Smoking Cessation During Previous Year Among Adults -- United States, 1990 and 1991

Although most smokers in the United States report that they want to stop using cigarettes (1), 46 million persons aged greater than or equal to 18 years continue to smoke (2). Current information about factors predictive of smoking or cessation is required to develop and assess measures effective in reducing smoking prevalence. To characterize the patterns of attempting to quit smoking and smoking cessation among U.S. adults during 1990 and 1991, CDC's National Health Interview Survey-Health Promotion and Disease Prevention (NHIS-HPDP) supplement collected self-reported information on cigarette smoking from a representative sample of the U.S. civilian, noninstitutionalized population aged greater than or equal to 18 years. This report summarizes findings from this survey.

The overall response rate for the 1991 NHIS-HPDP was 87.8%. Participants (n=43,732) were asked: "Have you smoked at least 100 cigarettes in your entire life?" Those who responded "yes" (i.e., ever smokers) were asked: "Around this time last year, were you smoking cigarettes every day, some days, or not at all?" They were then asked: "Do you smoke cigarettes now?" Those who responded "yes" were asked: "Do you now smoke cigarettes every day or some days?"; those who responded "no" were asked: "Do you now smoke cigarettes not at all or some days?" The time period from the reference time 1 year earlier (about which the ever smoker reported the frequency of smoking) to the date of interview was considered the study period.

Current every-day smokers were persons who stated that they smoked now and that they smoked every day. Those who stated that they did not smoke at all at the time of the survey were considered former smokers. Some-day smokers were those who smoked on some days. These definitions differ slightly from traditional definitions used by CDC's National Center for Health Statistics because they incorporate the concepts of every-day and some-day smoking. Current every-day smokers who stated that they quit for at least 1 day during the past year, some-day smokers, and former smokers were all considered to have been abstinent from smoking for at least 1 day during the study period. Those former smokers who quit smoking cigarettes for at least 1 month at the time of the survey in 1991 were considered to have maintained abstinence.

For this analysis, three racial/ethnic categories were used: white, non-Hispanic; black, non-Hispanic; and Hispanic. Other racial/ethnic groups were not included because numbers were too small for meaningful analysis. Data were adjusted for nonresponse and weighted to provide national estimates. Investigators used the Software for Survey Data Analysis (SUDAAN) to calculate 95% confidence intervals (CIs) and adjusted odds ratios (3).

Among U.S. adults who had smoked at least 100 cigarettes during their lifetimes as of 1991, an estimated 40.5 million smoked cigarettes every day at the beginning of the study period. Approximately 17.0 million (42.1%) of these did not smoke cigarettes for at least 1 day during the subsequent 12 months. Hispanics (52.1% {95% CI=46.4%-57.8%}) and blacks (48.7% {95% CI=45.2%-52.2%}) were more likely than whites (40.3% {95% CI=39.0%- 41.6%}) to quit smoking cigarettes for at least 1 day. Abstinence for at least 1 day, by age, was highest among persons aged 18-24 years (56.7% {95% CI=52.9%-60.5%}) and, by education, was lowest among those with less than 12 years of education (36.5% {95% CI=34.1%-38.9%}). These relations were also evident after statistical adjustment was made for other sociodemographic variables (Table 1).

Among persons who reported that they did not smoke cigarettes for at least 1 day during the previous year, 13.8% (2.3 million) were abstinent for 1 month or more at the end of the study period. Hispanics (16.3% {95% CI=10.3%-22.2%}) and whites (14.0% {95% CI=12.6%-15.4%}) were more likely than blacks (7.9% {95% CI=5.1%- 10.7%}) to remain abstinent; this difference remained after statistical adjustments were made for sex, age, education, and poverty status (Table 1). Persons aged greater than or equal to 65 years (19.4% {95% CI=14.6%-24.2%}) and college graduates (18.8% {95% CI=14.9%-22.7%}) were the most likely to maintain abstinence. Persons at or above the poverty level* (14.8% {95% CI=13.4%-16.3%}) were more likely to maintain abstinence than those below the poverty level (7.5% {95% CI=4.7%-10.3%}).

