Current Trends Smoking and Health: A National Status Report

When the Comprehensive Smoking Education Act, Public Law 98-474, was signed into law in October 1984, it was the first major smoking and health legislation enacted by the Congress in over 15 years. The law required that all cigarette packages and advertising include four new health warnings and that these warnings be rotated quarterly. These new warnings replaced the single statement that had appeared on packs and in advertising since 1970.

The legislation also required the Department of Health and Human Services to undertake significant new activities, including a biennial report to Congress. On November 20, 1986, the Department issued the first of these reports. "Smoking and Health: A National Status Report" provides significant new information on smoking and health at the national, state, and local levels (1). A summary of key findings is presented below. Smoking Prevalence 1955-1985

By 1985, 21 years after the first report of the Surgeon General's Advisory Committee, smoking prevalence rates in the United States had declined to the lowest level observed in nearly 40 years. Only 30% of all persons greater than or equal to 18 years of age now smoke cigarettes on a regular basis. This figure is down from nearly 45% at the time of the Advisory Committee's report in 1964 (2).

Smoking rates for men have declined more rapidly than smoking rates for women (Figure 1). In the early 1960s, male cigarette-use rates were well above 50%. In 1985, male smoking prevalence had decreased to 33%--probably the lowest rate among men in this country at any time except prior to World War I. From the mid-1960s to 1985, female smoking rates declined from 34% to 28%. However, the gap between male and female smoking is narrowing. When lifetime smoking prevalence is examined by birth cohort, it is clear that, among contemporary age groups, there no longer exists a significant difference between men and women either in initiating smoking or in regular use of cigarettes. Age of Initiation of Regular Cigarette Smoking

Data from the National Health Interview Survey shows a narrowing of the average age of initiation between men and women. Cigarette smoking among men began to increase around the turn of the century, and, by World War I, large numbers of men were smoking cigarettes. Women, however, did not begin to smoke in significant numbers until some 25 years later--just prior to and during World War II.

In more recent birth cohorts, the overwhelming majority of both men and women began smoking as teenagers. For the cohorts born from 1940 to 1949 and from 1950 to 1959, there is little difference in the proportion of men and women who began regular smoking before their 20th birthday (Figure 2). For the cohort born from 1950 to 1959, 88% of male and 84% of female ever smokers had initiated their behavior before age 20. Few adults initiate and adopt the behavior on a regular basis after age 20.

Reports of the Surgeon General and others have consistently noted a strong dose-response effect between smoking initiation at an early age and mortality from all the major smoking-related diseases, including cancer, cardiovascular disease, and chronic obstructive lung disease. The current report also states that the earlier a person begins to smoke as a teenager, the less likely that person is to quit smoking as an adult and the more likely that person is to be a heavy smoker. State Legislation on Smoking and Health

The new report contains a complete review of all state legislation on smoking and health. One of the major findings relates to sales and distribution of cigarettes and other tobacco products to minors. The majority of states (38) have enacted legislation restricting the sale or distribution of tobacco products to minors. However, 12 states have no such laws, and 14 of the states with restrictive legislation have set the minimum age for purchasing tobacco products at less than 18.

The Secretary of Health and Human Services, Dr. Otis Bowen, in his letter transmitting the report to the Congress, strongly urged all jurisdictions to adopt 18 as the minimum age at which any person should be allowed to purchase tobacco products. Concerning laws that impede the sale or availability of tobacco products to minors, Dr. Bowen wrote, "Enactment and enforcement of such legislation could have a strong preventive effect on early uptake of cigarettes and other tobacco products." Reported by Office on Smoking and Health, Center for Health Promotion and Education, CDC.

References

1. CDC. Smoking and health. A national status report. Rockville, Maryland: Public Health Service, 1986; DHHS publication no. (CDC)87-8396.

2. National Center for Health Statistics. Health promotion and disease prevention provisional data from the National Health Interview Survey: United States, January-June, 1985. Advance Data 1986;119:1-14.

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