.0      8.4      8.9      9.3      8.4      8.7      8.6      8.2
  Never                NA     22.3     20.8     18.3     17.3     16.8     16.7     16.1     14.0     13.9     14.0     14.0     14.0
 12
  Current              NA     13.7     13.7     14.3     16.4     16.0     16.4     17.8     17.7     18.2     18.5     17.6     17.8
  Former               NA      4.4      6.9      7.7     10.2     10.3     10.6     12.0     13.3     13.6     14.2     15.3     15.1
  Never                NA     12.6     14.3     14.9     17.8     19.0     19.4     21.1     22.0     23.5     24.0     25.5     25.1
 13-15
  Current              NA      4.0      4.4      5.1      6.2      6.4      6.8      7.2      7.5      7.4      7.9      7.3      7.8
  Former               NA      1.5      2.5      3.3      4.9      4.5      5.0      5.6      6.8      6.8      7.6      8.2      8.6
  Never                NA      3.4      4.4      5.1      7.0      7.3      8.3      9.6     10.3     11.9     12.6     14.2     14.2
 >=16
  Current              NA      3.3      3.4      4.0      4.6      4.7      5.3      5.3      5.2      4.8      5.1      4.7      4.8
  Former               NA      2.0      3.3      3.9      5.1      5.5      6.0      6.8      8.3      7.9      8.8      9.7      9.6
  Never                NA      4.0      5.1      6.0      9.5      9.6     10.4     13.6     13.9     16.2     17.3     19.3     20.3
-------------------------------------------------------------------------------------------------------------------------------------------
* In millions.
+ Persons >=18  years  of  age.
@ Current smokers reported smoking >=100 cigarettes  and currently smoked. Former smokers  reported
  smoking >=100  cigarettes  and  did  not currently  smoke.  Never smokers  reported that  they  had smoked <100  cigarettes.
& Data  on education are  presented for persons >=25 years  of age.

Source:  National  Health Interview  Surveys:  1965, 1966, 1970, 1974,  1978,  1979, 1980,  1983, 1985,  1987,  1988,  1990,  1991.
Note:  For any year,  95%  confidence  intervals  do  not  exceed  1.8 million for  the  total  population,   1.4 million for men,
 1.5 million for women,   2.0  million  for  whites,   1.6 million  for blacks,   1.5  million  for  Hispanics,  2.1 million  for
non-Hispanics,   1.0  million for persons ages 18-24  years,   1.3  million  for  persons  ages  25-44 years,   0.9  million  for
persons  ages  45-64  years,  1.1  million  for  persons  ages  365 years,  1.4  million for <12 years  of education,   1.1
million  for 12 years of education,   0.8  million  for 13-15 years  of  education, and   1.0 million  for 316  years  of  education.
For any year,  the  percent  of  persons  for whom smoking status was unavailable  does  not  exceed  5.8%  for the total population,
8.9% for men,  3.0% for women,  5.6% for whites, 7.2% for blacks,  4.2% for Hispanics, 3.0% for non-Hispanics,  7.4% for persons
ages 18-24 years, 6.0% for persons ages 25-44 years,  6.1% for persons ages 45-64 years,  3.4% for persons ages >=65  years,  4.1%
for <12 years  of  education, 5.3% for 12  years of education.  5.8% for 13-15 years  of education,  and  7.1% for >=16  years of
education.
===========================================================================================================================================

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Table_4
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TABLE 4.  Percentage distribution of adult * current cigarette smokers, + by number of cigarettes smoked per day, and percentage of adult
current cigarette smokers who smoked >=25 cigarettes per day, by sex, race, Hispanic origin, age, and education, National Health Interview
Surveys, selected years -- United States, 1974-1991
====================================================================================================================================================
                                                                                                                          Percentage
                                                                                                                            point       Percentage
                       1974      1978      1979      1980      1983      1985      1987      1988      1990      1991     Difference @    change &
----------------------------------------------------------------------------------------------------------------------------------------------------
Current smokers
 Number of cigarettes
  smoked per day
   <15                 31.6      29.4      29.8      29.1      29.3      31.6      32.1      31.0      34.5      36.6       + 5.0          +15.8
   15-24               43.2      42.6      42.7      42.1      44.7      41.8      41.4      43.4      42.6      41.9       - 1.3          - 3.0
   >=25                25.3      28.0      27.5      28.8      26.0      26.6      26.6      25.6      22.9      21.5       - 3.8          -15.0

  Mean                 19.8      20.9      20.6      21.2      20.3      20.3      20.1      20.2      19.1      18.2       - 1.6          - 8.1

Percent smoking >=25
 cigarettes per day
 Sex
  Male                 31.1      34.5      32.4      33.7      32.3      32.4      32.8      30.5      28.5      26.4       - 4.7          -15.1
  Female               18.7      20.8      22.0      23.2      19.4      20.6      19.9      20.3      16.6      16.1       - 2.6          -13.9
 Race
  White                27.6      30.5      29.8      31.6      28.6      29.5      29.6      28.4      25.4      23.8       - 3.8          -13.8
  Black                 8.7       9.7      10.5       9.4       9.2       9.3       8.2       9.0       6.0       8.6       - 0.1          - 1.2
 Hispanic origin
  Hispanic               NA      16.3      12.0      13.4       9.2      15.8      12.0       9.7       6.8       5.3       -11.0 **       -67.5 **
  Non-Hispanic           NA      28.7      28.4      29.6      26.8      27.2      27.5      26.6      24.1      22.5       - 6.2 **       -21.6 **
 Age (years)
  18-24                15.1      17.8      16.1      17.0      11.7      13.6      12.6      10.5       9.1       9.2       - 5.9          -39.1
  25-44                29.2      30.5      30.7      31.5      29.2      29.5      28.3      27.7      22.9      21.0       - 8.2          -28.1
  45-64                27.3      32.5      32.6      34.5      32.8      31.1      32.5      31.7      30.8      29.3       + 2.0          + 7.3
  >=65                 17.7      19.5      16.6      18.2      17.3      19.4      20.4      17.4      18.9      17.1       - 0.6          - 3.4
 Education ++ (years)
  <12                  25.8      28.5      27.9      29.4      29.1      29.0      28.8      29.1      24.5      27.4       + 1.6          + 6.2
  12                   27.8      30.7      30.7      31.6      29.1      29.0      29.8      28.1      25.7      22.9       - 4.9          -17.6
  13-15                32.5      33.1      33.1      32.7      30.3      29.3      28.1      27.9      25.5      20.0       -12.5          -38.5
  >=16                 27.3      30.9      30.8      33.3      28.4      28.7      26.9      25.0      22.6      20.1       - 7.2          -26.4
----------------------------------------------------------------------------------------------------------------------------------------------------
*  Persons >=18  years of age.
+  Current smokers reported smoking >=100 cigarettes and currently smoked.
@  Percentage point difference (or actual difference for the mean number of cigarettes smoked daily) from 1974 through 1991, except where noted.
&  Percentage change from 1974 through 1991, except where noted.
** Percentage change from 1978 through  1991.
++ Data on education are presented for persons >=25 years of age.

