Cigarette Smoking Among Adults -- United States, 1997

In the United States, cigarette smoking is the leading cause of preventable morbidity and mortality and results in approximately 430,000 deaths each year (1). One of the national health objectives for 2000 is to reduce the prevalence of cigarette smoking among adults to no more than 15% (objective 3.4) (2). To assess progress toward meeting this objective, CDC analyzed self-reported data about cigarette smoking among U.S. adults from the 1997 National Health Interview Survey (NHIS) Sample Adult Core Questionnaire. This report summarizes the findings of this analysis, which indicate that, in 1997, 24.7% of adults were current smokers and that the overall prevalence of current smoking in 1997 was unchanged from the overall prevalence of current smoking from the 1995 NHIS.

The 1997 NHIS Sample Adult questionnaire was administered to a nationally representative sample (n=36,116) of the U.S. noninstitutionalized civilian population aged greater than or equal to 18 years; the overall response rate for the survey was 80.4%. 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 greater than or equal to 100 cigarettes during their lifetime and who smoked every day or some days at the time of the interview. Former smokers were those who had smoked greater than or equal to 100 cigarettes during their lifetime but who did not smoke currently. Attempts to quit were determined by asking current daily smokers, "During the past 12 months, have you stopped smoking for one day or longer because you were trying to stop smoking?" Data were adjusted for nonresponse and weighted to provide national estimates. Confidence intervals (CIs) were calculated using SUDAAN.

In 1997, an estimated 48.0 million (24.7%) adults, including 25.7 million (27.6%) men and 22.3 million (22.1%) women, were current smokers (Table 1). Overall, 20.1% (95% CI=plus or minus 0.5) of adults were every-day smokers, and 4.4% (95% CI=plus or minus 0.2) were some-day smokers (every-day smokers constituted 81.9% [95% CI=plus or minus 0.9] of all smokers). Prevalence of smoking was highest among persons aged 18-24 years (28.7%) and aged 25-44 years (28.6%) and lowest among persons aged greater than or equal to 65 years (12%). Prevalence of current smoking was significantly higher among American Indians/Alaska Natives (34.1%), non-Hispanic blacks (26.7%), and non-Hispanic whites (25.3%) than among Hispanics (20.4%) or Asians/Pacific Islanders (16.9%). Current smoking prevalence was highest among persons with nine to 11 years of education (35.4%) and lowest among persons with greater than or equal to 16 years of education (11.6%), and was higher among persons living below the poverty level* (33.3%) than among those living at or above the poverty level (24.6%).

In 1997, an estimated 44.3 million adults (22.8% [95% CI=plus or minus 0.5]) were former smokers, including 25.1 million men and 19.2 women. Former smokers constituted 48.0% (95% CI=plus or minus 0.9) of persons who had ever smoked at least 100 cigarettes. Among current daily smokers in 1997, an estimated 16.0 million (40.7% [95% CI=plus or minus 1.4]) had stopped smoking for at least 1 day during the preceding 12 months.

Reported by: Epidemiology Br, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note:

The prevalence of smoking among adults aged greater than or equal to 18 years in 1997 was similar to that in 1995 (3). The findings in this report suggest that the goal of reducing the prevalence of cigarette smoking among adults to less than or equal to 15% by 2000 will not be attained. The 1997 NHIS data also demonstrate substantial differences in smoking prevalence across populations and suggest that prevalence may be increasing among young adults.

In 1997, smoking prevalence among persons aged 18-24 years was as high as the prevalence among persons aged 25-44 years. Historically, smoking prevalence has been highest among persons aged 25-44 years and significantly lower among persons aged 18-24 years. In addition, the data show a generally higher (although not statistically significant) prevalence among persons aged 18-24 years in 1997 than in 1995. Smoking prevalence among persons aged 25-44 years remained essentially unchanged from 1995 through 1997.

