SPECIAL SECTIONS E Introduction Since 1964, periodic Adult Use of Tobacco Surveys have been conducted to determine usage rates as well as descriptive information on smoking patterns of representative samples of the United States population. Information gathered included history of individual use of any tobacco product as well as attitudes on smoking-related issues. Previous Adult Use of Tobacco Surveys were conducted in 1964, 1966, 1970, and 1975. The most recent survey was conducted in 1986. Since the earlier surveys, Federal and private agencies have exerted considerable effort to educate smokers. This effort has included a number of Surgeon General's reports dealing with the health consequences of smoking. Since the landmark reports of 1964 and 1979, which were comprehen- sive reports on smoking-related diseases, specific reports have been prepared on the evidence linking smoking to can- cer, cardiovascular disease, and chronic obstructive lung disease. The 1986 Adult Use of Tobacco Survey was an opportunity to assess the impact of these reports and the public reaction to them by measuring attitudes towards smoking and the smoking behavior of the population. In recent years, there have been major advances in protecting the rights of the nonsmoker in work settings and in public places. Many of these changes followed the publication of the Surgeon General's 1986 report on involuntary smoking. More recently, the Surgeon General's 1988 report on nicotine ad- diction received broad media coverage and should further atter how people perceive the use of tobacco. Public reaction to these reports in the form of the enactment of nonsmoking legislation, for example, can be measured by the series of Adult UseofTobaccoSurveys. The 1986suweyoffersagood baseline for comparison since information was collected prior to the release of the last two Surgeon General's reports. Further, the impact of the reports can be measured in part by comparing the data from the 1986 survey with data from the surveys conducted in 1964,1966, and 1975. Trend data on smoking prevalence are also available from the National Health Interview Survey (NHIS), an in-person survey conducted by the National Center for Health Statistics every 2 to 3 years during the past quarter century. These data were presented in detail in the 1989 Surgeon General's report, Reducing the Health Consequences of Smoking: 25 Years of Progress. tt should be noted that the prevalence estimates derived from telephone surveys, including the 1970,1975, and 1986Adu#UseofTobaccoSurveys,aregenerallytwoorthree percentage points below those derived from in-person sur- veys, for reasons explained in the 1989 Surgeon General's report. The NHIS data are considered to be the data of highest quality (large sample size, high response rate), although the Adult Use of Tobacco Surveys offer much more comprehensive information related to tobacco use. Survey Description In 1986, a telephone survey of smoking history, attitudes and beliefs was conducted. In this survey, 13,031 members of the civilian, non-institutionalized population of the United States were contacted. A two-stage sampling procedure was used within a computer-assisted telephone interview format. The first stage invofved selecting a random sample of telephone exchanges within the United States. The sampling procedure was balanced for the number of telephones within the ex- change. Clusters of between IO and 15 households within each exchange were contacted using random digit dialing; up to 27 callbacks were made. Households were enumerated and smoking status of members ascertained. A total of 36,405 households were contacted for a response rate of 85.5 percent. In the second stage, a further stratified random sampling procedure was undertaken to provide an approximately equal proportion of respondents in each smoking category (current, former, never). The stratification variable was the number of smokers in the household. Up to 10 callbacks were made to interview the selected respondents for a response rate of 86.9 percent. The overall response rate from the two procedures was 74.3 percent, representing the product of the response rate of each. Quality control procedures in the survey involved 26 hours of survey-specific training and practice for interviewers and silent monitoring of ten percent of all interviews by supervisory staff. Data obtained were weighted to reflect the United States population in two stages. First, a base weight was calculated that was the product of weighting for cluster (completed screeners within cluster), household (telephone numbers within household) and person (to account for selection based on smoking status). Second, post-stratification weighting was done for region, education, race, sex, and age. Cigarette Smoking Status and Quit Ratios Table 1 presents the data on cigarette smoking status from the 1986 Adult Use of Tobacco Survey. All percentages in this table are weighted to the total population as indicated above. To obtain population numbers for any subgroup from this table, the population estimate for the subgroup is multi- plied by the proportion of the group that smokes. The quit ratio (Pierce et al., 1986) is the statistic which indicates the propor- tion of ever smokers who have become former smokers. lt is derived by dividing the number of former smokers in the population by the number who have ever smoked at least one hundred cigarettes in their lives. According to this survey, 26.5 percent of Americans of 17 years of age and older smoke cigarettes. Those who have never had a cigarette constitute 48.9 percent and those who 1986 ADULT USE OF TOBACCO SURVEY 15 have been smokers but have quit constitute 24.6 percent. Of those who have ever smoked, 48.1 percent are now former smokers (quit ratio). Among the male adult population, 29.5 percent are current smokers, 40.0 percent are never smokers and 30.4 percent are former smokers; the quit ratio is 50.8 percent. Among the female adult population, 23.8 percent are current smokers, 56.9 percent never smoked and 19.3 percent are former smokers: the quit ratio is 44.8 percent. There is an increase from 18.9 percent to 32.8 percent in smoking prevalence with increases in age from the 17 to 19 age group up to the 35 to 44 year olds. Prevalence declines to 13.9 percent for those 65 years of age and okfer. The quit ratio increases directly with age, from 22.3 percent for the 17 to 19 year olds to 70.4 percent for the 65 years of age and older group. The proportion of the white population currently smoking is 26.4 percent; the proportion of the black population currently smoking is 28.4 percent. Among whites who have ever smoked, 49.3 percent have stopped and among blacks who have ever smoked, 38.8 percent have stopped. The Western region has the lowest smoking prevalence, 24.5 percent, and the highest quit ratio, 51.7 percent. The Southeast region has the highest smoking prevalence, 28.2 percent, and shares the lowest quit ratio, 45.9 percent, with the Midwest. Among the different marital status groups, the divorced or separated group has the highest smoking prevalence, 38.2 percent. The widowed group, however, has the highest quit ratio, 58.9 percent. Smoking prevalence declines with increasing number of years of education, For those with 11 or fewer years of education, the prevalence is 31.4 percent; the proportion of smokers among those who have 16 years or more of education is 16.3 percent. The quit ratio increases from 44.1 percent for the less educated group to 63.5 percent for the more educated group. The same pattern is observed for income. Smoking prevalence falls from 28.9 percent for those with a household income of $10,000 or less, to 21.8 percent for those with a household income of more than $40,000. The quit ratio in- creases with each income category, from 41.5 percent to 58.8 percent. The smoking prevalence is 30.0 percent for those who fall below the poverty level and 27.3 percent for those who are above the poverty level; the quit ratio is 39.1 percent and 48.5 percent, respectively. Total Tobacco Use Status Cigarettes are the major type, but not the only type of tobacco, used by the population. People also smoke cigars and pipes and use chewing tobacco and snuff. Accordingly, it is important to review total tobacco use in the population. Table 2 presents the data on tobacco use, including quit ratios, by so&demographic variables. Among the adult male population, 37.9 percent are current users of some form of tobacco, 35.1 percent areformer users, and 27.0 percent have never been users; the quit ratio is 48.1 percent. Among the adult female population, 24.4 percent are current users of some form of tobacco, 20.9 percent areformer us8rs, and 54.7 percent have n8v8r b88n users; the quit ratio iS 46.1 percent. A comparison of Table 1 and Table 2 shows that the use of tobacco Other than cigarettes is predominantly a male