Source:  National Health Interview Surveys, 1974,1978,1979,1980,1983,1985,1987,1988,1990,1991.
Note: For any  year, 95% confidence intervals do not exceed  2.0% for the total population,  0.6 for the mean number of  cigarettes smoked per
day,  2.4% for men,  2.0% for women,  1.9% for whites,  3.0% for blacks,  5.3% for Hispanics,  1.7% for non-Hispanics,  2.8% for persons
ages 18-24 years,  2.4% for persons ages 25-44 years,  3.5% for persons ages 45-64 years,  4.6% for persons ages >=65 years,  3.2% for <12 years
of education,  3.1% for 12 years of education,  5.0% for 13-15 years of education, and  5.3% for >=16 years of education.
====================================================================================================================================================

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Table_5
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TABLE 5. Percentage of young adults * who were current, former, or never smokers, + overall and by sex, race, and education, National Health
Interview Surveys, selected years -- United States, 1965-1991
==================================================================================================================================================================================
                                                                                                                                                      Percentage
                                                                                                                                                        point        Percentage
                      1965      1966      1970      1974      1978      1979      1980      1983      1985      1987      1988      1990      1991    difference       change
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Smoking status
 Total population
  Current             45.5      44.6      38.0      37.8      34.4      34.4      33.3      34.2      29.3      27.1      25.9      24.5      22.9       -22.6         -49.7
  Former               6.9       6.0       9.2       9.5       9.2      10.6      10.5       9.3      10.1       8.0       9.3       9.5       7.7       + 0.8         +11.6
  Never               47.6      49.4      52.8      52.7      56.4      55.0      56.2      56.5      60.6      64.9      64.8      66.0      69.3       +21.7         +45.6
Sex
 Male
  Current             54.1      54.2      44.3      42.1      36.0      35.0      35.4      32.9      28.1      28.2      25.5      26.6      23.5       -30.6         -56.6
  Former               7.6       6.4      10.7      11.6      10.1      11.2      10.5       8.1      10.7       6.7       9.6       9.1       8.0       + 0.4         + 5.3
  Never               38.3      39.5      45.0      46.3      53.9      53.8      54.1      59.0      61.3      65.2      64.9      64.4      68.4       +30.1         +78.6
 Female
  Current             38.1      36.6      32.7      34.1      32.9      33.8      31.4      35.5      30.4      26.2      26.3      22.5      22.4       -15.7         -41.2
  Former               6.2       5.7       8.0       7.8       8.3      10.0      10.4      10.4       9.6       9.2       9.0       9.9       7.5       + 1.3         +21.0
  Never               55.7      57.7      59.3      58.2      58.7      56.2      58.2      54.1      60.0      64.7      64.7      67.6      70.2       +14.5         +26.0
Race
 White
  Current             45.2      44.9      37.9      37.2      35.0      34.4      33.1      34.6      30.1      28.5      27.1      26.4      25.1       -20.1         - 4.5
  Former               7.4       6.5       9.9      10.3       9.4      11.6      11.3       9.9      10.9       8.8      10.6      10.6       8.4       + 1.0         +13.5
  Never               47.4      48.7      52.2      52.5      55.6      54.0      55.7      55.5      58.9      62.8      62.3      63.1      66.5       +19.1         +40.3
 Black
  Current             48.8      44.5      39.8      43.4      32.1      35.4      35.6      33.0      25.3      22.4      20.3      15.2      13.3       -35.5         -72.8
  Former               2.6       2.4       4.6       3.2       8.0       4.5       5.2       6.2       6.0       3.7       3.4       5.2       3.9       + 1.3         +50.0
  Never               48.6      53.2      55.6      53.4      59.8      60.1      59.3      60.8      68.7      73.8      76.3      79.6      82.8       +34.2         +70.4
Education **
 <=12 years
  Sex
   Male
    Current           66.6      68.8      60.0      52.7      46.1      46.8      51.0      49.1      43.0      43.8      40.1      37.3      34.5       -32.1         -48.2
    Former             8.0       6.5      11.1      11.9      11.5      13.1      10.5      10.3      11.6       7.4      11.4      10.2      11.0       + 3.0         +37.5
    Never             25.4      24.6      29.0      35.4      42.4      40.2      38.5      40.6      45.4      48.8      48.6      52.4      54.5       +29.1        +114.6
   Female
    Current           43.9      42.7      40.2      40.1      39.4      41.4      40.3      45.5      43.6      37.6      37.0      33.4      30.6       -13.3         -30.3
    Former             6.8       6.8       8.7       9.5      10.2      12.1      12.5      11.7      11.8      10.8      11.5      11.7       9.0       + 2.2         +32.4
    Never             49.3      50.4      51.1      50.4      50.4      46.4      47.2      42.8      44.6      51.6      51.4      54.9      60.5       +11.2         +22.7
 >=13 years
  Sex
   Male
    Current           45.2      46.4      33.2      34.7      26.4      23.4      20.1      16.2      15.5      16.3      12.1      16.1      12.2       -33.0         -73.0
    Former            11.1       9.2      13.9      13.9      15.1      12.1      14.7       7.1      10.9       8.4       9.8      10.3       9.2       - 1.9         -17.1
    Never             43.7      44.4      52.8      51.4      58.6      64.5      65.3      76.7      73.7      75.4      78.1      73.7      78.6       +34.9         +79.9
   Female
    Current           36.3      36.6      26.8      26.4      21.6      21.9      20.0      22.9      17.2      15.1      16.2      13.8      14.6       -21.7         -59.8
    Former             8.8       8.3      12.1       6.4       8.6       9.8       8.3       9.4       9.7      10.0       8.9       8.5       7.6       - 1.2         -13.6
    Never             54.9      55.1      61.1      67.2      69.8      68.4      71.8      67.7      73.2      74.9      74.9      77.8      77.8       +22.9         +41.7
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
*  Persons  ages 18-24 years.
+  Current smokers reported smoking >=100 cigarettes and currently smoked. Former smokers reported smoking >=100 cigarettes and did not currently smoke. Never smokers reported
   that they had smoked <100 cigarettes.
@  Percentage point difference from 1965 through 1991.
&  Percentage change from 1965 through 1991.
** Data on education  are presented for persons ages 20-24 years, because some students enter college after age 18.

