TABLE 8.—Prevalence, awareness, and control rates of
hypertension, persons 25-74 years of age,
United States, 1960-1962, 1974-1975, 1976-1980'

 

Percentage of total with hypertension

 

Percentage of
population Aware, Aware, Aware, *
with hyperten- no medication, medication,
Year sion* Unaware* medication no control controlled
1960-1962 20.3 51.1 17.6 15.3 16.0
1974-1975 22.1 36.4 29.4 14.6 19.6
1976-1980 22.0 26.6 17.2 22.1 34.1

 

Rates age-adjusted by the direct method to the population at the midpoint of the 1976-1980 National Health
and Nutrition Examination Survey.

* Systolic blood pressure 160 mm Hg or greater, or diastolic blood pressure 95 mm Hg or greater, or on
antihypertensive medication. ~

* Reported never told by physician of having hypertension.

* Those with hypertension taking antihypertensive medication whose blood pressure was not hypertensive.

SOURCE: National Center for Health Statistics (32).

TABLE 9.—Percentage of adults with serum cholesterol
levels of 260 mg/100 ml and over, by sex and
age, United States, Health Examination Survey
(HES) 1960-1962 and Health and Nutrition
Examination Survey (HANES) 1971-1974!

 

 

 

HES, 1960-1962 HANES, 1971-1974

Age Men Women Men Women

Percentage

Total, age 18-74 176 22.7 14.7 17.5
18-24 39 46 28 3.0
25-34 10.4 7.4 8.2 5.6
35-44 20.2 . 12.9 17.1 9.6
45-54 25.7 28.0 24.1 24.6
55-64 23.5 49.7 20.2 35.3
65-74 21.6 61.0 20.9 40.7

 

? Age adjusted by the direct method to 1971-1974 civilian noninstitutionalized population.

NOTE: All cholesterol values have been adjusted to approximate the values of Abell et al. (Abell, L.L., Levy,
G.B., Brodie, B.B., Kendall, F.E. A simplified method for the estimation of total cholesterol in serum, and
demonstration of its specificity. Journal of Biological Chemistry 196: 357-366, 1952), the common referenced
method, by reducing the 1960-1962 data by 7.6 percent and the 1971-1974 data by 4.5 percent.

SOURCE: National Center for Health Statistics (24).

socioeconomic level and lesser declines in poorer areas of the country
are also consistent with a favorable impact of smoking prevention or
cessation efforts on CHD mortality, in view of the clearly demon-
strated inverse relationship of male income level and prevalence of
smoking.

351
TABLE 10.—Regression coefficients, risk ratios, and
statistical significance for the risk of
cardiovascular disease in 8 years, men and
women, age 35-74 years, Framingham heart

 

 

study
Risk ratios evaluated
at_age 55°
Multiple
regression Risk Risk factor
Risk factor coefficient ! T? ratio difference
MEN
Cigarette smoking 0.580 6.48 18 Smoker/nonsmoker
Serum cholesterol 0.020 3.65 13 42 mg/dl
Cholesterol/age interaction 0.001 -2.61 — _
Systolic blood pressure 0.017 9.12 14 20 mm Hg
Glucose intolerance 0.410 2.92 15 Present/absent
WOMEN
Cigarette smoking 0.233 2.37 13 Smoker/nonsmoker
Serum cholesterol 0.019 2.98 12 46 mg/dl
Cholesterol/age interaction -0.001 2.77 _ _
Systolic blood pressure 0.015 8.59 14 24 mm Hg
Glucose intolerance 0.757 5.40 2.1 Present/absent

 

‘ Unstandardized coefficient of the multiple risk function for cardiovascular disease within 8 years with the
independent variables being serum cholesterol, cholesterol times age, aystolic blood pressure, cigarette smoking,
glucose intolerance, left ventricular hypertrophy on ECG, age, and age squared; estimated over the age range 35-—
74 years.

" Theee risk factors are statistically significant for both men and women. The critical value of T is
approximately equal to 2.0 at a =0.05.

* The hypothetical risk of development of cardiovascular disease associated with the specified difference in risk
factor levels when other risk factors in the model are held constant. A ratio greater than 1 represents positive
association with cardiovascular disease. For serum cholestero] and systolic blood Pressure, the difference chosen
was one standard deviation of the measurement.

SOURCE: McGee and Abbott (14).

Some questions remain unanswered regarding the contribution of
smoking cessation to the decline in CHD mortality. The percentage
of smokers who are heavy smokers appears to be increasing,
although it is not known whether this represents a greater cessation
rate among lighter smokers than among heavier smokers. The
percentage decline in CHD mortality for women has been as large as
for men, although proportionately fewer women than men have
given up smoking. Assertions that preventive measures have re-
sulted in smoking changes that caused the decline in CHD mortality
differences by age, socioeconomic status, and geographic area are
based on limited available data.