phenomenon. There is a continual increase in prevalence of tobacco use as age increases, from 22.2 percent in the 17 to 19 years of age group, to 36.4 percent in the 35 to 44 years of age group. The prevalence deCr8aSeS significantly to 19.5 percent for those 65 years of age and older. The quit ratio increases with age, from 35.3 percent for those 17 to 19 years old to 63.9 percent for thOS8 65 years of age and older. The survey shows that th8 prevalence of tobacco us8 decreases with increasing years of education. It ranges from 37.1 percent for those with 11 or fewer years of education, to 21.3 percent for those who haV8 completed college and have 16 years or more of education. The quit ratio increases from 41.3 percent forthose with some high school education to 61.4 percent for those with a college degree. Among the marital status groups, those in the divorced or Separated category have th8 highest overall tobacco us8 at 41.6 percent. The widowed category hasthe highest quit ratio of 54.1 percent. In the household income category, those with an annual income of between $20,000 and $29,999 have the highest tobacco us8 prevalence at 36.4 percent. Those with an annual income of $40,000 or more have the highest quit ratio at 57.2 percent. Tobacco Use: Cigar/Pipe and Smokeless Status As shown in Table 3, currently 4.3 percent of the United States adult population smoke cigars or pipes and 2.7 percent us8 smokeless tobacco. As indicated earlier, use of these types of tobacco occurs mainly in males, 8.7 percent of whom smoke cigars or pipes and 5.2 percent of whom us8 smokeless tobacco. Usage of cigars and pipes increases with age, up to 6.7 percent in the 45 to 54 years of age group and Starts declining thereafter. Female usage is less than one percent. The opposite phenomenon is observed among the current us8rs of smok8l8ss tobacco. Smokeless tobacco us8 declines with age. up to th8 45 to 54 year okfs. Almost the same proportion of whites and blacks, 2.8 percent and 2.3 percent, respectively, us8 smokel8ss tobacco. Currently, 4.4 percent of whites and 3.7 percent of blacks are smoking cigars or pipes. There is no marked variation among regions for cigar and pipe US8. The Southeast, hOWeVer, has a higher pr8Val8nCe Of 16 smok8less tobacco us8, 4.2 percent, fOllOWed by the West with 2.3 percent. The populations with 11 or fewer years of education and with 16 or more years of 8dUCatiOn haV8 th8 highest prevalence of cigar and pipe smoking, 4.9 percent and 5.3 percent, respec- tively. The us8 of smokeless tobacco, however, declines from 4.5 percent to 1.6 percent as 8dUCatiOn increases. There is a pattern of increasing prevalence of cigar and pip8 us8 from 3.1 percent to 5.5 percent as household income increases. The opposite is true for the us8 of smok8l8ss tobacco: 4.1 percent for those with hous8hoM incomes of less than $10,000; 2.1 percent for those with household incomes of $40,000 or more. Of those above the poverty level, 4.7 percent smoke cigars or pipes and of thOS8 below the poverty level, 3.0 percent smoke cigars or pipes. For smok8less tobacco, the figures are reversed: 2.5 percent for those above the poverty level and 4.3 percent for those below the poverty level. Tobacco Use: Status of Different Combinations Table 4 shows the different combinations of tobacco us8. The proportion of the United States adult population that currently SmOk8S cigarettes, but does not us8 other forms of tobacco, is 24.3 percent, while another23 percent also us8 other forms of tobacco. Former cigarette smokers who do not us8 any Other form of tobacco represent 22.6 percent. Another 1.9 percent of the United States population are former cigarette smokers Who Currently use 8ith8r smok8less tobacco (9.9 percent) or cigars or pipes (1 .O percent). The proportion of the population that has nev8r smoked cigarettes nor used any Other tobacco is 46.5 percent. Another 1.1 percent, although they have never smoked cigarettes, currently us8 smokeless tobacco and 1.3 percent smoke cigars or pipes. Changes in Smoking and Tobacco Use Since 1975 Tables 5 and 6 present the cigarette smoking and tobacco us8 data from the 1975 Adult Use of Tobacco Survey. Comparison of the data from the 1975 survey with data from the 1986 survey shows that more aduft males smoked in 1975, 40.5 percent, than in 1986,29.5 percent. Smoking prevalence for adult females was also higher in 1975 at 31.4 percent compared to 23.8 percent in 1986. Smoking prevalence increased with age, peaking in the 35 to 44 years of age group, after which it decreased. In 1975, smoking prevalence increased from 38.2 percent in 21 to 24 year olds to 43.6 percent in 35 to 44 year old% then decreased to 17.4 percent for thOS8 65 years of age and older. A similar pattern existed in the 1986 data; however, the whole cUw8 was lower. In 1986, smoking prevalence increased from 18.9 percent in the 17 to 19 year oMs (a younger age group than surveyed in 1975), peaked at 32.8 percent in the 3510 44years of age group, then decreased to 13.9 percent for those 65 years of age and older. The quit ratio increases continually according to both the 1975 and the 1986 surveys, although it is at a higher overall level in 1986. In 1975, the quit ratio increased from 28.1 percent in the yOUng8St age group to 57.9 percent in the oldest age group. The pattern is similar in 1986. The quit ratio increased from 22.3 percent in the youngest age group to 70.4 percent in the Oldest age group. Within the education category, smoking prevalence in 1986 decreased as edu,@on level increased. Those with 11 or fewer years of education had a smoking prevalence of 31.4 percent while those with 16 or more years of education had a smoking prevalence of 16.3 percent. In 1975, however, the smoking preVal8tIC8 increased from 35.2 perCent for those with some high school education to 40.2 percent forthose with a high school education and decreased for those with a college education. Overall, smoking prevalence has decreased considerably from 1975 to 1986 for those with 16 or more years of education from 27.6 percent in 1975 to 16.3 percent in 1986. The quit ratio by education is totally different for each year surveyed. In 1986, it continued to increase from 44.1 percent for those with 11 or fewer years of education to 63.5 percent for those with 16 or more years. In 1975, however, th8 quit ratio was 38.8 percent for those with less than 12 years of 8dUCatiOn. It then increased for those with some college, 41 .l percent, to a high of 51.2 percent for thOS8 with a college degree. Describing Smoking Patterns The health consequences of smoking are related to the d8- gree of exposure that a person has to tobacco smoke (Sur- geon General's reports 1964-l 986). The most commonly used index of exposure is the number of cigarettes smoked per day. t-iowever, the accuracy of this index as a measure of exposure has been questioned. Biochemical studies havefound that the correlation between the number of cigarettes smoked per day and the biochemical markers of use, cotinine, th'kJCyanat8, and carbon monoxide, is not high. A related index of exposur8 iS the "strength" of the cigarette smoked. Three categories of this exposure variable, selected to give approximately equal distributions of the population, are reported in Table 7. The Federal Trade Commission has established a standard procedure for measuring the relative strengths of different cigarettes by assessing the amount of tar and nicotine that each delivers When smoked by a machine in a standard manner. The level of tar and the level of nicotine delivered by different cigarettes according to the standard measurement method are highly correlated and it is sufficient to report only one. Three categories of cigarette tar level, also selected t0 provide reasonably 8qUal distributions, are reported in this Table. The Table also provides information on the percentage of each groupthat smokes menthol Cigarett8S. Menthol, which has some local anesthetic properties, may enable a smoker to haV8 a stronger inhalation technique and, 17 therefore, to Obtain a larger dose Of tobacco SmOk8 con- stituents per cigarette. The proportion of current SmOk8rS who smoke 15 or fewer cigarettes per day ("light" smokers) is 35 percent. An equal proportion, 34.9 percent, smoke 16 to 24 cigarettes per day and 30.1 percent SmOk8 25 or more cigarettes per day ("heavy smokers"). The proportion of those smoking 15 or fewer cigarettes among male current smokers is 29.8 percent and among females it is 40.7 percent. There are 36.2 percent male and 23.4 percent female current smokers who are heavy SmOk8rS, smoking 25 or more cigarettes per day. Among 17 to 19 year olds, more smokers, 53.8 percent, tend to smoke 15 cigarettes or fewer per day. This proportion of light smokers decreases with increasing age up to the 55 to 64 years of age group at 29.8 percent. In the oldest age category, those 65 years of age and oMer, the