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Tobacco Use in America

Chapter 2. Prevalence of the Use of Tobacco Products

2.1 Introduction

Nicotine is found in multiple tobacco products—cigarettes, smokeless tobacco, cigars, and pipes. Despite the widespread knowledge of the negative consequences of use of tobacco products, too many Americans continue to use them. In 1999, according to the National Household Survey on Drug Abuse (NHSDA), 30 percent of those aged 12 or older, or 67 million persons, had used one or more tobacco products in the past month. Cigarette smoking has shown a long-term decline since the release of the first Surgeon General's report on smoking and health in 1964 but continues to be high. The 1999 NHSDA found that 26 percent of those aged 12 or older, or 57 million persons, were current cigarette smokers. Among youths aged 12 to 17, the prevalence of current smoking was about 15 percent, an unacceptably high rate of use.

2.2 Trends in Tobacco Use

Figure 2.1 presents trend data for the past month use of cigarettes, smokeless tobacco, and cigars from 1994 to 1999 for all respondents. More detailed data for age groups are presented in Table 2.1 in Appendix B (significance testing is shown in the table). These 1999 data are drawn from the supplemental paper-and-pencil interviewing (PAPI) questionnaire that was used in prior NHSDAs and are not directly comparable to estimates presented elsewhere in this report that are based on computer-assisted interviewing (CAI) data. Because of problems fielding the PAPI sample in 1999, and extensive review of study findings, an adjustment procedure was developed and applied to these data. Limited trend data are available based on this procedure. The 1999 PAPI data are described briefly in Appendix A in this volume and in more detail in the 1999 NHSDA Summary of Findings (Office of Applied Studies [OAS], 2000b).

Past month or current cigarette use was relatively stable for all persons aged 12 or older between 1994 and 1999, ranging from 28.6 percent in 1994 to 29.7 percent in 1999, with no significant differences between survey years. The age groups, however, showed some fluctuation in use over these years. Cigarette smoking among youths aged 12 to 17 and young adults aged 18 to 25 was stable between 1998 and 1999, but use among youths was lower in 1999 than earlier years and use among young adults was higher. Use among adults aged 26 to 34 was stable between 1994 and 1999. Among adults aged 35 or older, cigarette smoking increased between 1998 and 1999, and use in 1998 was lower than in prior survey years (i.e., 1994 to 1997). In 1999, past month cigarette use was highest among young adults aged 18 to 25 (41.0 percent), followed by adults aged 26 to 34 (34.4 percent), adults aged 35 or older (28.5 percent), and youths aged 12 to 17 (15.9 percent). 

Figure 2.1 Percentages of Persons Aged 12 or Older Reporting Past Month Use of Cigarettes, Smokeless Tobacco, and Cigars: 1994 to 1999 PAPI

Note: Past month cigar estimates are not available for the 1994 to 1996 NHSDAs.

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1994 to 1999-PAPI.

Smokeless tobacco use decreased significantly between 1994 and 1999 for all respondents aged 12 or older and for youths and young adults. For all persons aged 12 or older, current smokeless tobacco use dropped from 3.3 percent in 1994 to 2.2 percent in 1999. Declines were larger among young adults, from 6.2 percent in 1994 to 3.7 percent in 1999. Use was generally stable among older adults from 1994 to 1999, staying between 4 and 5 percent among adults aged 26 to 34 and between 2 and 3 percent among adults aged 35 or older. Between 1998 and 1999, significant decreases in current smokeless tobacco use were seen for both young adults (5.4 to 3.7 percent) and older adults (the rate fell from 2.6 to 1.6 percent).

Cigar use was stable between 1997 and 1999, staying between 6 and 7 percent among persons aged 12 or older.

2.3 Number and Percentage of Users of Tobacco Products

In 1999, almost three fourths of persons aged 12 or older reported they had ever used a tobacco product (72 percent), with more than one third (36 percent) reporting use in the past year and almost one third (30 percent) reporting use in the past month (see summary table below and Tables 2.2 and 2.3 in Appendix B). These percentages correspond to estimates of 159 million lifetime tobacco users, 80 million past year users, and 67 million past month users among persons aged 12 or older. Most of these tobacco users smoked cigarettes. Some 68 percent of persons had smoked a cigarette in their lifetime, 30 percent had smoked in the past year, and 26 percent had smoked in the past month. Almost 57 million persons were current cigarette smokers (i.e., they had smoked in the past month).