352
Conclusion

The evidence supports the conclusion that changes in smoking
habits have contributed to substantial improvement in mortality
rates from the cardiovascular diseases in the United States.

353
Technical Notes
International Classification of Diseases

Tables A and B contain the code numbers of the International
Classification of Diseases (ICD) applicable to the causes of death
described in this report (16, 20, 44, 45). Between each revision of the
ICD there are breaks in the continuity of these classifications,
affecting some diseases more than others. For cardiovascular dis-
ease, the most serious breaks in continuity are between the seventh
and eighth revisions and between the eighth and ninth revisions for
CHD and for hypertensive disease.

The cause of death commonly referred to as coronary heart disease
(CHD) was listed in both the sixth and seventh revisions of the ICD
(1949-1957, 1958-1967) as ‘“‘Arteriosclerotic heart disease, including
coronary heart disease,” code 420; in the eighth revision (1968-1978)
as “Ischemic heart disease,” codes 410-413; and in the ninth revision
(after 1978) as “Ischemic heart disease,” codes 410-414.

Expected Minus Observed Deaths

Multiplying the 1970 age-specific death rates (10-year age groups)
for total cardiovascular diseases times the 1980 census gives an
estimate of the number of cardiovascular disease deaths expected in
1980: 1,294,564 deaths, based on the level of mortality in 1970. An
estimate of the number of cardiovascular disease deaths observed in
1980 is 1,005,692. This latter estimate is made by combining the
estimated 989,000 deaths from major cardiovascular diseases in 1980
(ICD/9 codes 390-448) and the 4,803 deaths from diseases of the
veins in 1980 (ICD/9 codes 451-459) (27, 29). The difference is
288,872 cardiovascular disease deaths “averted” in 1980 because of a
decline in mortality from the level in 1970.

Multiplying the 1963 age-specific death rates (10-year age groups)
for coronary heart disease (ICD/7 code 420) times the 1979 popula-
tion estimate gives the number of CHD deaths, 804,000, expected in
1980, on the basis of the level of mortality in 1963 (2, 25, 27). The
observed number of deaths from CHD in 1980 for ICD/9 codes 410-
414 was 566,000, or 238,000 fewer than expected, based on the level
of mortality in 1963. This procedure assumes reasonably good
comparability of ICD classification of CHD in these 2 years.

Age-Adjusted Rates

Age adjustment for this Report is by the direct method. Age-
specific death rates in 10-year age groups are multiplied by the
“standard million” for 1940—the U.S. population by age as enumer-
ated in that year.

354
TABLE A.—Codes of the 6th, 7th, 8th, and 9th revisions of the International Classification of Diseases
for Selected Diagnoses

 

 

1949-1967 1968-1978 1979
Diagnosis 6th and 7th revisions 8th revision 9th revision
Cardiovascular diseases 330-334, 400-468 390-458 390-459
Coronary heart disease 420 . 410-413 410-414
Acute myocardial infarction no code for this diagnosis 410 410
Other coronary heart disease no code for this diagnosis 411-413 411-414
Cerebrovascular diseases 330-334 430-438 430438
Hypertensive disease 440-447 400-404 401-405
Other diseases of arteries 450~456 440-448 440-448
Atherosclerosis 450 440 440
Aortic aneurysm 451 441 441
Other 452-456 442-448 442-448
All other cardiovascular disease 400-416, 421-434, 460-468 390-398, 420-429, 450-458 390-398, 415-429, 451-459
Lung cancer 162, 163 162 — 162
Other cancers 140-161, 164-205 140-161, 163-209 140-161, 163-208
Diabetes mellitus 260 250 250
Influenza and pneumonia 480-493 470-474, 480-486 480-487
Chronic obstructive pulmonary disease 500, 501, 527.1 490-492, 519.3 490-492, 494-496
Cirrhosis of the liver 581 571 / 571
Accidents, poisonings, and violence E800-E985 E900-E999' E800-E999

 

SOURCE: World Health Organization (44, 45), National Center for Health Statistics (20).
TABLE B.—International classification of diseases codes for
cardiovascular-renal diseases' and
cardiovascular diseases?, 1900-1979

 

 

 

Years
Revision in use Codes
Ist 1900-1909 47, 64-66, 77-86, 120, 142
2nd 1910-1920 47, 64-66, 77-85, 120, 142
3rd 1921-1929 51, 74, 75, 83, 87-90,
91b, 91c, 92-96, 129, 151
4th 1930-1938 56, 82, 90-95, 97-103,
131, 132
5th 1939-1948 58, 83, 90-103, 131, 132
6th 1949-1958 330-334, 400-468, 592-594
Tth 1959-1967 330-334, 400-468
8th 1968-1978 390-458
9th 1979- 390-459
' Through 6th revision.
* After 6th revision.

