1 table, 1 figure omitted
One of the national health objectives for the United States for 2010
is to reduce the prevalence of cigarette smoking among adults to ≤12% (objective
27.1a).1 To assess progress toward this
objective, CDC analyzed self-reported data from the 2001 National Health Interview
Survey (NHIS). The findings of this analysis indicate that, in 2001, approximately
22.8% of U.S. adults were current smokers compared with 25.0% in 1993. During
1965-2001, smoking prevalence declined faster among non-Hispanic blacks aged
≥18 years than among non-Hispanic whites the same age. Preliminary data
for January-March 2002 indicate a continuing decline in current smoking prevalence
among adults overall.2 However, the overall
decline in smoking is not occurring at a rate that will meet the national
health objective by 2010. Increased emphasis on a comprehensive approach to
cessation that comprises educational, economic, clinical, and regulatory strategies
is required to further reduce the prevalence of smoking in the United States.
The 2001 NHIS adult core questionnaire was administered by personal
interview to a nationally representative sample (n = 33,326) of the U.S. civilian,
noninstitutionalized population aged ≥18 years; the overall survey response
rate was 73.8%. Respondents were asked, "Have you smoked ≥100 cigarettes
in your entire life?" and those who answered "yes" were asked, "Do you now
smoke cigarettes every day, some days, or not at all?" Ever smokers were those
who reported having smoked ≥100 cigarettes during their lifetime. Current
smokers were persons who reported both having smoked ≥100 cigarettes during
their lifetime and currently smoking every day or some days. Former smokers
were ever smokers who currently did not smoke. Data were adjusted for nonresponses
and weighted to provide national estimates of cigarette smoking prevalence.
Confidence intervals (CIs) were calculated by using SUDAAN.
In 2001, an estimated 46.2 million adults (22.8%; 95% CI = ±
0.5) were current smokers; an estimated 37.8 million (81.8%) smoked every
day, and 8.4 million (18.2%) smoked some days. Of current smokers who smoked
every day, an estimated 15.3 million (40.6%; 95% CI = ± 1.4) had stopped
smoking for ≥1 day during the preceding 12 months because they were trying
to quit. In 2001, an estimated 44.7 million adults were former smokers, representing
49.2% (95% CI = ± 0.9) of persons who had ever smoked.
The prevalence of cigarette smoking was higher among men (25.2% [95%
CI = ± 0.8]) than women (20.7%; 95% CI = ± 0.7). Among racial/ethnic
populations, Asians* (12.4%; 95% CI = ± 2.6) and Hispanics (16.7%;
95% CI = ± 1.2) had the lowest prevalence of current smoking; American
Indians/Alaska Natives (AI/ANs) had the highest prevalence (32.7%; 95% CI
= ± 7.5). By education level, adults who had earned a General Educational
Development diploma (47.8%; 95% CI = ± 4.2) and those with a grade
9-11 education (34.3%; 95% CI = ± 2.1) had the highest prevalence of
smoking; persons with master's, professional, and doctoral degrees had the
lowest prevalence (9.5%; 95% CI = ± 1.3). Current smoking prevalence
was highest among persons aged 18-24 years (26.9%; 95% CI = ± 1.8)
and among those aged 25-44 years (25.8%; 95% CI = ± 0.8) and lowest
among those aged ≥65 years (10.1%; 95% CI = ± 0.8). The prevalence
of current smoking was higher among adults living below the poverty level†
(31.4%; 95% CI = ± 1.8) than those at or above the poverty level (23.0%;
95% CI = ± 0.6).
Comparing current smoking prevalence data from 1965-1966 and 2000-2001
indicates a slow but steady decrease among non-Hispanic blacks and whites.
Since 1970-1974, prevalence has declined more rapidly among non-Hispanic black
men than among non-Hispanic white men. During 2000-2001, for the first time,
current smoking prevalence among non-Hispanic black men was similar to that
among non-Hispanic white men. Smoking prevalence also declined more rapidly
among non-Hispanic black women than non-Hispanic white women. Before 1993-1995,
current smoking prevalences among non-Hispanic black and white women generally
were comparable, except during 1970-1974, when prevalence among non-Hispanic
white women was lower. Since 1993-1995, prevalence among non-Hispanic black
women has been lower, except during 1997-1999, when no difference was observed.
T Woollery, PhD, A Trosclair, MS, C Husten, MD, RC Caraballo, PhD, J
Kahende, PhD, Office on Smoking and Health, National Center for Chronic Disease
Prevention and Health Promotion, CDC.
The findings in this report indicate that smoking prevalence has declined
among adults since 1965. Although selected population groups have met the
national health objective for 2010, slow or no progress has been observed
in other sections of the U.S. population.3 For
this reason, the overall decline in cigarette smoking prevalence in the adult
U.S. population is not occurring at a rate that will meet the 2010 national
The findings in this report are subject to at least three limitations.
First, questionnaire wording and NHIS data collection procedures have changed
since 1993. Because of these changes, trend analyses or comparisons with data
from years preceding 1993 should be interpreted with caution. Second, in 1997,
the Office of Management and Budget changed its data collection guidelines
to require that data on Asians and Native Hawaiians and Other Pacific Islanders
be collected separately. For this reason, trend data on smoking prevalence
for the combined category of Asians/Pacific Islanders cannot be estimated
by using publicly available data. Finally, because NHIS data for some subpopulations
(e.g., AI/ANs) are small, data for a single year might be unstable. Combining
data from several years would produce more reliable estimates for these subpopulations.
Comprehensive tobacco-control programs at the state level have helped
to reduce tobacco use.4 In 2000, the U.S.
Surgeon General concluded that the 2010 objective could be attained only if
comprehensive approaches to tobacco control were implemented.5 In
2002, six states were funding comprehensive programs at the minimum levels
recommended by CDC.6 In 2002 and 2003, state
budget cuts reduced state support for tobacco-prevention and -cessation programs
by $86.2 million (11.2%).7 To attain the
2010 national health objective, comprehensive tobacco-control programs that
meet CDC's recommended funding levels are needed.5,8- 10 Within
these comprehensive programs, a focus on reducing tobacco use among persons
in different socioeconomic strata, racial/ethnic populations, and education
levels could help reduce cigarette smoking and tobacco use and reduce the
substantial morbidity and mortality and economic costs associated with tobacco
*Excludes Native Hawaiians and Other Pacific Islanders.
†Calculated on the basis of U.S. Census Bureau 2000 poverty thresholds.
Cigarette Smoking Among Adults—United States, 2001. JAMA. 2003;290(18):2400–2401. doi:10.1001/jama.290.18.2400