State-Specific Prevalence of Current Cigarette and Cigar Smoking Among Adults -- United States, 1998

Each year, cigarette smoking causes an estimated 430,000 deaths in the United States (1). In addition, the health risks for smoking cigars, which include mouth, throat, and lung cancers, are well documented (2). This report summarizes the findings from the 1998 Behavioral Risk Factor Surveillance System (BRFSS) on the prevalence of current cigarette and cigar smoking in the 50 states and the District of Columbia. The findings indicate that state-specific cigarette smoking prevalence among adults aged greater than or equal to 18 years varied twofold and having ever smoked a cigar (i.e., ever cigar smoking) varied nearly fourfold.

BRFSS is a state-based, random-digit-dialed telephone survey of the civilian, noninstitutionalized U.S. population aged greater than or equal to 18 years. To determine current cigarette smoking, respondents were asked "Have you ever smoked at least 100 cigarettes in your entire life?" and "Do you now smoke cigarettes every day, some days, or not at all?" Current cigarette smokers were defined as persons who reported having smoked at least 100 cigarettes during their lifetime and who currently smoke every day or some days. For cigar smoking (i.e., large cigars, cigarillos, and small cigars), respondents were asked "Have you ever smoked a cigar, even just a few puffs?" and "When was the last time you smoked a cigar?" Ever cigar smoking was defined as ever having smoked a cigar, even just a few puffs. Past month cigar smoking was defined as smoking a cigar within the previous month. Estimates were weighted to represent the populations of each state; because BRFSS data are state-specific, median values, rather than a national average, are reported.

During 1998, the median prevalence of current cigarette smoking was 22.9% (Table 1); state-specific prevalences ranged from 14.2% (Utah) to 30.8% (Kentucky). Range endpoints were higher for men (15.9%-36.5%) than for women (12.5%-28.5%). Median prevalence also was higher for men (25.3%) than for women (21.0%). Current cigarette smoking was highest in Kentucky (30.8%), Nevada (30.4%), West Virginia (27.9%), Michigan (27.4%), and South Dakota (27.3%). Current smoking prevalence was highest for men in South Dakota (36.5%) and for women in Kentucky (28.5%). Current smoking prevalence was lowest for both men (15.9%) and women (12.5%) in Utah.

The median prevalence of ever cigar smoking was 39.0% (Table 2); state-specific prevalences ranged from 14.8% (Arizona) to 52.0% (Alaska). The median prevalence of past month cigar smoking was 5.2%; state-specific prevalences ranged from 1.4% (Arizona) to 7.4% (Nevada). Range endpoints were higher for men than for women for both ever cigar smoking (23.1%-76.7% compared with 6.9%-26.0%) and past month cigar smoking (2.9-13.2% compared with 0.1-2.9%). Median prevalence rates for ever cigar smoking (67.4% compared with 15.8%) and past month cigar smoking (9.7% compared with 1.3%) also were higher for men than for women. Ever cigar smoking rates were highest in Alaska (52.0%), Wisconsin (49.7%), Nevada (48.6%), Michigan (47.9%), and Oregon (46.7). Ever cigar smoking was highest for men in Wisconsin (76.7%) and for women in Alaska (26.0%). Past month cigar smoking was highest in Nevada (7.4%), Indiana (7.3%), Illinois (7.1%), Michigan (6.9%), and New Jersey (6.6%). Past month cigar smoking was highest for men in Indiana (13.2%) and for women in Nevada (2.9%).

Reported by the following BRFSS coordinators: J Cook, MBA, Alabama; P Owen, Alaska; B Bender, MBA, Arizona; T Clark, Arkansas; B Davis, PhD, California; M Leff, MSPH, Colorado; M Adams, MPH, Connecticut; F Breukelman, Delaware; I Bullo, District of Columbia; S Hoecherl, Florida; L Martin, MS, Georgia; A Onaka, PhD, Hawaii; J Aydelotte, MA, Idaho; B Steiner, MS, Illinois; K Horvath, Indiana; K MacIntyre, Iowa; J Tasheff, Kansas; T Sparks, Kentucky; B Bates, MSPH, Louisiana; D Maines, Maine; A Weinstein, MA, Maryland; D Brooks, MPH, Massachusetts; H McGee, MPH, Michigan; N Salem, PhD, Minnesota; D Johnson, MS, Mississippi; T Murayi, PhD, Missouri; P Feigley, PhD, Montana; L Andelt, PhD, Nebraska; E DeJan, MPH, Nevada; L Powers, MA, New Hampshire; G Boeselager, MS, New Jersey; W Honey, MPH, New Mexico; C Baker, New York; P Buescher, PhD, North Carolina; L Shireley, MPH, North Dakota; P Pullen, Ohio; N Hann, MPH, Oklahoma; J Grant-Worley, MS, Oregon; L Mann, Pennsylvania; J Hesser, PhD, Rhode Island; M Wu, MD, South Carolina; M Gildemaster, South Dakota; D Ridings, Tennessee; K Condon, Texas; K Marti, Utah; C Roe, MS, Vermont; K Carswell, MPH, Virginia; K Wynkoop-Simmons, PhD, Washington; F King, West Virginia; P Imm, MS, Wisconsin; M Futa, MA, Wyoming. K Gerlach, PhD, Robert Wood Johnson Foundation, Princeton, New Jersey. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note:

In 1996, the prevalence of cigarette smoking was added to the list of nationally notifiable health conditions reported by states to CDC (3). Current cigarette smoking has remained relatively stable during the 1990s in most states; however, smoking has declined significantly in Minnesota since 1997 and increased significantly in South Dakota since 1996 (4). Utah is the only state to have achieved the health objective for 2000 to reduce cigarette smoking to a prevalence of no more than 15.0% among persons aged greater than or equal to 18 years (objective 3.4) (5). The wide variation in current cigarette smoking prevalence across states underscores the potential for prevention and the need for continued efforts aimed at reducing tobacco use.

The findings in this report indicate that cigar smoking prevalences by state vary significantly. Despite the health effects associated with cigar smoking, total cigar consumption in the United States was approximately 5.3 billion cigars in 1998 (6). Overall, cigar consumption in the United States declined during the 1970s and 1980s but began increasing in the 1990s (2); however, a 1998 report suggests that the recent growth in cigar sales may have slowed (7).

National surveys have used various questions to ascertain cigar smoking status (2 ). This variation, combined with the lack of inclusion of cigar smoking questions on most national surveys after 1992, makes comparison of data among national surveys difficult. Questions about cigar smoking were included on the 1998 National Health Interview Survey and will provide more data on national patterns in adult cigar smoking prevalence.

The findings in this report are subject to at least three limitations. First, data are based on self-reports without biochemical verification. Second, the lack of standardized questions for cigar use among surveys limits comparisons between state-specific estimates and national estimates. Third, these prevalence estimates are only for adults and do not include persons aged less than 18 years. However, to assess adequately the impact of cigarette and cigar smoking, data about the prevalence of youth tobacco use also should be considered. Data on youth cigarette and cigar smoking in 1997 are available through the Youth Risk Behavior Survey (8,9).

Decreases in tobacco use consistent with national health objectives for 2010 are achievable. Given the large differences in current cigarette and cigar smoking rates among states, future state surveys should continue to monitor cigar smoking among adults and youth, and questions should be standardized across surveys. Such information is important to direct policy changes and develop public health initiatives that address the negative health effects of smoking. Monitoring trends of cigarette smoking and the use of other tobacco products also is essential for evaluating state efforts aimed at reducing tobacco-related morbidity and mortality.

CDC recommends that states establish tobacco-control programs that are comprehensive, sustainable, and accountable (10). Guidelines determined by evidence-based analyses of existing comprehensive state tobacco-control programs have been prepared to help states assess options for comprehensive tobacco-control programs and to evaluate local funding priorities. The guidelines provide evidence to support each of nine specific elements of a comprehensive program, including community programs to reduce tobacco use, chronic disease programs to reduce the burden of tobacco-related diseases, school programs, enforcement, statewide programs, counter-marketing, cessation programs, surveillance and evaluation, and administration and management (10).

References

1. CDC. Smoking-attributable mortality and years of potential life lost--United States, 1984. MMWR 1997;46:444-51.
2. National Cancer Institute. Cigars: health effects and trends. Smoking and Tobacco Control Monograph No. 9. Rockville, Maryland: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 1998. NIH publication no. 98-4302.
3. CDC. Addition of prevalence of cigarette smoking as a nationally notifiable condition--June 1996. MMWR 1996;45:537.
4. CDC. State tobacco control highlights--1999. Atlanta, Georgia: US Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1999.
5. National Center for Health Statistics. Healthy people 2000 review, 1989-1999. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1999.
6. US Department of Agriculture. Tobacco situation and outlook report. Washington, DC: US Department of Agriculture, Commodity Economics Division, Economics, Research Service, April 1999; document no. TBS-243.
7. Maxwell JC. Slowing sales: US cigar boom settles down. Tobacco Reporter, August 1999:36-8.
8. CDC. Youth Risk Behavior Surveillance--United States, 1997. MMWR 1998;47(no. SS-3).
9. CDC. Tobacco use among high school students--United States, 1997. MMWR 1998;47:229-33.
10. CDC. Best practices for comprehensive tobacco control programs--August 1999. Atlanta, Georgia: US Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1999.

Table 1

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Table 2

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