Current Trends Smoking Prevalence and Cessation in Selected States, 1981-1983 and 1985 -- The Behavioral Risk Factor Surveys

From 1981-1983, 28 states and the District of Columbia participated in Behavioral Risk Factor Surveys (BRFS) conducted by the Center for Health Promotion and Education of the Centers for Disease Control. The surveys were designed to study risk factors for the 10 leading causes of premature death in this country (1). They included questions on smoking behavior. The Behavioral Risk Factor Surveillance System (BRFSS) began in 1984 as a followup to the BRFS. The purpose of this system is to monitor changes in risk factors by state, over time. The BRFSS operated for the second year in 1985 and included 21 states and the District of Columbia. Thirteen states participated in both the 1981-1983 BRFS and the 1985 BRFSS. Analyses of data from participating states have permitted documentation of changes in smoking behavior between these two time periods.

In both the 1981-1983 BRFS and the 1985 BRFSS, data were collected by telephone from persons greater than or equal to 18 years of age who were selected using random digit dialing techniques (1,2). In these surveys, an "ever smoker" was defined as a respondent who reported smoking greater than or equal to 100 cigarettes in his or her lifetime. A "current smoker" was defined as a respondent who had smoked greater than or equal to 100 cigarettes and who was still smoking. A "former smoker" was defined as a respondent who was not currently smoking, but who reported having smoked greater than or equal to 100 cigarettes during his or her lifetime. The "quit ratio" was defined as the ratio of "former smokers" to "ever smokers". In the 1985 survey, an "attempter" was defined as a current smoker who had quit smoking for greater than or equal to 1 week in the past year. Tables 2 and 3 show the quit ratios and the prevalences of current smokers for both the 1981-1983 BRFS and the 1985 BRFSS. They also show the prevalences of attempters in the states participating in the 1985 BRFSS.

In 1985, women in five states (Connecticut, Florida, Montana, Rhode Island, and Wisconsin) reported current smoking at a rate equal to or greater than the rate reported by men. In all but one state, the percentage of current smokers among men decreased between the period 1981-1983 and 1985. However, these decreases were statistically significant in only three states: Kentucky, North Carolina, and Tennessee. The prevalence of smoking among women declined between the period 1981-1983 and 1985 in nine of the 13 states, but none of these changes in prevalence reached statistical significance. In 10 of the 13 states, the percentage decrease in current smoking among men between the period 1981-1983 and 1985 was greater than the percentage decrease among women.

In 1985, the male quit ratio in every state but two was higher than the female quit ratio. In 11 of the 13 states with data for both survey periods, the male quit ratio was greater in 1985 than for the period 1981-1983; in the remaining two states, the 1985 male quit ratio was less than or equal to the 1981-1983 ratio. In nine of the 13 states, women had a greater quit ratio in 1985 than for the period 1981-1983, and in the remaining four states their quit ratio was less in 1985.

