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). To assess progress toward meeting this
objective, the CDC analyzed self-reported information about cigarette
smoking among US 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 US noninstitutionalized civilian population
18 years old or more; 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 100 cigarettes or more in their lifetime and who smoked
every day or some days at the time of interview. Former smokers
were those who had smoked 100 cigarettes or more 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 nonresponse 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 = ±0.7%]),
including 25.3 million men and 22.7 million women, were current
smokers (Table 1): 21.0% (95% CI = ±0.7%) were every-day
smokers, and 4.6% (95% CI = ±0.4%) were some-day smokers.
Current every-day smokers in 1994 constituted 82.1% (95% CI =
±1.3%) of current smokers, similar to that for 1993 (81.8%
[95% CI = ±1.2%]) (CDC, unpublished data, 1996). Men were
significantly more likely to be current smokers (28.2% [95% CI
= ±1.1%]) than were women (23.1% [95% CI = ±0.9%]).
Racial/ethnic group-specific prevalence was highest for American
Indians/Alaskan Natives (42.2% [95% CI = ±9.4%]) and lowest
for Asians/Pacific Islanders (13.9% [95% CI = ±3.5%]). With
the exception of persons with 0 to 8 years of education, smoking
prevalence varied inversely with level of education and was highest
among persons with 9 to 11 years of education (38.2% [95% CI =
±2.5%]). Smoking prevalence was higher among persons living
below the poverty level (34.7% [95% CI = ±2.3%]) than among
those living at or above the poverty level (24.1% [95% CI = ±0.8%]).
In 1994, an estimated 46.0 million adults (24.5% [95% CI = ±0.7%])
were former smokers, including 26.0 million men and 20.0 million
women. An estimated 33.2 million (69.3% [95% CI = ±1.6%1)
current smokers wanted to quit smoking completely, and 18.1 million
(46.4% [95% CI = ±1.9%1) current every-day smokers had stopped
smoking for at least 1 day during the preceding 12 months.
Editorial Note from the CDC
The findings in this report indicate that the overall prevalence
of current cigarette smoking among US adults in 1994 was unchanged
compared with that in 1993 and suggest a plateau in the prevalence;
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 (3,836 cigarettes per adult
to 2,538); in comparison, the annual decline was only 11.5 cigarettes
from 1993 to 1995 (2,515 per adult) . The plateau in prevalence
and consumption corresponded to 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. This decrease in the real price
of cigarettes was due to 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.
Racial/ethnic variations in smoking prevalence probably reflect
differences in education level, income, employment status, and
cultural factors. For example, in many Asian cultures, smoking
by women is unacceptable. To further assess these differences,
the CDC has funded 11 academic institutions to collaborate in
examining variations in smoking behavior among racial, ethnic,
and gender 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
(eg, mass media campaigns). The document, Smoking Cessation: Clinical
Practice Guideline, recently released by the Agency for Health
Care Policy and Research 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.
Adapted from Morbidity and Mortality Weekly Report, vol 45, No.
27, July 12, 1996.