proportion of light smokers was 42.1 percent. However, this change may be a result of differential mortality in heavier smokers rather than a change in cigarette smoking pattern. The proportion of heavy smokers increases with age, from 12.1 percent of the 17 to 19 year olds, to 38.5 percent of the 45 to 54 year olds. Then it falls to 21.3 percent for those 65 years of age and oM8r. Among whit8 smokers 31.2 percent are light smokers and 33.1 percent are heavy smokers. Among blacks, however, the majority, 61.3 percent, are light SmOk8rS and 11.4 percent are heavy smokers. The region with the highest proportion of light smokers, 39.1 percent, and the lowest proportion of heavy smokers, 28.8 percent. is the Western region. The Midwest has the lowest proportion of light smokers, 31.7 percent, and the highest proportion of heavy smokers, 33.3 perCent. The difference in the number of cigarettes smoked per day by education level is only minor. Of those with 16 years or more of education, 39.1 percent smoked 15 or fewer cigarettes per day and of those with 11 or fewer years of education, 33.5 percent smoked 15 or fewer cigarettes per day. Only 28.1 percent Of th8 more 8dUCat8d and 30.0 percent Of the l8SS educated smoked 25 or more cigarettes per day. The majority of smokers, 58.8 percent, smoke cigarettes with a tar level of more than 15 mg/per cigarette. This is true for both males, 65.2 percent, and females, 51.7 percent, and for each age group. Among whit8 smokers, 31.8 percent smoke "low-tar" cigarettes, with a tar level of less than or equal to 10 mg/per cigarette, and 55.9 percent smoke "high-taPcigarettes with more than 15 mg/per cigarette. However, among black smokers, 14.5 percent smoke low-tar cigarettes, and the majority, 78.0 percent, smoke cigarettes with a high-tar yield. The Midwest region has the highest proportion of smokers of high-tar cigarettes, 84.3 percent, and the Northeast has the lowest proportion, 50.6 percent. High-tar cigarettes are smoked by 50.4 percent of the more educated SmOk8rS and 64.8 percent of the less educated smokers. Overall, 29.2 percent of current smokers, 24.9 percent of males and 34.0 percent of females, us8 menthol cigarettes. Noticeably, 75.5 percent of black SmOk8rS use menthol cigarettes, compared to 23.1 percent of whites. The SOUth8aSt region has th8 highest proportion, 31.2 percent, of m8nthOl cigarette users while the West has the lowest proportion. 24.5 percent. Of Smokers who fail below th8 poverty level, 38.6 percent Smoke menthol cigarettes, a higher percentage than the 27.7 percent above the poverty level who smoke menthol cigarettes. In general, the proportion that smokes menthol cigarettes in any particular subpopulation will reflect the distribution of blacks in that population. The Smoking Patterns of Former Smokers Smoking patterns, i.e., the amount and type of tobacco us8 of former smokers, are only important if they are different from those of current smokers. If, for example, heavy SmOk8rS predominated among current smokers and light smokers predominated among former smokers, there would be con- cern that there might be a large group of "hard-core" smokers resistant to change. Therefore, th8 smoking prevalence might start to level off. Table 8 presents data for those who have quit in the last 5 years. In this group of former smokers, 38.2 percent smoked 15 or fewer cigarettes per day, 29.6 percent smoked 16 to 24 cigarettes per day, and 32.2 percent smoked 25 or more cigarettes per day. Among these former smokers, 31.2 per- cent of males and 46.6 percent of females were light Smokers, but 39.2 percent of males and 23.7 percent of females were heavy smokers. The proportion that used to be heavy smokers increased in each age group to 30.8 percent of 25 to 44 year olds and 45.1 percent of the 45 to 64 year olds, but it was lower, 27.8 percent, among those 65 years of age and Older. Among whit8 smokers, 36.1 percent used to be light smokers and 34.2 percent used to be heavy Smokers. Among black smokers, these proportions were 57.0 percent and 12.1 percent, respectively. Among former smokers, 42.1 percent of those with 16 or more years of education used to smoke 15 or fewer cigarettes as opposed to 36.0 percent of those with 11 or fewer years of education. Of the more educated former SmOk8rS, 25.5 per- cent used to be heavy SmOk8rS, and 35.2 percent of the less educated former smokers w8r8 heavy SmOk8rS. Overall, 57.6 percent of former smokers used to smoke high-tar cigarettes, 60.5 percent of males and 54.1 percent of females. For all groups, the proportion of former smokers who used to Smoke high-tar cigarettes is higher than the proportion who used to smoke cigarettes with lower tar content. Low-tar cigarettes, less than or equal to 10 mg, w8r8 used by 33.4percent of white former smokers and 15.5 percent of black former smokers. Also, 55.3 percent of white former smokers used to smoke high-tar cigarettes compared to 77.2 percent of black former smokers. Menthol cigarettes were used by 30.3 percent of former smokers, 23.6 percent of males and 38.3 percent of females. Again, menthol usage is mainly a black phenomenon with 72.4 percent of black former smokers who used to Smoke menthol cigarettes compared to 25.9 percent of whit8 former smokers. The overall conclusion is that there are not substantial dif- ferences between former SmOk8rS and current smokers in their pattern of smoking. This lack of diff8renCe suggests that 18 the patterns of smoking examined here (daily cigarette con- sumption, tar yield, mentholation) might not be associated with smokers' ability to quit. Attempts to Quit Smoking Among Current Smokers Knowledge of changes in current smoking status is not ex- clusive in predicting what is likely to happen over the next several years with respect to smoking prevalence. Also relevant is the proportion of smokers who have made quit attempts. Table 9 presents these data for different subgroups of the population. More than one-third, 35.5 percent, of current smokers have never tried to quit; 36.7 percent of male and 34.2 percent of female smokers. Another 37.3 percent of all smokers made one to two attempts, 18.9 percent made three to five attempts, and 8.3 percent attempted to quit six or more times. By age, 47.2 percent of the youngest age group, 17 to 19 year olds, have never tried to stop, 32.2 percent of the 35 to 44 year age group and 37.0 percent of the 65 years of age and older group have never tried to stop. The proportion of those who did not try to quit is similar for whites and blacks, 35.6 percent and 34.3 percent, respectively. 01 those who have not completed high school, 37.1 percent have never made an attempt to quit, while of those with a college degree or more, 32.5 percent have not tried to quit. As shown in Table 10, among current smokers in 1975, 37.6 percent had never attempted to quit: 35.4 percent of males and 40.4 percent of females. Another 37percent of all smokers made one to two attempts, 18.1 percent made three to five attempts, and 7.3 percent made six or more attempts to quit. In the 21 to 24 years of age group in 1975,37.8 percent had never attempted to quit, a contrast to 42.5 percent of the 20 to 24 years of age group in 1986. Among the older groups, however, more people made no attempt to quit in 1975,40.4 percent for the 55 to 64 years of age group and 44.9 percent for the 65 years of age and older group. In 1986, those figures had dropped to 35.8 percent and 37.0 percent, respectively. In 1975, among those who had not completed high school, 36.4 percent had never tried to stop, while among those with a college degree or more, 33.3 percent had made no attempt to quit. In the different marital status categories, the widowed had the highest proportion of those who had never tried to quit, 48.7 percent. This proportion does not vary substantially for the different income groups, from 38.1 percent among those earning less than $10,000 to 36.1 percent among those with an income of $20,000 or more. Comparing the 1975 data to the 1986 data on the number of attempts to quit, there are very few differences of any mag- nitude among any subgroups of the population. There are two possible interpretations of this lack of change. Either the process of changing smoking patterns is consistent over time or the way in which quit attempts are recalled does not truly reflect quitting behavior. Given the consistent pattern of decrease in smoking prevalence over time, the first interpretation seems likely. Quit Attempts of Former Smokers The number of former smokers who succeed on either the first or the second quit attempt is a measure of the success rate of quit attempts in the community. These data are presented for 1986 in Table 11. The majority of former smokers, 70.2 percent, have madoone to two attempts before quitting, 21.2 percent tried three to fiie times, and 8.6 percent tried six or more times. The same pattern holds