SOURCE: Moriyama et al. (76), National Center for Health Statistics (20), World Health Organization (#8).

Population Estimates

Death rates for census years and for years prior to 1961 are based
on the resident or census population estimates that were available at
the time the official U.S. vital statistics were prepared. Rates for
1961 to 1969, however, are based on estimates of the resident
population revised to reflect the 1970 census, and rates for 1971 to
1979 are based on estimates of the resident population revised to

reflect the 1980 census (1, 2).

356
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APPENDIX B: TRENDS IN U.S.

CIGARETTE USE, 1965
TO 1980

361
introduction

This discussion of national trends in adult cigarette smoking over
recent years in the United States includes data on prevalence,
consumption, and cessation. It focuses on adult cigarette smoking
patterns and cessation by age and sex cohorts. Data were drawn from
an analysis of three national surveys by the National Center for
Health Statistics (NCHS) and three other national surveys on adult
use of tobacco conducted by the former National Clearinghouse for
Smoking and Health over the period from 1965 through 1980 (6, 7, 8).
A brief description of the data sources is presented, followed by a
discussion of the data.

Surveys of Tobacco Use
The 1966 Survey on the Use of Tobacco

Two separate national probability sample surveys on adult usage
of and attitudes toward tobacco conducted by the National Clearing-
house for Smoking and Health in 1966 have been combined and are
treated here as a single survey.

One study design imposed a two-way stratification on all house-
holds in the continental United States, classifying each household by
three types of population and nine geographic areas. The other
design divided the entire area of the United States into approximate-
ly 1,700 primary sampling units (PSUs). Weighting procedures
resulted in the selection of 5,770 respondents.

Within each household, the first eligible respondent (age 21 or
older) was the person interviewed; all current and former smokers
were also interviewed, but only a subsample of those who had never
smoked was interviewed. Weighting procedures were used to bring
the three groups into balance.

The 1970 and 1975 Surveys on the Adult Use of Tobacco

The 1970 and 1975 surveys sponsored by the National Clearing-
house for Smoking and Health employed the same sampling and
interviewing methodologies. Where possible, questions were phrased
similarly. The questionnaires for current, former, and never smokers
differed slightly.

In both surveys, the sample design consisted of two parts: a
national probability sample of telephone households and a national
probability sample of nontelephone households.

The respondent selection procedure was designed to produce 75
percent of the interviews with “ever” smokers and 25 percent with
“never” smokers. Weighting procedures were used to compensate for
this oversampling of ever versus never smokers. Other weighting
factors were used to adjust for age, sex, and smoker mix of the

363
household. The weighted number of respondents (age 21 or older)
was 5,875 in 1970 and 12,079 in 1975.

Smoking Supplement to the National Health Interview
Survey

The National Health Interview Survey (NHIS), a continuous
nationwide sample personal household interview survey by the
National Center for Health Statistics, included questions on ciga-
rette smoking in 1965, 1966, 1970, 1974, 1976, 1977, 1978, 1979, and
1980. Information is routinely obtained on personal and demograph-
ic characteristics. Questions focused primarily on such characteris-
tics as present smoking status, amount smoked daily, and in more
recent years, attempts to quit, and on tar and nicotine levels of
cigarettes smoked. Information was not obtained on opinions,
attitudes, or beliefs related to smoking.

The universe for the NHIS is the civilian noninstitutionalized
population of the United States. The survey is based on a multistage
probability sample of primary sampling units in about 42,000
households containing about 85,000 persons. A one-third subsample
of the adult respondents is interviewed for the smoking supplement
(during 1965 and 1966 smoking data were obtained for all adults).

Patterns of Smoking Prevalence and Cessation
Prevalence of Cigarette Smoking

The percentage of adults who report being current regular
smokers, defined as persons who have smoked at least 100 cigarettes
and who were smokers at the time of interview, has been declining
steadily over the last 15 years (Table 1). For the total white male
population, this decline has been from 51.3 percent in 1965 to 37.1
percent in 1980, and for white females, from 34.5 to 30.0 percent.
Among black adults a similar pattern was seen—for males a decline
from 59.6 to 44.9 percent, and for females, from 32.7 to 30.6 percent.

Conversely, the percentage of the white adult male population who
reported being former smokers increased between 1965 to 1980 from
21.2 to 31.9 percent, and of white females, from 8.5 to 16.3 percent by
1980. Again, a similar trend was observed among blacks, with the
percentage of former smokers increasing from 12.6 to 20.6 percent of
males, and from 5.9 to 11.8 percent of females. This increase in the
percentage of former smokers is more marked among males (20.3 to
30.5 percent) than among females (8.2 to 15.7 percent), although the
proportion among males increased by a factor of 1.5, while that
among females doubled.

