Current Cigarette Smoking Among Adults

United States, 2005-2012

Israel T. Agaku, DMD; Brian A. King, PhD; Shanta R. Dube, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2014;63(2):29-34. 

In This Article

Editorial Note

During 2005–2012, cigarette smoking prevalence declined among U.S. adults, and the quit ratio (i.e., the percentage of ever smokers who had quit) increased. During the same period, the proportion of daily smokers who smoked ≥30 CPD also declined. Adults aged 18–24 years had the greatest decrease in cigarette smoking prevalence; however, this decline might be attributable, in part, to the use of other tobacco products, such as flavored little cigars, which are especially popular with this age group.[4]

The decline in overall smoking prevalence from 20.9% in 2005 to 18.1% in 2012 is encouraging and likely reflects the success of tobacco control efforts across the country. However, given the slowing decline in adult smoking in recent years, continued implementation of evidence-based interventions outlined in the World Health Organization MPOWER package is critical.†† These include increasing the price of tobacco products, implementing and enforcing comprehensive smoke-free laws, warning about the dangers of tobacco use with antismoking media campaigns, and increasing access to help quitting. Such population-based interventions have been shown to reduce population smoking prevalence.[3]

In recent years, major advances were made in tobacco control. These include the 2009 Family Smoking Prevention and Tobacco Control Act, which granted the Food and Drug Administration the authority to regulate the manufacture, distribution, and marketing of tobacco products.§§ Additionally, the 2009 Children's Health Insurance Program Reauthorization Act¶¶ raised the federal tax rate for cigarettes from $0.39 to $1.01 per pack, and the 2010 Patient Protection and Affordable Care Act*** provided expanded coverage for evidence-based smoking-cessation treatments for many persons in the United States. Finally, in 2012, CDC debuted Tips from Former Smokers (TIPS),††† the first federally funded, nationwide, paid-media tobacco education campaign in the United States. During the campaign, calls to the quitline portal 1-800-QUIT-NOW increased 132%, and the number of unique visitors to a smoking cessation website (http://www.smokefree.gov) increased 428%.[5] Additionally, an estimated 1.6 million quit attempts were attributable to the campaign.[6]

Disparities in smoking prevalence described in this report are consistent with previous studies.[2] Variations across racial/ethnic groups might be attributable, in part, to targeted tobacco product marketing or differences in the social acceptability of smoking, whereas disparities by education might be related to differences in understanding of the health hazards of smoking and increased vulnerability to tobacco marketing. Differences by disability/limitation status might be attributable, in part, to smoking-attributable disability in smokers and increased stress associated with disabilities.[7] The high smoking prevalence observed among some population groups underscores the need for enhanced implementation and reach of proven strategies to prevent and reduce tobacco use among these groups.

The findings in this report are subject to at least six limitations. First, smoking status was self-reported and not validated by biochemical testing. However, self-reported smoking status correlates highly with serum cotinine levels.[8] Second, small sample sizes for certain population groups resulted in less precise estimates. Third, data could not be disaggregated for specific racial/ethnic subgroups; although smoking prevalence was lowest among Hispanics and non-Hispanic Asians, variability in smoking prevalence exists among Hispanic and Asian subpopulations.[9] Fourth, because NHIS does not include institutionalized populations and persons in the military, results might not be generalizable to these groups. Fifth, the NHIS response rate of 61.2% might have resulted in nonresponse bias, even after adjustment for nonresponse. Finally, these estimates might differ from those derived from other surveillance systems. For example, the National Survey on Drug Use and Health consistently yields higher current smoking estimates than NHIS.[10] These differences can be explained, in part, by the varying survey methodologies, the types of surveys administered, and the definitions of current smoking that are used. However, trends in prevalence are comparable across surveys.

Sustained, comprehensive state tobacco control programs funded at CDC-recommended levels accelerate progress toward reducing the health burden and economic impact of tobacco-related diseases in the United States.[3] However, during 2013, despite combined revenue of $25.7 billion from settlement payments and tobacco taxes for all states, only $459.5 million (1.8%) was spent on state comprehensive tobacco control programs, representing only 12.4% of the CDC-recommended level of funding for all states combined; moreover, only two states (Alaska and North Dakota) currently fund tobacco control programs at CDC-recommended levels.§§§ Implementation of comprehensive tobacco control policies and programs can result in a substantial reduction in tobacco-related morbidity and mortality and billions of dollars in savings from averted medical costs.[3]

††Additional information available at http://www.who.int/tobacco/mpower/mpower_report_full_2008.pdf.
§§Additional information available at http://www.fda.gov/tobaccoproducts.
¶¶Additional information available at http://www.cms.gov/chipra.
***Additional information available at http://www.dol.gov/ebsa/healthreform.
†††Additional information available at http://www.cdc.gov/tobacco/campaign/tips.
§§§Robert Wood Johnson Foundation. Broken promises to our children: the 1998 state tobacco settlement fourteen years later. A report on the states' allocation of the tobacco settlement dollars. Princeton, NJ: Robert Wood Johnson Foundation; 2012. Available at http://www.tobaccofreekids.org/content/what_we_do/state_local_issues/settlement/FY2013/1.%202012%20State%20Report%20-%20Full.pdf.

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