Numbers (in Thousands) and Percentages of Lifetime, Past Year, and Past Month Users of Tobacco Products among Persons Aged 12 or Older: 1999

Tobacco Product

Lifetime

Past Year

Past Month

Number

Percent

Number

Percent

Number

Percent

Any Tobacco

159,114

72.0

79,775

36.1

66,766

30.2

    Cigarettes

150,715

68.2

66,641

30.1

56,966

25.8

    Smokeless Tobacco

42,213

19.1

10,310

4.7

7,558

3.4

    Cigars

78,613

35.6

25,976

11.7

12,120

5.5

    Pipes

39,222

17.7

-

-

2,390

1.1

- Not available.

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse: 1999.

About one third of the population had ever smoked a cigar (36 percent), one in five had ever used smokeless tobacco (19 percent), and fewer than one in five had ever smoked a pipe (18 percent). About 6 percent or 12 million persons were current cigar smokers; 3 percent or almost 8 million persons were current smokeless tobacco users; and about 1 percent or 2.4 million persons were current pipe users.

As shown in Table 2.3 in Appendix B, about three fourths of young adults aged 18 to 25 and older adults aged 26 or older had ever used a tobacco product, mostly cigarettes. Lifetime use rates were lower among youths aged 12 to 17, but 40.6 percent reported they had ever used any tobacco product and 37.1 percent had used cigarettes. About 10 percent of youths had ever used smokeless tobacco in their lifetime, 19.6 percent had ever used cigars, and 3.4 percent had used pipes.

Past month use rates were highest for each of the tobacco products among young adults aged 18 to 25. Almost one half were current users of any tobacco product (44.7 percent), 39.7 percent were current cigarettes smokers, 6 percent were current users of smokeless tobacco, 11.5 percent were current cigar smokers, and 1 percent had smoked pipes in the past month. Among youths, 17.3 percent had used a tobacco product in the past month, 14.9 percent had smoked a cigarette, 2.3 percent were smokeless tobacco users, 5.4 percent smoked cigars, and less than 1 percent were pipe smokers. Among persons aged 26 or older, 29.5 percent had used a tobacco product in the past month, 24.9 percent had smoked a cigarette, 3.2 percent were smokeless tobacco users, 4.5 percent smoked cigars, and 1.1 percent were pipe smokers.

2.4 Prevalence of Use of Tobacco Products, by Demographic Characteristics

Important variations in the use of tobacco products occur with demographic characteristics, such as age, gender, race/ethnicity, region, county type, education, and employment. The distribution of use of tobacco products by detailed age categories is presented in Tables 2.4 to 2.6 in Appendix B, and the distribution by other demographic characteristics in Tables 2.7 to 2.10.  

2.4.1 Age

As noted above and in Table 2.3, current use of all tobacco products was highest among young adults aged 18 to 25. Almost 40 percent were current cigarette users compared with about 15 percent of youths aged 12 to 17 and almost 25 percent of adults aged 26 or older, for example. These higher rates among young adults are also reflected in more detailed age categories shown in Figure 2.2 for past month of cigarettes, smokeless tobacco, and cigars (see also Tables 2.4 to 2.6 in Appendix B). Past month cigarette use increased steadily with each year of age to age 20, from 2.2 percent at age 12 to a high of 43.5 percent at age 20. Use generally declined after age 23, to 22.5 percent at ages 50 to 64 and 10.7 percent at age 65 or older.

Current cigar use (see Table 2.6) also increased during the teenage years, to a peak of 14.4 percent at age 18. Use gradually declined with age, to about 4 percent among those aged 50 to 64 and 1 percent of those aged 65 or older. Use of smokeless tobacco (see Table 2.5) also increased during the teenage years to a peak of 6 percent during the early 20s, when use began to decline. Smokeless tobacco use was about 2 percent after age 40. 