Source: National Health Interview Surveys:  1965, 1966, 1970, 1974, 1978, 1979, 1980, 1983, 1985, 1987, 1988, 1990, 1991.
Note: For any year, 95% confidence intervals do not exceed  2.4% for the total population,  3.7% for men,  3.4%  for women,  2.6% for whites,  7.6% for blacks,  4.5% for men with
<=12 years education,  4.0% for women with <=12 years education,  5.3% for men with >=13 years education, and  5.5% for women with >=13 years education.
==================================================================================================================================================================================


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Table_6
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TABLE 6. Percentage of adult * ever smokers who are former smokers + (prevalence of cessation), overall and by sex, race, Hispanic  origin, age, and
education, National Health Interview Surveys, selected years -- United States, 1965-1991
=======================================================================================================================================================================================
                                                                                                                                                          Percentage
                                                                                                                                                            point         Perccentage
                       1965      1966      1970      1974      1978      1979      1980      1983      1985      1987      1988      1990      1991       Difference @      Change &
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Total                  24.3      24.2      33.1      34.5      37.9      38.9      39.0      40.4      44.5      44.3      45.8      49.1      48.5         +24.2            +99.6

Sex
 Male                  27.6      27.7      37.4      39.2      42.7      43.1      42.8      44.6      48.7      48.0      49.0      51.6      51.6         +24.0            +87.0
 Female                19.1      18.9      26.9      28.3      31.6      33.4      34.0      35.1      39.4      39.6      42.0      46.0      44.7         +25.6           +134.0
Race
 White                 25.2      25.3      34.3      36.1      39.2      40.2      40.4      41.8      46.2      45.8      47.6      50.4      50.2         +25.0            +99.2
 Black                 15.5      14.2      20.6      19.7      26.1      27.2      27.2      28.3      31.3      31.0      32.4      38.9      33.4         +17.9           +115.5
Hispanic origin
 Hispanic                NA        NA        NA        NA      33.0      36.4      33.5      38.4      40.0      40.5      44.9      42.5      45.6         +12.6 **         +38.2 **
 Non-Hispanic            NA        NA        NA        NA      38.2      39.0      39.3      40.5      44.8      44.5      45.9      49.5      48.7         +10.5 **         +27.5 **
Age (years)
 18-24                 13.1      12.0      19.6      20.2      21.1      23.5      23.9      21.3      25.7      22.8      26.5      28.0      25.2         +12.1            +92.4
 25-44                 21.0      20.8      29.7      29.2      33.2      33.5      34.3      34.4      38.1      37.2      36.8      40.3      38.9         +17.9            +85.2
 45-64                 27.9      27.8      36.0      39.7      41.6      43.9      42.8      46.3      49.7      49.2      52.8      55.0      55.1         +27.2            +97.5
 >=65                  45.5      47.2      56.9      57.5      63.4      62.7      61.8      64.8      68.1      69.2      69.8      74.1      73.3         +27.8            +61.1
Education ++  (years)
 <12                     NA      25.2      33.1      34.4      37.0      39.1      38.2      40.1      43.5      42.1      44.0      46.1      44.6         +19.4 @@         +77.0 @@
 12                      NA      24.3      33.6      35.0      38.3      39.2      39.2      40.4      42.9      42.9      43.3      46.5      46.0         +21.7 @@         +89.3 @@
 13-15                   NA      27.5      36.4      38.9      44.0      41.3      42.4      43.9      47.4      48.1      49.2      52.8      52.3         +24.8 @@         +90.2 @@
 >=16                    NA      37.9      49.1      49.1      52.4      54.0      52.9      56.2      61.5      62.1      63.4      67.3      66.5         +28.6 @@         +75.5 @@
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
*  Persons >=18 years of age.
+  Current smokers reported smoking >=100 cigarettes and currently smoked. Former smokers reported smoking >=100 cigarettes and did not currently smoke. Ever smokers include both
   current and former smokers.
@  Percentage point difference from 1965 through 1991, except where noted.
&  Percentage change from 1965 through 1991, except where noted.
** From 1978 through 1991.
++ Data on education are presented for persons >=25 years of age.
@@ From 1966 through 1991.
NA=Data not available.

Source: National  Health  Interview  Surveys:  1965, 1966, 1970, 1974, 1978, 1979, 1980,  1983, 1985, 1987, 1988, 1990, 1991.
Note: For any year, 95% confidence intervals do not exceed  1.6% for the total  population,   2.0% for men,  2.2%  for women,  1.6% for whites,  4.1% for blacks,  6.3% for Hispanics,
 1.7% for non-Hispanics,  2.9% for persons  ages  18-24  years,   2.3% for persons ages 25-44 years,  2.4% for persons  ages  45-64 years,   4.0% for persons  ages 365  years,   2.6%
for <12 years of education,  2.6% for  12 years of education,  4.0% for 13-15  years of education,  and   3.9% for >=16  years  of  education.
=======================================================================================================================================================================================

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Table_7
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TABLE  7. Percentage of adults * who are current, former, and never smokers + and percentage distribution of adult current smokers by number of
cigarettes smoked per day, by race, ethnicity, and sex, National Health Interview Surveys, 1987, 1988, 1990, 1991 (combined) -- United States
=========================================================================================================================================================
                                   Non-Hispanic                                                         Hispanic
                      ------------------------------------------------            --------------------------------------------------------
                                                       American
                                          Asian/       Indian/                                   Puerto
                                          Pacific      Alaska                     Mexican        Rican         Cuban
                      White     Black     Islander     Native      All            American       American      American     Other      All     Total @
---------------------------------------------------------------------------------------------------------------------------------------------------------
Sex
 Male
  Smoking status
   Current            29.1      35.9      23.6         38.0        29.7           29.0           28.3          26.3         28.6       28.6    29.6
   Former             32.1      19.6      19.6         26.0        30.3           22.1           19.4          24.1         20.8       21.6    29.6
   Never              38.9      44.6      56.8         36.1        40.0           48.9           52.4          49.6         50.6       49.8    40.7
  Cigarettes smoked
   per day &
    <15               21.7      54.1      56.1         27.5        26.9           65.9           52.1          38.5         52.4       58.8    29.1
    15-24             42.9      36.3      37.8         49.7        42.0           27.2           31.7          39.9         35.7       30.9    41.2
    >=25              35.4       9.6       6.1         22.8        31.2            6.9           16.2          21.6         11.9       10.3    29.7
  Female
   Smoking status
    Current           25.7      25.4       7.8         36.2        25.3           15.5           22.7          16.4         17.2       17.0    24.6
    Former            20.4      12.0       6.9         17.9        19.1           11.7           14.0          12.5         16.3       13.4    18.6
    Never             53.9      62.6      85.3         46.0        55.7           72.7           63.3          71.1         66.5       69.5    56.8
   Cigarettes smoked
    per day &
     <15              32.1      65.8      64.6         52.3        36.6           72.8           52.3          49.2         65.9       65.2    38.1
     15-24            46.9      27.9      27.6         30.9        44.3           23.2           41.1          40.4         26.6       28.8    43.5
     >=25             21.1       6.3       7.9         16.8        19.1            4.0            6.6          10.5          7.5        6.0    18.4

Total
 Smoking status
  Current             27.3      30.1      16.0         37.1        27.4           22.2           25.0          20.7         22.4       22.5    27.0
  Former              26.0      15.4      13.4         21.9        24.4           16.8           16.3          17.5         18.4       17.2    23.8
  Never               46.7      54.6      70.6         41.1        48.2           61.0           58.7          61.9         59.3       60.3    49.2
 Cigarettes smoked
  per day &
   <15                26.8      59.6      58.1         39.7        31.6           68.4           52.2          43.3         57.9       61.4    33.4
   15-24              44.8      32.4      35.3         40.4        43.1           25.7           36.7          40.1         32.0       30.0    42.3
   >=25               28.3       8.0       6.5         19.9        25.3            5.9           11.1          16.6         10.1        8.6    24.3
---------------------------------------------------------------------------------------------------------------------------------------------------------
*  Persons >=18 years  of  age.
+  Current smokers reported smoking >=100 cigarettes and currently smoked. Former smokers reported smoking >=100 cigarettes and did not currently smoke.
   Never smokers reported that they had smoked <100 cigarettes.
@  Includes other, unknown, multiple  race, and unknown Hispanic origin.
&  Among current smokers.