In addition to this increase in percentage of former smokers over
the 15-year period, among most of the sex, race, and age groups there
also appears to be an increase in the percentage of persons who

364
TABLE 1.—Percentage distribution of adult current and
former cigarette smokers, according to sex,
race, and age, in 1965, 1976, and 1980

 

Current smoker' (percent)

Former smoker (percent)

 

Sex, race, and age 1965 1976 1980* 1965 1976 1980?
MALE

Total 34

All ages > 20° 52.1 41.6 379 20.3 29.6 30.5
20-24 59.2 45.9 39.7 9.0 12.2 12.1
25-34 60.7 48.5 43.1 14.7 18.3 20.6
35-44 58.2 47.6 42.6 20.6 27.3 27.6
45-64 519 413 40.8 24.1 37.1 36.9
>65 28.5 23.0 179 28.1 44.4 47.4
White

All ages > 20* 51.3 41.0 37.1 21.2 30.7 31.9
20-24 58.1 45.3 39.0 9.6 13.3 12.2
25-34 60.1 47.7 42.0 15.5 18.9 21.9
35-44 57.3 46.8 42.4 21.5 28.9 28.8
45-64 513 40.6 40.0 55.1 38.1 38.4
>65 27.7 22.8 16.6 28.7 45.6 50.1
Black

All ages > 20° 59.6 50.1 449 12.6 20.2 20.6
20-24 67.4 52.8 45.5 38 41 10.6
25-34 68.4 59.4 52.0 6.7 11.8 119
35-44 67.3 58.8 44.2 12.3 13.8 21.2
45-64 57.9 49.7 48.8 15.3 28.6 26.3
>65 36.4 26.4 27.9 21.5 33.0 26.6

FEMALE

Total 34

All ages > 20° 34.2 32.5 29.8 8.2 13.9 15.7
20-24 419 342 32.7 7.3 10.4 11.0
25-34 43.7 375 31.6 99 12.9 14.4
35-44 43.7 38.2 34.9 96 15.8 18.9
45-64 32.0 348 30.8 8.6 15.9 17.1
>65 96 128 16.8 45 11.7 14.2
White

All ages > 20° 345 32.4 30.0 85 14.6 16.3
20-24 419 34.4 33.3 8.0 11.4 12.5
25-34 43.4 37.1 31.6 10.3 13.7 14.7
35~44 43.9 38.1 35.6 99 17.0 20.2
45-64 32.7 34.7 30.6 8.8 16.4 174
>65 98 13.2 17.4 4.5 11.5 14.3
Black

All ages > 20° 32.7 34.7 30.6 5.9 10.2 11.8
20-24 44.2 34.9 32.3 2.5 5.0 2.2
25-34 47.8 42.5 34.2 6.7 8.9 11.6
35-44 42.8 41.3 36.5 7.0 9.6 12.5
45-64 25.7 38.1 34.3 66 119 14.1
>65 TA 9.2 9.4 45 13.3 14.1

 

? A current smoker has smoked at least 100 cigarettes and now smokes; includes occasional smokers.
* Final estimates. Based on data for the last 6 months of 1980.
$ Base of percentage excludes persons with unknown smoking status.

“Includes all other races not shown separately.

5 Age adjusted by the direct method to the 1970 civilian noninstitutionalized population using 5 age groupe.

NOTE: Percentages do not add up to 100 because of “never smokers” in the survey population.

SOURCE: Deta from the National Health Interview Survey, National Center for Health Statistics, 1965, 1976,

and 1980, based on household interviews with a sample of the civilian noninstitutionalized population.

report never having smoked. In males, this is demonstrated by both
races and by the age groups younger than 45 years of age. In females,

365
TABLE 2.—Average number of cigarettes smoked per day
by current and former smokers, by sex, age,
and educational level, in 1970, 1975, and 1980

 

 

1970? 1975? 1980?
Sex, age, Current Former Current Former Current Former
and education smoker smoker smoker smoker smoker smoker
Total
All ages >21 20.0 22.6 21.2 24.5 21.7 25.0
Male
All ages >21 21.8 25.0 22.8 27.2 23.4 28.1
21-24 20.8 16.2 18.9 20.8 19.4 18.7
25-34 21.0 23.4 22.1 24.0 22.1 24.0
35-44 23.0 27.7 23.4 28.0 25.6 28.7
45-54 24.2 25.4 25.1 29.5 27.2 31.6
55-64 21.8 27.7 25.0 28.1 23.3 31.3
>65 17.2 25.3 20.3 28.0 20.9 27.1
Female
All ages >21 17.7 17.3 19.1 18.8 19.7 19.8
21-24 16.1 13.8 18.6 14.7 17.8 17.6
25-34 181 18.7 18.5 17.7 19.4 20.3
35-44 18.6 18.2 20.1 19.5 22.5 19.8
45-54 18.4 19.0 20.3 20.8 20.7 22.4
55-64 17.0 15.4 19.0 20.8 20.0 20.4
> 65 14.0 14.6 16.1 17.1 15.6 17.2
Educational level
0-8 18.1 21.7 21.7 25.9 20.5 26.2
9-11 20.3 22.2 216 25.0 22.3 27.8
12 20.2 22.8 20.8 24.2 21.9 24.4
13-15 20.3 22.5 21.3 25.1 22.1 24.3
>16 20.8 23.2 20.6 22.1 21.1 24.0

‘ National Survey on Adult Use of Tobacco, PHS, 1970.
* National Health Interview Survey Smoking Supplement, PHS, 1980.
NOTE: Data from 1966 National Survey were not compatible with other years.

