US national smoking rates flat across past 5 years.

On November 13th I commented on a new report on smoking rates and secondhand smoke exposure by state. I was relatively positive in that article, largely because my own state of New Jersey continued to show lower smoking rates (now consistently 3rd lowest in the country). However, another report based on a national survey was released and it gives a less positive picture of the rate of change in smoking across the country.

The report was based on the 2008 national Health Interview Survey of almost 22,000 U.S. adults, and comparison of smoking rates back to 1998. In 2008, an estimated 20.6% (46.0 million) of U.S. adults were current cigarette smokers; of these, 79.8% (36.7 million) smoked every day, and 20.2% (9.3 million) smoked some days. Among current cigarette smokers, an estimated 45.3% (20.8 million) had stopped smoking for 1 day or more during the preceding 12 months because they were trying to quit.
Although the smoking rate has declined from 24.1% in 1998, over the 5 years for 2004 to 2008 it has hardly changed at all and the 2008 rate was actually slightly higher than 2007 (19.8%). There are marked differences in smoking rates by education and socioeconomic status. For example, only 6% of adults with a graduate degree smoke, whereas 32% of people living below the poverty level smoke. There was an increase in the proportion of women living below the poverty level who smoke, from 2007 to 2008 (from 26% to 32%). Similarly, while the proportion of ever smokers who have quit is around 80% for people with a graduate degree, it is less than 50% for those with no education beyond high school.

These stagnating smoking rates are all the more surprising considering that over the period 2004-2008, many states have increased cigarette taxes and passed laws banning smoking in public places. However, across the same time period many states have also cut tobacco control funding to the point where the state can no longer conduct a viable tobacco control program. Such funding cuts are incredibly short-sighted as they will actually result in an increase in state healthcare costs and worsen the state’s budget. The way to reduce smoking, improve health and reduce overall health spending in tough fiscal times is to (a) increase excise taxes on all tobacco products, significantly (b) pass legislation banning smoking inside all workplaces and (c) fund a viable statewide comprehensive tobacco control program that includes adequate resources to help smokers to quit, targeted at smokers with less education/income.

The report from CDC can be accessed at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5844a2.htm

Labels: cigarette smoking, jonathan foulds, prevalence, USA

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Make Yours A Smoke-free Home (2)

A new report was published today from the Centers for Disease Control and Prevention (CDC), showing wide variability in exposure to secondhand smoke and cigarette smoking prevalence across the United States, but overall things are moving in the right direction.

Around 8% of the adult population report exposure to tobacco smoke while at work, and a similar number report it at home. 45% of smokers live in a household with an indoor smoking ban, as do 85% of non-smokers, giving an overall average of around 78%(note these figures are from surveys covering 11 states).

The report also gave state-by-state figures for cigarette smoking prevalence from a state-based survey carried out in 2008 (BRFSS). This found a median smoking rate of 18.4% (20.4% for men and 16.7% for women). But there continue to be wide differences in smoking rates across states, from 9% in Utah to 27% in West Virginia. I was pleased to see New Jersey again doing well with the third lowest cigarette smoking prevalence in the country (14.8%), catching up on California at 14%. New Jersey is now one of 6 or 7 states with a lower male cigarette smoking prevalence than California and New Jersey is the state with the highest proportion of ex-smokers. For a summary of why New Jersey has done so well at reducing smoking, check out my posting of June 30th:
http://www.healthline.com/blogs/smoking_cessation/2009/06/why-have-so-many-new-jersey-smokers.html

West Virginia, in addition to having the highest smoking rate overall (26.6%), is the only state in which more women (27.1%) smoke than men (26.1%). I’d be interested in hearing your views on why cigarette smoking rates remain so high in West Virginia, particularly among women.

West Virginia has a relatively low state cigarette tax rate (55 cents per pack). Rhode Island has the highest state cigarette tax ($3.46 per pack). West Virginia has not passed legislation protecting all workers from exposure to secondhand tobacco smoke.