Source: National Health  Interview  Surveys,  1987, 1988, 1990, and  1991 (combined).
Note: For cigarette-smoking status, 95% confidence  intervals do not  exceed   0.6% for non-Hispanic whites,   1.4% for non-Hispanic  blacks,  3.1%  for
non-Hispanic Asians/Pacific  Islanders,   6.6% for  non-Hispanic  American Indians/Alaska  Natives,   0.5% for all non-Hispanics,  2.3%  for Mexican
Americans,   5.2% for Puerto  Rican Americans,   6.5% for Cuban Americans,   3.3% for other Hispanics,  1.7% for all Hispanics, and  0.5% for the total
population. For the number of  cigarettes smoked  daily, 95% confidence intervals do not exceed   0.8% for non-Hispanic whites,  2.2% for non-Hispanic
blacks,  9.7%  for  non-Hispanic  Asians/Pacific  Islanders,   10.4% for  non-Hispanic  American  Indians/Alaska  Natives,   0.9% for all non-Hispanics,
 4.7% for Mexican Americans,  8.6% for Puerto Rican Americans,   12.4% for Cuban  Americans,  6.8% for other Hispanic,  3.4%  for all Hispanics, and
0.8% for the total  population.
========================================================================================================================================================

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Table_8
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TABLE  8. Percentage  of  adults * who used + cigars, pipes, chewing  tobacco, snuff, or any form of  tobacco, by Hispanic  origin, race,
and sex, National  Health Interview Surveys, 1987, 1991  (combined) -- United States
==========================================================================================================================================
                               Non-Hispanic                                                     Hispanic
                -------------------------------------------------         ----------------------------------------------------
                                                 American
                                    Asian/       Indian/                               Puerto
                                    Pacific      Alaska                   Mexican      Rican        Cuban
                White     Black     Islander     Native       All         American     American     American     Other     All     Total @
------------------------------------------------------------------------------------------------------------------------------------------
Cigar smoking
 Male           4.8       3.9       2.2          5.3          4.6         1.3          1.5          2.5          3.8       2.1     4.4
 Female         0.1       0.1       0.1          0.2          0.1         0.1           .            .           0.2       0.1     0.1
 Total          2.3       1.8       1.1          2.7          2.2         0.7          0.6          1.0          1.9       1.1     2.1

Pipe smoking
 Male           2.9       2.4       2.3          6.9          2.8         0.2          1.5          2.6          1.7       1.0     2.7
 Female         0.1        .         .            .           0.0          .            .            .            .         .      0.0
 Total          1.4       1.1       1.2          3.5          1.4         0.1          0.7          1.1          0.8       0.5     1.3

Cigar or pipe
smoking
 Male           6.7       5.6       3.3          9.8          6.5         1.5          2.7          5.1          4.3       2.7     6.2
 Female         0.1       0.1       0.1          0.2          0.1         0.1           .            .           0.2       0.1     0.1
 Total          3.3       2.5       1.7          4.9          3.1         0.8          1.2          2.1          2.1       1.3     3.0

Any tobacco
smoking
 Male          33.2      40.2      24.0         37.3         33.7        29.4         31.9         30.8         27.2      29.3    33.4
 Female        26.3      26.5       7.8         35.6         25.9        14.8         23.1         16.9         16.9      16.8    25.2
 Total         29.6      32.6      16.0         36.4         29.6        22.1         26.8         22.5         21.7      22.7    29.1

Chewing tobacco
use
 Male           4.1       2.7       0.4          5.3          3.8         0.8          0.3           .           1.1       0.7     3.5
 Female         0.1       1.5        .           0.8          0.3         0.1           .            .           0.1       0.1     0.3
 Total          2.0       2.0       0.2          3.1          2.0         0.4          0.1           .           0.5       0.4     1.8

Snuff use
 Male           3.8       0.9       0.9          3.2          3.4         1.0          0.6          0.3          1.6       1.0     3.2
 Female         0.3       1.9        .           0.4          0.5         0.2           .            .           0.0       0.1     0.4
 Total          1.9       1.4       0.5          1.8          1.8         0.6          0.3          0.1          0.8       0.5     1.7

Chewing tobacco
or snuff use
 Male           6.8       3.1       1.2          7.8          6.2         1.5          0.6          0.3          2.3       1.5     5.9
 Female         0.3       2.9        .           1.2          0.6         0.3           .            .           0.1       0.1     0.6
 Total          3.4       3.0       0.6          4.5          3.3         0.9          0.3          0.1          1.1       0.8     3.1

Any tobacco use
 Male          38.0      42.4      25.6         43.9         38.2        30.7         32.8         31.2         28.4      30.4    37.6
 Female        26.8      29.3       7.9         36.6         26.7        15.1         23.3         17.0         17.1      17.0    26.0
 Total         32.2      35.2      16.8         40.2         32.2        22.9         27.4         22.7         22.4      23.4    31.5
------------------------------------------------------------------------------------------------------------------------------------------
*  Persons >=18  years of age.
+  Current use identified those persons who, for cigars, had smoked >=50 cigars and currently smoked cigars; for pipes, had  smoked a
   pipe >=50  times  and  currently  smoked a  pipe;  for cigars or pipes, were  current  users of cigars  or pipes;  for any tobacco
   smoking,  were current users  of  cigarettes (i.e., had  smoked  >=100  cigarettes  and  currently  smoked cigarettes),  cigars,
   or pipes; for  chewing  tobacco,  had used chewing tobacco  >=20 times and currently  used chewing tobacco; for  snuff, had  used
   snuff >=320 times and currently used snuff;  for chewing tobacco  or snuff,  were current users  of  chewing  tobacco  or  snuff;
   for any tobacco  use,  were  current  users  of  cigarettes, cigars, pipes, chewing  tobacco,  or  snuff.
@  Includes  other, unknown, and  multiple  race and unknown  Hispanic origin.