While the quit ratio is a measure of cessation over an extended time period, attempts to quit, which were measured in 1985, indicate recent cessation efforts by current smokers. In 16 of 22 states, the percentage of male attempters was greater than the percentage of female attempters. Reported by R Brooks, Office of Health Education, Arizona Dept of Health Svcs; F Capell, Health Education-Risk Reduction Program, California Dept of Health Svcs; S Benn, Chronic Disease Control Sec, Connecticut State Dept of Health Svcs; R Conn, EdD, Preventive Health Svcs Administration, District of Columbia Dept of Human Svcs; WW Mahoney, Health Promotion Program, Florida Dept of Health and Rehabilitative Svcs; JD Smith, Div of Public Health, Georgia Dept of Human Resources; JV Patterson, Health Education Sec, Bureau of Preventive Medicine, Idaho Dept of Health and Welfare; D Patterson, Div of Education and Information, Illinois Dept of Public Health; S Jain, Div of Health Education, Indiana State Board of Health; K Bramblett, Dept of Health Svcs, Kentucky Cabinet for Human Resources; N Salem, PhD, Minnesota Center for Health Statistics; R Moon, Health Education and Promotion Program, Montana Dept of Health and Environmental Sciences; T Gerber, Bur of Adult and Gerontological Health, New York State Dept of Health; R Staton, Health Promotion Br, Div of Health Svcs, North Carolina Dept of Human Resources; B Lee, Div of Research, Information and Support, North Dakota State Dept of Health; E Capwell, Ohio Dept of Health, Bur of Preventive Medicine; J Cataldo, Div of Health Promotion, Rhode Island Dept of Health; FC Wheeler, Div of Chronic Disease, South Carolina Dept of Health and Environmental Control; J Fortune, Div of Health Promotion, Tennessee Dept of Health and Environment; GV Lindsay, Bur of Health Promotion and Risk Reduction, Div of Community Health Svcs, Utah Dept of Health; R Anderson, Health Education Dept, West Virginia Dept of Health; DR Murray, Wisconsin Center for Health Statistics; Div of Nutrition, Behavioral Epidemiology and Evaluation Br, Div of Health Education, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: Prevention and cessation of smoking will accomplish significant improvements in health status (3,4). While the favorable decreasing trend in smoking prevalence seen in 13 selected states does not necessarily reflect the degree of change in the entire country, it is consistent with the national trend observed since 1965 (5,6).

More men appear to be stopping smoking than women, even though the smoking hazards for both men and women have been widely publicized. The 1980 Surgeon General's report indicated that smoking cessation is more difficult for women than for men (7).

Approximately two-fifths of both men and women smokers reported stopping smoking for greater than or equal to 1 week in the past 12 months. This is over twice the rate (15%) of yearly attempts to quit smoking reported elsewhere (8). Increased cessation efforts may be due to policies against smoking in public places and worksites, growing societal pressure against smoking, increased tobacco costs, increased awareness of health consequences, and greater availability of formal smoking cessation programs (8).

The information reported here shows important, consistent changes in smoking behavior that will provide substantial health benefits to the nation. Four states (Idaho, Montana, Utah, and Wisconsin) have reached the 25% smoking prevalence stated as a goal in the 1990 Objectives for the Nation (2,9). However, even this prevalence will translate into substantial disease risk. The growing emergence of women as the group showing the slowest decline in smoking is disturbing and indicates a need for additional efforts in cessation and prevention of smoking among women. Further analyses of BRFSS data from participating states may identify other groups that need to be targeted by prevention and cessation strategies.

References

1. Marks JS, Hogelin GC, Gentry EM, et al. The behavioral risk factor surveys: I. state-specific prevalence estimates of behavioral risk factors. Am J Prev Med 1985;1:1-8.

2. CDC. Behavioral risk-factor surveillance in selected states--1985. MMWR 1986;35:441-4.

3. Office on Smoking and Health. The health consequences of smoking--cancer: a report of the Surgeon General. Rockville, Maryland: Public Health Service, 1982; DHHS publication no. (PHS) 82-50179.

4. Rosenberg L, Kaufman DW, Helmrich SP, Shapiro S. The risk of myocardial infarction after quitting smoking in men under 55 years of age. N Engl J Med 1985;313:1511-4.

5. National Center for Health Statistics. Health--United States, 1985. Hyattsville, Maryland: Public Health Service, 1985; DHHS publication no. (PHS) 86-1232.

6. Remington PL, Forman MR, Gentry EM, Marks JS, Hogelin GC, Trowbridge FL. Current smoking trends in the United States: the 1981-83 behavioral risk factor surveys. JAMA 1985;253:2975-8.

7. Office on Smoking and Health. The health consequences of smoking for women: a report of the Surgeon General. Rockville, Maryland: Public Health Service, 1980.

8. Health and Public Policy Committee, American College of Physicians. Methods for stopping cigarette smoking. Ann Intern Med 1986;105:281-91.

9. Public Health Service. Promoting health--preventing disease: objectives for the nation. Washington, DC: Public Health Service, 1980.

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