Cigarette Smoking Among Adults -- United States, 1994

Reducing the prevalence of cigarette smoking among adults to no more than 15% is one of the national health objectives for the year 2000 (objective 3.4) (1). To assess progress toward meeting this objective, CDC analyzed self-reported information about cigarette smoking among U.S. adults contained in the Year 2000 Objectives Supplement of the 1994 National Health Interview Survey (NHIS-2000). This report summarizes the findings of this analysis, which indicate that, in 1994, 25.5% (48.0 million) of adults were current smokers and that the overall prevalence of current smoking and estimates for sociodemographic subgroups were unchanged from 1993 to 1994.

The 1994 NHIS-2000 was administered to a nationally representative sample (n=19,738) of the U.S. noninstitutionalized civilian population aged greater than or equal to 18 years; 79.5% responded. Participants were asked "Have you smoked at least 100 cigarettes in your entire life?" and "Do you now smoke cigarettes every day, some days, or not at all?" Current smokers were persons who reported having smoked greater than or equal to 100 cigarettes in their lifetime and who smoked every day or some days at the time of interview. Former smokers were those who had smoked greater than or equal to 100 cigarettes in their lifetime but who did not smoke currently. Interest in quitting smoking was determined by asking current smokers "Would you like to completely quit smoking cigarettes?" Quit attempt was determined by asking current every-day smokers "During the past 12 months, have you stopped smoking for one day or longer?" Data were adjusted for non-response and weighted to provide national estimates. Confidence intervals (CIs) were calculated using SUDAAN.

In 1994, an estimated 48.0 million adults (25.5% {95% CI=plus or minus 0.7%}), including 25.3 million men and 22.7 million women, were current smokers (Table_1): 21.0% (95% CI=plus or minus 0.7%) were every-day smokers, and 4.6% (95% CI=plus or minus 0.4%) were some-day smokers. Current every-day smokers in 1994 constituted 82.1% (95% CI=plus or minus 1.3%) of current smokers, similar to that for 1993 (81.8% {95% CI=plus or minus 1.2%}) (CDC, unpublished data, 1996). Men were significantly more likely to be current smokers (28.2% {95% CI=plus or minus 1.1%}) than were women (23.1% {95% CI=plus or minus 0.9%}). Racial/ethnic group-specific prevalence was highest for American Indians/Alaskan Natives (42.2% {95% CI=plus or minus 9.4%}) and lowest for Asians/Pacific Islanders (13.9% {95% CI=plus or minus 3.5%}). With the exception of persons with 0-8 years of education, smoking prevalence varied inversely with level of education and was highest among persons with 9-11 years of education (38.2% {95% CI=plus or minus 2.5%}). Smoking prevalence was higher among persons living below the poverty level * (34.7% {95% CI=plus or minus 2.3%}) than among those living at or above the poverty level (24.1% {95% CI=plus or minus 0.8%}).

In 1994, an estimated 46.0 million adults (24.5% {95% CI=plus or minus 0.7%}) were former smokers, including 26.0 million men and 20.0 million women. An estimated 33.2 million (69.3% {95% CI=plus or minus 1.6%}) current smokers wanted to quit smoking completely, and 18.1 million (46.4% {95% CI=plus or minus 1.9%}) current every-day smokers had stopped smoking for at least 1 day during the preceding 12 months.

Reported by: Epidemiology Br, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that the overall prevalence of current cigarette smoking among U.S. adults in 1994 was unchanged compared with that in 1993 (2) and suggest a plateau in the prevalence (2,3); in addition, estimated prevalences were unchanged for sociodemographic subgroups, for current and every-day smokers, and for former smokers. From 1981 to 1993, average per capita consumption of cigarettes declined by 108.2 cigarettes annually (3836 cigarettes per adult to 2538); in comparison, the annual decline was only 11.5 cigarettes from 1993 to 1995 (2515 per adult) (3,4). The plateau in prevalence and consumption corresponded with a 10.4% decrease in the real price per pack of cigarettes during 1992-1994 after annual increases of an average of 4% since 1984 (5). This decrease in the real price of cigarettes was because of increased market shares for discount brands and price decreases in premium brands. In addition, during this period, domestic cigarette marketing expenditures increased at more than four times the rate of inflation, with the largest increases in expenditures for coupons and other items that make cigarettes more affordable (6).

Racial/ethnic variations in smoking prevalence probably reflect the differences in education level (7), income, employment status, and cultural factors. For example, in many Asian cultures, smoking by women is unacceptable (8). To further assess these differences, CDC has funded 11 academic institutions to collaborate in examining variations in smoking behavior among racial, ethnic, and sex groups. These studies include focus groups of teenagers to determine differences among groups in the functional values, parenting styles, and social norms associated with tobacco use.

To achieve national health objectives for decreased prevalence of smoking, efforts must be intensified to discourage the initiation of smoking among youth and to encourage smokers to quit. Specific prevention strategies include reducing both the access to and the appeal of tobacco products for minors, educational efforts encouraging cessation, improved access to cessation services for smokers interested in quitting, and implementation of other strategies (e.g., mass media campaigns) (9). The document Smoking Cessation: Clinical Practice Guideline recently released by the Agency for Health Care Policy and Research (10) should be widely disseminated and its recommendations fully implemented by all health-care professionals; in addition, all health insurance plans are encouraged to offer treatment for nicotine addiction as a covered benefit (1).