 

the increase in percentage of persons who report never having
smoked is limited to the age groups younger than 35 years.

Average Daily Consumption of Cigarettes

Table 2 shows data on the average number of cigarettes smoked
daily during three survey periods (1970, 1975, and 1980) for both
current and former smokers.

Overall, current smokers reported an increased consumption, from
a mean of 20.0 cigarettes per day in 1970 to 21.7 cigarettes per day in
1980. The 1970 to 1980 increase in mean number of cigarettes
smoked daily was slightly greater for females than for males (2.0
versus 1.2), a finding consistent with the increasingly similar
smoking behavior in females and males. Thus, although males
continue to smoke a greater average number of cigarettes per day

366
than do females, the difference in daily consumption between the
sexes for current smokers in 1980 was less than that observed a
decade earlier.

The heaviest daily consumption is observed in the middle-aged
groups (35 to 64 years). A greater mean increase from 1970 to 1980
was observed among women aged 35 to 64.

Male former smokers generally reported greater daily cigarette
consumption than did current smokers in each survey. This trend
was not found in females. This finding is contrary to the widely held
belief that those who smoke fewer cigarettes per day are more likely
to quit. It may be due in part to a tendency of former smokers to
overestimate their consumption and of current smokers to underesti-
mate their consumption or both.

Among former smokers of both sexes, average daily consumption
rates increased with age, peaking at the 45- to 54-year-old age
category.

No trend over time is discernible by educational level in the
overall mean daily consumption among current smokers. There was,
however, an increase in the daily cigarette consumption of former
smokers with 8 or fewer years of education, from 21.7 in 1970 to 26.2
in 1980. Within each survey year, there is also no discernible trend
between level of education and daily cigarette consumption. The
greater reported average daily consumption by educational status
for former smokers than for current smokers may reflect cognitive
dissonance, or changing social pressures that result in reporting bias.

Table 3 displays the percentage distribution of current smokers by
grouped number of cigarettes smoked daily, over the 1965, 1976, and
1980 NHIS surveys. Cigarette smokers had a tendency to round off
their reported number of cigarettes smoked per day (3) (Table 4).
Approximately one-third of the smokers reported smoking exactly 20
cigarettes (one pack) a day in each of the survey years. The
proportion of current smokers reporting consumption levels of 21 to
29 or 31 to 39 cigarettes per day remained relatively constant
between 1970 and 1980.

Although the proportion of smokers who report consumption
levels of 20 to 39 cigarettes per day has remained fairly stable over
the last 10 years (48.6 vs. 49.3), a clear difference is observed at the
more extreme ends of the distribution, ie., among those smoking
fewer than 20 cigarettes and those smoking 40 or more cigarettes per
day.

In 1970, only 11.4 percent of the respondents reported smoking 40
or more cigarettes per day; by 1980, 16.8 percent reported smoking
40 or more cigarettes per day. During the same period, smokers
reporting consumption levels of less than 20 cigarettes per day
decreased from 39.8 percent in 1970 to 33.8 percent in 1980 (Table 4).

367
TABLE 3.—Percentage distribution of adult current
smokers’ by grouped number of cigarettes
smoked per day by sex, race, and age, 1965,
1976, and 1980

 

Cigarettes smoked per day

 

 

 

 

