Recent Decline in U.S. Smoking Prevalence Stalls

The United States likely will fall well short of the Healthy People 2010 objective of reducing to less than 12 percent the prevalence of cigarette smoking among adults.

According to a Morbidity and Mortality Weekly Report, or MMWR, article released Nov. 13, the proportion of U.S. adults who were cigarette smokers declined from 24.1 percent in 1998 to 19.8 percent in 2007. However, the figure increased to 20.6 percent in 2008.

The CDC said in the MMWR article that none of the states are funding tobacco control programs at levels the agency has recommended. CDC officials said funding at recommended levels is needed to continue and improve tobacco control programs, especially to reach populations that have disproportionately high rates of smoking.

Smoking rates varied widely by ethnic group and education level, according to data from the 2008 National Health Interview Survey. Adults with General Educational Development, or GED, certificates had the highest smoking rate, at 41.3 percent, compared with a rate of less than 6 percent among adults with graduate degrees.

The CDC said that evidence-based programs known to be effective at reducing smoking should be intensified among groups with lower education levels.

"Because persons with lower educational attainment generally have higher rates of smoking, are less likely to quit, and have less knowledge about the health effects of smoking but are interested in quitting, health care providers should take education level into account when communicating with such patients," the agency said.

Quit ratios among adults 25 and older were 39.9 percent for those with a GED and 45.7 percent for those with no high school diploma. That's compared with quit ratios of more than 60 percent for those with an undergraduate degree and more than 80 percent for those with a graduate degree. Quit ratios are the ratio of former smokers to ever smokers for each survey year.

According to the MMWR article, American Indians/Alaska Natives had the highest prevalence of smoking (32.4 percent), followed by non-Hispanic whites (22.0 percent), non-Hispanic blacks (21.3 percent), Hispanics (15.8 percent) and Asians (9.9 percent).

Men (23.1 percent) were more likely to smoke than women (18.3 percent).

Previous studies have shown that prevalence of tobacco use also varies by state.

The CDC estimates 46 million American adults are smokers. The agency said offering effective cessation counseling and treatments are integral to reducing smoking, especially in populations with high rates of smoking.

The AAFP's tobacco cessation program, Ask and Act, encourages members to ask their patients about tobacco use and to then act to help them quit. Through the Ask and Act program, AAFP members have access to a variety of resources to help patients quit using tobacco, including

Pamela Rodriguez, AAFP's tobacco control manager, said more than 500,000 quitline referral cards have been distributed to Academy members, providing patients with access to free counseling and tips on their quit plan.