0.0  Indicates  a  value  >0  and  <0.05.
.    Indicates  a value  of zero.

Source:  National  Health  Interview Survey,  1987  and  1991  (combined)
Note:  95% confidence intervals do  not  exceed:   0.7% for non-Hispanic  whites,  2.1% for  non-Hispanic  blacks,  4.0%  for
non-Hispanic Asians/Pacific  Islanders,   9.6%  for  non-Hispanic American  Indians/Alaska  Natives,   0.7%  for  all  non- Hispanics,
 2.9%  for  Mexican Americans,  7.0% for Puerto Rican Americans,   8.0%  for Cuban Americans,   3.9% for other Hispanics,   2.2% for
all Hispanics,  and   0.7% for the total population.
==========================================================================================================================================

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Table_9
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TABLE 9. Percentage of adults * who used + cigars, pipes, chewing tobacco, or snuff, by
race, sex,  and age,  National Health Interview Surveys,  1970,  1987,  and 1991
-- United States
==============================================================================================

                           White                Black                   Total
                    ------------------    -------------------    --------------------
                     1970   1987  1991    1970   1987    1991    1970    1987    1991
----------------------------------------------------------------------------------------------
Cigar smoking
 Male (age in years)
  18-24               7.4    1.8   1.0     3.2    0.4      .      6.8     1.6     0.8
  25-34              17.3    5.3   2.4    11.8    2.4     2.2    16.7     4.9     2.3
  35-44              19.5    7.5   4.9    16.5    5.5     3.0    19.0     7.1     4.6
  45-64              18.8    7.4   5.2    22.0    4.2     6.9    19.0     7.0     5.5
  >=65               16.7    4.2   2.7    23.8   10.7     6.6    17.2     4.8     3.0
  Total              16.5    5.6   3.6    15.2    4.0     3.6    16.3     5.3     3.5
 Female (age in years)
  18-24               0.2    0.0    .      0.1    0.1      .      0.2     0.0      .
  25-34               0.2    0.1   0.1     0.6     .      0.2     0.2     0.1     0.1
  35-44               0.3    0.0   0.1     0.1     .       .      0.3     0.0     0.1
  45-64               0.2    0.1   0.1      .     0.2     0.1     0.2     0.1     0.1
  >=65                0.1    0.0    .      1.0    0.2      .      0.2     0.1     0.0
  Total               0.2    0.1   0.1     0.3    0.1     0.1     0.2     0.1     0.1

Pipe smoking
 Male (age in years)
  18-24               8.7    0.7   0.3     4.3    0.3      .      8.1     0.8     0.2
  25-34              14.6    1.8   0.8     9.5    2.3     0.6    13.9     2.0     0.8
  35-44              14.0    4.1   2.7    10.2    4.0     2.3    13.5     4.0     2.7
  45-64              14.4    5.2   3.0    14.3    4.4     1.8    14.3     5.1     3.0
  >=65               14.8    4.4   3.2    17.0    7.9     2.4    14.9     4.7     3.1
  Total              13.5    3.4   2.1    10.8    3.4     1.4    13.1     3.4     2.0
 Female (age in years)
  18-24               0.1     .    0.1      .      .       .      0.1      .      0.0
  25-34               0.0    0.2   0.0     0.2     .       .      0.0     0.1     0.0
  35-44               0.2    0.1   0.1     0.2     .       .      0.2     0.1     0.0
  45-64               0.1    0.0   0.0     0.6     .       .      0.1     0.0     0.0
  >=65                0.1     .    0.0     2.6     .       .      0.3      .      0.0
  Total               0.1    0.1   0.0     0.5     .       .      0.1     0.1     0.0

Cigar or pipe smoking
 Male (age in years)
  18-24              13.8    2.2   1.2     6.4    0.7      .     12.9     2.1     1.0
  25-34              25.9    6.4   3.1    17.6    4.4     2.6    24.9     6.1     3.0
  35-44              27.1   10.0   6.5    22.3    7.9     5.2    26.4     9.5     6.4
  45-64              26.8   10.8   7.3    29.5    7.5     8.4    26.9    10.3     7.5
  >=65               25.7    7.4   5.3    33.3   15.2     8.5    26.1     8.1     5.5
  Total              24.4    7.8   5.0    21.3    6.3     4.7    24.0     7.5     5.0
 Female (age in years)
  18-24               0.4    0.0   0.1     0.1    0.1      .      0.3     0.0     0.0
  25-34               0.2    0.3   0.1     0.6     .      0.2     0.2     0.2     0.1
  35-44               0.4    0.1   0.1     0.2     .       .      0.4     0.1     0.1
  45-64               0.2    0.1   0.1     0.6    0.2     0.1     0.3     0.1     0.1
  >=65                0.2    0.0   0.1     2.9    0.2      .      0.4     0.1     0.1
  Total               0.3    0.1   0.1     0.7    0.1     0.1     0.3     0.1     0.1

Chewing tobacco use
 Male (age in years)
  18-24               1.8    6.5   5.0     1.3    1.0      .      1.8     5.5     4.1
  25-34               2.2    3.7   3.6     1.7    0.8     0.4     2.2     3.3     3.1
  35-44               2.8    3.3   2.7     7.7    1.6     1.8     3.3     3.1     2.5
  45-64               4.0    3.5   2.4     7.1    8.0     3.4     4.2     3.9     2.4
  >=65                8.9    5.2   3.8    16.1    7.3     4.5     9.4     5.4     3.9
  Total               3.8    4.2   3.3     5.9    3.4     1.8     3.9     4.1     3.1
 Female (age in years)
  18-24               0.1    0.1    .      1.5    0.1      .      0.3     0.1     0.1
  25-34               0.2    0.0    .      1.0    0.6     0.2     0.3     0.1     0.0
  35-44               0.2    0.1   0.1     2.8    1.6     0.6     0.5     0.3     0.1
  45-64               0.3    0.0   0.2     3.5    1.9     1.7     0.6     0.2     0.4
  >=65                0.3    0.2   0.3     8.9    6.2     4.4     1.0     0.7     0.6
  Total               0.2    0.1   0.1     3.1    1.7     1.2     0.5     0.3     0.3

Snuff use
 Male (age in years)
  18-24               0.7    7.3   7.5     0.7    0.7      .      0.7     6.4     6.2
  25-34               0.5    4.1   5.5      .     0.1     0.5     0.5     3.6     4.8
  35-44               0.7    2.7   3.3     1.1    0.7     0.4     0.8     2.5     2.9
  45-64               1.8    1.6   1.6     2.0    2.0     0.5     1.8     1.6     1.4
  >=65                3.4    2.1   2.1    11.4    3.5     1.8     4.0     2.2     2.2
  Total               1.4    3.3   3.7     2.2    1.1     0.5     1.5     3.1     3.3
 Female (age in years)
  18-24               0.1    0.3   0.2     0.6    0.2      .      0.2     0.3     0.2
  25-34               0.2    0.1   0.0     1.2    0.4     0.0     0.3     0.1     0.1
  35-44               0.3    0.1   0.1     2.7    0.9     0.2     0.6     0.2     0.1
  45-64               1.2    0.2   0.1     7.9    2.6     2.2     1.8     0.4     0.3
  >=65                3.1    0.8   0.8    15.8    9.6     6.9     4.0     1.5     1.3
  Total               1.0    0.3   0.2     5.0    2.2     1.5     1.4     0.5     0.4