<5 15-24 225
Sex, race, and age 1965 1976 19802 1965 1976 1980! 1965 1976 19902
MALE
Total 3.4
All ages > 20 28.3 24.2 23.1 46.3 448 42.7 25.4 310 6341
20-24 349 316 32.0 49.7 499 478 15.4 18.5 20.2
25-34 25.7 25.5 23.6 50.0 45.8 46.5 24.3 28.7 29.9
35-44 23.7 19.6 15.8 448 412 42.3 31.5 39.2 419
45-64 26.7 185 21.6 45.3 44.1 36.4 28.0 37.4 42.0
>65 47.1 39.1 29.2 39.0 42.7 46.1 13.8 18.2 24.7
White
All ages > 20 25.9 21.4 19.1 46.8 449 43.6 27.4 33.7 37.4
20-24 32.3 27.5 27.1 50.8 528 504 16.9 19.7 22.4
25-34 22.8 22.1 19.5 511 46.5 47.4 26.1 31.4 33.1
35-44 213 17.2 12.8 448 404 421 339 425 45.1
45-64 24.6 16.2 17.3 45.4 43.3 37.4 30.0 40.4 45.3
>65 446 37.5 26.1 40.3 42.2 46.2 16.1 20.4 27.7
Black
All ages > 20 48.1 43.8 48.7 42.6 448 40.3 9.3 11.5 10.9
20-24 52.7 56.9 56.6 419 34.2 36.7 5.3 8.9 68
25-34 478 46.0 44.4 41.7 43.5 46.2 10.5 10.5 9.6
35-44 42.5 38.5 45.6 455 448 411 12.0 16.7 13.2
45-64 46.9 35.9 61.1 43.7 50.8 35.0 9.4 13.3 141
>65 64.9 53.0 41.7 319 470 472 3.2 111
FEMALE
Total 3«
All ages > 20 43.6 36.5 34.2 42.2 43.8 42.0 14.2 19.6 23.7
20-24 48.4 43.1 42.8 419 42.4 41.1 9.7 14.6 16.1
25-34 41.4 34.3 33.5 43.1 45.2 41.9 15.5 20.5 24.6
3544 39.1 33.8 27.8 43.7 444 39.3 17.1 21.8 33.0
45-64 44.4 34.3 29.8 42.0 442 459 13.6 21.5 24.2
>65 62.6 49.3 48.9 310 389 37.7 6.4 11.8 13.4
White
All ages > 20 41.0 33.2 30.6 43.9 45.2 438 16.1 216 25.6
20-24 45.3 39.3 37.4 44.4 4430 44.1 10.4 16.4 18.5
25-34 37.9 30.6 28.6 45.4 468 449 16.7 22.6 26.5
3544 36.2 29.5 24.6 45.3 45.4 39.9 18.4 25.1 35.5
45-64 42.4 32.0 26.4 43.2 45.1 478 14.5 23.0 259
> 65 61.5 45.7 48.1 31.8 417 37.7 68 12.6 14.2
Black
All ages > 20 67.7 60.0 61.1 26.4 338 289 59 61 10.0
20-24 73.4 65.7 78.0 22.1 31.3 22.0 45 3.0 -
25-34 66.2 588 61.9 25.1 33.6 22.0 87 77 16.2
35-44 63.4 60.4 55.6 30.4 38.1 35.6 6.2 14 8.8
45-64 69.4 53.2 53.8 26.9 36.7 34.2 3.6 10.1 12.0
>65 83.2 100.0 66.3 168 - 34.7 - - -
‘ A current smoker has smoked at least 100 cig and now kes; includ ional kers.

* Based on data for the last 6 months of 1980.

? Base of percentage excludes unknown amount smoked.

*Includes al] races not shown separately.

SOURCE: Data from the Nationa! Health Interview Survey, National Center for Health Statistics, 1965, 1976,
and 1980, based on household interviews with a sample of the civilian noninstitutionalized population.
TABLE 4.—Percentage distribution of adult current
smokers who reported smoking specific
numbers of cigarettes per day, in 1970, 1975,

 

 

 

and 1980
Percentage of current smokers
Number of cigarettes/day 1970? 1975! 1980?
1-9 15.8 13.5 13.1
39.8] 37,0} 33.8{
10-19 24.0 23.5 20.7
20 34.9 32.0 34.8
21-29 3.1 28 2.3
30 9.6 12.1 115
31-39 10 08 0.7
40 88 10.7 11.1
11.4{ 15.2{ 16.8}
41+ 26 45 5.7

 

* National Survey on Adult Use of Tobacco, PHS, 1970 and 1975.
* National Health Interview Survey Smoking Supplement, PHS (Preliminary), 1980.
NOTE: Data from 1966 National Survey are not compatible with other years.

These findings may be due to several factors, including (1)
increased smoking (possibly among those who have switched to lower
tar cigarettes), (2) a higher cessation rate among persons smoking
fewer cigarettes, (3) the entry of new smokers of greater numbers of
cigarettes, or (4) some combination of these factors.

Number of Attempts to Quit Smoking

Survey data have shown that the majority of current smokers
have made at least one serious but unsuccessful attempt to quit (4).

Table 5 shows the percentage of current smokers who reported
having made three or more attempts to quit. Similar data are shown
for former smokers for two of the survey years. A modest downward
trend is observed in the percentage of current smokers who reported
making three or more attempts to quit (from 41.2 percent in 1966 to
38.7 percent in 1980), but the proportion of former smokers reporting
three or more attempts to quit increased from 36.0 percent to 53.2
percent over the period from 1966 to 1975; this increase is seen in
most of the sex, race, and age groups.

