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Progress in Chronic Disease Prevention Regional Variation in Smoking Prevalence and Cessation: Behavioral Risk Factor Surveillance, 1986

A recent article in the MMWR (1) reported the lowest prevalences of smoking among adults ever recorded in the United States: 30% for men, 24% for women, and 27% overall. However, state-specific rates of smoking prevalence among participants in the 1986 Behavioral Risk Factor Surveillance System (BRFSS) varied almost twofold, from a low of 18% to a high of 35% (2). An assessment of the geographic variation in rates of current smoking and of smoking cessation using data from the 1986 BRFSS follows.

Health departments in 26 states (includes the District of Columbia) collected data by telephone from persons 18 years of age or older who were selected using random-digit dialing techniques. Each state conducted approximately 100 interviews per month, or an average of 1,200 interviews for the entire year (range = 559 to 3,023). For this survey, an "ever smoker" was defined as a respondent who reported smoking 100 or more cigarettes in his or her lifetime. A "current smoker" was defined as a respondent who had smoked 100 or more cigarettes and who was still smoking. A "former smoker" was defined as a respondent who reported having smoked 100 or more cigarettes during his or her lifetime but who was not currently smoking.

State-specific current smoking rates* and quit ratios** were calculated to determine smoking prevalence and cessation for each state. These were adjusted to the age distribution of the 1980 census for the 26 participating states and then ranked from highest to lowest and divided into terciles. To study regional variations, the geographic distributions of the states by tercile of smoking rate and quit ratio were examined.

When ranked according to smoking rates, the states in the highest tercile were all clustered east of the Mississippi River, primarily along the Ohio River Valley. States in the middle and lowest terciles appeared more evenly distributed geographically (Figure 1). The median rate of smoking prevalence for states in the highest tercile was 28% (range = 27% to 35%); for states in the middle tercile, it was 26% (range = 26% to 27%); and, for states in the lowest tercile, it was 24% (range = 18% to 26%). Similar geographic patterns were noted when data for men and women were considered separately.

When ranked according to quit ratios, states in the highest and middle terciles were widely distributed geographically. However, most of the states in the lowest tercile (representing the lowest rates of smoking cessation) were clustered east of the Mississippi River (Figure 2). The median quit ratio for states in the highest tercile was 49% (range = 48% to 52%); for states in the middle tercile, it was 46% (range = 43% to 48%); and, for states in the lowest tercile, it was 41% (range = 37% to 42%). Reported by: J McVay, Alabama Dept of Public Health. T Hughes, Arizona Dept of Health Svcs. LF Folkers, California Dept of Health Svcs. R Conn, EdD, District of Columbia Dept of Human Svcs. WW Mahoney, Florida Dept of Health and Rehabilitative Svcs. JD Smith, Georgia Dept of Human Resources. E Tash, Hawaii Dept of Health. JV Patterson, Idaho Dept of Health and Welfare. S Knoblock, Illinois Dept of Public Health. S Joseph, Indiana State Board of Health. K Bramblett, Kentucky Cabinet for Human Resources. SJ Allison, Massachusetts Dept of Public Health. N Salem, Minnesota Center for Health Statistics. M Van Tuinen, PhD, Missouri Dept of Health. R Moon, Montana State Dept of Health and Environmental Sciences. L Pendley, New Mexico Health and Environment Dept. H Bzduch, New York State Dept of Health. C Washington, North Carolina Dept of Human Resources. B Lee, North Dakota State Dept of Health. E Capwell, Ohio Dept of Health. J Cataldo, Rhode Island Dept of Health. FC Wheeler, PhD, South Carolina Dept of Health and Environmental Control. J Fortune, Tennessee Dept of Health and Environment. G Edwards, Utah Dept of Health. RH Anderson, West Virginia State Dept of Health. DR Murray, Wisconsin Center for Health Statistics. Div of Nutrition; Office on Smoking and Health, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: Current smoking rates in a population are determined by both the rates of initiation and cessation of smoking as well as by prior smoking prevalence. Data in this report suggest that smoking prevalence is unevenly distributed across the United States. The regional clustering of higher smoking rates east of the Mississippi River may be partially attributable to the lower rates of smoking cessation in this region, as reflected by the lower quit ratios. State-specific exceptions to this pattern may have resulted from differences in the rates of smoking initiation and prior smoking prevalence, which were not assessed in this report.

Several points need to be considered when interpreting these data. First, the grouping of states into terciles based on single-point prevalence estimates permits visualization of general regional variations. However, comparisons between individual states are not intended. Second, these results are based on data from 25 states and the District of Columbia. Information from the remaining 25 states could alter the observed regional trends. However, data from all states from the 1985 Current Population Surveys (3) reveal a similar geographic distribution of current smoking rates (CDC, unpublished data).

This report is being published during the same week as the American Cancer Society's eleventh annual Great American Smokeout. On November 19, the day of the Smokeout, smokers throughout the United States were encouraged to give up the habit for the day. An estimated 24 million smokers participated in last year's Smokeout. Efforts such as this to encourage smokers to quit are critical to ensuring a continued decline in smoking prevalence in the United States.


  1. Centers for Disease Control. Cigarette smoking in the United States, 1986. MMWR 1987;36:581-5.

  2. Centers for Disease Control. Behavioral risk factor surveillance--selected states, 1986. MMWR 1987;36:252-4.

  3. Bureau of the Census. Current population survey, September 1985; United States immunization and smoking survey technical documentation. Washington, DC: US Department of Commerce, Bureau of the Census, 1985. *The current smoking rate is the percentage of current smokers in the population. **The quit ratio, which is an index of smoking cessation, is the ratio of former smokers to ever smokers.

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