State-Specific Prevalence of Cigarette Smoking Among Adults and Quitting Among Persons Aged 18--35 Years --- United States, 2006

Morbidity and Mortality Weekly Report. 2007;56(38):993-996. 

In This Article

Editorial Note

Substantial variations among states and territories were observed in smoking prevalence among adults overall and smoking prevalence and quitting among adults aged 18--35 years. These variations likely are attributed to differences in the distribution of socioeconomic determinants of smoking (e.g., race/ethnicity, age, and socioeconomic status), cultural norms, and the strength of tobacco-control programs and policies.[5] In 2006, Utah and USVI were the only areas to achieve the Healthy People 2010 objective to reduce overall adult smoking prevalence to ≤12% (objective 27-1a);[6] California achieved this objective among women only. Utah and USVI also were the only areas to achieve this objective among persons aged 18--35 years. The low prevalences in Utah and USVI might be a result of stronger social and cultural norms against tobacco use compared with other parts of the United States. Since 2003, Utah and USVI have met the ≤12% target for overall adult smoking prevalence, and California, Utah, PR, and USVI have achieved this objective among women since 2004. In 2006, Utah met the ≤12% target among men, as it had in 2004 but not in 2005.

The findings in this report indicate that in the 53 areas surveyed, the majority of current daily smokers aged 18--35 years had tried to quit during the past year. On average, approximately one third of persons aged 18--35 years who had ever smoked reported that they did not currently smoke. The rates differed between adults in the 18--35 years age group and the total adult population (CDC, unpublished data, 2007).

Early cessation should be encouraged because persons who quit before the age of 35 years have a life expectancy similar to that of never smokers.[3] The longer young adults smoke, the more likely they are to develop adverse health effects that are not reversible. Young adults who smoke include persons who are just beginning to smoke, those who do not smoke daily, persons who are transitioning to daily smoking, and daily smokers who might or might not have tried to quit. Diverse strategies are needed to motivate these different groups to quit smoking, such as conducting sustained mass media campaigns, increasing the price of tobacco products, providing brief counseling by health-care professionals at every clinic visit, reducing out-of-pocket costs of smoking-cessation treatments, and offering telephone quitlines.[4] Similar to older adults, young adults usually try to quit on their own.[7] Among adolescent and young adult smokers aged 16--24 years who reported ever trying to quit, only 20% reported talking with a nurse, doctor, or dentist for assistance with their quit attempts, and even smaller proportions had used counseling (e.g., individual, group, or telephone counseling) or medications approved by the Food and Drug Administration.[7] Therefore, strategies also are needed to increase the use of effective cessation treatments among these smokers.

The findings in this report are subject to at least five limitations. First, BRFSS does not survey persons in households without landline telephones or those with wireless-only telephones, populations that might more likely include smokers.[8,9] Wireless telephone use is highest among young adults and decreases with age.[9] Preliminary findings from the National Health Interview Survey indicate that approximately one in four adults aged 18--24 years and nearly one in three adults aged 25--29 years lived in households with only wireless telephones in 2006.[9] The exclusion of persons with wireless-only telephone service might have led to the underestimation of smoking prevalence, particularly among those aged 18--35 years. Second, estimates for cigarette smoking are based on self-report and are not validated by biochemical tests. However, self-reported data on current smoking status have high validity.[8] Third, the median response rate was 51.4% (range: 35.1%--66.0%). Lower response rates indicate a potential for response bias; however, BRFSS estimates for current cigarette smoking are comparable to smoking estimates from other surveys with higher response rates.[8] Fourth, the survey did not include information on the length of time between the quit attempt and the interview. Finally, the number of young adults who quit smoking was low; thus, certain estimates derived from state-level data are unstable.

Effective interventions have been identified for preventing smoking initiation and increasing cessation rates,[4] but they have not been implemented adequately by most states. Fully implementing comprehensive state tobacco-control programs as recommended by CDC[5] would accelerate progress in reducing rates of smoking and other tobacco use. Moreover, because persons who quit smoking before the age of 35 years have a life expectancy similar to that of never smokers,[3] these programs should target young adults.

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