Collaboration in Civic Spheres

U.S. young adults reach a new low – in smoking

by Matt Rosenberg November 15th, 2012

For the first time since standardized data began to be collected in 1965, young adults – aged 18 to 24 – last year bested all U.S. adults in percent not smoking, according to a new report from the U.S. Centers For Disease Control and historical U.S. data. From 2005 though 2011 prevalence of cigarette smoking among the U.S. adult population has declined only slightly, from about 21 percent to 19 percent. But a bright spot is young adults, for whom the rate in that period dropped from 24.4 percent to 18.9.

The news comes in a new research brief issued by the U.S. Centers For Disease Control just last week in its journal Morbidity and Mortality Weekly. In years past, young adults smoked more than all adults in the U.S. A National Institutes of Health report drawing on CDC and other U.S. government data found that overall, 41.9 percent of adults were “current smokers” in 1965 versus 20.9 percent by 2005. That’s currently defined as having smoked at least 100 cigarettes overall, and still smoking on at least some days (the first part of the definition has changed slightly over the years). In contrast, according to a 2007 medical journal article by a CDC expert, the U.S. young adult percent of “current smokers” declined from 45.5 percent in 1965 to 24.5 percent in 2005.

But as the new CDC report shows, by 2011, young adult smoking prevalence had dropped just slightly below that of all adults in the U.S., as it continued to decline steadily from 2005 forward.

Rates of different age groups, 2005-2011, from Current Cigarette Smoking Among Adults - United States, 2011, U.S. Centers For Disease Control, Morbidity and Mortality Weekly, November 9, 2012

A 2008 University of California study suggests possible reasons. It noted that in recent years, young adults who did start smoking were more likely to succeed at quitting because they smoked fewer cigarettes per day than older smokers, relied less on pharmaceutical interventions, and were more often exposed to smoke-free environments in their teen and early adult years, when it is easier to quit.

Other findings for 2011, according to the new report:

Among racial groups in the U.S., Asians had lowest adult smoking prevalence rate in 2011 (9.9 percent) and American Indians/Alaska Natives the highest at 31.5 percent. Adults 25 to 44 years old and 45 to 64 had the highest rates of smoking and those over 64 the lowest. Of those living below the poverty level, 29 percent were smokers versus 17.9 percent for those at or above poverty level. One quarter of adults who reported they had a disability were smokers in 2011 versus 17.3 percent of those with no disability. More men were smokers than women in 2011, 21.6 percent versus 16.5 percent.

Of the 43.8 million American adult “current smokers,” more than three quarters smoked every day in 2011. They typically smoked 15.1 cigarettes per day in 2011, down from 16.7 in 2005.

The national projections are based on interviews of participants in the 2011 National Health Interview Survey, with the resulting data run through a number of statistical checks and balances, described in the report, to enhance the validity of the final results. Smoking status in the survey results is self-reported by respondents – but the CDC stresses research has shown that “correlates highly with measured serum cotinine levels,” an indicator of smoking.

Although there was good news about young adult smoking, challenges remain for the broader adult population. Its 2011 rate of current smoking is 19 percent but the nation’s “Healthy People 2020″ program goal is 12 percent. The report says meeting the goal will require “extensive implementation of evidence-based interventions” including higher cigarette prices, more legally-mandated smoke-free work places and public places, and expansion of quit support services, anti-tobacco media campaigns, and restrictions on tobacco advertising and marketing.

The U.S. adult smoking rate could drop more sharply following the implementation earlier this year of a federally-sponsored national media campaign “which included graphic personal stories on the adverse health impact of smoking,” the report states.

State support for intervention remains very mixed, however. The report says 27 U.S. states fund their tobacco control programs at less than 25 percent of CDC-recommended levels.

The new CDC report says that tobacco use (which includes smokeless tobacco products and cigars) “remains the single largest preventable cause of death and disease in the United States,” ending about 443,000 adult lives annually while imposing $96 billion in annual direct medical costs and $97 billion in yearly lost productivity.

Through reduced incidence of certain types of disease, and other public health benefits, researchers have found a 5-to-1 return on investment from smoking cessation programs in Washington state. One newer approach to public education – unveiled in King County last year – is community-based video storytelling on the benefits of a healthier diet and not smoking, through a CDC program implemented by Public Health – Seattle-King County, and local non-profits.

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