The data for 2008 presented in this new report were collected prior to the $1 increase in federal cigarette taxes, and so there is every reason to believe that this will help continue the trend towards less smoking in 2009 and 2010. However, there is a greater need to provide assistance to smokers who want to quit but find that they are addicted. The head of CDC, Dr Tom Frieden pointed out in an interview that various state and local governments across the country collect $25 billion per year from tobacco settlements and taxes, but spend only 3% of that on tobacco control. It would be far better to invest more of that money in prevention.
The new CDC report can be found at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5844a3.htm

For a previous post on smoke-free homes:
http://www.healthline.com/blogs/smoking_cessation/2007/08/make-yours-smoke-free-home.html

Labels: CDC, cigarette smoking, jonathan foulds, prevalence, secondhand smoke, smoke-free home

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New Report on Cigarette Smoking in USA

An important new report funded by the Robert Wood Johnson Foundation was released this week by Dr Gary Giovino and colleagues. This report provides details on recent changes in cigarette smoking in every state. It used the best quality data from large national surveys (e.g. the Current Population Survey and the National Health Interview Survey) and so it is the best available guide to cigarette consumption.

Here are some of the main findings:
From 1955 to 2007 U.S. cigarette smoking rates fell from 57% to 22% in men and from 28% to 17% in women, with an overall rate (both sexes) of 20% in 2007.

However, the smoking rates vary considerably by educational status. Around a third of people without a completed high school education smoke, compared with less than 10% of those with at least 16 years of education smoke.

There are also fairly dramatic differences in smoking rates between states. Smoking rates range from lows of 12.4% in Utah, 12.6% in California and 13.7% in New Jersey, up to 25.6% in Oklahoma, 26.2% in West Virginia and 28.2% in Kentucky.

The places with the highest smoking rates also have the highest death rates from smoking. Thus in California the mortality rate per 100,000 is 235, whereas in Kentucky it is 371. In Utah the age-standardized death rate from lung cancer in men is 34/100,000 whereas in Kentucky it is 108/100.000.

This report makes it easy to find out how your own state compares to the rest of the country, on a whole range of measures related to cigarette use. I was very pleased to find that my home state, New Jersey, has the third lowest smoking rate in the country (13.7%)_and the highest proportion of smokers who have quit smoking (62%, compared with 52% nationally and 41% in West Virginia).

Important progress is being made on increasing state and federal cigarette taxes, and broadening smoke-free workplaces (by legislation) and homes (by family choice). However, there are some warning signs. While CDC recommends that 12% of the money received by states from the Master Settlement Agreement should be invested in tobacco control, that figure was only 2.7% in 2007, a drop from 2001-2.

You can view the complete report online at:
www.impacteen.org/tobaccodata.htm

Reference:
Giovino GA et al. Cigarette Smoking Prevalence and Policies in the 50 States: an Era of Change.. The Robert Wood Johnson Foundation Impacteen Tobacco Chart Book. Buffalo, NY. University at Buffalo, State University of New York, 2009.

Labels: cigarette smoking, Gary Giovino, jonathan foulds, prevalence, Robert Wood Johnson Foundation

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Which U.S. states smoke most and least?

The latest data on cigarette smoking prevalence by state was just released in the U.S.
Before I tell you the results, make a guess at what percentage of adults you think are cigarette smokers (a) in your state and (b) in the whole of the US?

The data are from a survey called the Behavioral Risk Factor Surveillance System (BRFSS) which is organized by CDC. It obtains a representative sample of adults in each state, and asks them loads of questions about health-related behaviors.

In 2007 (latest year data is available for), the median state cigarette smoking prevalence was 19.7%, of whom only 14.5% were daily smokers and 5.2% smoke somedays.

The states with the lowest smoking rates were Utah (11.7), California (14.3), Massachusetts (16.4), Minnesota (16.5), Washington (16.8), Oregon (16.9), Rhode Island (17), Hawaii (17) and my home state of New Jersey (17.1).

