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). 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in 1994 constituted 82.1% (95% CI = ±1.3%) of current smokers, similar to that for 1993 (81.8% [95% CI = ±1.2%]) (CDC, unpublished data, 1996).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(Drug information on nicotine) addiction as a covered benefit.

Adapted from Morbidity and Mortality Weekly Report, vol 45, No. 27, July 12, 1996.