National Health Interview Survey (NHIS) Celebrating the First 50 years: 1957 - 2007

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1. Background of Cigarette Smoking Questions on the NHIS

This section provides information on the background research for tobacco related questions on the NHIS.

1.1  Early Research on the Effects of Smoking on Health

Before the 1930’s, lung cancer was so rare that it did not appear among the top causes of death in U.S. reports.  As physicians began to notice an increase in lung cancer among male patients, several research studies were initiated.

Two noted retrospective studies described the relationship between cigarette smoking history and lung cancer:  Doll and Hill [1] in England, and Wynder and Graham [2] in the United States.

Findings were strengthened by subsequent prospective studies that established a relationship between smoking and the development of lung cancer. [3, 4]

Actions of Two Surgeons General

In 1956, Dr. Leroy E. Burney, Surgeon General of the United States convened a panel to assess the available data on smoking and health.

In 1957,  Dr. Burney stated:  “many independent studies have thus confirmed beyond reasonable doubt that there is a high degree of statistical association between lung cancer and heavy and prolonged cigarette smoking,” and that “excessive smoking is one of the causative factors in the increasing incidence of lung cancer.”  [5, 6]

In 1962, the next Surgeon General, Luther L. Terry, established another expert committee, independent of the first, to again review the evidence on the relationship between smoking and lung cancer.

The 1964 Report to the Surgeon General on Smoking and Health

In 1964, the second review committee produced a comprehensive report on smoking and health, presented to the Surgeon General, that confirmed the earlier findings of a relationship between cigarette smoking and lung cancer, and added evidence of a relationship between smoking and cardiovascular disease. [7]

1.2 Reports of the Surgeon General on Tobacco Topics

1.3 Initiation of Questions on Selected Tobacco Topics

Initiation of NHIS Questions on Cigarette Smoking in Adults

The earliest federal survey to include questions on cigarette smoking was the Current Population Survey of 1955.

Questions on cigarette smoking first appeared on the NHIS in FY 1965 [8] and were repeated in FY 1966.

In parallel, under contract with the Bureau of the Census, the Division of Health Interview Statistics fielded the 1966-1968 CPS supplement questionnaires on cigarette smoking, and processed the resulting data. [9]

In the 1970's and the early 1980's, smoking questions were asked in some years, using pages added to the core questionnaire.

Between 1985 and 1995, smoking questions were included in health promotion and disease prevention supplements, and the cancer supplements of 1987 and 1992.

With the questionnaire redesign, smoking questions have been included in the NHIS core questionnaire each year from 1997 to the present.

Initiation of NHIS Questions on Environmental Tobacco Smoke

Questions on environmental tobacco smoke first appeared on the NHIS in 1988.

In 1993, the Environmental Protection Agency (EPA) issued a report that cited environmental tobacco smoke (ETS) as a cause of lung cancer in non-smokers affected by the smoke from smokers. [10,11]

The International Agency For Research On Cancer (IARC) issued a similar report. [12]  Questions on ETS were included on NHIS supplements in 1990-1994, 1998, 2000, and 2005.

Questions on ETS appeared in the NHIS in the occupational health supplement of 1988, and the health promotion/disease prevention supplements during the 1990’s and the cancer supplements of 2000 and 2005.

In 2006, the Surgeon General issued a report that updated the review of the scientific evidence of the harmful effects of involuntary exposure to tobacco smoke. [13]

Initiation of NHIS Questions on Other Tobacco Products

“Other Tobacco Products” refers to tobacco products other than cigarettes, both smoked (pipes, cigars and bidis) and smokeless (snuff and chewing tobacco).  See the Glossary for more information about each product.

Questions about the use of pipes and cigars were included in the earliest NHIS smoking supplements of FY 1965, FY 1966 and 1970.

Subsequent questions about other tobacco use were asked in the health promotion / disease prevention supplements of 1991, 1992, and 1998, and in the cancer supplements of 1987, 1992, 2000 and 2005.

Questions on snuff and chewing tobacco were first asked in 1970.  They were also asked in 1987, 1991, 1992, 1993, 1994, 1998, 2000 and 2005.

Questions on smoking bidis were asked in 2000 and 2005.

Initiation of NHIS Questions on Methods of Quitting Cigarette Smoking

The first list of methods to quit smoking was included in 1983.

Questions on cigarette smoking quit methods appeared in the NHIS Cancer Control Supplements of 1987, 1992, 2000 and 2005 but not in the Health Promotion  and Disease Prevention Supplements.

One nicotine replacement therapy method was mentioned in 1987.  By 2005 six such methods were mentioned.

Other smoking cessation medications were first asked about in 2000.

Stopping all at once or “cold turkey” was asked in 1983, 1987, 1992, and 2000 but not in 2005.

References:

1.   Doll, Richard and A. Bradford Hill.  Smoking and carcinoma of the lung: preliminary report. 1950;  British Medical Journal.  22(ii):739-48.  Sept 30.

2.   Wynder, Ernst L. and Graham, Evarts A.  Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma.  JAMA. 1950; 143(4):329-336.  May 27.

3.   Doll, Richard and A. Bradford Hill. The mortality of doctors in relation to their smoking habits:  a preliminary report.  British Medical Journal. 1954; 228(i):1451-1455.  June 26.

4.   Wynder, Ernst L. and Cornfield  J (1953).  Cancer of the lung in physicians.  N Engl J Med. 1952; 248(11):441-4.  Mar 12.

5.   Burney, Leroy E.  Excessive Cigarette Smoking.  Public Health Reports.  1957;  72(9):786.  Sept.

6.   Burney, Leroy E.  Smoking and lung cancer:  a Statement of the Public Health Service.  JAMA.  1959; 171:1829-37.  Nov 28.

7.   Smoking and Health:  Report of the Advisory Committee to the Surgeon General of the Public Health Service.  Washington, DC:  US Department of Health, Education and Welfare. 1964.

8.   Wilson, Ronald W. Cigarette Smoking and Health Characteristics.  United States – July 1964-June 1965.  National Center for Health Statistics.  Series 10(34). Washington, DC: US Department of Health, Education  and Welfare. 1967.

9.  Ahmed, Paul I. and Gleason, Geraldine A.  Changes in Cigarette Smoking habits between 1955 and 1966.  National Center for Health Statistics.  Series 10(59). Rockville, MD: US Department of Health, Education  and Welfare. 1970.

10. EPA.  Respiratory Health Effects of  Passive Smoking:  Lung Cancer and Other Disorders.  Washington, DC:  Environmental Protection Agency. EPA Document Number 43-F-93-003.  1993.  Jan.

11. Jinot, J and Bayard, S.  Respiratory health effects of exposure to environmental tobacco smoke.  Rev Environ Health.  1996; 11(3): 89-100.  Jul-Sep.

12. International Agency for Research on Cancer.  IARC monographs on the evaluation of carcinogenic risks to humans.  Vol 83.  Tobacco smoke and involuntary smoking.  Lyons:  IARC.  2004; 33-47.

13. US Department of Health and Human Services.  The Health Consequences of Involuntary Exposure to Tobacco Smoke:  A Report of the Surgeon General.  Atlanta, GA:  US Department of Health and Human Services.  2006.

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