Cigarette Smoking Among Adults in the United States

• DOI: 10.1097/01.cot.0000343804.37975.8c
• Publication Date: 2013-01-10T17:28:20Z
• Authors: SL Thorne; A Malarcher; E Maurice; R Caraballo
• Keywords: 03 medical and health sciences; 0302 clinical medicine

One of the national health objectives for 2010 is to reduce prevalence cigarette smoking among adults less than 12% (Objective 27.1a).1 To assess progress toward this objective, each year Centers Disease Control and Prevention analyzes self-reported data from National Health Interview Survey (NHIS). This report summarizes findings 2007, which indicated that approximately 19.8% were current smokers in a decrease 1.0 percentage point 2006 (20.8%).2 Cigarette has declined during past 40 years all sociodemographic subpopulations adults; however, declines decade have been smaller previous decades. The proportion everyday who made quit attempt preceding decreased 7.2 points 1993 (47.0%) 2007 (39.8%). During young (aged 18 24) consistently had highest quitting more day (59.3% 53.1% 2007). initiation cessation at ages beneficial reducing morbidity mortality. Clinicians should strongly advise recommend they use effective treatments.3 insurers, insurance purchasers, systems assist clinicians making treatments available by including counseling medications as covered benefits support community interventions cessation, increased excise taxes, mass media campaigns, smoke-free laws.3,4 NHIS adult core questionnaire, contained questions on attempts, was administered in-person interview nationally representative sample noninstitutionalized, US civilian population over age (total 23,393 individuals). per selected household chosen randomly participate survey. oversampled blacks, Hispanics, Asians 65, twice probability other household. (For report, persons identified white, black, Asian, American Indian/Alaska Native are non-Hispanic. Persons Hispanic might be any race.) total response rate 87.1%, overall survey component 67.8%. Smoking status classified based respondent's answers following questions: “Have you smoked least 100 cigarettes your entire life?” “Do now smoke every day, some days, or not all?” Current reported their lifetime currently days. Former do smoke. Prevalence Various Categories one attempts assessed included those responded yes question, “During 12 months, stopped because trying smoking?” Data adjusted nonresponse weighted provide estimates attempts; 95% confidence intervals calculated using statistical software account multistage design. For comparisons, significance determined two-sided z test; differences considered statistically significant p<0.05. In an estimated (43.4 million) smokers; these, 77.8% (33.8 22.2% (9.6 39.8% (13.4 months quit. Among 86.8 million (defined ever smokers), 52.1% (47.3 no longer time interview. higher men (22.3%) women (17.4%). different racial/ethnic populations, (9.6%) lowest prevalence, whereas Indians/Alaska Natives (36.4%) significantly populations. whites (21.4%) blacks (19.8%) Hispanics (13.3%). also varied education level 25. Those General Education Development (GED) diploma (44.0%) with nine 11 (33.3%) smoking. undergraduate graduate degree (11.4% 6.2%, respectively). By group, 65 (8.3%), compared younger (age 18–24 [22.2%], 25–44 [22.8%], 45–64 [21.0%]). whose incomes below federal poverty (28.8%) above (20.3%), lower (20.8%). Subgroups decreases (from 23.0% 10.2% 8.3% 2007. Attempts Quit From (the first quit-attempt collected separately) decreased; these 25 44 over. year, tried increasing age, 24 likely older adults. 24, 39.9% 44, 38.1% 45 64, 25.3% older. Big Change After three remained virtually unchanged (20.9% 2004, 20.9% 2005, 20.8% 2006), 2006.2 five consecutive years, 20% (19.2% 2003, 18.5% 18.2% 18.0% 2006, 17.4% 2007), although there variability subgroups women. Need Better Interventions Specific Subpopulations Also, six former outnumbered smokers. subpopulation. However, large disparities continue exist race/ethnicity level. continuing several such (36.4%), GED diplomas (44.0%), reporting family (28.8%), emphasizes need policy environmental individual-level reach subpopulations. trends showing slow 1990s through early- mid-2000s similar surveys (e.g., Household Drug Use Tobacco Supplement Population Survey). primary measure used meeting Healthy People objective least, indicate will met. Before met same continued meet goal. goal include: (8.3%) Asian (4.0%) Women up eight (10.0%) (9.4%) degrees (6.0%). (7.6%). Men (6.4%). (9.3%). attempted lack funding comprehensive state tobacco-control programs barrier achieving smokers' attempts. fiscal investments states tobacco control varied; mean capita expenditure $2.76, investing $11.00, others invested nothing.4 CDC recommends annual $9.23 $18.03 implement programs.5 majority recommended methods,3 most untreated relapse within days after quitting; 24% 51% abstinent week, 15% 28% month, 10% months.6 Of try only 4% 7% successful.3 daily smokers, finding consistent studies.7 Young levels addiction, heavy homes dependence having home associated increases year.7 age; greater premature mortality.8 Limitations subject limitations: First, self-report validated biochemical tests. validity when measured serum cotinine yields estimates.9 Second, questionnaire English Spanish only, affect populations speak primarily. Finally, single-year certain groups Natives) primarily resulted small sizes. screening brief intervention top clinical preventive services found cost-saving.10 Effective include clinicians; individual, telephone counseling; pharmacologic therapies: Bupropion SR, Varenicline, nicotine gum, inhaler, lozenge, nasal spray, patch.3 care delivery identify document status, treat user seen health-care setting, promote patients' quitlines (available countrywide toll-free access number 1–800 QUIT- NOW).3 These approaches part program includes real price products, implementing policies, coverage interventions; wider implementation policies programs, could attained.4,5 Reprinted (slightly edited) Morbidity Mortality Weekly Report, 11/14/07, Vol. 57, No. 45, pp1221–1226.