true for male former smokers, 68.9 percent of whom tried one to two times, and female former smokers, 72.2 percent of whom made one to two attempts. White former smokers who made one to two attempts were 70.3 percent, and black former smokers, 68.6 percent. Table 12 shows that in 1975, the majority of former smokers, 59.0 percent, made one to two attempts before quitting, 24.8 percent tried three to five times and 16.2 percent tried six or more times. The same pattern holds for males, 56.9 percent of whom tried one to two times, and females, 62.9 percent of whom tried one to two times. The major difference between 1975 and 1986 is that a greater proportion of former smokers indicated that they were suc- cessful on their first or second attempt to quit in 1986 (70.2 percent) than in 1975 (59.0 percent). Age of Initiation of Smoking Age of initiation of smoking is another important variable predicting what will happen to smoking prevalence. Initiation of smoking by adolescents is influenced by social mores. Table 13 shows that almost half of current smokers, 46.7 percent, started when they were younger than 18 years of age. By the age of 20, 78.3 percent had initiated smoking. Among males currently smoking, 51.7percent started before 18years of age and 83.9 percent started before their 21st birthday. Among female current smokers, however, these figures are 41.0 percent and 72.0 percent, respectively, indicating that females have traditionally started smoking at older ages. Among the 25 to 44 years of age group, 20.2 percent started smoking regularly after the age of 20 years, among the 45 to 64 years of age group, 29.2 percent had done so, and among those 65 years of age and older, the proportion is44.3 percent. Thus, the age of initiation of smoking has remained an adoles- cent phenomenon and has decreased over time. Among white smokers, 49.1 percent started before 18 years of age, 79.9 percent before 21 years of age. However, among blacks, 31 .O percent had started before they reached the age of 18 years and 68.2 percent before the age of 21 years. Thus, black smokers tend to start smoking at okfer ages than white smokers. 19 People with 16 years or more of education tend to start later in life compared to those with less education; 28.1 percent had started before the age of 18 years, 69.1 percent before the age of 21 years and 30.9 percent after the age of 20 years. For those with 11 or fewer years of education, these propor- tions are 59.3 percent, 83.3 percent and 16.7 percent, respec- tively. Age of initiation among former smokers is important if it is different from that of current smokers. Age of initiation might predict the strength of addiction and the difficulty in quitting. Again, this might indicatethat current smokers may have more difficufty quitting than former smokers. Table 14 shows that among former smokers, 41.3 percent started smoking before 18 years of age and 76.1 percent before 21 years of age. Among male former smokers, 46.0 percent initiated smoking before 18 years of age and 81.2 percent had done so before 21 years of age. However, the respective figures for female former smokers are 34.6 percent and 68.8 percent. Only 18.8 percent of male former smokers started smoking regularly after the age of 20 years, white 31.2 percent of the female former smokers did so. The proportion of former smokers that started after they were 20 years of age differs within the different age groups; 16.1 percent of the 25 to 44 years of age group, 26.1 percent of the 45 to 64 years of age group and 41.2 percent of those 65 years of age and older. In summary, slightly higher proportions of current smokers began to smoke before the age of 18 years compared to former smokers. This pattern is in accord with the hypothesis that the lower the age of initiation, the greater is the difficulty of quitting. Among former white smokers, 42.0 percent started before the age of 18 years and 76.9 percent before the age of 21 years. Among black former smokers, however, 34.9 percent started smoking regularly before 18 years of age and 68.7 percent had started before 21 years of age. Among those with 11 or fewer years of education, 26.7 percent started smoking after the age of 20 years. The proportion for those who have 16 years or more of education is 24.0 percent. Further Information This summary of the 1986 Adult Use of Tobacco Survey provides only some of the basic information relating to smok- ing behavior. More detailed information on the survey, includ- ing detailed analyses of smoking behavior in subgroups defined by more than one variable, and an outline of how people in the major so&demographic categories responded to each question, will be available from the Office on Smoking and HeaRh before the end of 1988. Further, afully documented public access computer tape will also be available before the end of 1988. 20 Table 1 Cigarette Smoking Status and Quit Ratios by Soclo Demographlc Variables 1966 Total (Age 17+ years) SEX Male Female AGE (1 st grouping) 17-19 20-24 25-34 35-44 45-54 55-64 65+ AGE (2nd grouping) 17 1 a-24 25-44 45-64 65+ RACE White Black Other REGION Midwest Northeast Southeast west MARITAL STATUS MarrfedXohabitating Widowed Divorced/Separated Never Married Unknown EDUCATION 11 or Fewer Years 12 Years 13-15 Years 16+ Years HOUSEHOLD INCOME $10,000 or Less $lO.OOO-$19,999 $20.000-$29.999 $30,000~$39,999 $40.000+ Unknown EMPLOYMENT Administrator/Manager ProfessionaVTechnicaI SalesIClericsl Craftsman Operative Laborer/Service Never in Labor Force Occuwtion Not Reported POVERTY LEVEL"' ' Above Below Unknown Smoking status (%) Current Former 26.5 24.6 29.5 30.4 23.8 19.3 18.9 5.4 25.0 10.2 31.4 19.8 32.8 26.0 29.3 31.6 26.0 36.0 13.9 33.2 15.9 3.6 24.1 9.4 32.0 22.5 27.7 33.8 13.9 33.2 26.4 25.7 28.4 i 8.0 24.5 19.1 Quit Est. ooo. Sample Never ratio" (mil.) 48.9 0.481 176.5 40.0 0.508 83.9 56.9 0.448 92.6 75.7 0.223 ' 10.7 size 13,031 6,377 6,654 64.7 0.290 48.8 0.387 41.2 0.442 39.1 0.519 38.0 0.560 52.8 0.704 80.5 0.186 66.6 0.280 45.4 0.413 38.5 0.550 52.8 0.704 48.0 0.493 53.6 0.388 56.4 0.439 20.0 41.2 32.2 22.6 22.3 27.4 560 1,086 3,010 2,792 i ,825 1,791 1.967 4.4 193 26.4 1,453 73.4 5,802 44.9 3,616 27.4 1,967 151.4 11,563 19.4 1,096 5.7 372 26.6 25.5 28.2 24.5 22.6 26.8 23.9 26.2 50.8 0.459 43.7 3,236 47.7 0.513 37.1 2,968 47.9 0.459 61.9 4.301 49.3 0.517 33.8 2,526 26.9 28.5 44.6 0.515 113.8 8,364 18.0 25.8 56.3 0.589 12.4 1.011 38.2 23.9 37.9 0.384 14.9 1.446 23.4 ii.8 64.8 0.335 35.1 2,179 33.5 37.1 29.4 0.526 0.4 31 31.4 24.8 28.9 24.0 24.4 22.2 16.3 28.4 46.3 2,431 66.9 4,872 32.8 3.118 30.5 2,610 28.9 20.5 28.7 23.0 31.4 22.8 28.0 24.9 21.8 31.2 21.4 23.1 43.8 0.441 47.2 0.454 53.4 0.476 55.2 0.635 50.6 0.415 48.3 0.445 45.8 0.420 47.1 0.470 47.0 0.588 55.5 0.519 17.9 1,220 31.4 2,204 37.7 2.853 22.5 1,735 36.0 2,947 31.1 2,072 22.6 33.0 44.4 0.593 16.0 t ,438 17.1 26.3 56.6 0.605 27.5 2,240 25.7 23.4 50.9 0.476 43.3 3,290 34.8 32.6 32.6 0.483 22.7 1,725 32.6 24.0 43.3 0.424 18.8 1,286 30.2 20.8 49.0 0.408 28.7 i ,873 20.9 9.2 69.9 0.307 11.9 597 28.4 24.4 47.2 0.463 7.5 582 27.3 25.7 47.0 0.485 128.4 9,913 30.0 19.3 50.7 0.391 17.0 1,046 21.4 23.1 55.5 0.519 31.1 2,072 o Smoking status totals to 100%. o * The Quit ratio is the number of former smokers divided by the number of people who have ever smoked. *** Poverty Level is based on the definition provided by the U.S. Bureau of the Census. See text for exact procedures. 21 Table 2 Tobacco Use: Status and Quit Ratlos by Soclo Demographic Variables 1986 Total (Age 17+ years) 30.8 27.7 41.5 0.473 176.5 13,031 Sf3 Male Female 37.9 35.1 27.0 0.401 63.9 6,377 24.4 20.9 54.7 0.461 92.6 6,654 AGE (1 st grouping) 17-19 20-24 25-34 35-44 45-54 55-64 65+ AG;7Wd CPQW 18-24 25-44 45-64 65+ RACE White Wade Other REGION Mdwest Northeast Southeast west MARITAL STATUS Marrtsd/Cohabitatfng Widowed Divorced/Separated Never Married Unknown EDUCATION 11 cr Fewer Years 12 Years 13-15 Years 16+ Years HOUSEHOLD INCOME $10,000 or Less $10,000-$19,999 $20,000-$29,999 $30.000939999 S40.000+ Unknown EMPLOYMENT Administrstor/Manager ProfsssionaKTechnicaf sales/clerical -. Craftsman Operative Laborer/Setvice Never in Labor Force Occupation Not Reported POVERTY LEVEL"' Above Below Unknown Tobacco use status 1%) Quit Est. pop. Sample Current Former Never ratio" (mil.) size 22.2 12.1 65.7 0.353 28.1 16.8 55.2 0.374 34.8 24.0 41.2 0.408 36.4 29.1 34.5 0.445 35.1 32.1 32.8 0.477 31.8 36.9 31.3 0.537 19.5 34.4 46.2 0.639 10.7 20.0 41.2 32.2 22.6 22.3 27.4 560 1,086 3,010 2,792 1,825 1,791 1,967 19.1 10.8 70.2 0.360 4.4 193 27.2 15.9 57.0 0.369 26.4 1,453 35.5 26.2 38.3 0.425 73.4 5,802 33.5 34.5 32.0 0.507 44.9 3,616 19.5 34.4 46.2 0.639 27.4 1,967 30.8 28.6 40.5 0.482 151.4 11.563 32.3 21.5 46.2 0.399 19.4 1,096 26.2 22.8 50.9 0.465 5.7 372 30.6 26.3 43.1 29.6 28.7 41.7 33.2 26.9 39.9 28.2 29.7 42.1 0.462 0.492 0.448 0.513 43.7 3,236 37.1 2,968 61.9 4,301 33.8 2,526 31.5 30.9 37.6 22.1 26.1 51.8 41.6 26.9 .