Increased smoking prevalence among persons aged 18-24 years was reported in a recent study from a nationally representative sample of approximately 15,000 students at 116 four-year colleges (4). Among these college students, the prevalence of current smoking increased from 22.3% in 1993 to 28.7% in 1997. If high school students retain their smoking behavior as they enter young adulthood, the increases documented in recent NHIS surveys may reflect the increased prevalence among high school students in recent years and the aging of this cohort into young adulthood. Alternatively, the increase may indicate increased initiation of smoking among young adults (5). Additional surveillance data are needed to clarify these patterns.

The high prevalence of smoking among persons aged 18-24 years indicates a need to focus tobacco-use treatment interventions on this age group. Interventions for young adults before they become addicted may be critical in reducing tobacco use among young adults. However, only one third of college students aged 18-24 years reported receiving tobacco use prevention information at their educational institution (6).

Smoking prevalence reported for racial/ethnic subgroups showed few changes from 1995 (3) through 1997. Among Asian/Pacific Islander women, smoking prevalence increased from 4.3% in 1995 to 12.4% in 1997. However, the sample size for Asian/Pacific Islander women was small. In addition, there were procedural changes in the NHIS survey design and changes in the questions defining racial/ethnic groups. Therefore, these data should be interpreted with caution.

The findings in this report are subject to at least two limitations. First, the questionnaire for the 1997 NHIS was completely redesigned. Although the smoking questions remained unchanged, their context changed substantially; therefore, trend analysis or comparison of data from the 1997 NHIS with data from prior years must be conducted with caution. Second, the sample size of certain subgroups was small, potentially creating unstable estimates.

To reduce the prevalence of smoking among adults, public health programs should include smoking cessation interventions. Before 1999, tobacco-control programs did not specifically include cessation as a major feature, but concentrated on policy interventions and the prevention of the initiation of tobacco use. Although preventing tobacco use among adolescents is critical to the long-term success of tobacco-control goals, reductions in morbidity and mortality in the short term can only be achieved by helping current smokers quit. To assist in this process, Smoking Cessation: Clinical Practice Guideline includes recommendations for a multifaceted approach to treating nicotine dependence (7). This guideline has specific recommendations for three major target audiences: primary-care clinicians; tobacco cessation specialists and programs; and health-care administrators, insurers, and purchasers. CDC includes cessation as one of the nine core elements for tobacco control (8). In addition, CDC's National Tobacco Control Program includes promoting cessation among adults as one of its four goals. The other three goals are preventing smoking initiation, reducing exposure to environmental tobacco smoke, and eliminating disparities among various populations in the health effects of tobacco use.

References

1. CDC. Smoking-attributable mortality and years of potential life lost--United States, 1984. MMWR 1997;46:444-51.
2. Public Health Service. Healthy people 2000: midcourse review and 1995 revisions. Washington, DC: US Department of Health and Human Services, Public Health Service, 1995.
3. CDC. Cigarette smoking among adults--United States, 1995. MMWR 1997;46:1217-20.
4. Wechsler H, Rigotti NA, Gledhill-Hoyt LH. Increased levels of cigarette use among college students: a cause for national concern. JAMA 1998;280:1673-8.
5. Everett S, Husten C, Kann L, et al. Smoking initiation and smoking patterns among U.S. college students. J Am Coll Health 1999;48:55-60.
6. CDC. Youth risk behavioral surveillance: National College Health Risk Behavior Survey--United States, 1995. MMWR 1997;46(no. SS-6).
7. The Smoking Cessation Clinical Practice Guideline Panel and Staff. The Agency for Health Care and Research smoking cessation clinical practice guideline. JAMA 1996;275:1270-80.
8. CDC. Best practices of comprehensive tobacco control programs. Atlanta, Georgia: US Department of Health and Human Services, CDC, 1999.

* Use of trade names and commercial sources is for identification only and does not imply endorsement by CDC or the U.S. Department of Health and Human Services.

TABLE 1. Percentage of persons aged >=18 years who were current smokers,* by selected characteristics -- United States, National Health Interview Survey, 1997

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