Cigarette Smoking Among Adults -- United States, 1990

An essential component of tobacco-control programs is the monitoring of tobacco use over time (1). To determine the prevalence of smoking among adults in the United States during 1990, the National Health Interview Survey - Health Promotion and Disease Prevention (NHIS - HPDP) supplement collected self-reported information about cigarette smoking from a representative sample of the U.S. civilian, noninstitutionalized population. This report presents data from that survey supplement.

The overall response rate for the NHIS - HPDP supplement was 83.4%. Approximately 41,000 persons aged greater than or equal to 18 years responded to the following questions on smoking behavior: "Have you smoked at least 100 cigarettes in your entire life?" and "Do you smoke cigarettes now?" Current smokers were defined as those who answered "yes" to both questions; former smokers were defined as those who answered "yes" to the first question and "no" to the second question. Ever smokers included current and former smokers. Current smokers were also asked, "On the average, about how many cigarettes a day do you now smoke?" The data were adjusted for nonresponse and weighted to provide national estimates. Ninety-five percent confidence intervals (CIs) were calculated by using standard errors generated by the Software for Survey Data Analysis (SUDAAN) (2).

In 1990, an estimated 89.9 million (50.1%) U.S. adults were ever smokers, and 45.8 million (25.5%) were current smokers. Approximately 44.1 million (49.1% of all ever smokers) were former smokers in 1990.

An estimated 24.2 million (28.4%) men and 21.6 million (22.8%) women were current smokers (Table 1); in all sociodemographic groups, the prevalence of smoking was higher among men than among women. The prevalence of smoking was highest among persons aged 25-44 years, American Indians/Alaskan Natives, non-Hispanics, and persons with fewer than 12 years of education (Table 1).

During 1990, 26.4% of persons in the United States aged 20-24 years were current cigarette smokers (Table 2). Smoking prevalence in this age group (which can be used as an indirect measure of smoking initiation (3)), was 28.6% for men, 24.3% for women, 28.3% for whites, and 17.3% for blacks. Regardless of education level, among persons in this age group, men were more likely than women to be current cigarette smokers; prevalence was highest among men who had not completed 12 years of education (Table 2).

During 1990, for all age groups combined, the average number of cigarettes smoked per day by current smokers who smoked one or more cigarettes per day was 19.1 (95% CI=18.8-19.4); 22.9% (95% CI=21.8%-23.9%) of current smokers reported smoking 25 or more cigarettes per day.

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

Editorial Note

Editorial Note: The 1990 NHIS - HPDP data indicate that, for the first time since NHIS monitoring began in 1965 (3), the prevalence of smoking was similar among blacks and whites overall. In addition, the difference in smoking prevalences among black men and white men is less than when compared with previous years (4). Based on an analysis of data for 1974-1985, the rate of decline in smoking prevalence was higher for blacks than whites, and this difference was substantial for men (4). The decrease in smoking prevalence among blacks aged 20-24 years (from 38.7% in 1983 (3)) is consistent with recent reports of lower smoking rates among black adolescents (3,5).

From 1965 through 1985, the overall smoking prevalence among U.S. adults declined an average of 0.5 percentage points annually (3). During this time, prevalence among women aged 20-24 years with fewer than 12 years education ranged from 39% to 45% with no declines; however, a sharp decline in smoking prevalence occurred in this subgroup by 1990. From 1987, when overall prevalence among adults was 28.8% (6), to 1990, overall prevalence declined an average of 1.1 percentage points annually. This rate of decline must be sustained to achieve the year 2000 national health objective of reducing cigarette smoking prevalence to no more than 15% among persons aged greater than or equal to 20 years (objectives 3.4 and 16.6) (7).

Factors that may have contributed to the accelerated decline in smoking include a decrease in the social acceptability of smoking (3), the increased cost of cigarettes (8), and an increased awareness of the health consequences of active and passive smoking (3). The possibility of underreporting of smoking (9) needs further research.

References

1. CDC. Smoking and health in the Americas: a 1992 report of the Surgeon General, in collaboration with the Pan American Health Organization. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1992; DHHS publication no. (CDC)92-8419.

2. Shah BV. Software for Survey Data Analysis (SUDAAN) version 5.30 (Software documentation). Research Triangle Park, North Carolina: Research Triangle Institute, 1989.

3. CDC. Reducing the health consequences of smoking: 25 years of progress -- a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411.

4. Fiore MC, Novotny TE, Pierce JP, Hatziandreu EJ, Patel KM, Davis RM. Trends in cigarette smoking in the United States: the changing influence of gender and race. JAMA 1989;261:49-55.

5. CDC. Cigarette smoking among youth -- United States, 1989. MMWR 1991;40:712-5.

6. CDC. Tobacco use by adults -- United States, 1987. MMWR 1989;38:685-7.

7. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

8. Tobacco Institute. The tax burden on tobacco: historical compilation. Washington, DC: Tobacco Institute, 1990;25.

9. Wagenknecht LE, Burke GL, Perkins LL, Haley NJ, Friedman GD. Misclassification of smoking status in the CARDIA study: a comparison of self-report with serum cotinine levels. Am J Public Health 1992;82:33-6.

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