`31.5 27.2 17.9 54.9 38.0 32.6 29.4 0.496 0.541 0.393 113.8 12.4 14.9 0.397 0.461 35.1 0.4 8,364 1,011 1,446 2,179 31 37.1 26.1 36.7 0.413 46.3 2,431 32.3 26.2 41.5 0.448 66.9 4,872 27.8 26.9 45.3 0.492 32.8 3.118 21.3 33.9 44.8 0.614 30.5 2,610 33.3 23.6 43.2 0.415 32.9 24.8 42.2 0.430 35.4 25.9 38.7 0.423 32.0 27.9 40.1 0.466 26.8 35.9 37.2 0.572 25.6 25.2 49.2 0.497 17.9 31.4 37.7 22.5 36.0 31.1 1,220 2,204 2.853 1,735 2,947 2,072 28.0 37.6 20.7 30.7 27.4 25.4 42.9 33.9 39.4 26.8 34.3 23.2 23.3 16.5 34.2 26.2 34.4 48.6 47.1 23.2 iit 6012 39.5 0.574 0.597 0.481 0.441 0.404 0.404 0.415 0.434 16.0 27.5 43.3 22.7 18.8 28.7 11.9 7.5 1.438 2,240 3,290 1,725 1,286 i ,873 597 582 31.6 28.9 39.6 0.477 34.0 23.1 42.2 0.399 25.6 25.2 49.2 0.497 128.4 17.0 31.1 9,913 1,046 2.072 o Tobacco use stahrs totsls to 100%. .* The &it ratio is the number of former smokers divided by the number of people who have ever smoked. . . . Poverty Level Is bssed on the definition provided by the U.S. Bureau of the Census. See text for exact procedurss. 22 Table 3 Tobacco Use: Cigar/Pipe and Smokeless Tobacco Use Status by Socio DemoaraDhic Variables Total (Age 17+ years) SEX Male Female AGE (1 st grouping) 17-19 20-24 25-34 35-44 45-54 55-64 65+ AGE (2nd grouping) 17 18-24 25-44 45-64 65+ RACE White Black Other REGION Midwest Northeast Southeast Kest MARITAL STATUS MarriedCohabitating Widowed Divorced/Separated Never Married Unknown EDUCATION 11 or Fewer Years 12Years 13-15 Years 16+ Years HOUSEHOLD INCOME Less than $10,000 $10,000-$19,999 $20,000-$29,999 $30,000-$39.999 $40.000+ Unknown EMPLOYMENT Administrator/Manager Professional/Technical Sales/Clerical Craftsman Operative Laborer/Service Never in Labor Force Occupation Not Reported POVERTY LEVEL' Above Below Unknown Cigar/pipe smoking Smokeless tobacco use status (%) status (%) Current Former Never Total Current Former Never Total 4.3 22.2 73.5 8.7 41.8 49.6 0.3 4.5 95.2 1.5 13.6 85.0 2.0 16.6 81.4 4.0 19.1 76.9 5.0 26.2 68.8 6.7 25.2 68.1 5.1 27.9 67.0 3.9 22.6 73.5 0.8 13.0 86.2 2.0 16.0 82.0 4.4 22.2 73.3 5.9 26.5 67.6 3.9 22.6 73.5 4.4 23.4 72.2 3.7 13.9 82.4 3.5 19.4 77.1 4.8 22.6 72.6 4.6 19.6 75.7 3.8 23.2 73.0 4.1 22.7 73.2 4.8 25.3 69.9 1.8 8.9 89.2 5.6 20.1 74.3 2.8 17.7 79.4 2.4 27.5 60.1 4.9 22.8 72.3 3.6 20.0 76.5 3.9 22.5 73.6 5.3 26.0 68.7 3.1 4.0 :.z 515 3.3 16.8 80.1 21.2 74.9 23.1 72.6 24.2 70.8 28.1 66.4 17.1 79.6 6.0 30.0 63.9 3.5 21.3 75.2 2.2 13.9 83.8 8.2 41.0 50.7 6.5 27.8 65.7 3.5 17.7 78.7 1.6 10.1 88.3 4.4 22.2 73.4 4.7 23.9 71.4 3.0 18.6 78.3 3.3 17.1 79.6 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 2.7 3.9 93.4 5.2 7.4 87.4 0.5 0.8 98.7 4.1 f :: Z 3.1 3.0 6.1 89.8 5.0 92.1 3.3 94.3 2.9 94.9 3.9 93.6 4.1 92.8 4.2 92.8 4.0 4.0 92.0 3.2 5.6 91.1 2.3 3.1 94.5 2.8 4.0 93.2 3.0 4.2 92.8 2.8 3.9 93.3 2.3 3.9 93.7 1.8 3.7 94.5 2.1 3.5 94.4 1.4 2.0 96.5 4.2 5.0 90.8 2.3 4.4 93.2 2.7 3.2 El 1.4 4.0 93.3 2.4 94.4 4.3 93.5 4.0 93.2 1.4 87.2 4.5 2.4 1.9 1.6 S*f 3:7 1.7 89.7 93.8 94.5 96.7 4.1 3.0 z 2:1 2.7 5.4 4.7 4.1 4.0 3.0 3.0 90.5 92.3 93.3 93.4 94.9 94.3 1.6 1.1 0.7 6.4 4.6 3.4 2.5 4.8 2.2 1.8 2.0 9.3 5.6 d:i 4.1 96.2 97.1 97.3 84.2 89.8 92.3 93.5 91.1 2.5 3.8 93.7 4.3 6.2 89.5 2.7 3.0 94.3 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 Est. pop. Sample (mil.). size 176.5 13,031 83.9 6,377 92.6 6,654 10.7 560 20.0 1.086 41.2 3,010 32.2 2,792 22.6 1,825 22.3 1,791 27.4 1,967 4.4 193 26.4 1,453 73.4 5.802 44.9 3,616 27.4 1,967 151.4 11,563 19.4 1,096 5.7 372 43.7 3,236 37.1 2,968 61.9 4.301 33.8 2,526 113.8 8,364 12.4 1,011 14.9 1,446 35.1 2,179 0.4 31 46.3 2,431 66.9 4,872 32.8 3,118 30.5 2,610 17.9 1,220 31.4 2,204 37.7 2,853 22.5 1,735 36.0 2,947 31.1 2,072 16.0 1,438 27.5 2,240 43.3 3.290 22.7 1,725 18.8 1,286 28.7 1,873 11.9 597 7.5 582 128.4 9,913 17.0 1,046 31.1 2,072 o Poverty level is based on the definition provided by the U.S. Bureau of the Census. See text for exact procedures. 23 Table 4 Tobacco Use: Status of Different Comblnations by Soclo Demographlc Variables i 986 Current Cigarettes Former Cigarettes Never Cigarettes No other Plus other Total (Age 17+ years) 24.3 2.3 22.6 0.9 1.0 46.5 1.1 1.3 SEX Male Female 24.9 4.6 26.4 1.9 2.2 35.8 1.8 2.5 23.7 0.1 19.3 0.1 0.0 56.3 0.4 0.2 AGE (1st grouping) 17-19 20-24 25-34 35-44 45-54 55-64 65+ AGE (2nd grouping) 17 18-24 25-44 45-64 65+ RACE White Black Other REGION Midwest Northeast Southeast West MARITAL STATUS MarriedJCohabitating Widowed Divorced/Separated Never Married Unknown EDUCATION 11 or Fewer Years 12 Years 13-15 Years 16+ Years HOUSEHOLD INCOME Less than $10,000 $10.000-$19,999 $20.000-$29,999 !$x&~~-$39.999 Unknown+ EMPLOYMENT Administrator/Manager ProfossionaUTechnil SalosJCforfcal Craftsman Operative Laborer/Service Never In Labor Force Occuoatfon Not Reported POVERTY LEVEL' ' Above Below Unknown No other Only Only No other Only Only tObaCC0 smokeless cigars/pipe tobacco smokeless cigars/pipe 17.2 23.4 28.8 29.6 26.6 23.8 12.8 1.7 1.6 b-X 2:7 2.2 1.1 5.3 0.2 9.8 0.3 18.5 0.7 23.9 1.0 28.0 1.6 33.2 1.3 30.6 1.3 0.; 0.7 1.2 2.1 1.4 1.3 72.5 2.5 0.7 62.2 1.7 0.8 46.7 1.0 1.0 39.8 0.2 1.2 36.9 0.3 1.9 35.0 1.4 1.6 49.9 1.4 1.5 14.9 22.3 Ef 12:8 0.9 1.7 2.8 2.5 1.1 3.6 2::: 30.6 30.6 0.3' 0.; 0.8 0.9 1.4 1.8 1.3 1.3 77.3 3.2 63.9 1.8 43.7 0.7 35.9 0.9 49.9 1.4 0.9 1.1 1.8 1.5 24.1 2.3 23.5 1.0 1.1 45.6 26.4 1.9 16.9 0.7 0.5 50.8 21.6 2.9 18.5 0.3 0.3 55.3 1.1 1.5 1.3 1.4 1.1 24.2 23.8 25.6 22.3 2.4 :.; 2:2 20.7 0.6 24.8 0.4 21.5 1.6 24.9 0.6 1.2 ATi 0:7 48.6 0.8 1.3 45.6 0.7 1.5 45.4 1.4 1.1 47.0 1.2 1.2 24.4 2.5 26.1 17.2 0.8 24.2 34.6 3.6 22.2 21.9 1.5 11 .o 25.7 7.8 32.6 1.2 0.4 0.4 0.4 1.2 42.5 1.1 53.6 1.3 36.2 0.4 61.8 4.6 29.4 0.8 2.7 0.6 1.6 1.4 i.i 1.4 28.3 3.1 22.2 1.6 1.0 40.6 1.9 1.3 26.7 2.2 22.2 0.9 0.8 45.4 0.8 0.9 22.4 2.0 20.8 0.5 0.9 51.4 0.8 1.2 14.8 1.5 26.1 0.5 1.8 52.6 0.7 1.9 26.3 2.5 19.0 26.4 2.3 20.6 29.0 2.4 21.0 25.1 3.0 22.5 19.8 2.1 29.2 19.8 1.6 21.3 1 .o 1.6 1 .o 1 .o i:X 0.5 47.7 0.9 46.5 0.8 43.6 1.4 45.5 1.4 44.0 1.1 53.1 2.3 Ki 0:5 0.8 1.5 0.6 1 .o 1.3 ::: 1 .o 20.7 16.3 24.7 29.3 28.9 27.8 19.7 25.5 1.9 0.8 1.0 5.6 9:: ::i 30.9 24.6 22.4 28.3 21.6 18.7 2::; E 0:3 2.8 1.6 2: 0:s 1.5 41.2 1.3 54.7 0.7 50.2 1.5 28.8 0.8 39.0 1.1 47.0 0.3 68.0 1.5 43.5 ii 0:2 1.9 1.8 1.5 ::4" 2.4 1.5 0.5 1.9 E 0.3 1.4 24.9 2.4 23.6 1 .o 1.1 44.8 0.8 1.4 27.7 2.3 17.7 1.2 0.4 47.6 2.5 0.6 19.8 1.6 21.3 0.6 1.1 53.1 1.5 1 .o Tobacco use status (96) o Poverty level is based on the definition provided by the U.S. Bureau of the Census. See text for exact procedures. 24 Table 5 Cigarette Smoking Status and Quit Ratlos by Socio Demographic Variables 1975 Smoking status (%) Total (Age 21+ years) 35.8 24.0 40.3 100 0.401 10,682 SEX Mate Female AGE (1 st grouping) 21-24 25-34 35-44 45-54 55-64 65+ AGE (2nd grouping) 21-24 25-44 4564 65+ MARITAL STATUS Married Widowed Divorced/Separated Never Married Unknown EDUCATION Some high school High school graduate Some college College graduate Unknown HOUSEHOLD INCOME Less than $10.000 $10,000-$19.999 $20.000+ Unknown EMPLOYMENT ProfessionaVTechnicaI Administrator/Manager Sales/Clerical Craftsman Operatives Laborer/Service Not in Later Force Occupation Not Reported 40.5 32.1 27.5 31.4 16.4 52.2 100 0.442 100 0.343 100 0.281 100 0.345 100 0.349 100 0.418 100 0.483 100 0.579 100 0.281 100 0.347 100 0.446 100 0.579 4,949 5,733 38.2 14.9 46.9 41.5 21.8 36.7 43.6 23.4 33.0 38.5 27.6 33.9 31.8 29.8 38.4 17.4 24.0 58.6 1,144 2,757 2,050 1,891 1,434 1,406 38.2 14.9 46.9 42.4 22.5 35.1 35.5 28.6 35.9 17.4 24.0 58.6 1,144 4,807 3,325 1,406 35.4 26.3 38.3 100 0.426 7,387 24.0 15.8 60.2 100 0.397 1,075 54.8 17.7 27.5 100 0.244 1,029 36.5 16.9 46.7 100 0.316 1,170 27.4 31.0 41.7 100 0.530 21 35.2 22.1 42.7 100 0.386 2,828 40.2 22.1 37.6 100 0.355 3,742 36.3 25.3 38.3 100 0.411 2,173 27.6 29.0 43.4 100 0.512 1,863 25.1 24.3 50.6 100 0.492 76 34.8 19.3 45.9 38.2 26.4 35.3 36.9 30.7 32.4 29.6 19.5 50.9 28.3 20.6 51.2 32.6 19.2 48.2 32.7 20.6 46.7 34.9 14.3 50.8 36.0 14.9 49.1 36.4 15.6 48.0 28.9 15.5 55.6 37.8 27.9 34.3 100 0.356 100 0.409 100 0.454 100 0.398 100 0.421 100 0.370 100 0.386 100 0.291 100 0.293 100 0.300 100 0.350 100 0.425 3,685 3,919 1,778 1,300 652 696 336 699 380 257 461 7,201 Current Former Never Total Quit ratio Sample size 25 Table 6 Tobacco Use: Status and Quit Ratios by Socio DemoaraDhlc Variables 19% Tobacco use status (%.) Total (Age 21+ years) 42.9 22.9 34.2 SEX Male Female A={`;; ww+d 25-34 35-44 45-54 : 5564 85+ AG:j2;: grouping) 53.7 29.2 17.1 100 0.352 4,949 32.8 17.1 50.1 100 0.343 5,733 42.1 16.9 41.1 100 0.286 1,144 46.9 21.4 31.7 100 0.313 2,757 49.1 22.3 26.6 100 0.312 2,050 46.9 25.0 26.1 100 0.348 1,891 40.2 26.9 33.0 100 0.401 1,434 28.3 23.8 47.8 100 0.457 1,406 42.1 16.9 41.1 100 0.266 1,144 47.9 21.8 30.4 100 0.313 4.607 43.9 25.8 30.3 100 0.370 3,325 28.3 23.8 47.8 100 0.457 1,406 2544 45-64 65+ MARITAL STATUS Married Widowed Divorced/Separated Never Married Unknown