Tobacco—What it Is and What it Does - Trends In Tobacco Use

Cigarettes

CONSUMPTION DATA.

According to the Centers for Disease Control and Prevention (CDC), the consumption of cigarettes, the most widely used tobacco product, has decreased over the past generation among adults. After increasing rather consistently for sixty years, the per capita consumption of cigarettes peaked in the 1960s and early 1970s at about four thousand cigarettes per year. Since 1974 the per capita consumption has consistently declined each year. By 2003 the annual rate was slightly less than two thousand. (See Figure 5.1.)

Figure 5.2 shows adult smokers as a percent of the population from 1955 to 2002. In 1965, 42.4% of the population reported smoking. In 2002 this figure stood at 22.5%. Men have consistently been more likely to smoke than women. In 2002, 25.2% of adult men reported smoking, while 20% of women reported smoking. The steady decline in smoking came shortly after 1964, when FIGURE 5.1
Annual per capita cigarette consumption by adults, and major smoking-related events in the United States, 1900-2003
SOURCE: Rosemarie Henson, "Adult per Capita Cigarette Yearly Consumption and Major Smoking and Health Events, United States, 1900-1999," in "Public Health Demands Continuing Progress in Tobacco Control," Chronic Disease Notes & Reports, vol. 14, no. 3, Fall 2001, http://www.cdc.gov/nccdphp/cdnr/cdnr_fall0102.htm (accessed March 2, 2005), and Tom Capehart, "Table 2. Per Capita Consumption of Tobacco Products in the United States (Including Overseas Forces), 1993-2003," in Tobacco Outlook, United States Department of Agriculture, Economic Research Service, April 22, 2004, http://www.ers.usda.gov/Publications/so/view.asp?f=specialty/tbs-bb/ (accessed April 6, 2005) the U.S. Surgeon General's report concluded that cigarette smoking is a cause of lung and laryngeal cancer in men, a probable cause of lung cancer in women, and the most important cause of chronic bronchitis in both genders.

THE NATIONAL HOUSEHOLD SURVEY ON DRUG ABUSE.

Each year the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services (HHS) surveys American households on drug use with the National Survey on Drug Use and Health (NSDUH), formerly known as the National Household Survey on Drug Abuse (NHSDA). In 1985, 78% of Americans (150 million) reported smoking cigarettes at some time during their lives, and 39% (seventy-five million) were current smokers (meaning that they had smoked within the month prior to the survey). In its 2003 Survey SAMHSA reported that 68.7% of the U.S. population had smoked cigarettes at some time in their lives, and 25.4% were current smokers. (See Table 5.1.)

In 2003 men (28.1%) were more likely than women (23%) to be current smokers. Additionally, whites (26.6%) were more likely to be current smokers than blacks (25.9%), Hispanics (21.4%), or Asians (12.6%). Those aged eighteen to twenty-five had the highest rates of smoking at 40.2%, compared with 12.2% for twelve- to seventeen-year-olds and 24.7 for those twenty-six and older. (See Table 5.1.)

NATIONAL HEALTH INTERVIEW SURVEY.

The National Health Interview Survey (NHIS), conducted annually by the National Center for Health Statistics, reports findings similar to those of the NHSDA. Preliminary findings from the 2004 National Health Interview Survey showed that 20.1% of adults in the United States were current smokers in 2004, down from 24.7% in 1997 (see Figure 5.3) and down significantly from 42.4% in 1965. As did the NHSDA, the NHIS found that men were more likely than women to smoke. The current smoker category comprised 22.9% of adult men and 17.5% of adult women. FIGURE 5.2
Trends in smoking prevalence among adults, 1955-2002
SOURCE: Adapted from "Percentage of Smoking Prevalence among U.S. Adults, 18 Years of Age and Older, 1955-2002," in Smoking Prevalence among U.S. Adults, Centers for Disease Control and Prevention, National Center For Chronic Disease Prevention and Health Promotion, Tobacco Information and Prevention Source (TIPS), http://www.cdc.gov/tobacco/research_data/adults_prev/prevali.htm (accessed March 2, 2005) Women were more likely than men to have never smoked. (See Figure 5.4.)

Although the NHIS uses different age groups than the NHSDA, results of both surveys showed that younger people smoke at a higher rate than older people. Figure 5.5 shows that those aged eighteen to forty-four were slightly more likely than those aged forty-five to sixty-four to smoke. The rate of smoking in the sixty-five and over age group was dramatically lower than in either of the two younger groups. Men in all age categories were more likely than women in the same age group to smoke.

Also, like the NHSDA, the NHIS found that the prevalence of current smoking was highest for whites (21.8% in 2004) among various races/ethnicities. African-Americans were slightly less likely to smoke, with the prevalence of smoking in this group at 20.3% in 2004. Hispanics were the group least likely to smoke; prevalence of current smoking among them was 13%. (See Figure 5.6.)

THE GALLUP POLL.

