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Cigarette Smoking Among Adults--United States, 1993

Cigarette Smoking Among Adults--United States, 1993

The annual prevalence of cigarette smoking among adults in the United States declined 40% during 1965 to 1990 (from 42.4% to 25.5%) but was virtually unchanged during 1990 to 1992. To determine the prevalence of smoking among adults, smoker interest in quitting, and the prevalence of cessation (ie, quit ratio) among adults during 1993, the Year 2000 Health Objectives Supplement of the 1993 National Health Interview Survey (NHIS-2000) collected self-reported information about cigarette smoking from a random sample of civilian, noninstitutionalized adults aged more than 18 years. This report presents the prevalence estimates for 1993 and compares them with estimates from the 1992 Cancer Epidemiology Supplement and presents 1993 estimates for smoker interest in quitting completely and the prevalence of cessation among ever smokers.

The overall response rate for the 1993 NHIS-2000 (n = 20,860) was 81.2%. For 1993, current smoking status was determined through two questions: "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?" Ever smokers were persons who reported having smoked at least 100 cigarettes during their entire lives. Current smokers were defined as those who had smoked 100 cigarettes and now smoked either every day (ie, daily smokers) or some days (ie, some-day smokers). Former smokers had smoked at least 100 cigarettes in their lives but did not currently smoke.

The prevalence of cessation was the percentage of former smokers among ever smokers. Interest in quitting smoking was assessed using answers to the question "Would you like to completely stop smoking cigarettes?" Data were adjusted for nonresponse and weighted to provide national estimates. Confidence intervals (CIs) were calculated using standard errors generated by the software for Survey Data Analysis (SUDAAN).

Prevalence estimates for 1992 were based on two definitions of current smoking and were calculated by averaging the estimates generated by each definition. One of the 1992 definitions of current smoking (smoking every day or some days) was identical to the definition used in 1993; these estimates are compared in this report.

In 1993, an estimated 46 million (25%) adults in the United States were current smokers (Table 1): 20.4% were daily smokers, and 4.6% were some-days smokers. Smoking prevalence was significantly higher among men (27.7% or 24 million men) than among women (22.5% or 22 million women) (Table 1). The racial/ethnic group-specific prevalence was highest among American Indians/Alaskan Natives (38.7%) and lowest among Asians/Pacific Islanders (18.2%). For all groups, the prevalence of smoking was highest among males who had dropped out of high school (42.1%). Smoking prevalence was higher among persons living below the poverty level (32.1%) than among those living at or above the poverty level (23.8%).

The prevalence of current smokers in 1993 was unchanged statistically from 1992 (25.0% and 26.3%, respectively). However, the prevalence of daily smoking in 1993 (20.4%) was significantly lower than in 1992 (22.3%). In addition, prevalence estimates for current smokers during 1993 were lower overall for women, persons with a college education or higher, total persons living at or above the poverty level, and women living at or above the poverty level (Table 1).

Of current smokers, an estimated 32 million persons (69.7%) reported they wanted to quit smoking completely. Women were more likely to report an interest in quitting (72.7%) than men (67.1%). In 1993, an estimated 46 million adults were former smokers.

Editorial Note from the CDC: Although the overall prevalence of current smoking did not change from 1992 to 1993, the prevalence of daily smoking declined during 1993, possibly reflecting the proliferation of restrictive worksite and public smoking policies. In addition, the relatively greater decline among women is consistent with a previous report that, in workplace settings, women may be more likely to quit smoking because of worksite smoking bans.

Differences in prevalence among racial/ethnic groups may be influenced by differences in education levels and socioeconomic status, as well as by social and cultural phenomena. For example, in a recent report, the prevalence of behavioral risk factors, including cigarette smoking, was generally higher among persons with 12 years or less of education.

From 1992 to 1993, daily smoking prevalence increased among high school seniors from 17.2% to 19.0%. To be effective, school-based prevention programs should begin in kindergarten and continue through high school. This intervention should be especially intensive in middle school and should be reinforced in high school. CDC has published guidelines for incorporating tobacco-use prevention and cessation strategies in the early grades in schools. School-based programs should provide instruction about the short- and long-term physiologic and social consequences of tobacco use, social influences on tobacco use, peer norms regarding tobacco use, and refusal skills.

The findings in this report are subject to at least two limitations. First, because the 1992 and 1993 estimates are based on data collected during a 6 month period, these estimates may not be representative of annual prevalence. In particular, other data suggest that the restriction of the surveys to these periods may have minimized the true magnitude of declines in prevalence (National Household Survey on Drug Abuse, unpublished data, 1992 and 1993). Second, because these estimates are based on self-reported data, prevalence may be underestimated. However, underreporting is believed to be low in national prevalence surveys.

To sustain the decline in smoking prevalence, efforts must be intensified to discourage initiation and to promote cessation. Although 70% of smokers want to stop smoking and 34% attempt to quit each year, only 2.5% successfully stop smoking each year. The high rate of relapse is a consequence of the effect of nicotine dependence. Smokers who need assistance with stopping can receive self-help materials from local voluntary agencies, CDC (telephone [800] 232-1311 or [404] 488-5705), and the National Institutes of Health (telephone [800] 422-6237). Many smokers are addicted to nicotine and could potentially benefit from nicotine replacement therapy (NRT); NRT and other cessation assistance can be obtained from physicians and dentists. Information about formal cessation programs can be obtained from local voluntary agencies or health-care providers.

The health risks of cigarette smoking can be eliminated only by quitting; switching to lower "tar" and nicotine cigarettes is not a safe alternative. Comprehensive measures for promoting cessation and reducing the prevalence of smoking include increasing tobacco excise taxes, enforcing minors' access laws, restricting smoking in public places, restricting tobacco advertising and promotion, and conducting counteradvertising campaigns.

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