Cigarette Smoking Among Adults--United States, 1993

The annual prevalence of cigarette smoking among adults in theUnited States declined 40% during 1965 to 1990 (from 42.4% to25.5%) but was virtually unchanged during 1990 to 1992. To determinethe prevalence of smoking among adults, smoker interest in quitting,and the prevalence of cessation (ie, quit ratio) among adultsduring 1993, the Year 2000 Health Objectives Supplement of the1993 National Health Interview Survey (NHIS-2000) collected self-reportedinformation about cigarette smoking from a random sample of civilian,noninstitutionalized adults aged more than 18 years. This reportpresents the prevalence estimates for 1993 and compares them withestimates from the 1992 Cancer Epidemiology Supplement and presents1993 estimates for smoker interest in quitting completely andthe 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 throughtwo questions: "Have you smoked at least 100 cigarettes inyour entire life?" and "Do you now smoke cigarettesevery day, some days, or not at all?" Ever smokers were personswho reported having smoked at least 100 cigarettes during theirentire lives. Current smokers were defined as those who had smoked100 cigarettes and now smoked either every day (ie, daily smokers)or some days (ie, some-day smokers). Former smokers had smokedat least 100 cigarettes in their lives but did not currently smoke.

The prevalence of cessation was the percentage of former smokersamong ever smokers. Interest in quitting smoking was assessedusing answers to the question "Would you like to completelystop smoking cigarettes?" Data were adjusted for nonresponseand weighted to provide national estimates. Confidence intervals(CIs) were calculated using standard errors generated by the softwarefor Survey Data Analysis (SUDAAN).

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

In 1993, an estimated 46 million (25%) adults in the United Stateswere current smokers (Table 1): 20.4% were daily smokers, and4.6% were some-days smokers. Smoking prevalence was significantlyhigher among men (27.7% or 24 million men) than among women (22.5%or 22 million women) (Table 1). The racial/ethnic group-specificprevalence was highest among American Indians/Alaskan Natives(38.7%) and lowest among Asians/Pacific Islanders (18.2%). Forall groups, the prevalence of smoking was highest among maleswho had dropped out of high school (42.1%). Smoking prevalencewas 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 statisticallyfrom 1992 (25.0% and 26.3%, respectively). However, the prevalenceof daily smoking in 1993 (20.4%) was significantly lower thanin 1992 (22.3%). In addition, prevalence estimates for currentsmokers during 1993 were lower overall for women, persons witha college education or higher, total persons living at or abovethe poverty level, and women living at or above the poverty level(Table 1).

Of current smokers, an estimated 32 million persons (69.7%) reportedthey wanted to quit smoking completely. Women were more likelyto report an interest in quitting (72.7%) than men (67.1%). In1993, an estimated 46 million adults were former smokers.

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

Differences in prevalence among racial/ethnic groups may be influencedby differences in education levels and socioeconomic status, aswell as by social and cultural phenomena. For example, in a recentreport, the prevalence of behavioral risk factors, including cigarettesmoking, was generally higher among persons with 12 years or lessof education.

From 1992 to 1993, daily smoking prevalence increased among highschool seniors from 17.2% to 19.0%. To be effective, school-basedprevention programs should begin in kindergarten and continuethrough high school. This intervention should be especially intensivein middle school and should be reinforced in high school. CDChas published guidelines for incorporating tobacco-use preventionand cessation strategies in the early grades in schools. School-basedprograms should provide instruction about the short- and long-termphysiologic and social consequences of tobacco use, social influenceson tobacco use, peer norms regarding tobacco use, and refusalskills.

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

To sustain the decline in smoking prevalence, efforts must beintensified to discourage initiation and to promote cessation.Although 70% of smokers want to stop smoking and 34% attempt toquit each year, only 2.5% successfully stop smoking each year.The high rate of relapse is a consequence of the effect of nicotinedependence. Smokers who need assistance with stopping can receiveself-help materials from local voluntary agencies, CDC (telephone[800] 232-1311 or [404] 488-5705), and the National Institutesof Health (telephone [800] 422-6237). Many smokers are addictedto nicotine and could potentially benefit from nicotine replacementtherapy (NRT); NRT and other cessation assistance can be obtainedfrom physicians and dentists. Information about formal cessationprograms can be obtained from local voluntary agencies or health-careproviders.

The health risks of cigarette smoking can be eliminated only byquitting; switching to lower "tar" and nicotine cigarettesis not a safe alternative. Comprehensive measures for promotingcessation and reducing the prevalence of smoking include increasingtobacco excise taxes, enforcing minors' access laws, restrictingsmoking in public places, restricting tobacco advertising andpromotion, and conducting counteradvertising campaigns.