Chewing tobacco or
snuff use
 Male (age in years)
  18-24               2.2   10.4  10.1     1.5    1.0      .      2.2     8.9     8.4
  25-34               2.7    6.9   7.9     1.7    0.8     0.7     2.5     6.0     6.9
  35-44               3.5    5.1   5.4     7.7    2.3     2.1     3.9     4.8     4.9
  45-64               5.6    4.7   3.8     8.8    8.4     3.8     5.8     5.0     3.7
  >=65               11.8    6.6   5.5    24.5    9.5     6.0    12.7     6.9     5.6
  Total               5.0    6.4   6.2     7.4    3.8     2.2     5.2     6.1     5.6
 Female (age in years)
  18-24               0.2    0.4   0.2     2.0    0.3      .      0.4     0.3     0.2
  25-34               0.3    0.1   0.0     1.9    0.7     0.2     0.5     0.2     0.1
  35-44               0.5    0.1   0.1     4.6    1.8     0.8     1.0     0.3     0.2
  45-64               1.4    0.2   0.3    10.9    3.8     3.5     2.3     0.6     0.6
  >=65                3.3    0.9   1.0    23.2   13.4     9.9     4.8     1.9     1.7
  Total               1.2    0.3   0.3     7.5    3.2     2.4     1.8     0.6     0.6

*  Persons >=18 years of age.
+  For 1970, current use identified those persons who, for  cigars,  had  smoked >=50
   cigars and currently  smoked cigars;  for  pipes,  had smoked >=3 packages  of pipe
   tobacco  and currently smoked a pipe; for cigars or pipes, were current users of
   cigars or pipes; for chewing tobacco, currently used chewing  tobacco; for snuff,
   currently used snuff; for chewing tobacco or snuff, were current  users  of  chewing
   tobacco  or snuff. For  1987  and  1991, current  use  identified those persons
   who, for cigars, had smoked >=50 cigars and currently smoked cigars; for pipes, had
   smoked a pipe >=50 times and currently smoked a pipe; for cigars or pipes, were
   current users  of cigars  or  pipes;  for  chewing  tobacco,  had  used chewing tobacco
   >=20  times  and currently used chewing tobacco; for snuff, had used snuff >=20 times
   and currently used snuff; for  chewing  tobacco or snuff, were current users of
   chewing tobacco or snuff.
@  Includes  other, unknown, and multiple race.

0.0=Indicates a value >zero and <0.05.
.  Indicates a value of zero.

Source: National Health Interview Survey, 1970, 1987,  and 1991.
Note: For any year and any age category, 95% confidence  intervals do not exceed, for
cigar smoking,  1.1% for white men,  4.9% for black men,  1.1% for all men,  0.2% for white
women,  1.4% for black women, and  0.2% for all women; for pipe smoking,  1.3% for white
men,  4.1% for black men,  1.2% for all men,  0.1% for white women,  2.0% for black women,
and  0.2% for all women; for cigar or pipe smoking,  1.5% for white men,  5.0% for black men,
 1.4% for all men,  0.3% for white women,  2.1% for black women, and  0.3% for all women;
for chewing tobacco use,  1.3% for white men,  4.3% for black men,  1.2% for all men,  0.2%
for white women,  3.6% for black women, and  0.4% for all women; for snuff use, 1.6% for
white men,  3.5% for black men,   1.3%  for  all men,  0.6% for white women,  3.8% for black
women,  and  0.6%  for all women; for chewing tobacco  or snuff use,  1.6% for white men,
 4.7% for black men,  1.5% for all men,  0.6% for white women,  4.1% for black women, and
 0.7% for all women.
=============================================================================================

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Table_10
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TABLE 10. Current cigarette smoking * prevalence (%) among adults, + Behavioral Risk Surveillance
System, participating states -- United States, 1984-1992 @
=================================================================================================
State                    1984      1985    1986    1987    1988    1989    1990    1991    1992
-------------------------------------------------------------------------------------------------
Alabama                    _         _     24.6    27.2    26.2    21.9    22.4    22.0    21.8
Alaska                     _         _       _       -       _       _       _     25.9    28.0
Arizona                  27.7      26.4    24.4    26.2    23.5    25.2    20.7    23.7    19.2
Arkansas                   _         _       _       _       _       _       _     26.5      _
California               25.6      25.6    24.5    21.3    22.2    21.4    19.7    19.6    19.4
Colorado                   _         _       _       _       _       _     21.3    23.5    23.1
Connecticut                _       26.7      _       _     26.7    26.6    22.2    22.4    22.1
Delaware                   _         _       _       _       _       _     23.3    25.9    26.5
District of Columbia       _       26.0    26.6    24.2    20.0    21.9    19.4    21.5    18.7
Florida                    _       27.2    27.9    28.0    23.9    24.6    23.6    24.6    22.1
Georgia                    _       28.7    27.2    25.0    25.1    23.2    24.0    21.7    19.1
Hawaii                     _         _     24.4    22.5    23.6    21.8    21.1    20.4    19.5
Idaho                    24.5      23.7    23.4    20.5    20.1    19.2    20.4    21.1    18.7
Illinois                 33.6      26.2    27.8    25.8    26.8    25.6    24.2    23.6    23.6
Indiana                  25.7      32.2    27.2    28.7    27.3    27.0    26.6    24.4    27.0
Iowa                       _         _       _       _     22.3    22.7    21.7    20.9    19.3
Kansas                     _         _       _       _       _       _       _       _     22.3
Kentucky                   _       29.3    34.7    32.3    34.2    30.4    29.1    30.2    27.9
Louisiana                  _         _       _       _       _       _     24.9    24.2    24.2
Maine                      _         _       _     27.7    26.4    27.2    26.9    26.1    23.2
Maryland                   _         _       _     24.8    25.1    22.0    22.0    21.7    19.9
Massachusetts              _         _     27.0    26.4    26.4    23.6    23.5    22.5    22.9
Michigan                   _         _       _       _     26.2    27.5    29.1    27.5    25.1
Minnesota                26.5      27.8    25.1    24.3    22.5    21.0    21.4    23.3    21.4
Mississippi                _         _       _       _       _       _     24.1    24.1    23.5
Missouri                   _         _     25.7    29.2    26.0    25.9    26.2    25.1    23.3
Montana                  28.9      24.6    23.0    22.3    19.7    19.4    19.4    21.0    18.0
Nebraska                   _         _       _     24.0    20.9    22.3    22.7    22.0    17.4
Nevada                     _         _       _       _       _       _       _       _     30.5
New Hampshire              _         _       _     26.6    28.0    24.8    22.0    23.8    22.8
New Jersey                 _         _       _       _       _       _       _     22.4    20.1
New Mexico                 _         _     26.1    20.9    23.8    22.1    22.3    16.4    19.6
New York                   _       31.4    27.0    23.2    23.9    23.4    22.5    22.9    22.1
North Carolina           28.6      27.4    26.5    26.1    26.2    26.5    28.0    23.9    26.4
North Dakota               _       25.3    26.0    23.7    22.1    20.4    20.3    19.8    21.9
Ohio                     28.7      28.7    28.0    26.8    26.2    26.6    26.1    22.9    23.4
Oklahoma                   _         _       _       _     24.2    26.7    26.6    25.0    25.6
Oregon                     _         _       _       _       _     23.4    21.9    20.6    20.8
Pennsylvania               _         _       _       _       _     27.0    23.6    25.3    24.4
Rhode Island             31.3      29.4    30.2    24.3    24.3    26.1    25.7    24.9    22.2
South Carolina           26.2      29.2    26.5    25.3    25.6    24.2    24.9    22.8    26.7
South Dakota               _         _       _     25.2    21.1    21.8    20.7    22.8    21.9
Tennessee                25.1      27.5    28.0    27.7    29.8    27.0    26.7    28.2    26.6
Texas                      _         _       _     23.0    23.7    21.8    22.9    21.8    22.0
Utah                     16.1      15.6    18.2    15.0    14.7    16.4    16.8    14.3    15.6
Vermont                    _         _       _       _       _       _     21.6    21.6    21.7
Virginia                   _         _       _       _       _     25.0    22.6    21.5    22.8
Washington                 _         _       _     23.7    24.6    24.2    22.3    23.1    21.2
West Virginia            32.8      26.7    29.1    28.8    26.7    27.6    26.6    25.2    24.5
Wisconsin                27.4      24.6    26.0    26.0    24.3    26.0    24.7    26.4    22.5
Median                   27.4      26.9    26.5    25.2    24.3    24.2    22.7    23.0    22.2
Range
 Low                     16.1      15.6    18.2    15.0    14.7    16.4    16.8    14.3    15.6
 High                    33.6      32.2    34.7    32.3    34.2    30.4    29.1    30.2    30.5
States participating     15        22      26      33      37      40      45      48      49
-------------------------------------------------------------------------------------------------
*  Current cigarette smokers were persons who a) reported ever smoking >=100 cigarettes and
   currently smoked and b) did  not volunteer that they are occasional smokers  when asked to
   report the average number of cigarettes they smoke daily.
+  Persons >=18 years of age.
@  No data were available for Wyoming.