References

1. Public Health Service. Healthy people 2000: midcourse review and 1995 revisions. Washington, DC: US Department of Health and Human Services, Public Health Service, 1995.

2. CDC. Cigarette smoking among adults -- United States, 1993. MMWR 1994;43:925-30.

3. Giovino GA, Schooley MW, Zhu BP, et al. Trends and recent patterns in selected tobacco-use behaviors -- United States, 1900-1993. MMWR 1994;43(no. SS-3).

4. US Department of Agriculture. Tobacco: situation and outlook report. Washington, DC: US Department of Agriculture, Economic Research Service, April 1996.

5. The Tobacco Institute. The tax burden on tobacco. Washington, DC: The Tobacco Institute, 1995.

6. US Federal Trade Commission. Federal Trade Commission report to Congress for 1993: pursuant to the Federal Cigarette Labeling and Advertising Act. Washington, DC: US Federal Trade Commission, 1995.

7. Escobedo LG, Zhu BP, Giovino GA, Eriksen MP. Educational attainment and racial differences in cigarette smoking. J Natl Cancer Inst 1995;87: 1552-3.

8. Chollat-Traquet C. Women and tobacco. Geneva, Switzerland: World Health Organization, 1992.

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

10. US Department of Health and Human Services. Smoking cessation: clinical practice guideline {no. 18}. Washington, DC: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1996; DHHS publication no. (AHCPR)96-0692.

Poverty statistics are based on definitions originated by the Social Security Administration in 1964 (which were subsequently modified by federal interagency committees in 1969 and 1980) and prescribed by the Office of Management and Budget as the standard to be used by federal agencies for statistical purposes.

TABLE 1. Percentage of persons aged >=18 years who were current cigarette smokers *,
by selected characteristics -- Year 2000 Objectives Supplement of the National Health
Interview Survey, United States, 1994
================================================================================================
                                  Men                Women              Total
                               (n=8,303)           (n=11,435)         (n=19,738)
                            ----------------    ----------------   ----------------
Characteristic               %    (95% CI +)     %     (95% CI)     %     (95% CI)
-----------------------------------------------------------------------------------
Race/Ethnicity &
 White                      28.0   (+/- 1.2)    24.7   (+/- 1.1)   26.3   (+/- 0.9)
 Black                      33.9   (+/- 4.0)    21.8   (+/- 2.2)   27.2   (+/- 2.3)
 Hispanic                   24.3   (+/- 4.1)    15.2   (+/- 2.8)   19.5   (+/- 2.5)
 American Indian/
  Alaskan Native @          53.7   (+/-16.9)    33.1   (+/-10.8)   42.2   (+/- 9.4)
 Asian/Pacific Islander     20.4   (+/- 6.1)     7.5   (+/- 3.5)   13.9   (+/- 3.5)

Education (yrs) **
   <=8                      30.4   (+/- 4.1)    17.8   (+/- 2.8)   23.7   (+/- 2.4)
  9-11                      45.8   (+/- 3.9)    32.1   (+/- 3.0)   38.2   (+/- 2.5)
    12                      33.2   (+/- 2.1)    27.3   (+/- 1.6)   29.8   (+/- 1.3)
 13-15                      28.4   (+/- 2.5)    23.3   (+/- 2.1)   25.7   (+/- 1.6)
  >=16                      13.8   (+/- 1.7)    10.4   (+/- 1.4)   12.3   (+/- 1.1)

Age (yrs)
 18-24                      29.8   (+/- 3.3)    25.2   (+/- 2.8)   27.5   (+/- 2.2)
 25-44                      32.3   (+/- 1.7)    27.8   (+/- 1.4)   30.0   (+/- 1.1)
 45-64                      28.3   (+/- 2.1)    22.8   (+/- 1.9)   25.5   (+/- 1.4)
  >=65                      13.2   (+/- 1.9)    11.1   (+/- 1.3)   12.0   (+/- 1.1)

Poverty status ++
 At/Above                   26.6   (+/- 1.1)    21.6   (+/- 1.0)   24.1   (+/- 0.8)
 Below                      41.9   (+/- 4.1)    30.2   (+/- 2.6)   34.7   (+/- 2.3)
 Unknown                    31.8   (+/- 4.2)    26.8   (+/- 3.4)   28.8   (+/- 2.7)

Total                       28.2   (+/- 1.1)    23.1   (+/- 0.9)   25.5   (+/- 0.7)
-----------------------------------------------------------------------------------
 * Persons who reported having smoked >=100 cigarettes and who reported now smoking every
   day or some days. Excludes 171 respondents for whom smoking status was unknown.
 + Confidence interval.
 & Excludes 251 respondents in unknown, multiple, and other racial categories.
 @ Estimates should be interpreted with caution because of the small sample sizes.
** Persons aged >=25 years. Excludes 118 persons with unknown years of education.
++ Poverty statistics are based on definitions developed by the Social Security Administration
   in 1964 (which were subsequently modified by federal interagency committees in 1969 and
   1980) and prescribed by the Office of Management and Budget as the standard to be used
   by federal agencies for statistical purposes.
================================================================================================

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