State-Specific Prevalence of Quit Attempts Among Adult Cigarette Smokers — United States, 2011–2017

Kimp Walton, MS; Teresa W. Wang, PhD; Gillian L. Schauer, PhD; Sean Hu, MD; Henraya F. McGruder, PhD; Ahmed Jamal, MBBS; Stephen Babb, MPH

Disclosures

Morbidity and Mortality Weekly Report. 2019;68(28):621-626. 

In This Article

Abstract and Introduction

Introduction

From 1965 to 2017, the prevalence of cigarette smoking among U.S. adults aged ≥18 years decreased from 42.4% to 14.0%, in part because of increases in smoking cessation.[1,2] Increasing smoking cessation can reduce smoking-related disease, death, and health care expenditures.[3] Increases in cessation are driven in large part by increases in quit attempts.[4] Healthy People 2020 objective 4.1 calls for increasing the proportion of U.S. adult cigarette smokers who made a past-year quit attempt to ≥80%.[5] To assess state-specific trends in the prevalence of past-year quit attempts among adult cigarette smokers, CDC analyzed data from the 2011–2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys for all 50 states, the District of Columbia (DC), Guam, and Puerto Rico. During 2011–2017, quit attempt prevalence increased in four states (Kansas, Louisiana, Virginia, and West Virginia), declined in two states (New York and Tennessee), and did not significantly change in the remaining 44 states, DC, and two territories. In 2017, the prevalence of past-year quit attempts ranged from 58.6% in Wisconsin to 72.3% in Guam, with a median of 65.4%. In 2017, older smokers were less likely than younger smokers to make a quit attempt in most states. Implementation of comprehensive state tobacco control programs and evidence-based tobacco control interventions, including barrier-free access to cessation treatments, can increase the number of smokers who make quit attempts and succeed in quitting.[2,3]

BRFSS is an annual state-based telephone (landline and cellular) survey of a randomly selected representative sample of noninstitutionalized U.S. adults aged ≥18 years.* During 2011–2017, BRFSS sample sizes ranged from 441,456 (2014) to 506,467 (2011). Median survey response rates ranged from 45.3% (2017) to 53.0% (2011) for landlines and from 27.9% (2011) to 47.2% (2015) for cellular phones.

Overall and age group–specific (18–24, 25–44, 45–64, and ≥65 years) prevalences of smokers who made quit attempts were calculated for 2011–2017 for the 50 states, DC, Guam, and Puerto Rico. Making a past-year quit attempt was defined as answering yes to the question, "During the past 12 months, have you stopped smoking for 1 day or longer because you were trying to quit smoking?" Past-year quit attempts were assessed among both current cigarette smokers and former cigarette smokers who quit within the past year.§ Chi-square tests were performed to examine differences in past-year quit attempts between the years 2011 and 2017 (p<0.05). Logistic regression was used to assess overall changes in prevalence during 2011–2017, controlling for sex, age group, and race/ethnicity (p<0.05). Quartiles were mapped and assessed by U.S. Census region. All analyses were conducted using SAS-callable SUDAAN software (version 11.0.3; RTI International) to account for the complex survey sampling design.

In 2017, the prevalence of past-year quit attempts ranged from 58.6% (Wisconsin) to 72.3% (Guam), with a median of 65.4% (North Carolina) (Table 1). The lowest quartile of quit attempt prevalence (58.6%–62.5%) included six states in the Midwest, four in the South, three in the West, and one in the Northeast (Figure). In comparison, in 2011, the prevalence of past-year quit attempts ranged from 57.4% (West Virginia) to 71.6% (New York), with a median of 64.9% (Mississippi). The prevalence of past-year quit attempts was significantly higher in 2017 compared with 2011 in four states (Alabama, Hawaii, Kansas, Louisiana) and one territory (Guam) and significantly lower in two states (New York and Wisconsin). During 2011–2017, past-year quit attempts increased in four states (Kansas, Louisiana, Virginia, and West Virginia, p-value for trend<0.05), and declined in two states (New York and Tennessee, p-value for trend<0.05).

Figure.

Percentage of current and former cigarette smokers aged ≥18 years who reported a past-year quit attempt* — Behavioral Risk Factor Surveillance System, United States, 2017
Abbreviations: DC = District of Columbia; GU = Guam; PR = Puerto Rico.
* Quit attempt percentages were calculated among current cigarette smokers who answered yes to the question "During the past 12 months, have you stopped smoking for 1 day or longer because you were trying to quit smoking?" and also among former cigarette smokers who answered "within the past month," "within the past 3 months," "within the past 6 months," or "within the past year" to the question "How long has it been since you last smoked a cigarette, even one or two puffs?"
Median = 65.4%.

In 2017, the prevalence of past-year quit attempts generally decreased with increasing age (Table 2). The median prevalence of past-year quit attempts was 76.4% among persons aged 18–24 years (Hawaii), 68.6% among persons aged 25–44 years (Kansas), 60.8% among persons aged 45–64 years (Illinois), and 55.8% among persons aged ≥65 years (DC) (Table 2).

* https://www.cdc.gov/brfss.
Current cigarette smokers were defined as persons aged ≥18 years who reported smoking at least 100 cigarettes in their lifetime and smoking "every day" or "some days" at the time of the survey.
§ Former cigarette smokers were defined as persons aged ≥18 years who reported smoking at least 100 cigarettes in their lifetime and who do not smoke now. Quitting within the past year was defined as answering "within the past month," "within the past 3 months," "within the past 6 months," or "within the past year" to the question "How long has it been since you last smoked a cigarette, even one or two puffs?"
Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.

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