Cigarette Smoking Among Adults--United States, 1994

Reducing the prevalence of cigarette smoking among adults to nomore than 15% is one of the national health objectives for theyear 2000 (objective 3.4). To assess progress toward meeting thisobjective, the CDC analyzed self-reported information about cigarettesmoking among US adults contained in the Year 2000 ObjectivesSupplement of the 1994 National Health Interview Survey (NHIS-2000).This report summarizes the findings of this analysis, which indicatethat, in 1994, 25.5% (48.0 million) of adults were current smokersand that the overall prevalence of current smoking and estimatesfor sociodemographic subgroups were unchanged from 1993 to 1994.

The 1994 NHIS-2000 was administered to a nationally representativesample (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, ornot at all?" Current smokers were persons who reported havingsmoked 100 cigarettes or more in their lifetime and who smokedevery day or some days at the time of interview. Former smokerswere those who had smoked 100 cigarettes or more in their lifetimebut who did not smoke currently. Interest in quitting smokingwas determined by asking current smokers "Would you liketo completely quit smoking cigarettes?" Quit attempt wasdetermined by asking current every-day smokers "During thepast 12 months, have you stopped smoking for one day or longer?"Data were adjusted for nonresponse and weighted to provide nationalestimates. 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 currentsmokers (Table 1): 21.0% (95% CI = ±0.7%) were every-daysmokers, 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in 1994 constituted 82.1% (95% CI =±1.3%) of current smokers, similar to that for 1993 (81.8%[95% CI = ±1.2%]) (CDC, unpublished data, 1996).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 weresignificantly 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 AmericanIndians/Alaskan Natives (42.2% [95% CI = ±9.4%]) and lowestfor Asians/Pacific Islanders (13.9% [95% CI = ±3.5%]). Withthe exception of persons with 0 to 8 years of education, smokingprevalence varied inversely with level of education and was highestamong persons with 9 to 11 years of education (38.2% [95% CI =±2.5%]). Smoking prevalence was higher among persons livingbelow the poverty level (34.7% [95% CI = ±2.3%]) than amongthose 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 millionwomen. 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 stoppedsmoking for at least 1 day during the preceding 12 months.

Editorial Note from the CDC

The findings in this report indicate that the overall prevalenceof current cigarette smoking among US adults in 1994 was unchangedcompared with that in 1993 and suggest a plateau in the prevalence;in addition, estimated prevalences were unchanged for sociodemographicsubgroups, for current and every-day smokers, and for former smokers.From 1981 to 1993, average per capita consumption of cigarettesdeclined by 108.2 cigarettes annually (3,836 cigarettes per adultto 2,538); in comparison, the annual decline was only 11.5 cigarettesfrom 1993 to 1995 (2,515 per adult) . The plateau in prevalenceand consumption corresponded to a 10.4% decrease in the real priceper pack of cigarettes during 1992-1994 after annual increasesof an average of 4% since 1984. This decrease in the real priceof cigarettes was due to increased market shares for discountbrands and price decreases in premium brands. In addition, duringthis period, domestic cigarette marketing expenditures increasedat more than four times the rate of inflation, with the largestincreases in expenditures for coupons and other items that makecigarettes more affordable.

Racial/ethnic variations in smoking prevalence probably reflectdifferences in education level, income, employment status, andcultural factors. For example, in many Asian cultures, smokingby women is unacceptable. To further assess these differences,the CDC has funded 11 academic institutions to collaborate inexamining variations in smoking behavior among racial, ethnic,and gender groups. These studies include focus groups of teenagersto determine differences among groups in the functional values,parenting styles, and social norms associated with tobacco use.

To achieve national health objectives for decreased prevalenceof smoking, efforts must be intensified to discourage the initiationof smoking among youth and to encourage smokers to quit. Specificprevention strategies include reducing both the access to andthe appeal of tobacco products for minors, educational effortsencouraging cessation, improved access to cessation services forsmokers interested in quitting, and implementation of other strategies(eg, mass media campaigns). The document, Smoking Cessation: ClinicalPractice Guideline, recently released by the Agency for HealthCare Policy and Research should be widely disseminated and itsrecommendations fully implemented by all health-care professionals;in addition, all health insurance plans are encouraged to offertreatment for nicotine addiction as a covered benefit.

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