EDUCATION Some high school High school graduate Some college College graduate Unknown HOUSEHOLD INCOME Less than $10,000 $10,000-$19.999 $20,000+ Unknown EMPLOYMENT Professional/Technical Administrator/Manager Sales/Clerical Craftsman Operatives Laborer/service Not in Labor Force Occupation Not Reported Current Former Never Quit Total ratio 100 0.346 10.682 42.9 24.6 32.5 100 0.364 7,387 31.0 16.1 52.9 100 0.341 1,075 59.3 17.7 23.0 100 0.230 1,029 42.0 19.1 39.0 100 0.312 1.170 27.4 31.0 41.7 100 0.530 21 43.8 46.0 41.9 36.6 37.7 ii:: 25.9 27.8 20.4 35.3 100 0.323 2,828 33.5 100 0.308 3,742 32.2 100 0.382 2,173 35.6 100 0.432 1,863 42.0 100 0.351 76 41.8 18.9 39.5 100 0.312 3,685 45.3 25.0 29.6 100 0.355 3,919 45.8 27.9 26.3 100 0.379 1,778 35.1 20.3 44.6 100 0.366 1,300 30.0 22.0 48.0 100 0.423 652 34.0 19.8 46.1 100 0.368 696 33.5 20.7 45.8 100 0.382 336 35.7 15.2 49.1 100 0.299 699 38.9 17.1 44.0 100 0.306 380 37.0 16.4 46.6 100 0.307 257 30.8 16.3 52.9 100 0.347 461 40.2 25.7 26.1 100 0.347 7,201 Sample size 26 Table 7 ClQarette Exposure Levels: Amount Smoked. Tar Levels and Percent Menthol Among Current Smokers by Scclo Demoarephlc Variables i986 - . Cigarettes per day Tar level, mg/cig 150r Total (1765+) 35.0 34.9 30.1 SEX Male Female 29.8 34.0 36.2 40.7 35.9 23.4 AGE (1 st grouping) 17-19 20-24 25-34 35-44 45-54 5564 65+ AGIEf$d grouping) 1624 2544 45-64 65+ RACE White Black Other REGION Midwest Northeast southeast west MARITAL STATUS Marrie&Cohabitatino Widowed Divorced/Separated Never Married Unknown EDUCATION 11 or Fewer Years 12 Years 13-15 Years 18+ Years HOUSEHOLD INCOME Less than $10,000 $lO,OoO-$19.999 $20,000-$29,999 $30.000-$39.999 w*ooo+ Unknown EMPLOYMENT Administrator/Manager Professionamechnical SabdClerid Craftsman Operative Laborer/Service Never in Labor Force Occupation Not Reported POVERTY LEVEL' Above Below Unknown 53.8 34.1 12.1 41.0 40.0 19.0 39.2 32.8 28.0 28.8 35.3 35.9 26.9 34.6 38.5 29.8 33.8 36.4 42.1 36.7 21.3 51.7 42.8 5.5 43.8 37.9 18.3 34.5 33.9 31.5 28.3 34.2 37.5 42.1 36.7 21.3 31.2 35.7 33.1 61.3 27.3 11.4 40.5 40.6 16.8 31.7 35.0 33.3 34.9 35.3 29.8 35.3 35.9 28.8 39.1 32.0 28.8 32.7 34.6 32.7 40.3 37.0 22.7 30.2 37.2 32.6 45.3 33.8 20.9 53.6 22.4 23.8 33.5 36.5 30.0 34.4 33.7 31.9 36.4 36.1 27.4 39.1 32.8 28.1 40.5 33.8 25.7 34.0 34.2 31.0 34.0 36.5 29.6 35.3 34.4 30.3 29.3 34.1 36.6 39.3 35.2 25.5 32.3 36.3 31.4 34.6 34.7 30.7 38.2 34.4 27.3 27.8 33.6 38.6 32.3 34.0 33.7 37.0 34.6 28.4 43.6 36.7 19.6 40.1 41.4 18.5 33.3 35.2 31.6 41.4 32.4 26.2 39.3 35.2 25.5 16-24 25 or more Total <=lO SlO-15 >I5 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 29.6 11.6 58.6 100 29.2 26.8 32.7 31.7 30.4 32.2 30.6 26.3 26.2 26.3 8.0 65.2 100 24.9 15.6 51.7 100 34.0 2.7 65.6 100 29.3 4.9 64.8 100 24.1 5.6 62.1 100 36.9 12.7 56.7 100 31.3 19.2 54.5 100 23.0 16.2 57.5 100 24.4 22.6 51.1 100 21.1 38.9 29.9 31.5 26.3 26.3 31.8 14.5 26.2 25.3 36.8 28.0 31.0 29.6 30.3 26.9 31.6 19.5 4.0 57.1 4.3 65.8 8.8 59.7 17.8 55.9 22.6 51.1 12.3 55.9 7.6 78.0 5.3 68.5 10.4 64.3 12.6 50.6 12.7 59.3 9.6 59.4 12.4 58.0 19.1 50.7 13.8 59.3 5.0 63.4 80.5 23.5 29.4 36.8 36.4 22.1 27.5 31.5 30.7 34.6 27.9 31.2 41.6 32.7 24.0 24.3 28.9 25.1 27.9 31.1 21.9 27.9 11.6 64.8 11.9 58.7 9.7 53.5 13.2 50.4 11.0 66.9 12.9 59.5 11.4 57.1 9.7 59.6 11.9 53.4 11.9 60.2 15.1 53.7 13.0 45.3 14.4 52.9 10.3 65.7 9.0 66.7 9.3 61.8 10.7 64.3 10.1 62.0 11.7 57.2 10.1 68.0 11.9 60.2 % who Total tn~n%~ol 100 29.0 100 25.2 100 34.4 100 23.7 100 21.1 100 23.1 100 75.5 100 24.9 100 30.5 100 27.9 100 31.2 100 24.5 100 27.3 100 28.9 100 32.3 100 34.1 100 34.7 100 27.6 100 29.7 100 32.0 100 27.1 100 36.8 100 26.7 100 28.3 100 29.6 100 27.7 100 29.6 100 26.4 100 29.7 100 33.0 100 23.5 100 26.0 100 30.0 100 35.7 100 32.9 100 27.7 100 38.6 100 29.6 o Poverty level is based on the definition provided by the U.S. Bureau of the Census. See text for exact procedures. 27 Total (Age 17+ years) 38.2 29.6 32.2 SEX Male Female AG:$I;;grouping) 20-24 25-34 35-44 45-54 55-64 65+ AGE(2nd grouping) 17 18-24 25-44 45-64 65+ RACE White Black Other REGION Midwest Northeast Southeast West MARITALSTATUS MarriedICohabitating Widowed Divorce&Separated Never Married Unknown EDUCATION 1lorFewer Years 12Years 13-15 Years 16+ Years HOUSEHOLDINCOME L8SS than $10,000 $lO,OOO-$19,999 $20.000-$29,999 $30,000-$39.999 $40,000+ Unknown EMPLOYMENT Administrator/Manager Professional/l8chnicaI Sales/Clerical Craftsman Operative Laborer/Service Never in Labor Force OccupationNot Reported POVERTYLEVEL" Above Below UnkrKiWn 31.2 29.6 39.2 46.6 29.7 23.7 80.6 58.3 40.5 34.9 27.0 24.8 36.3 2g.42 32:0 29.8 27.0 31.0 35.9 12.0 16.5 27.5 35.4 46.0 44.2 27.8 96.6 3.4 61.5 22.0 38.2 31.1 25.8 29.1 36.3 35.9 16.i 30.8 45.1 27.8 36.1 29.7 34.2 57.0 30.9 12.1 41.5 23.4 35.1 37.4 32.6 30.0 34.3 31.3 34.4 37.4 29.0 33.6 45.0 25.4 29.6 33.8 47.0 37.4 54.4 30.6 28.1 30.7 24.8 63.5 35.6 XE '. 20:7 36.5 36.0 28.8 35.2 36.5 29.8 33.7 40.8 27.7 31.5 42.1 32.4 25.5 45.6 29.6 24.9 33.7 33.3 33.0 39.9 28.2 32.0 34.6 30.7 34.7 39.6 28.1 32.2 37.3 29.5 33.2 30.5 33.1 36.4 43.4 27.5 29.1 46.9 29.6 23.4 25.8 27.3 46.9 28.6 38.5 32.9 39.8 28.2 32.0 50.3 20.1 29.7 36.7 27.4 35.9 37.7 29.9 32.4 45.2 27.0 27.7 37.3 29.5 33.2 Table 6 Cigarette Exposure Levels: Amount Smoked, Tar Levels and Percent Menthol Among Former Smokers* by Soclo Demographic Variables 1986 Cigarettesperday Tar level, mglcig %who 15 or less 16-24 25 ormore Total <=lO >lO-15 >15 Total min%ol 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 1: 100 100 100 100 31.5 10.9 57.6 100 30.3 29.4 10.1 60.5 100 23.6 34.0 11.9 54.1 100 38.3 25.3 4.5 70.2 100 34.4 42.1 1.9 56.0 100 31.6 38.2 4.5 57.3 100 34.0 25.0 10.8 64.2 100 35.6 32.9 16.3 50.8 100 26.5 23.7 19.3 57.0 100 21.7 26.4 21.1 52.5 100 23.9 7.3 40.1 32.8 28.0 26.4 2.1; 92.7 57.1 7.1 60.1 17.9 54.1 21.1 52.5 100 35.8 100 32.0 100 34.7 100 23.9 100 23.9 33.4 11.3 55.3 100 25.9 15.5 7.4 77.2 100 72.4 25.2 11.6 63.2 100 28.0 26.6 11.3 62.1 42.1 11.5 46.4 28.5 10.3 61.2 30.3 10.8 58.9 31.4 11.8 56.8 25.6 19.7 54.7 21.6 10.6 67.8 39.0 4.8 56.3 12.7 . 87.3 100 39.5 100 25.5 100 27.2 100 30.2 100 29.7 100 28.8 100 39.5 100 28.6 100 23.8 20.8 33.4 33.5 39.2 20.8 33.0 31.7 34.2 36.9 23.7 12.4 66.8 10.8 55.8 11.4 55.1 8.7 52.1 12.4 88.9 10.4 56.5 6.1 62.2 10.2 55.6 12.9 50.2 14.8 61.5 100 31.3 100 29.5 100 29.7 100 31.2 100 39.5 100 27.2 100 33.9 100 34.6 100 25.8 100 27.7 37.3 11.3 51.4 100 28.2 36.4 9.6 54.0 100 33.6 36.4 10.7 52.9 100 33.3 25.4 14.3 60.3 100 16.9 24.4 9.6 68.0 100 32.3 26.3 12.0 61.8 100 33.4 22.0 9.3 68.7 100 32.9 30.7 5.8 63.5 100 32.0 34.2 10.0 55.8 100 30.0 19.7 12.3 67.9 100 39.0 23.7 14.8 61.5 100 27.7 o Formersmokerswhohadquitwithinthelastfive years. "Povertyk?velisbasedon thedefinitionprovidedbythe U.S.Bureau ofthe Census. See text forexactprocedures. 28 Table 9 Qulttlng: Total Number of Attempts of Current Smokers by Soclo Demographlc Variables 1966 Attempts to quit smoking (% of current smokers) Total (Age 17+ years) SEX Male Female AGE (1 st grouping) 17-19 20-24 25-34 3544 45-54 5564 65+ AGE (2nd grouping) 17 18-24 25-44 45-64 65+ RACE White Black Other REGION Midwest Northeast southeast West MARITAL STATUS MarriedZohabitating Divorced/Separated Never Married Unknown EDUCATION 11 or Fewer Years 12 Years 13-15 Years 16+ Years HOUSEHOLD INCOME Less than $10,000 $lO.oOo-$19,999 $20,000-$29,999 $3o,ooo-$39,999 $40,000+ Unknown EMPLOYMENT Administrator/Manager Professional/Technical Sales/Clerical Craftsman Operative Laborer/Service Never in Labor Force Occupation Not Reported POVERTY LEVEL Above 34.5 38.2 18.9 8.4 Below 35.0 36.4 19.8 8.9 Unknown 41.2 33.4 18.2 7.2 0 l-2 3-5 6+ Total (mil.) 35.5 37.3 18.9 8.3 36.7 36.9 17.1 9.4 34.2 37.8 20.9 7.0 47.2 31.1 18.6 3.1 42.5 42.3 11.6 3.5 33.8 40.2 19.2 6.8 32.2 39.6 20.0 8.2 34.1 35.3 21.5 9.2 35.8 32.5 20.0 11.7 37.0 28.9 18.8 15.4 60.8 20.6 17.2 1.4 42.0 41.2 13.2 3.6 33.1 39.9 19.5 7.5 34.9 34.0 20.8 10.4 37.0 28.9 18.8 15.4 35.6 37.9 18.8 7.7 34.3 32.9 19.9 12.8 37.7 39.0 17.3 5.9 35.3 38.8 17.2 8.7 32.1 37.2 20.9 9.8 37.2 36.7 18.3 7.8 36.1 36.8 20.3 6.7 33.6 38.8 19.4 8.2 34.7 29.3 22.7 13.3 35.3 38.1 17.2 9.5 43.4 33.2 17.4 6.1 12.3 55.6 18.3 13.8 37.1 33.5 20.2 9.2 35.2 38.6 18.8 7.4 35.1 39.3 17.7 7.9 32.5 40.8 17.4 9.4 33.6 36.6 20.0 9.8 35.3 37.4 19.7 7.6 37.1 37.7 16.2 9.0 29.5 39.1 24.9 6.5 34.4 39.2 17.2 9.2 41.2 33.4 18.2 7.2 29.7 42.7 18.7 8.9 36.0 38.4 16.4 9.3 35.7 37.0 20.9 6.4 35.6 35.4 19.1 9.9 33.1 38.3 19.5 9.2 37.0 37.0 17.0 8.9 42.3 36.1 17.1 4.5 35.6 34.7 21.8 7.8 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 Est. ooo Sample size 46.7 4,686 24.7 2,341 22.0 2,345 2.0 168 5.0 419 12.9 1,276 10.6 1,154 6.6 687 5.8 575 3.8 407 0.7 2% 12:4 3.8 49 538 2,430 1,262 407 39.8 4,112 5.5 438 1.4 136 11.6 1X 8:2 1,197 1,056 1,582 851 30.5 ::f ::: 2,853 294 730 794 15 14.5 946 19.3 1,955 8.0 1,140 5.0 645 5.2 490 9.0 889 11.8 1,170 6.3 642 7.9 874 6.6 621 3.6 459 4.7 579 11.1 1,197 7.9 726 6.1 533 8.6 791 2.5 186 2.1 215 35.0 3,627 5.1 438 6.6 621 o Poverty level is based on the definition provided by the U.S. Bureau of the Census. See text for exact procedures. 