Overall, however, the news is mostly positive, as the percentage of U.S. adults who smoke cigarettes declined from 20.9% in 2005 to 15.1% in 2015, and the proportion of those identified as daily smokers declined from 16.9% to 11.4%, according to lead author Ahmed Jamal, MBBS, and colleagues in Morbidity and Mortality Weekly Report (November 11, 2016, Vol. 65:44, pp. 1205-1211).
"The [U.S.] Surgeon General has concluded that the burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products," the authors wrote.
Jamal and his five co-authors are all employed in the Office on Smoking and Health at the National Center for Chronic Disease Prevention and Health Promotion of the CDC in Atlanta.
The U.S. Department of Health and Human Services launched the Health People 2020 initiative in 2010 to improve the nation's health. It provides science-based 10-year goals and objectives for health promotion and disease prevention. One target of the initiative is to reduce the percentage of U.S. adults who smoke cigarettes to 12% or less. Jamal and colleagues at the CDC wanted to measure progress toward this goal, so they studied the latest estimates of cigarette smoking prevalence among U.S. adults using data from the 2015 National Health Interview Survey (NHIS).
This annual survey is a "nationally representative, in-person survey of the noninstitutionalized U.S. civilian population." The survey contained responses from more than 33,000 adults 18 years and older. Current cigarette smokers were defined as adults who smoked 100 cigarettes or more during their lifetime and who reported smoking every day or on some days.
In 2005, an estimated 45 million U.S. adults (20.9%) smoked cigarettes, the authors reported. In 2015, that number fell to 36.5 million (15.1%), a decline of more than 27%. The biggest declines in cigarette smoking were seen in the Northeast and Southern regions, with drops of 29.7% and 29.5%, respectively, over the 10-year period. However the West continues to have the lowest rate of cigarette smoking overall at 12.4%.
The U.S. data revealed that men (16.7%) were more likely to smoke than women (13.6%), and adults between 25 and 44 years are more than twice as likely to smoke as those 65 and older (17.7% compared with 8.4%). More than a third of adults 25 and older with a GED certificate smoked cigarettes, compared with less than 4% of people with a graduate degree. Adults in the following categories also were more likely to smoke:
- Adults living below the poverty level
- Adults enrolled in Medicaid or who are uninsured
- Adults who have a disability or limitation
The authors noted four limitations to their findings:
- Smoking status was self-reported and was not validated by biochemical testing.
- Results are not generalizable to institutionalized populations and persons in the military.
- The response rate of 55.2% might have resulted in nonresponse bias.
- The reported estimates differ from those in other surveys, which the authors noted can be partially explained by varying survey methodologies, types of surveys administered, and definitions of current smoking. They also noted that "trends in prevalence are comparable across surveys."
"Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, antitobacco mass media campaigns, and barrier-free access to tobacco cessation counseling and medications, are critical to reducing cigarette smoking and smoking-related disease and death among U.S. adults," the authors concluded.
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