From 1965 through 1985, smoking prevalence in the United States declined at a rate of 0.5 percentage points per year (1), and from 1987 through 1990, the rate of decline accelerated to 1.1 percentage points per year (2). CDC monitors the use of tobacco in the United States to evaluate progress in reducing smoking prevalence. To determine the prevalence of smoking among U.S. adults during 1991, the 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 the results of 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?" and "Do you smoke cigarettes now?" Current smokers were defined as those who reported smoking at least 100 cigarettes and who were currently smoking and former smokers as those who reported having smoked at least 100 cigarettes and who were not smoking now. Ever smokers included current and former smokers. Current smokers were then asked: "Do you now smoke cigarettes every day or some days?" Respondents reporting they smoked every day were asked: "On the average, how many cigarettes do you now smoke a day?" Data were adjusted for nonresponse and weighted to provide national estimates. Confidence intervals (CIs) were calculated using standard errors generated by the Software for Survey Data Analysis (SUDAAN) (3).

In 1991, an estimated 89.8 million (49.8%) adults in the United States were ever smokers, and 46.3 million (25.7%) were current smokers. Approximately 43.5 million persons (48.5% of all ever smokers {95% CI=47.7%-49.3%}) were former smokers during 1991. The proportion of former smokers among ever smokers was higher among men (51.6% {95% CI=50.4%-52.7%}) than among women (44.7% {95% CI=43.6%-45.8%}) and increased with increased education from 41.8% (95% CI=40.1%-43.6%) for those with less than 12 years of education to 66.1% (95% CI=64.3%-67.9%) for those with greater than or equal to 16 years of education.

Among men, 24.0 million (28.1%) were current smokers; among women, 22.2 million (23.5%) were current smokers (Table 1). The prevalence of smoking was higher among men than among women for most sociodemographic groups (Table 1). Smoking was most prevalent among persons aged 25-44 years. The prevalence of smoking was highest among American Indians/Alaskan Natives and blacks, and lowest among Asians/Pacific Islanders. Differences between black and white adults were mainly among men. The prevalence of smoking was lower among Hispanics than non-Hispanics, reflecting the lower prevalence of smoking among Hispanic women. Cigarette smoking prevalence decreased with increasing education, and was higher among persons who lived below the poverty level * (Table 1).

In 1991, the mean number of cigarettes smoked daily per smoker was 20.0 (95% CI=19.7-20.3). The mean was substantially higher for men (21.6 {95% CI=21.2-22.0}) than women (18.3 {95% CI=18.0-18.6}), for whites (21.0 {95% CI=20.7-21.3) than blacks (15.0 {95% CI=14.4- 15.6}), for non-Hispanics (20.4 {95% CI=20.1-20.7}) than Hispanics (13.4 {95% CI=12.5-14.3}), and for persons at or above the poverty level (20.3 {95% CI=20.0-20.6}) than persons below the poverty level (18.7 {95% CI=18.1-19.3}).

Reported by: Epidemiology Br, 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 in this report indicate that the estimate of smoking prevalence in 1991 was the same as in 1990 (2). These findings are consistent with national household surveys on drug abuse (4-6), and public polls (7) that reveal similar patterns of declining prevalence until 1990 followed by a leveling during 1991. Among blacks and women, the prevalence of current smoking during 1991 was slightly higher than during 1990 (2). Factors that contributed to the leveling in smoking prevalence may include the steady growth in market share of discount cigarettes (8) and the recent 10.4% annual increase to an estimated $3.9 million in domestic cigarette advertising and promotional expenditures (9).

Differences in prevalence among racial and ethnic groups may be influenced by differences in educational levels and socioeconomic status, as well as social and cultural phenomena that require further explanation. For example, targeted marketing practices may play a role in maintaining or increasing prevalence among some groups, and affecting the differential initiation of smoking by young people (1). The national health objectives for the year 2000 have established special population target groups for the reduction of smoking prevalence including blacks, Hispanics, American Indians/Alaskan Natives, and Southeast Asian men (10).

Acceleration of the decline in smoking prevalence will require intensified efforts to discourage the use of tobacco by helping smokers break the addiction to nicotine, persuading children never to start smoking, and enacting public policies that discourage smoking. Such policies include increasing taxes on tobacco products, enforcing minors'-access laws, restricting smoking in public places, and restricting tobacco advertising and promotion (1).

References

1. CDC. Reducing the health consequences of smoking: 25 years of progress -- a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411.

2. CDC. Cigarette smoking among adults -- United States, 1990. MMWR 1992;41:354-5,361-2.

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

4. National Institute on Drug Abuse. National Household Survey on Drug Abuse: main findings, 1988. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, 1990; DHHS publication no. (ADM)90-1682.

5. National Institute on Drug Abuse. National Household Survey on Drug Abuse: main findings, 1990. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, 1991; DHHS publication no. (ADM)91-1788.

6. National Institute on Drug Abuse. National Household Survey on Drug Abuse: population estimates, 1991. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, 1992; DHHS publication no. (ADM)92-1887.

7. Hugick L, Leonard J. Despite increasing hostility, one in four Americans still smokes. The Gallup Poll Monthly (December) 1991;315:2-10.

8. Maxwell JC Jr. The Maxwell consumer report: third quarter 1992 sales estimates for the cigarette industry. Richmond, Virginia: Butcher and Singer, October 30, 1992; publication no. WFBS-6824.

9. US Federal Trade Commission. Federal Trade Commission report to Congress for 1990: pursuant to the Federal Cigarette Labeling and Advertising Act. Washington, DC: US Federal Trade Commission, 1992.

10. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

• 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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