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Progress in Chronic Disease Prevention Cigarette Smoking -- Behavioral Risk Factor Surveillance System, 1988

Cigarette smoking prevalence during 1988 was examined in relation to generation cohort and level of education using data from the Behavioral Risk Factor Surveillance System (BRFSS). In 1988, health departments from 36 states and the District of Columbia participated in the BRFSS monthly random-digit-dialed telephone interviews of adults aged greater than or equal to 18 years (1). Respondents were asked if they had ever smoked at least 100 cigarettes, if they had ever quit smoking, and if they currently smoked. Current smokers are defined as persons who have smoked at least 100 cigarettes and who continue to smoke; former smokers, as persons who have smoked 100 cigarettes but who no longer smoke; and ever smokers, as current and former smokers combined (2).

Smoking rates among persons aged 18-34 years varied widely by state (Table 1). The proportion of persons who ever smoked ranged from 27.1% in Utah to 53.1% in Maine (median: 41.1%). The proportion of former smokers ranged from 9.1% in Utah to 20.3% in Maine (median: 15.1%). The proportion of persons who currently smoked ranged from 18.1% in Utah to 37.9% in Kentucky (median: 26.2%).

Smoking rates also varied by generation and level of education (Figure 1). Three generations were defined: persons 18-34 years of age, persons 35-54 years of age, and persons greater than or equal to 55 years of age. From the older to middle generation, the likelihood of being a current smoker increased substantially with each decrease in level of education. From the middle to younger generation, the likelihood of being a current smoker decreased substantially only for persons with more than a high school education. Reported by: The following BRFSS coordinators: R Strickland, Alabama; T Hughes, Arizona; L Parker, California; M Adams, Connecticut; M Rivo, District of Columbia; S Hoecherl, Florida; J Smith, Georgia; E Tash, Hawaii; J Mitten, Idaho; B Steiner, Illinois; S Joseph, Indiana; S Tietje, Iowa; K Bramblett, Kentucky; R Schwartz, Maine; A Weinstein, Maryland; L Koumijian Yandel, Massachusetts; J Thrush, Michigan; N Salem, Minnesota; N Hudson, Missouri; R Moon, Montana; R Thurber, Nebraska; K Zaso, New Hampshire; L Pendley, New Mexico; H Bzduch, New York; C Washington, North Carolina; B Lee, North Dakota; E Capwell, Ohio; N Hann, Oklahoma; J Cataldo, Rhode Island; D Lackland, South Carolina; L Post, South Dakota; D Riding, Tennessee; J Fellows, Texas; B Neiger, Utah; K Tollestrup, Washington; R Anderson, West Virginia; M Soref, Wisconsin. Office of Surveillance and Analysis and Office on Smoking and Health, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Based on findings from the 1988 BRFSS, young adults with low educational attainment (a correlate of low socioeconomic status) were more likely to be current smokers than were other persons. These results indicate that limited progress has been made in reducing the prevalence of cigarette smoking among young adults of low educational attainment levels--a finding consistent with data from other surveys (3).

Differences in socioeconomic levels by state may account for some of the variation in observed prevalences. Cultural factors, such as emphasis among the largely Mormon population of Utah to limit or abstain from tobacco use, may also affect smoking rates by state (4). Other determinants that may vary by state include: the extent of smoking prevention activities (including school programs emphasizing smoking prevention (5)); state cigarette excise tax rates (2); and the intensity of tobacco advertising or promotional events sponsored by the tobacco industry (6).

Recent smoking prevention strategies have been directed toward young persons through the school, home, workplace, and community (2). Life-skills instruction on resisting smoking has been effective in reducing smoking initiation (7). Data from the BRFSS and National Health Interview Surveys (3) show that educational attainment levels are becoming an increasingly important factor in determining whether young persons smoke; therefore, effective smoking prevention strategies need to be targeted toward children and adolescents in groups with generally low educational attainment.


  1. Remington PL, Smith MY, Williamson DF, Anda RF, Gentry EM, Hogelin GC. Design, char acteristics, and usefulness of state-based behavioral risk factor surveillance: 1981-87. Public Health Rep 1988;103:366-75.

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

  3. Pierce JP, Fiore MC, Novotny TE, Hatziandreu EJ, Davis RM. Trends in cigarette smoking in the United States: educational differences are increasing. JAMA 1989;261:56-60.

  4. Fuchs VR. Who shall live? Health, economics, and social choice. New York: Basic Books, 1974.

  5. CDC. School policies and programs on smoking and health--United States, 1988. MMWR 1989;38:202-3.

  6. Davis RM. Current trends in cigarette advertising and marketing. N Engl J Med 1987;316:725-32.

  7. Glynn TJ. Essential elements of school-based smoking prevention programs. J Sch Health 1989;59:181-8.

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