29 Table 10 Oulttlng: Total Number of Attempts of Current Smokers by Soclo Demographic Variables 1975 Attempts to quit smoking (% of current smokers) Total (Age 21+ years) SEX Male Female 25-44 45-64 MA;;AL STATUS Married wkk3Jved Di~rced/Separated Never Married Unknown EDUCATION Some high schod High schod graduate Some college College graduate Unknown HOUSEHOLD INCOME Less than $10,000 $1 o,OOO-$19.999 $2o.ooo+ Unknown EMPLOYMENT ProfessionaVTechnicacal Administrator/Manager !%kWCl6flCd Craftsman Operatives Laborer/Service Not in Labor Force Occupation Not Reported 0 1-2 3-5 6+ Total size 37.6 37.0 18.1 7.3 4,262 35.4 39.2 17.8 7.7 40.4 34.3 18.4 6.9 2.139 2,123 37.8 41.0 16.4 35.3 39.7 18.7 34.6 39.5 17.6 39.5 33.7 18.3 40.4 30.8 19.9 44.9 33.5 15.6 4.8 6.4 t: 8:9 5.8 497 1,249 976 786 504 248 37.8 41.0 16.4 35.0 39.6 18.2 39.9 32.6 18.9 44.9 33.5 15.8 4.8 7.2 ::: 497 2,225 1,292 248 36.0 37.6 48.7 32.0 39.3 36.8 42.3 35.5 40.6 43.4 18.5 14.1 17.8 17.1 S:X 6.1 5.1 16.0 2,951 272 572 463 4 36.4 35.9 19.4 40.4 36.1 17.2 36.9 38.8 15.9 33.3 39.1 21.3 32.5 35.7 10.3 t :: it: 21.5 1,130 1,680 879 558 15 ::; 36.1 45.5 35.8 17.9 39.1 18.4 37.8 18.9 31.2 16.0 8.3 Y-Z 7:3 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 :: :: 100 1,452 1,661 723 426 34.8 44.2 39.5 37.1 45.1 36.7 37.9 34.6 41.0 32.0 39.2 32.1 39.2 35.8 36.9 37.3 15.2 18.7 12.6 20.0 20.9 21.7 15.2 5.8 4.7 5.6 5:; 18.2 7.6 210 274 130 303 168 108 165 2,904 30 Table 11 Qulttlng: Total Number of Attempts of Former Smokers by Soclo Demographic Variables 1986 Attempts to quit smoking (96 of former smokers) Total (Age 17+ years) SEX Male Female AGE (1 st grouping) 17-19 20-24 25-34 35-44 45-54 5564 65+ AGE (2nd grouping) 17 18-24 25-44 45-64 65+ RACE White Black Other REGION Midwest Northeast West MARITAL STATUS MarrfedICohabitating Widowed Divorced/Separated Never Married Unknown EDUCATION 11 or Fewer Years 12 Years 13-15 Years 16+ Years HOUSEHOLD INCOME Less fhan $10,000 $1 o,ooO-$19,999 $20,000-$29,999 $30,000-$39,999 $40,000+ Unknown EMPLOYMENT Administrator/Manager Professional~echnical Safes/Clerical Craftsman Operative Laborer/Service Never in Labor Force Occupation Not Reported POVERTY LEVEL* Above Below 0 l-2 3-5 6+ Total (mfl.)' size 70.2 21.2 8.6 100 43.5 4,614 68.9 21.6 9.5 100 25.6 2.606 72.2 20.5 7.2 100 17.9 2.008 88.0 73.4 73.4 68.8 62.8 ::: 2::: 20.3 22.4 25.4 20.8 18.4 2.6 100 0.6 42 5.0 100 2.0 180 6.3 100 8.2 867 8.8 100 8.4 983 11.8 100 7.1 731 10.8 100 8.0 831 7.3 100 9.1 980 100.0 75.1 71 .l 65.8 74.3 2o.i 4.8 21.3 7.6 23.0 11.2 18.4 7.3 100 0.2 11 100 2.5 211 100 16.8 1,850 100 15.2 1,562 100 9.1 980 70.3 21.1 8.6 100 38.9 4,228 68.6 22.8 8.7 100 3.5 282 72.4 19.5 8.1 100 1.1 104 71.1 21.5 7.5 100 9.9 1,090 68.5 23.2 8.3 100 9.9 1.110 70.6 19.6 9.8 100 14.8 1,478 70.7 21.2 8.2 100 8.9 936 70.0 21.1 8.9 72.8 19.7 7.5 68.3 22.4 9.3 71.5 22.4 6.1 69.9 7.3 22.7 73.0 71.2 68.1 66.8 19.2 Ed 23.2 7.9 t: 1o:r 100 32.4 100 3.2 100 3.6 41 i: 0:1 100 11.5 100 16.0 100 7.3 100 8.7 3,265 424 475 438 12 857 1,574 1,058 1,125 70.7 22.2 71.0 22.0 72.1 18.4 67.3 24.4 68.9 22.6 71.5 18.3 7.1 7.0 ii.2 8:5 10.3 100 3.7 374 100 7.2 712 100 8.6 922 100 5.6 608 100 11.2 1,264 100 7.2 734 64.0 25.8 67.0 23.2 73.2 19.7 70.4 21.1 67.6 21.4 74.7 19.2 76.3 17.2 72.2 16.7 70.0 21.7 69.6 22.1 71.5 18.3 10.1 9.9 7.1 1::: it 11:1 t.: 10:3 100 5.3 635 100 7.2 906 100 10.1 1,094 100 690 100 ::: 437 100 6.0 540 100 1.1 109 100 1.8 203 100 33.0 3,593 100 3.3 287 100 7.2 734 Est. crop. Samde Poverty level is based on the definition provided by the U.S. Bureau of the Census. See text for exact procedures. 31 Table 12 Qulttlng: Total Number of Attempts of Former Smokers by Soclo DemoaraDhlc Variab& lG75' Attempts to quit smoking (% of former smokers) Total (Age 21+ years) SEX Male Female AG:1(~;;grwing) 25-34 35-44 45-54 55-64 85+ AG:Gf;t wwh) 25-44 4564 MA:;AL STATUS Married Widowed Divorced/Separated Never Married Unknown EDUCATION Some high school High schod graduate Some college College graduate Unknown HOUSEHOLD INCOME Less than $10,000 $10.000-$19,999 $20,000+, Unknown EMPLOYMENT ProfessionaVTechnicaI Administrator/Manager SalesClerfcal Craftsman Operatives LabcrerfService Not in Labor Force Occupation Not Reported 0 l-2 3-5 6+ Total 59.0 24.8 16.2 56.9 25.5 17.6 62.9 23.7 13.5 55.8 32.0 12.2 63.7 24.4 11.8 60.2 23.5 16.3 53.1 29.0 18.0 56.3 23.3 20.4 64.1 19.9 16.0 55.8 32.0 12.2 62.1 24.0 13.9 54.6 26.4 19.1 64.1 19.9 16.0 58.0 25.0 66.4 21.0 58.4 26.0 64.9 25.1 79.1 20.9 17.0 12.6 15.6 10.0 57.2 24.8 18.0 57.8 23.7 18.6 62.7 25.2 12.1 58.6 26.8 14.7 83.1 12.5 4.4 57.7 24.4 17.9 58.3 26.2 15.5 59.7 23.5 16.8 63.5 23.4 13.1 66.6 20.4 13.0 70.6 17.8 11.6 48.6 36.7 14.7 59.2 28.0 12.8 64.0 20.7 15.2 54.6 32.3 13.2 60.0 22.3 17.7 57.8 25.1 17.1 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 Sample size 2,687 1,632 1,055 185 651 495 567 446 343 185 1,146 1,013 343 2.112 171 181 217 6 645 872 579 572 19 736 1,103 578 270 159 150 79 122 67 47 84 1,979 32 Table 13 Age of lnltlatlon of Smoking: Current Smokers by Soclo Demographlc Variables 1986 Age when started smoking regularly (% of current smokers) Total (Age 17+ years) SEX Male Female AGE (1 st grouping) 17-19 20-24 25-34 35-44 45-54 55-64 65+ AGE (2nd grouping) 17 18-24 25-44 4564 65+ RACE White Black Other REGION Midwest Northeast Southeast West MARITAL STATUS MarriedZohabitating Widowed Divorced/Separated Never Married Unknown EDUCATION 11 or Fewer Years 12 Years 13-15 Years 16+ Years HOUSEHOLD INCOME Less than $10,000 510.000-$19.999 520;000-$i29;999 $30.000-$39,999 w.ooo+ Unknown EMPLOYMENT Administrator/Manager Professional/Technical Safes/Clerical Craftsman Operative Laborer/Service Never in Labor Force Occupation Not Reported POVERTY LEVEL Above Below ~16 16-17 Est. ooo. Sample (mil.) size 20.8 25.9 18-20 21+ 31.6 21.7 45.8 4,615 23.5 28.2 32.2 16.2 24.3 2.312 17.7 23.3 31.0 28.0 21.5 2,363 43.4 43.0 13.6 2.0 166 28.2 36.9 31.6 3.2 5.0 416 23.5 29.2 31.5 15.8 12.7 1,259 16.3 24.6 33.6 25.5 10.4 1,141 16.2 17.4 39.3 27.1 6.5 880 15.8 21.5 31 .o 31.7 5.7 563 17.1 15.2 23.5 44.3 3.6 390 54.8 45.2 30.2 38.0 20.3 27.1 16.0 19.3 17.1 15.2 29.3 2.5 32.4 20.2 35.4 29.2 23.5 44.3 0.7 47 6.3 535 23.1 2,400 12.2 1,243 3.6 390 21.9 27.2 30.8 20.2 39.0 4.052 11.5 19.5 37.2 31.8 5.4 431 25.6 14.4 33.9 26.1 1.4 132 21.5 25.0 31.7 21.8 11.5 1,182 20.1 26.2 34.3 19.4 9.3 1,037 20.0 25.5 31.9 22.7 16.9 1,549 22.1 27.6 28.0 22.3 8.2 847 19.4 25.0 13.0 16.2 21.7 24.8 26.9 32.3 41.9 30.4 33.3 22.3 25.8 45.1 27.5 26.0 30.2 10.6 16.6 11.1 24.0 16.7 32.5 22.0 37.5 24.5 41.0 30.9 25.1 25.6 32.8 19.4 32.6 21.1 33.6 19.7 35.3 23.2 27.1 23.3 29.9 f:62 ::1 2,807 289 720 784 15 30.0 29.3 18.4 27.1 15.0 23.0 12.5 15.6 14.1 927 19.1 1,935 7.9 1,127 4.8 626 21.8 27.6 24.6 23.1 19.7 26.6 18.8 27.9 16.6 24.9 23.5 26.2 S::, 11.5 6.3 67:: 486 881 1.153 640 858 597 15.9 22.5 34.1 27.5 3.6 456 12.8 19.8 40.0 27.5 4.6 563 18.0 24.0 33.5 24.5 10.9 1,176 27.2 27.8 28.9 16.1 7.8 718 21.5 30.9 28.9 18.7 6.1 529 19.8 26.8 30.4 23.0 8.5 781 31.3 30.2 25.4 13.2 2.5 186 26.6 24.3 29.6 19.6 2.0 206 20.0 25.5 33.2 21.3 34.4 3,585 22.5 27.9 26.6 23.0 5.1 433 23.5 26.2 27.1 23.3 6.3 597 o Poverty level is based on the definition provided by the U.S. Bureau of the Census. See text for exact procedures. 33 Table 14 Age of Initiation of Smoklng: Former Smokers by Soclo Demographic Variables 1986 Age when started smoking regularly (% of former smokers) Total (Age 17+ years) 17.2 24.1 34.8 23.8 40.9 4,352 SEX Male Female AGE (1 st grouping) 17-19 20-24 25-34 35-44 45-54 55-64 65+ AGE (2nd grouping) 17 18-24 25-44 45-64 65+ RACE White Black Other REGION Midwest Northeast Southeast West MARITAL STATUS Married/Cohatitating Widowed Divorced/Separated Never Married Unknown EDUCATION 11 or Fewer Years 12 Years 13-15 Years 16+ Years HOUSEHOLD INCOME Less than $10,000 $lO,OOO-$19.999 $20.000-$29,999 $30,000-$39,999 $4o,ooo+ Unknown EMPLOYMENT Administrator/Manager Professional/Technical Safes/Clerical Craftsman Operative Laborer/Service Never in Labor Force Occupation Not Reported POVERTY LEVEL` 20.5 25.5 12.5 22.1 35.2 18.8 34.2 31.2 3% 1.4 3410 12.4 36.6 19.6 :A 24.4 32:7 27.7 41.2 24.3 2,487 16.6 1,865 44.6 51.2 27.1 41.2 23.2 30.3 18.0 25.9 15.1 24.5 14.9 19.5 11.0 15.0 0.5 38 2.0 173 7.7 818 8.0 934 6.8 695 7.7 793 8.3 901 35.0 65.0 30.3 41.9 20.5 28.0 15.0 21.8 11.0 15.0 26.6 * 35.3 1Z 37.1 26:l 32.7 41.2 0.1 2.3 15.7 14.5 8.3 10 l,Z 1,488 901 17.9 24.1 10.5 24.4 16.7 22.9 36.7 3,993 3.2 260 1.0 99 14.7 26.0 16.3 25.1 18.1 23.7 19.7 21.6 34.9 23.1 33.8 31.3 33.3 27.1 34.1 25.2 37.6 21.1 33.4 24.8 34.9 23.8 9.3 1,028 9.2 1,043 13.9 1,387 8.4 894 17.1 207:; 22.8 13.6 24.6 36.1 22.2 14.9 27.9 49.3 21.2 31.9 26.8 29.7 31.9 15.6 35.0 31.1 20.4 30.9 2.8 3.4 ::: 3,117 378 445 400 12 21.1 25.9 26.2 26.7 10.6 796 18.4 24.7 34.0 23.0 15.4 1,507 16.1 24.3 38.5 21.1 6.7 994 11.1 20.6 44.3 24.0 6.2 1,055 15.7 18.5 20.5 22.2 19.1 27.9 17.3 27.2 14.9 24.4 16.2 21.3 3.3 342 8.7 674 8.3 879 5.3 577 10.7 1,198 6.6 682 12.9 24.8 13.1 19.8 13.7 22.6 20.7 26.2 25.8 23.1 19.4 24.5 23.4 37.7 19.9 31.0 26.8 39.0 29.4 27.9 31.7 21.3 36.7 18.9 40.8 19.9 37.0 25.4 37.2 25.1 39.0 28.1 36.8 26.8 34.7 18.4 32.6 18.5 28.4 27.8 28.7 10.1 30.3 18.8 5.0 3 4':; 5.5 1.1 1.7 31.3 596 855 1,027 ES 508 103 187 Above 17.6 24.9 35.1 22.4 Below 15.3 22.0 27.1 35.5 Unknown 16.2 21.3 37.0 25.4 ~16 16-17 18-20 21+ Est. DOD. Sample (mil.) size 3,405 265 682 o Poverty level is based on the definition provided by the U.S. Bureau of the Census. See text for exact procedures. 