Note: Ranges of 95% confidence  intervals: 1984 ( 2.5% to  4.8%), 1985 ( 2.0% to  4.3%), 1986
( 1.7%  to 4.1%), 1987 ( 1.6% to  3.0%), 1988 ( 1.5% to  3.2%), 1989 ( 1.5% to  2.9%), 1990
( 1.5% to   3.7%), 1991 ( 1.5% to  3.2%), 1992 ( 1.4% to  3.4%).
=================================================================================================

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Table_11
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TABLE  11. Percentage  of  adults *  who  used smokeless  tobacco, +  by sex,  Behavioral Risk  Factor  Surveillance System, participating states -- United
States, 1987-1992 @
================================================================================================================================================================

                          1987                   1988                    1989                      1990                    1991                    1992
                   -------------------   ---------------------   ---------------------     ---------------------   ---------------------    --------------------
State              Total  Male  Female   Total   Male   Female   Total   Male   Female     Total   Male   Female   Total   Male   Female    Total  Male  Female
----------------------------------------------------------------------------------------------------------------------------------------------------------------
Alabama             6.2   10.6   2.2      6.9    11.5    2.7       _       _      _          _       _      _       6.4    11.3    2.0       5.6   10.8   1.1
Alaska               _      _     _        _       _      _        _       _      _          _       _      _       5.4    9.4     0.9       5.4    9.0   1.4
Arizona             3.0    6.1   0.1      3.0     5.5    0.6       _       _      _          _       _      _        _      _       _         _      _     _
California          0.9    1.7   0.1      1.3     2.5    0.0       _       _      _          _       _      _        _      _       _         _      _     _
Colorado             _      _     _        _       _      _        _       _      _         4.1     8.3    0.1      4.2    8.4     0.0        _      _     _
Connecticut          _      _     _       0.9     1.7    0.1       _       _      _          _       _      _        _      _       _         _      _     _
Delaware             _      _     _        _       _      _        _       _      _          _       _      _       1.4    3.0     0.0        _      _     _
D.C.                0.8    1.5   0.2      0.6     0.6    0.6       _       _      _          _       _      _        _      _       _         _      _     _
Florida             2.7    4.4   1.1      2.5     5.2    0.1       _       _      _          _       _      _        _      _       _         _      _     _
Georgia             4.2    7.0   1.7      3.0     4.0    2.1       _       _      _         5.2     9.0    1.8      4.4    6.5     2.6       4.4    5.8   3.2
Hawaii              0.6    1.3   0.0      0.8     1.6    0.0       _       _      _          _       _      _        _      _       _         _      _     _
Idaho               5.1   10.0   0.5      3.8     7.7    0.0       _       _      _          _       _      _        _      _       _        4.4    8.8   0.3
Illinois            1.9    3.8   0.2      1.7     3.3    0.3       _       _      _          _       _      _        _      _       _         _      _     _
Indiana             3.6    7.4   0.2      3.6     7.4    0.2      2.7     5.5    0.0        3.1     6.4    0.1      3.4    7.1     0.1       3.2    6.5   0.1
Iowa                 _      _     _       2.9     5.6    0.5      4.7     9.8    0.0        3.0     6.1    0.1      4.1    8.6     0.0       4.1    8.7   0.0
Kansas               _      _     _        _       _      _        _       _      _          _       _      _        _      _       _        4.4    9.2   0.0
Kentucky            4.6    8.8   0.8      6.1    11.9    0.9       _       _      _          _       _      _        _      _       _         _      _     _
Louisiana            _      _     _        _       _      _        _       _      _         3.6     5.9    1.4       _      _       _         _      _     _
Maine               2.7    5.7   0.0      1.6     3.3    0.0       _       _      _          _       _      _        _      _       _         _      _     _
Maryland            0.3    0.5   0.0      0.1     0.2    0.0       _       _      _          _       _      _        _      _       _         _      _     _
Massachusetts       0.5    0.9   0.1      0.2     0.5    0.0       _       _      _          _       _      _        _      _       _         _      _     _
Michigan             _      _     _       3.4     6.0    1.0       _       _      _          _       _      _        _      _       _         _      _     _
Minnesota           3.4    7.1   0.0      3.3     6.6    0.2       _       _      _          _       _      _        _      _       _         _      _     _
Mississippi          _      _     _        _       _      _        _       _      _         8.7    15.8    2.4       _      _       _         _      _     _
Missouri            2.9    5.8   0.3      2.6     5.2    0.3       _       _      _         3.6     7.1    0.4      3.2    6.8     0.0        _      _     _
Montana             6.5   13.1   0.2      7.9    15.4    0.1      6.3    12.2    0.6        7.6    15.4    0.0      7.9   15.3     0.6       7.2   14.4   0.3
Nebraska            4.2    8.6   0.2      4.4     8.8    0.3      3.8     8.0    0.0        4.5     9.5    0.0      4.2    8.6     0.2       4.7    9.9   0.0
New Hampshire       0.9    1.7   0.1      0.9     2.0    0.0      0.7     1.4    0.0        1.7     3.4    0.0       _      _       _         _      _     _
New Mexico          3.0    5.8   0.4      4.3     8.5    0.4       _       _      _         3.9     7.7    0.3      3.2    6.5     0.0       3.3    6.9   0.0
New York            0.6    1.2   0.2      0.6     0.5    0.7       _       _      _          _       _      _        _      _       _         _      _     _
North Carolina      5.8    8.4   3.4      5.4     7.6    3.5       _       _      _          _       _      _        _      _       _         _      _     _
North Dakota        5.0   10.0   0.1      3.9     7.8    0.1       _       _      _          _       _      _       4.1    8.2     0.0        _      _     _
Ohio                3.1    6.4   0.1      3.2     6.4    0.3      2.7     5.4    0.2        2.2     4.6    0.0      3.8    7.2     0.8        _      _     _
Oklahoma            5.1   10.3   0.3       _       _      _        _       _      _         5.4    10.7    0.5      6.2   12.6     0.3       5.4   11.4   0.0
Pennsylvania         _      _     _        _       _      _        _       _      _          _       _      _       4.1    8.7     0.0        _      _     _
Rhode Island        0.5    1.1   0.0      0.5     0.9    0.1       _       _      _          _       _      _        _      _       _         _      _     _
South Carolina      6.1   10.7   1.8      4.7     8.0    1.6       _       _      _          _       _      _        _      _       _         _      _     _
South Dakota        4.6    9.3   0.1      4.9    10.0    0.0       _       _      _         5.0    10.2    0.1       _      _       _         _      _     _
Tennessee           5.9   10.4   1.8      4.5     8.3    1.0       _       _      _          _       _      _        _      _       _         _      _     _
Texas               5.6   10.9   0.6      4.1     7.7    0.5       _       _      _          _       _      _        _      _       _         _      _     _
Utah                2.4    4.9   0.0      1.0     2.0    0.0       _       _      _          _       _      _        _      _       _         _      _     _
Vermont              _      _     _        _       _      _        _       _      _          _       _      _       1.6    3.3     0.0        _      _     _
Washington          3.7    7.1   0.3      2.2     4.5    0.0       _       _      _          _       _      _        _      _       _        2.7    5.3   0.1
West Virginia       8.3   17.0   0.4      9.7    19.5    0.8      8.6    17.7    0.4        8.1    16.6    0.3      9.0   18.1     0.7       9.0   18.8   0.4
Wisconsin           2.7    5.3   0.2      2.3     4.6    0.1      2.2     4.4    0.1         _       _      _        _      _       _         _      _     _

