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Progress in Chronic Disease Prevention
Cigarette Smoking -- Behavioral Risk Factor Surveillance System,
1988
Cigarette smoking prevalence during 1988 was examined in
relation to generation cohort and level of education using data
from the Behavioral Risk Factor Surveillance System (BRFSS). In
1988, health departments from 36 states and the District of
Columbia participated in the BRFSS monthly random-digit-dialed
telephone interviews of adults aged greater than or equal to 18
years (1). Respondents were asked if they had ever smoked at
least 100 cigarettes, if they had ever quit smoking, and if they
currently smoked. Current smokers are defined as persons who have
smoked at least 100 cigarettes and who continue to smoke; former
smokers, as persons who have smoked 100 cigarettes but who no
longer smoke; and ever smokers, as current and former smokers
combined (2).
Smoking rates among persons aged 18-34 years varied widely by
state (Table 1). The proportion of persons who ever smoked ranged
from 27.1% in Utah to 53.1% in Maine (median: 41.1%). The
proportion of former smokers ranged from 9.1% in Utah to 20.3% in
Maine (median: 15.1%). The proportion of persons who currently
smoked ranged from 18.1% in Utah to 37.9% in Kentucky (median:
26.2%).
Smoking rates also varied by generation and level of education
(Figure 1). Three generations were defined: persons 18-34 years
of age, persons 35-54 years of age, and persons greater than or
equal to 55 years of age. From the older to middle generation,
the likelihood of being a current smoker increased substantially
with each decrease in level of education. From the middle to
younger generation, the likelihood of being a current smoker
decreased substantially only for persons with more than a high
school education.
Reported by: The following BRFSS coordinators: R Strickland,
Alabama; T Hughes, Arizona; L Parker, California; M Adams,
Connecticut; M Rivo, District of Columbia; S Hoecherl, Florida; J
Smith, Georgia; E Tash, Hawaii; J Mitten, Idaho; B Steiner,
Illinois; S Joseph, Indiana; S Tietje, Iowa; K Bramblett,
Kentucky; R Schwartz, Maine; A Weinstein, Maryland; L Koumijian
Yandel, Massachusetts; J Thrush, Michigan; N Salem, Minnesota; N
Hudson, Missouri; R Moon, Montana; R Thurber, Nebraska; K Zaso,
New Hampshire; L Pendley, New Mexico; H Bzduch, New York; C
Washington, North Carolina; B Lee, North Dakota; E Capwell, Ohio;
N Hann, Oklahoma; J Cataldo, Rhode Island; D Lackland, South
Carolina; L Post, South Dakota; D Riding, Tennessee; J Fellows,
Texas; B Neiger, Utah; K Tollestrup, Washington; R Anderson, West
Virginia; M Soref, Wisconsin. Office of Surveillance and Analysis
and Office on Smoking and Health, Center for Chronic Disease
Prevention and Health Promotion, CDC. Editorial Note
Editorial Note: Based on findings from the 1988 BRFSS, young
adults with low educational attainment (a correlate of low
socioeconomic status) were more likely to be current smokers than
were other persons. These results indicate that limited progress
has been made in reducing the prevalence of cigarette smoking
among young adults of low educational attainment levels--a
finding consistent with data from other surveys (3).
Differences in socioeconomic levels by state may account for
some of the variation in observed prevalences. Cultural factors,
such as emphasis among the largely Mormon population of Utah to
limit or abstain from tobacco use, may also affect smoking rates
by state (4). Other determinants that may vary by state include:
the extent of smoking prevention activities (including school
programs emphasizing smoking prevention (5)); state cigarette
excise tax rates (2); and the intensity of tobacco advertising or
promotional events sponsored by the tobacco industry (6).
Recent smoking prevention strategies have been directed toward
young persons through the school, home, workplace, and community
(2). Life-skills instruction on resisting smoking has been
effective in reducing smoking initiation (7). Data from the BRFSS
and National Health Interview Surveys (3) show that educational
attainment levels are becoming an increasingly important factor
in determining whether young persons smoke; therefore, effective
smoking prevention strategies need to be targeted toward children
and adolescents in groups with generally low educational
attainment.
References
Remington PL, Smith MY, Williamson DF, Anda RF, Gentry EM,
Hogelin GC. Design, char acteristics, and usefulness of
state-based behavioral risk factor surveillance: 1981-87. Public
Health Rep 1988;103:366-75.
CDC. Reducing the health consequences of smoking: 25 years of
progress--a report of the Surgeon General, 1989. Rockville,
Maryland: US Department of Health and Human Services, Public
Health Service, 1989; DHHS publication no. (CDC)89-8411.
Pierce JP, Fiore MC, Novotny TE, Hatziandreu EJ, Davis RM.
Trends in cigarette smoking in the United States: educational
differences are increasing. JAMA 1989;261:56-60.
Fuchs VR. Who shall live? Health, economics, and social
choice. New York: Basic Books, 1974.
CDC. School policies and programs on smoking and
health--United States, 1988. MMWR 1989;38:202-3.
Davis RM. Current trends in cigarette advertising and
marketing. N Engl J Med 1987;316:725-32.
Glynn TJ. Essential elements of school-based smoking
prevention programs. J Sch Health 1989;59:181-8.
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