The Gallup Organization has also observed a decline in the use of cigarettes. In 1954 nearly one-half (45%) of those asked indicated they had smoked within the last week; the proportion dropped to one-quarter (25%) as of July 2004. (See Figure 5.7.) For more than two decades, the Gallup Organization has polled smokers on how many cigarettes they smoke each day. In 2004, 52% reported that they smoked less than one pack per day; 33% reported smoking one pack a day; and 14% said they smoked more than one pack a day.

SMOKING AND THE MILITARY.

Soldiers throughout the past two centuries have smoked to calm their fears, fight fatigue, or pass the time. During the Revolutionary War (1775-83) George Washington is said to have urged those on the home front, "If you can't send money, send tobacco." Cigarettes were shipped to soldiers overseas in TABLE 5.1
Percentages reporting lifetime, past year, and past month use of cigarettes among persons aged 12 or older, by demographic characteristics, 2000-03SOURCE: "Table H.27. Percentage Reporting Lifetime, Past Year, and Past Month Use of Cigarettes among Persons Aged 12 or Older, by Demographic Characteristics: 2000 and 2001," in Results from the 2001 National Household Survey on Drug Abuse: Volume II. Technical Appendices and Selected Data Tables, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, August 2002, http://oas.samhsa.gov/nhsda/2k1nhsda/vol1/toc.htm (accessed February 21, 2005), and "Table G.27. Cigarette Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2002 and 2003," in Results from the 2003 National Survey on Drug Use and Health: National Findings, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, September 2004, http://oas.samhsa.gov/nhsda/2k3nsduh/2k3ResultsW.pdf (accessed February 21, 2005)

World War I (1914-18) and World War II (1939-45). Images of soldiers during the conflicts in Korea (1950-53) and Vietnam (1955-75) feature service personnel with cigarettes prominently extended from their mouths. In 1975, however, authorities stopped including cigarettes in the K-rations and C-rations issued to soldiers and sailors. Effective April 8, 1994, the U.S. Department of Defense banned smoking in all military workplaces. In 1996 the Pentagon ended a subsidy that made tobacco products cheaper at military commissaries (grocery stores).

Cigars, Pipes, and Other Forms of Tobacco

According to the 2003 NSDUH (published in 2004), 3.3% (7.7 million) of those age twelve and older were current users of smokeless tobacco (chewing tobacco or snuff), and 5.4% (12.8 million) were current users of cigars. These numbers were up from previous years.

According to the Department of Agriculture, U.S. smokers consumed an estimated 3.8 billion large cigars in 2002, or eighteen cigars per person age eighteen and over. (See Figure 5.8.) This is significantly higher than 1993, when U.S. consumers smoked 2.1 billion large cigars.

Youths remain a significant portion of the tobacco-consuming population. The 2003 Youth Risk Behavior Survey, a component of the Youth Risk Behavior Surveillance (Morbidity and Mortality Weekly Report, May 21, 2004), revealed that 27.5% of high school students reported being current users of some form of tobacco. (See Table 5.2.) Male students used cigars at approximately twice the rate of female students (19.9% vs. 9.4%). Among high school students, whites were the most likely to use smokeless tobacco. Whites and African-Americans had similar rates of cigar use, at 15.1% and 15.0% respectively.

Kreteks, or clove cigarettes, and bidi cigarettes are popular with some American youth. Most clove cigarettes are manufactured in Indonesia. They have been exported into the United States since 1968 and contain approximately 40% ground cloves and 60% tobacco with added clove oil. Clove cigarettes are rolled tighter than regular cigarettes and deliver, on average, twice as much tar, nicotine, and carbon monoxide as do moderate tar-containing American cigarettes. (Tars are sticky, cancer-causing substances similar to road tar. Carbon monoxide reduces the blood's ability to carry oxygen.)

FIGURE 5.3
Current adult smokers, 1997-2004
SOURCE: J.S. Schiller, Z. Coriaty Nelson, C. Hao, and P. Barnes, "Figure 8.1. Prevalence of Current Smoking among Adults Aged 18 Years and Over: United States, 1997-2004," in Early Release of Selected Estimates Based on Data from the January–June 2004 National Health Interview Survey, Centers for Disease Control and Prevention, National Center for Health Statistics, December 2004, http://www.cdc.gov/nchs/data/nhis/earlyrelease/200412_08.pdf (accessed March 2, 2005)

Bidis are small, strong-smelling, flavored brown cigarettes, wrapped in leaves much like cigars. They are produced in India and other Southeast Asian countries and were not widely used in the United States until the mid-1990s. Bidis produce approximately three times the amount of carbon monoxide and nicotine as American cigarettes, and about five times the amount of tar.

The 2003 Monitoring the Future: Overview of Key Findings reports that 2% of eighth graders, 3.8% of tenth graders, and 6.7% of twelfth graders used kreteks within the year before they were surveyed for the study. These numbers have decreased for all three age groups since 2001. The findings regarding bidi cigarettes are similar. In 2003, 2% of eighth graders, 2.8% of tenth graders, and 4% of twelfth graders used this form of tobacco—much smaller percentages than in 2000.