Report of US Centers for Disease Control Show Downward Trend in Current Smokers

The US Centers for Disease Control and Prevention (CDC) have issued 2 reports, both published in Morbidity and Mortality Weekly Report and reprinted in the December 23/30 issue of the Journal of the American Medical Association, on smoking trends and secondhand smoke exposure in 2008.

“Approximately one in five U.S. adults smoke cigarettes, and certain subpopulations have disproportionately higher prevalences of smoking,” write S. R. Dube, PhD, from the CDC Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, and colleagues. “Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in the United States. Full implementation of population-based strategies and clinical interventions can educate adult smokers about the dangers of tobacco use and assist them in quitting.”

An analysis of data from the 2008 National Health Interview Survey showed that the proportion of US adults who were current cigarette smokers decreased by 3.5% during 1998 to 2008, from 24.1% to 20.6%. However, there was no significant change in that proportion from 2007 (19.8%) to 2008 (20.6%).

Of current cigarette smokers in 2008, 79.8% (36.7 million) smoked every day and 20.2% (9.3 million) smoked some days. An estimated 45.3% of smokers (20.8 million) had stopped smoking for at least 1 day during the preceding 12 months because they were trying to quit.

Of about 94 million persons who had smoked 100 cigarettes or more during their lifetime, more than half (51.1% [48.1 million]) were no longer smoking.

In 2008, the highest prevalence of smoking was in adults at least 25 years of age with low educational attainment (41.3% for persons with a General Educational Development certificate and 27.5% for those with less than a high school diploma vs 5.7% for those with a graduate degree).

The lowest quit ratios in 2008 were in adults with education levels at or below the equivalent of a high school diploma (range, 39.9% - 48.8%). During the 10-year period examined, smoking cessation for adults with low educational attainment did not change.

“Because persons with lower educational attainment generally have higher rates of smoking and are less likely to quit, evidence-based programs known to reduce smoking should be intensified among these groups,” the study authors write. “Health-care providers should take education level into account when communicating about cessation and smoking hazards to these patients.”

An accompanying CDC editorial note indicates at least 5 limitations of this report: self-reported estimates of cigarette smoking were not confirmed by biochemical tests, possible underestimates for certain racial/ethnic populations, a lack of generalizability to institutionalized populations and the military, limited information was available on former smokers, and small sample sizes were included for certain population groups (eg, American Indians/Alaska Natives).

“Effective population-based strategies for preventing tobacco use and encouraging tobacco use cessation (including enforcing bans on advertisement) are outlined in the World Health Organization’s MPOWER package,” the editorial states. “Despite partial bans on some forms of advertisement, the tobacco industry continues to conduct targeted marketing toward socially disadvantaged subgroups and vulnerable populations, such as persons with low socioeconomic status and youths. Offering and providing effective cessation counseling and treatments are integral to reducing the smoking epidemic, especially in subpopulations with high rates of smoking.”

Report on Secondhand Smoke Exposure

The second report analyzed 2008 Behavioral Risk Factor Surveillance System data from 11 states and the US Virgin Islands (USVI) on secondhand smoke (SHS) exposure.

“State variation exists in the prevalence of current smoking, in non-smoker exposure to SHS, and in the prevalence of persons who have completely smokefree rules for their homes,” write A. Malarcher, PhD, from the CDC Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, and colleagues.

“SHS causes immediate and long-term adverse health effects in nonsmoking adults and children, including heart disease and lung cancer, and SHS exposure occurs primarily in homes and workplaces,” the authors note. “Smoke-free policies, including not allowing smoking anywhere inside the home (i.e., having a smoke-free home rule), are the best way to provide protection from exposure to SHS.”

SHS exposure in homes varied widely among states, from 3.2% in Arizona to 10.6% in West Virginia. For indoor workplaces, the range was from 6.0% in Tennessee to 17.3% in the USVI. Most persons surveyed reported having smoke-free home rules (from 68.8% in West Virginia to 85.7% in the USVI).

This report also provided 2008 findings for Behavioral Risk Factor Surveillance System–based state-specific estimates of current smoking in 50 states, the District of Columbia, and 3 territories (Guam, Puerto Rico, and the USVI). There was marked variation in self-reported cigarette smoking prevalence (range, 6.5% - 27.4%).

“Additional legislation is needed to increase the number of smoke-free workplaces and other public places,” the report authors write. “Health-care providers should continue to encourage persons to make their homes completely smoke-free.”

The accompanying CDC editorial note points out at least 4 limitations of these findings: the failure to survey persons without any telephone service or with only wireless telephones, that the estimates for cigarette smoking and SHS exposure were based on self-report, a median response rate of only 53.3%, and the determination of SHS exposure only for the 7 days preceding the survey.

“Enacting legislation that eliminates smoking in indoor work spaces and public places and encouraging persons to implement smoke-free home rules will protect persons from exposure to SHS,” the editorial states. “The Institute of Medicine recently concluded that SHS exposure can cause acute myocardial infarction (AMI) and that communities that enact smoke-free policies realize a reduction in hospitalization for AMI among the general population. All persons, including those with an increased risk for heart disease, can protect themselves from SHS exposure by avoiding indoor areas that allow smoking.”

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