Prevalence and Trends in Adult Cigarette Smoking

Cigarette smoking in the United States results in an estimated 443,000 premature deaths and $193 billion in direct health-care expenditures and productivity losses each year.1 During 2007, an estimated 19.8% of adults in the United States were current smokers.2 To update 2006 state-specific estimates of cigarette smoking, CDC analyzed data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey and examined trends in cigarette smoking from 1998-2007.
Results of these analyses indicated substantial variation in current cigarette smoking during 2007 (range: 8.7%-31.1%) among the 50 states, the District of Columbia (DC), Guam, Puerto Rico (PR), and the U.S. Virgin Islands (USVI). Trend analyses of 1998-2007 data indicated that smoking prevalence decreased in 44 states, DC, and PR, and six states had no substantial changes in prevalence after controlling for age, sex, and race/ethnicity. However, only Utah and USVI met the Healthy People 2010 target for reducing adult smoking prevalence to 12% (objective 27-1a).3 The Institute of Medicine (IOM) calls for full implementation of comprehensive, evidence-based tobacco control programs at CDC-recommended funding levels to achieve substantial reductions in tobacco use in all states and areas.4

BRFSS conducts state-based, random-digit–dialed telephone surveys of the noninstitutionalized U.S. civilian population aged ≥18 years, collecting data on health conditions and health risk behaviors. The 2007 BRFSS survey was conducted in the 50 states, DC, Guam, PR, and USVI and included data from 430,912 respondents. Those respondents who answered “yes” to the question “Have you smoked at least 100 cigarettes in your entire life?” and answered “every day” or “some days” to the question “Do you now smoke cigarettes every day, some days, or not at all?” were classified as current cigarette smokers. These questions have been included in the survey each year since 1996; for this analysis, survey data from 1998-2007 were examined.

For each year, estimates were weighted to the respondent’s probability of being selected and the age-, race-, and sex-specific populations from the census for the state or area. These weights were used to calculate the state smoking prevalence estimates; 95% confidence intervals also were calculated. BRFSS uses a multistage sampling design primarily to generate state/area estimates. The median prevalence among all states and DC is generally comparable to overall national estimates from other surveys.2 Response rates for BRFSS are calculated using Council of American Survey and Research Organizations (CASRO) guidelines.* Median survey response rates were 59.1% (range: 32.5%-76.7%) for 1998 and 50.6% (range: 26.9%-65.4%) for 2007. Median cooperation rates were 63.0% for 1998 (range: 38.3%-83.6%) and 72.1% (range: 49.6%-84.6%) for 2007. For comparisons of smoking prevalence between males and females during 2007, statistical significance (p≤0.05) was determined using a two-sided z-test. Logistic regression analysis was used to analyze temporal changes in current smoking during 1998-2007, controlling for changes in state and area distributions of sex, age, and race/ethnicity. Linear and quadratic trends over time were included in the models. Nonsignificant quadratic terms were dropped from the final models. Quadratic trends indicated a significant but nonlinear trend in smoking prevalence over time.{dagger}

Current Cigarette Smoking

In 2007, the median prevalence of adult current smoking in the 50 states and DC was 19.8%. Among states, current smoking prevalence was highest in Kentucky (28.3%), West Virginia (27.0%), and Oklahoma (25.8%); and lowest in Utah (11.7%), California (14.3%), and Connecticut (15.5%). Smoking prevalence was 8.7% in USVI, 12.2% in PR, and 31.1% in Guam. Median smoking prevalence among the 50 states and DC was 21.3% (range: 15.5%-28.8%) for men and 18.4% (range: 8.0%-27.8%) for women. Men had a significantly higher prevalence of smoking than women in 30 states, DC, and all three territories.

Trends in Cigarette Smoking

During 1998-2007, linear decreases were observed in 28 states, DC, and PR. Nonlinear trends were detected in 19 other states. Trends in smoking prevalence varied among these states; however, all had reached a peak prevalence before 2004 and then began to decrease. Among 16 of these 18 states, logistic regression models indicated that the prevalence decreased during 1998-2007; in the other two states no change in prevalence occurred. No change over time in smoking prevalence (quadratic or linear) was observed in Alabama, Arizona, Tennessee, and West Virginia.
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