Comparing the proportion of current smokers who had made three
or more attempts to quit by years of education showed a general
downward trend over time for all education levels except in the less
than 8 years of education group, where the proportion increased
from 38.9 percent in 1966 to 47.0 percent in 1980. Among the most
educated current smokers, the decline was from 59.8 to 39.4 percent.

369
TABLE 5.—Percentage of current and former smokers who
made three or more attempts to quit, by sex,
age, and educational level, in 1966, 1975, and

 

 

1980
1966' 1975! 1980*

Sex, age, Current Former* Current Former? Current Former‘
and education smoker smoker smoker smoker smoker smoker
Total

All ages >21 41.2 36.0 40.5 53.2 38.7
Male

All ages >21 40.7 36.9 39.4 55.1 38.8

21-24 35.4 21.5 39.0 50.0 315

25-34 37.4 50.0 38.2 43.7 38.7

35-44 418 36.6 37.1 48.8 35.0

45-54 42.9 36.8 44.1 58.4 39.8

55-64 44.1 34.1 45.6 63.3 42.8

>65 46.9 30.1 31.0 61.9 52.6
Female

All ages >21 41.5 34.0 42.0 49.1 38.7

21-24 28.6 35.3 32.3 52.9 31.3

25-34 34.5 38.1 39.5 47.2 31.0

35-44 43.5 33.3 45.1 42.7 42.5

45-54 56.7 23.9 448 57.0 37.1

55-64 38.6 43.6 44.7 50.9 49.2

>65 43.5 28.6 46.9 46.4 46.1
Educational level

0-8 38.9 32.3 44.3 58.5 47.0

9-11 42.7 30.0 40.8 53.6 38.4

12 38.4 39.2 40.0 56.3 37.2

13-15 37.7 | 428 38.4 46.8 35.2

>16 59.8 36.8 414 52.2 39.4

 

* National Survey on Adult Use of Tobacco, PHS, 1966 and 1975.

* National Health Interview Survey Smoking Supplement, PHS (Preliminary), 1980.
* Includes the last successful attempt.

* 1980 former amoker data not available.

Recent Attempt to Quit

Data in Table 6 show the percentage of current and former
smokers who reported an attempt to quit in the 12 months prior to
the interview. Although there was little change overall from 1966 to
1975 in the percentage of current smokers who reported making an
attempt to quit smoking in the previous year (1.5 percent), from 1975
to 1980 there was an increase of almost 10 percent. This increase is
shown consistently for all the sex, race, and age groups. Among those
who had attempted to quit, proportionately more young persons
(under 35 years) than older persons reported attempting to quit
during the previous 12 months.

370
TABLE 6.—Percentage of current and former smokers who
attempted to quit during the last year, by sex,
age, and educational level, in 1966, 1975, and

 

 

1980
1966! 1975! 1980?

Sex, age, Current Former Current Former Current Former*
and education smoker smoker smoker smoker smoker smoker
Total

All ages >21 26.0 13.8 275 9.8 36.7
Male

All ages >21 23.3 12.1 25.5 8.2 33.4

21-24 44.0 6.7 44.0 29.2 52.5

25-34 23.8 20.4 28.7 15.8 37.3

35-44 19.4 11.2 19.1 63 26.9

45-54 19.1 14.8 20.0 7.0 27.3

55-64 12.2 13.1 25.3 19 29.9

> 65 15.6 18 19.3 3.1 29.2
Female

All ages >21 29.4 17.2 30.0 12.7 40.6

21-24 40.0 33.3 50.8 27.5 55.1

25-34 35.7 24.2 33.0 20.3 47.1

35-44 25.0 12.5 29.1 11.7 39.5

45-54 25.2 13.0 19.8 9.3 30.0

55-64 17.9 11.4 23.6 6.4 31.8

> 65 27.8 179 25.2 42 37.0
Educational level

0-8 25.4 12.1 27.6 42 36.7

9-11 25.9 15.5 28.0 9.9 38.8

12 26.8 15.1 26.1 10.0 37.7

13-15 25.0 10.2 29.1 13.4 31.3

>16 26.1 15.5 27.5 9.3 38.4

 

* National Survey on Adult Use of Tobacco, PHS, 1966 and 1975.
* National Health Interview Survey Smoking Supplement, PHS (Preliminary), 1980.
* 1980 former smoker data not available.

Relationship of Tar Yields to Smoking Behavior

In 1972, the Public Health Service classified tar as one of the
“most likely” contributors to the health hazards posed by cigarettes,
and studies have confirmed its carcinogenicity (4). In response to this
finding, a major change occurred in the cigarette products manufac-
tured and actually used. Over the last two decades, the proportion of
domestically consumed cigarettes yielding 15 mg or less of tar has
increased from 15 percent in 1968 to 60.9 percent in 1981 (7).