Of all persons who were daily smokers at the beginning of the study period, 5.7% quit smoking and maintained abstinence for at least 1 month. Among persons who were daily smokers at the beginning of the study period, college graduates and persons at or above the poverty level were more likely than those with fewer years of formal education and persons below the poverty level, respectively, to abstain from cigarette smoking for 1 month or more.

Reported by: 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 findings from this survey indicate that, in 1990 and 1991, approximately 42% of daily smokers abstained from smoking cigarettes for at least 1 day but that approximately 86% of these persons subsequently resumed smoking. The high relapse rate is likely because of the addictive nature of nicotine (4). However, because relapse occurs later in the process of maintenance, the overall rate of cessation will be lower than suggested by this report. From 1974 through 1991, an estimated 45.8- 53.5 million persons aged greater than or equal to 18 years smoked; of these, approximately 1.2 million persons became former smokers each year (CDC, unpublished data), suggesting that approximately 2.5% of U.S. smokers quit smoking permanently each year.

Education level and age are both important predictors for cessation attempts and maintaining abstinence. The findings in this report are consistent with previous studies noting that increasing level of education correlates directly with smoking cessation prevalence and inversely with prevalence of smoking (2). In addition, although persons aged greater than or equal to 65 years were less likely to abstain for 1 day, those who did abstain were the most likely to be successful in maintaining abstinence during the study period. This finding may suggest that older persons may be more motivated than younger persons to overcome nicotine addiction (5).

In 1991, among the three racial/ethnic groups studied, the maintenance rate of abstinence from smoking was higher for Hispanics and whites than for blacks. Potential explanations for the high relapse rate among blacks include the use of cigarettes with higher tar and nicotine yields (4), a higher prevalence of nicotine dependency among persons who smoke (6), and comparatively limited access to preventive health services (4,7). Smoking-cessation programs are important for all racial/ethnic groups. Programs have been developed for Asian/Pacific Islanders, American Indians/Alaskan Natives (T. Stratton, California Department of Health Services, personal communication, 1993), and Hispanics (8). The elevated prevalence of cigarette smoking among (2 ) and the higher smoking-attributable death rate for (9) blacks indicate the need for specific efforts to reduce the adverse impact of tobacco use among blacks. CDC and the National Medical Association are initiating a targeted mass media campaign in July 1993 called "Legends" that contrasts the deaths of black civil-rights leaders to preventable smoking-related deaths. In addition, a toll-free telephone number ({800} 232-1311) is available to request a smoking-cessation guide, Pathways to Freedom. This guide addresses important topics including nicotine addiction, possible misconceptions about the safety of smoking menthol cigarettes, stress-reduction techniques, preparing for quitting, relapse-prevention techniques, and the cultural meaning of smoking (6).

References

1. Thomas RM, Larsen MD. Smoking prevalence, beliefs, and activities by gender and other demographic indicators. Princeton, New Jersey: The Gallup Organization, Inc, 1993.

2. CDC. Cigarette smoking among adults -- United States, 1991. MMWR 1993;42:230-3.

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

4. Public Health Service. The health consequences of smoking: nicotine addiction. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1988; DHHS publication no. (CDC)88-8406.

5. Hatziandreu EJ, Pierce JP, Lefkopoulou M, et al. Quitting smoking in the United States in 1986. J Natl Cancer Inst 1990;82:1402-6.

6. Royce JM, Hymowitz N, Corbett K, Hartwell TD, Orlandi MA, for the COMMIT Research Group. Smoking cessation factors among African Americans and whites. Am J Public Health 1993;83:220-6.

7. Hymowitz N, Sexton M, Ockene J, Grandits G, for the MRFIT Research Group. Baseline factors associated with smoking cessation and relapse. Prev Med 1991;20:590-601.

8. Marin G, Marin BV, Perez-Stable EJ, Sabogal F, Otero-Sabogal R. Changes in information as a function of a culturally appropriate smoking cessation community intervention for Hispanics. Am J Community Psychol 1990;18:847-64.

9. CDC. Smoking-attributable mortality and years of potential life lost -- United States, 1988. MMWR 1991;40:62-3,69-71.

• Poverty statistics are based on definitions developed by the Social Security Administration that include a set of income thresholds that vary by family size and composition.

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