Cigarette Smoking's Decline Levels Off

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Report on Prevalence of Smoking in the U.S. Shows 'Battle Has Not Been Won'

By Bill Hendrick
WebMD Health News

Reviewed By Louise Chang, MD

Nov. 12, 2009 -- The prevalence of adult American cigarette smokers, which dropped below 20% in 2007, leveled off in 2008, the CDC says in a new report.

The report shows "the battle has not been won," and economic factors may be part of the problem, Matthew McKenna, MD, MPH, director of the CDC's Office on Smoking and Health, tells WebMD.

The proportion of adult smokers declined from 24.1% in 1998 to 19.8% in 2007, but remained relatively unchanged at 20.6% in 2008, the CDC says in its Morbidity and Mortality Weekly Report for Nov. 13, 2009.

"At the national level, we're kind of stuck," McKenna tells WebMD. "Now we're back to where we had been. Too many bars, restaurants, and construction sites are still exempted from smoke-free laws."

The CDC looked at data from the 2008 National Health Interview Survey administered to nearly 22,000 people aged 18 years and older.

In 2008, adults 25 and older with low educational attainment had the highest prevalence of smoking; it was 41.3% among people with a General Educational Development certificate and 27.5% among people with less than a high school diploma, compared with 5.7% of people with a graduate degree.

Poverty also played a role in the stagnation of the numbers of quitters, McKenna says. The percentage of smokers living below the poverty level rose from 28.4 % to 31.5% from 2007 to 2008.

"Evidence-based [quitting] programs known to be effective at reducing smoking should be intensified among groups with lower education, and health care providers should take education level into account about smoking hazards and cessation to those patients," writes lead author Shanta R. Dube, PhD, MPH, a health scientist with CDC.

The report also estimates that:

• 46 million U.S. adults currently smoke, including 36.7 million who smoke daily, and 9.3 million who smoke some days.

Other details:

• Of the current smokers, 20.8 million had stopped smoking for one day or more during the preceding year because they were trying to quit.
• Of 94 million people who'd smoked at least 100 cigarettes during their lifetime, 51.1%, or 48.1 million, were no longer smoking when interviewed. Gender, race, and ethnicity also played roles in smoking prevalence, the report says:
• In 2008, smoking prevalence was 23.1% for men, compared to 18.3% for women.
• 32% among American Indians/Alaska natives smoked in 2008, 22% of non-Hispanic whites, 21.3% of non-Hispanic blacks, 15.8% of Hispanics, and 9.9% of Asians.

According to the CDC, the decline in smoking since 1998 coincides with an agreement that year by seven major tobacco companies to change marketing tactics and pay $206 billion to states as compensation for tobacco-related health care costs.

Cultural factors also may play a role in lower prevalence, the researchers say. People with the most education likely understand more about the health hazards of smoking, for example.

Although comprehensive tobacco control programs have been effective, they remain underfunded, the researchers say, and tobacco companies still target socially disadvantaged groups, such as youths and people with low socioeconomic status.

"Offering and providing effective cessation counseling and treatments are integral to reducing the smoking epidemic," the CDC says.

McKenna tells WebMD that "the approach has to be comprehensive," that prices should rise, and more public places should ban smoking.

Regionally, tobacco companies have more influence in the South, where smoking prevalence is higher, he says.

SOURCES: Morbidity and Mortality Weekly Report, Nov. 13, 2009.

Matthew McKenna, MD, MPH, director, Office on Smoking and Health, CDC.

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