Median              3.1    6.4   0.2      3.0     5.6    0.3      3.3     6.6    0.1        4.1     8.3    0.1      4.1    8.4     0.1       4.4    9.0   0.1
Range
 Low                0.3    0.5   0.0      0.1     0.2    0.0      0.7     1.4    0.0        1.7     3.4    0.0      1.4    3.0     0.0       2.7    5.3   0.0
 High               8.3   17.0   3.4      9.7    19.5    3.5      8.6    17.7    0.6        8.7    16.6    2.4      9.0   18.1     2.6       9.0   18.8   3.2
States
 participating     34                    36                       8                        15                      17                       13
----------------------------------------------------------------------------------------------------------------------------------------------------------------
*  Persons >=18 years of age.
+  Smokeless-tobacco users were persons who reported ever using smokeless tobacco  (i.e., chewing  tobacco  or snuff) and who currently used smokeless-tobacco
   products.
@  No data were available for Arkansas, Nevada, New Jersey, Oregon, Virginia,  and Wyoming.

Note: Ranges of 95%  confidence  intervals: 1987  total  ( 0.3%  to  2.0%), men  ( 0.7%  to   3.8%),  women ( 0.0%  to   1.2%);  1988 total  ( 0.2%  to   2.8%),
men ( 0.5% to  5.3%), women ( 0.0%  to  2.1%);  1989 total  ( 0.2%  to  1.8%),  men ( 1.0%  to  3.5%),  women ( 0.0%  to   0.9%);  1990  total ( 0.8%  to
 1.9%),  men ( 1.6% to  3.7%),  women  ( 0.0% to  1.5%); 1991 total ( 0.7%  to  1.8%), men ( 1.5%  to  3.6%),  women  ( 0.0% to  1.2%);  1992  total  ( 0.8% to
 2.1%), men ( 1.5% to  3.7%), women ( 0.0%  to  1.1%).
================================================================================================================================================================

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Table_12
Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

TABLE 12. Prevalence of daily cigarette smoking * among high school seniors,
by sex and race, Monitoring the Future Project -- United States, 1976-1993
=============================================================================
                                     Sex                    Race
                               ----------------       -----------------
Year                Total      Male      Female       White       Black
-----------------------------------------------------------------------------
1976                28.8       28.0       28.8        28.8        26.8
1977                28.9       27.2       30.1        29.0        23.7
1978                27.5       25.9       28.3        27.8        22.2
1979                25.4       22.3       27.9        25.8        19.3
1980                21.4       18.5       23.5        21.8        15.7
1981                20.3       18.1       21.7        20.9        13.6
1982                21.0       18.2       23.2        22.4        12.4
1983                21.1       19.2       22.1        21.9        12.6
1984                18.7       16.0       20.5        20.1         9.0
1985                19.5       17.8       20.6        20.7        10.8
1986                18.7       16.9       19.8        20.4         7.8
1987                18.7       16.4       20.6        20.6         8.1
1988                18.1       17.4       18.1        20.5         6.7
1989                18.9       17.9       19.4        21.7         6.0
1990                19.1       18.7       19.3        21.8         5.4
1991                18.4       18.8       17.9        21.1         4.9
1992                17.2       17.2       16.7        19.9         3.7
1993                19.0       19.4       18.2        22.9         4.4

Percentage point
 difference
 1976-1993         - 9.8      - 8.6      -10.6       - 5.9       -22.4
 1976-1984         -10.1      -12.0      - 8.3       - 8.7       -17.8
 1984-1993         + 0.3      + 3.4      - 2.3       + 2.8       - 4.6
Percentage change
 1976-1993         -34.0      -30.7      -36.8       -20.5       -83.6
 1976-1984         -35.1      -42.9      -28.8       -30.2       -66.4
 1984-1993         + 1.6      +21.2      -11.2       +13.9       -51.1
-----------------------------------------------------------------------------
*  Daily cigarette smokers were persons who reported smoking >=1
   cigarettes per day during the 30 days before the survey.

Source: University of Michigan, Institute for Social Research,
Monitoring the Future Project. References 27-43 and unpublished data.
Note: For any year, 95% confidence intervals do not exceed  1.3% for
the total population,   1.6% for males,  1.6% for females,  1.4% for
whites, and   3.5% for blacks.
=============================================================================

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