34 Table 15 Age of Initiation of Smoklng: Current Smokers bv Socio Demoarauhic Variables 1975 - . Age when started smoking regularly (% of current smokers) Total (Age 21+ years) 21.9 20.8 32.7 24.6 4,339 SEX Male 28.8 22.6 31.9 16.6 2.176 13.6 18.5 33.8 34.1 2,163 AGE (1st grouping) 21-24 25-34 35-44 45-54 55-64 65+ AGE (2nd grouping) 21-24 25-44 4564 65+ MARITAL STATUS Married Widowed Divorced/Separated Never Married Unknown EDUCATION Some high school High school graduate Some college College graduate Unknown HOUSEHOLD INCOME Less than $10,000 SlO.OOO-$19.999 Qi20;000+. Unknown EMPLOYMENT ProfessionaUTechnicaI Administrator/Manager Sales/Clerical Craftsman Operatives Laborer/Service Not in Labor Force Occupation Not Reported <16 16-17 18-20 21t Sample size 27.0 28.7 25.3 23.1 18.9 20.3 18.1 19.8 20.3 17.4 24.1 10.7 499 1,262 990 805 517 266 27.0 28.7 22.4 21.8 19.0 18.8 24.1 10.7 36.8 7.4 36.0 15.7 35.0 25.9 31.2 30.9 29.0 33.4 19.7 45.5 36.8 7.4 35.5 20.3 30.3 31.9 19.7 45.5 499 2,252 1,322 266 22.2 20.6 33.5 23.8 2,997 13.0 13.7 26.2 47.1 287 24.4 21.9 28.1 25.6 580 21.6 24.9 35.6 17.9 470 78.2 7.9 15.9 . 5 33.1 20.9 20.0 21.6 15.8 20.9 13.7 18.0 25.6 16.5 24.6 19.7 22.0 21.7 16.2 22.5 23.4 17.8 24.7 21.3 33.6 24.9 39.0 24.3 37.5 30.8 32.0 25.9 29.5 26.1 34.7 21.7 35.9 25.4 29.8 29.0 1,155 1,704 887 571 22 1,479 1,680 734 446 9.9 18.8 35.9 35.4 211 12.5 18.9 35.5 33.1 278 18.8 20.8 33.5 26.8 131 15.0 24.5 35.9 24.6 304 23.6 15.3 34.5 26.5 170 16.7 27.1 32.7 23.5 110 11.7 16.8 32.0 39.5 167 25.5 21.1 31.8 21.7 2,968 35 Table 16 Age of lnltlatlon of Smoking: Former Smoken by Soclo Demographic Variables 1975 Age when started smoking regularly (% of former smokers) Total (Age 21 t years) 21.3 21.5 SEX Male Female AGE (1 st grouping) 21-24 25-34 35-44 45-54 55-64 65+ AGE (2nd grouping) 21-24 2544 4564 65+ MARITAL STATUS Married Widowed Divorced/Separated Never Married Unknown EDUCATION 25.8 22.6 13.0 19.5 26.5 31.2 23.2 25.6 24.7 22.2 17.1 23.9 21.5 15.3 18.2 15.4 26.5 31.2 23.9 24.1 19.1 19.9 18.2 15.4 21.3 22.0 15.2 14.0 21.7 22.9 24.8 20.5 43.6 13.2 Some high school High school graduate Some college College graduate Unknown HOUSEHOLD INCOME Less than $10.000 $10,000-$19,999 $20,000+ Unknewn EMPLOYMENT ProfessionaKfechnicaI Administrator/Manager Sales/Clerical Craftsman Operatives laborer/Service Not in Labor Force Occupation Not Reported <16 16-17 18-M 21+ 34.4 22.8 Sample size 2,686 33.2 18.3 36.5 31.0 37.0 5.3 40.5 10.7 33.0 20.0 36.3 22.7 30.0 33.2 29.3 37.0 37.0 5.3 37.1 15.0 33.4 27.5 29.3 37.0 1,632 1,054 185 651 495 567 445 343 185 1,146 1,012 343 27.8 21.6 24.3 21.0 18.8 24.6 10.8 19.5 35.1 13.1 35.0 21.6 26.5 44.2 29.6 25.8 36.4 18.2 17.8 25.3 26.6 24.0 33.9 20.8 36.7 19.9 42.7 27.0 23.0 28.9 2,112 171 180 217 6 644 672 579 572 19 23.5 20.1 30.3 26.1 735 21.9 22.7 36.0 19.4 1.103 16.5 21.5 38.3 23.7 578 23.8 20.7 29.9 25.5 270 12.6 14.4 9.5 16.5 32.5 13.5 22.9 45.8 18.8 21.5 38.7 25.4 18.6 53.3 18.6 25.3 30.4 27.9 24.4 23.6 19.6 25.1 43.1 18.3 13.9 29.7 51.2 21.5 33.1 21.5 159 150 79 122 67 47 36 SMOKING-ATTRIBUTABLE MORTALITY, YEARS OF POTENTIAL LIFE LOST, AND ECONOMIC COSTS STATE-SPECIFIC ESTIMATES, 1985 INTRODUCTION Cigarette smoking has been identified as the chief avoidable cause of death in the United States (USDHHS, 1982). Meas- urements of the impact of smoking, using calculations of smoking-attributable mortality and economic costs, have recently appeared in several medical journal articles (Rice et al., 1986; Ravenhott, 1985; CDC, 1987b) as well as in an Office of Technology Assessment Staff Memorandum (OTA, 1985). These estimates of disease impact vary according to methods and data sources used in the calculations. Nonethe- less, reported numbers of smoking-attributable deaths are enormous, ranging from a low of 270,000 in 1980 (Rice et al., 1986) to a high of 485,000 in 1983 (Ravenholt, 1985). In 1987, the Office on Smoking and Health (OSH) of the Centers for Disease Control (CDC) estimated that 320,515 deaths were attributable to smoking in the United States in 1984 (CDC, 1987b). This was approximately 15.7 percent of the total number of deaths in the United States in that year. Sub- sequently, the 1989 report of the Surgeon General estimated that 390,000 deaths were caused yearly by smoking. This estimate was based on updated relative risks from the American Cancer Society's Cancer Prevention Study II (USDHHS, 1989). In addition to mortality, years of potential life lost (YPLL) are used to measure disease impact. Rice estimated 3.9 million YPLL were lost due to smoking in 1980. The CDC estimate was 949,924 years lost before age 65 and 3.6 million if YPLL were calculated to life expectancy. To better understand the economic impact of smoking, smok- ing-attributable direct and indirect costs have been calculated. Economic calculations of smoking-attributable disease impact range from $53.7 billion in 1984 (Rice et al., 1986) to $65 billion in 1985 (OTA, 1985). Economic costs generated by diseases associated with smoking include direct health-care costs (hospitalization, physician fees, medications, nursing home costs, and other professional fees), indirect morbidity losses (lost income due to disability, transportation costs, homecare services, etc.), and indirect mortality losses (lost productivity from persons who die prematurely from smoking-attributable diseases). This report will present State-specific calculations for smok- ing-attributable mortality, years of potential life lost, and economic costs in the United States. These calculations were performed using a software program (SAMMEC) developed by the Minnesota Department of Health (MDH) and provided to States through the CDC (Shultz, 1986). BACKGROUND In 1984, the MDH's Technical Advisory Committee on Non- smoking and Health produced The Minnesota Plan for Non- smoking and Health (MDH, 1984). The background research for this document included calculations of smoking- attributable disease impact specific for Minnesota. Analysts at the MDH designed a computer program using well-known software (Lotus l-2-3) (Lotus, 1984), which produced the calculations, tables, and graphs used in the Plan as well as in numerous presentations to the public and to the State legis- lature. The calculations were subsequently incorporated into a menu-driven software package, SAMMEC: Smoking- Attributable Mortality, Morbidity, and Economic Costs (Shultz, 1988), which facilitates similar analyses for any given popula- tion if the appropriate raw data are available. In Minnesota, smoking-attributable disease impact estimates effectively portrayed the magnitude of the smoking and health issue to the public and were used in support of nonsmoking legislation in Minnesota. These data and a strong coalition of public health, medical, educational, and other disciplines succeeded in bringing about important nonsmoking legislation. This legis- lation funds statewide smoking intervention curricula, promotes nonsmoking through a public education campaign, establishes agrants program for community-based programs, expands enforcement of the Minnesota Clean Indoor Air Act, provides evaluation of all programs, and raises the State excise tax on cigarettes (Shultz et al., 1986). METHODS FOR CALCULATING SMOKING-ATTRIBUTABLE DISEASE IMPACT Smoking-Attributable Mortality and Years of Potentlal Life Lost The theoretical bases for the calculations used in SAMMEC are found in a 1986 paper by Rice (Rice el al., 1986). The method used by Rice invdlves celculating smoking-at- tributable fractions (SAFs) of total mortality due to 21 diseases known to be caused by or associated with smoking in adults. This calculation has three components: the relative risks (RR) (defined as the mortality rate among exposed persons divided by the mortality rate among unexposed persons) of smoking- related disease in current and former smokers, the prevalence of smoking among men and women 20 years of age and older, and the crude mortality data for the population under study. For these calculations, the RR estimates used are weighted averages derived from four longitudinal studies of smoking- related illness (Hammond, 1966; Doll and Pete, 1976; 37