At the other end, the states with the highest smoking rates are: Kentucky (28.2), West Virginia (26.9), Oklahoma (25.8), Missouri (24.5), and Tennessee (24.3).

I find that most people overestimate the proportion of people who smoke, often by a large amount. How did you do?

So here in the United States we have some states where smoking is twice as common as in others. The main factors influencing this are the strength of tobacco control policies such as excise taxes, clean indoor air legislation, media campaigns and smoking cessation services. Utah is a bit of an outlier in that the smoking prevalence there is largely determined by the high proportion of people following the Mormon religion.

Clearly an individual smoker’s ability to quit, or the chances that your kids might start smoking is highly influenced by the environment in which we live. If you live in Kentucky, almost one in three people smoke, cigarettes are cheap, and there are few services to help smokers quit. In California only one in ten people are daily smokers, you are not allowed to smoke in any indoor public place, and there have consistent media campaigns warning about the health effects of smoking. These differences have a massive impact on the health profiles in these states, such that people living their life in Kentucky are more likely to die of lung cancer than people in California.

So if you want a healthy life for you and your kids, either advocate for tobacco control policies in your state, or move to a state that already has them.

Data on the 2007 BRFSS can be found and searched at:
http://apps.nccd.cdc.gov/brfss/display.asp?cat=TU&yr=2007&qkey=4394&state=UB

Labels: cigarette smoking, jonathan foulds, prevalence, United States

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State-specific prevalence of cigarette smoking.

In previous posts I’ve discussed international differences in tobacco use, which showed that by international standards, male cigarette smoking prevalence is relatively low in the United States, but female smoking prevalence is higher in the US than most other parts of the world. The clearest contrast is with a countries like China, where almost two-thirds of men smoke, but only a few percent of women smoke.

On Friday (Sept 28th, 2007) the US Centers for Disease Control published the latest (2006) figures for adult cigarette smoking prevalence within each U.S. state. The median prevalence was 20.2%, but consistent with recent years, there were some large between-state differences. The highest smoking rates were in tobacco-growing states such as Kentucky (28.6%), or West Virginia (25.7%). The lowest smoking rates were in places with strong cultural prohibitions against tobacco such as Utah (9.8%) and California (14.9%).

Overall, the median smoking rates were higher for men (22.2%) than for women (18.5%). Although it is probably unwise to make too much of single-year prevalence estimates for relatively small geographic regions, such as individual states, I like to look at these to see if anything potentially interesting pops out. The California figures are always of interest as a guide to how low we can go in the rest of the United States. Although the low smoking rates in California are partly related to the high number of non-smoking immigrants to that state, they are largely due to California’s comprehensive tobacco control program that was the first to be reasonably well funded, to increase cigarette taxes, and to pass legislation requiring smoke-free indoor public places. The California program also used a hard hitting media campaign to publicize the harmfulness of tobacco smoke (including to non-smokers), and to encourage smokers to try to quit.

Kentucky provides us with a good example of what happens in a state where the tobacco industry dominates the political agenda – you get very weak tobacco control and very high smoking rates. One thing that stood out was the low smoking rate in Idaho (16.8%). I must say I have no idea why Idaho’s smoking rates are so low, but would be grateful if someone could tell me! The other odd thing I noticed was that despite the fact that men generally smoke more than women, in two states that wasn’t the case. In West Virginia 25.4% of men smoke cigarettes and 26% of women smoke them, and in Montana 18.5% of men smoke as do 19.6% of women. The very high female smoking rate in W.V. may just be a blip in the data, (?) but the Montana difference looks to be related to unusually low male smoking rates in that state. The only other part of the world where the proportion of men who smoke is consistently lower than women is Sweden, and in that case it is because many men have switched from smoking to snuff (smokeless) tobacco. If anyone out there has an explanation for the male/female smoking pattern in Montana and West Virginia I’d be interested to hear it.

If you would like to find out the latest figures for your own state, check them out via this link: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5638a2.htm

Labels: cigarette, cigarette smoking, prevalence

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