The cigarette industry has also increased its promotional activities
in marketing brands yielding 15 mg or less tar. The percentage of
dollars expended in the United States on advertising and promotion
of cigarettes yielding 15 mg or less tar has increased from 19.6
percent in 1975 to 48.1 percent in 1978. These factors may account,

371
TABLE 7.—Percentage distribution of current regular
smokers by tar level of primary brand of
cigarettes, by sex and age, in 1975 and 1980

 

 

 

1975! 1980?
Tar level Tar level
<5 5-9 10-14 15-19 204 <5 5-9 10-14 15-19 204
Sex and age mg mg mg mg mg mg mg mg img = mg
Total
All ages >21 0.8 0.6 95 679 202 6.3 13.1 25.4 448 10.4
Male
All ages >21 05 0.6 95 63.5 268 41 106 225 495 133
21-24 _ —- 84 79.0 126 26 81 22.2 66.0 10
25-34 0.5 08 10.3 = 70.5 179 3.9 10.2 23.7 584 3.7
35-44 1.1 0.2 85 658 244 3.8 10.9 2653 450 149
45-54 _- 05 12.1 56.1 31.3 5.0 10.1 22.2 390 23.6
55-64 12 16 85 50.2 385 5.4 116 196 308 236
> 65 04 0.8 67 493 42.7 3.7 15.5 16.2 383 263
Female
All ages >21 11 0.6 11.7 73.2 13.4 89 159 28.7 39.4 V1
21-24 12 0.3 117° = 80.4 6.4 5.5 85 325 519 17
25-34 0.6 0.4 10.9 78.4 9.7 67 189 289 445 09
35-44 12 0.9 13.0 746 10.3 13.6 152 291 37.1 5.1
45-54 15 0.3 108 656 219 8.1 178 299 32.5 11.7
55-64 08 _ 126 8 8=670.3 16.3 9.7 13.7 242 376 14.9
> 65 21 3.1 12.5 639 18.5 96 186 266 302 14.9

 

' National Survey on Adult Use of Tobacco, PHS, 1975.
* National Health Interview Survey Smoking Supplement, PHS (Preliminary), 1980.

in part, for the ever-increasing use by current smokers of lower tar
cigarettes.

The definition of cigarettes as “lower tar” at 15 mg is arbitrary.
Nonetheless, this breakpoint has gained general acceptance. Special
note should be taken, however, that tar yields vary continuously, and
groupings by relative yield measurements do not automatically
imply differences in either the type or the magnitude of their
biological effects.

The percentage distribution of current regular smokers by tar
level of their primary brand of cigarette is presented in Table 8. A
clear trend toward increased use of lower tar products is apparent.

The 1975 data on brands were coded to the 1975 Federal Trade
Commission (FTC) values for tar yield, and the 1980 data were coded
to the 1979 FTC values. As tar values have been progressively
declining, the 1980 data probably represent slightly higher values of
tar yields than were actually being used at that time.

372
Conclusions

1.The proportion of current regular smokers declined steadily
between 1965 and 1980. The decline was steeper among males
(from 52.1 to 37.9 percent) than among females (from 34.2 to
29.8 percent).

2. The proportion of never smokers increased steadily from 1965
to 1980 among males (27.6 to 31.6 percent), except those 45
years old and older. Among females, only 20- to 34-year-olds
showed an increase in proportion of never smokers.

3.The mean number of cigarettes smoked per day by current
smokers increased slightly from 1970 to 1980 (from 20 to 21.7
cigarettes).

4. Males smoked a higher mean number of cigarettes throughout
the 1970-1980 period, but the number for males and females
increased about the same amount.

5. Heaviest daily consumption was in the middle-aged group (35-
65 years). The greatest mean increase was observed among
women aged 35 to 44.

6. The proportion of current smokers who smoked less than 20
cigarettes per day decreased between 1970 and 1980 (39.8 to
33.8 percent); the proportion smoking one pack exactly (20
cigarettes) remained constant (34.9 to 34.8 percent); the propor-
tion smoking from 21 to 39 cigarettes increased slightly (13.7 to
14.5 percent); and the proportion smoking two or more packs
per day increased (11.4 to 16.8 percent).

7. The proportion of current smokers who attempted to quit three
or more times decreased slightly from 1966 to 1980 (41.2 to 38.7
percent).

8. The proportion of former smokers having made three or more
attempts to quit increased sharply (36 to 53.2 percent) from
1966 to 1975.

9. The proportion of current smokers who had attempted to quit
during the past year increased from 1966 to 1980 (26.0 to 36.7
percent).

10. Among current smokers, younger persons and females were
more likely than older persons and males to have attempted to
quit during the previous 12 months.

11. The proportion of former smokers who had attempted to quit
during the previous 12 months decreased from 1966 to 1975
(13.8 to 9.8 percent).

12. Among former smokers, younger persons and females were
more likely than older persons and males to have quit during
the previous 12 months.
References

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374