Figure 2.2 Percentages of Persons Aged 12 to 25 Reporting Past Month Use of Cigarettes, Smokeless Tobacco, and Cigars, by Age: 1999

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999.

2.4.2 Gender

Males were more likely than females aged 12 or older to be current users of cigarettes, smokeless tobacco, cigars, and pipes, as shown in Tables 2.7 to 2.10 in Appendix B. Although rates of cigarette use were more nearly equal among males and females (28.3 vs. 23.4 percent), rates of cigar use were almost 6 times higher among males than females (9.5 vs. 1.7 percent) and rates of use of smokeless tobacco and pipes were about 10 times higher. These gender differences in the use of tobacco products found for persons aged 12 or older were also found for each of the age groups, with the one exception that past month cigarette use was the same among youths aged 12 to 17 (i.e., about 15 percent).

2.4.3 Race/Ethnicity

American Indians and Alaska Natives aged 12 or older were more likely than their peers in other racial/ethnic groups to report past month use of cigarettes, smokeless tobacco, cigars, and pipes, as shown in Figure 2.3 for cigarettes and in Tables 2.7 to 2.10 in Appendix B for all tobacco products. The lowest rates for each tobacco product were generally found among Asians. For example, 36 percent of American Indians/Alaska Natives were current cigarette users compared with 27 percent of whites, about 23 percent of blacks and Hispanics, 17 percent of Asians, and 30 percent of persons of more than one race. These differences among persons aged 12 or older generally held for other age groups, although not all estimates were of sufficient precision for comparison. These differences were especially exaggerated among youths where 26.8 percent of American Indian/Alaska Native adolescents were current smokers compared with 17.1 percent of whites, 12.1 percent of Hispanics, 8.6 percent of blacks, 8.1 percent of Asians, and 16.0 percent of adolescents of more than one race.

The prevalence patterns for cigar use by race/ethnicity were different from those observed for cigarettes. In particular, among young adults aged 18 to 25 years, persons of more than one race were most likely to report past month cigar use (16.2 percent), followed by blacks (13.5 percent) then whites (12.3 percent). Blacks and whites in the 26- to 34-year-old age group were also most likely to report current cigar use (8.3 and 7.6 percent, respectively). Racial/ethnic differences for smokeless tobacco were similar to those observed for cigarettes. Among adolescents, American Indians/Alaska Natives were most likely to be current users of smokeless tobacco (5.9 percent) followed by whites (3.1 percent). Blacks had the lowest rates of current smokeless tobacco use; prevalence was under 1 percent for both black adolescents and black young adults.

2.4.4 Region

Regional differences in the use of tobacco products were not as pronounced, as shown in Table 2.7 to 2.10 in Appendix B. Current cigarette smoking ranged from a low of 21.9 percent in the Pacific portion of the West region to a high of 30.5 percent in the East South Central portion of the South, an area that includes Mississippi, Tennessee, Kentucky, and Alabama. Past month cigar use was highest in the Mountain area of the West region (6.8 percent), and smokeless tobacco use was a lot higher in the East South Central portion of the South (6.9 percent). For smokeless tobacco use, no other geographic area came close to the East South Central. The next highest rate of current smokeless tobacco use was reported by persons in the West North Central area (5.1 percent). Pipe use was also highest in the East South Central portion of the South (2.2 percent). Among youths aged 12 to 17, use of cigarettes, smokeless tobacco, and cigars were highest in the East South Central area (18.4, 4.8, and 7.9 percent, respectively). Pipe use among youths was highest in the Mountain area of the West region (1.2 percent). 

Figure 2.3 Percentages of Persons Aged 12 or Older Reporting Past Month Use of Cigarettes, by Race/Ethnicity: 1999

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999.

2.4.5 County Type

Use of cigarettes and pipes among persons aged 12 or older was somewhat higher in nonmetropolitan counties than large or small metropolitan counties, while cigar use was slightly higher in small metropolitan counties, as shown in Tables 2.7 to 2.10 in Appendix B. However, smokeless tobacco use was substantially higher in nonmetropolitan counties than large or small metropolitan counties (6.9 percent vs. 1.8 and 3.9 percent, respectively). Among youths, use of cigarettes, smokeless tobacco, cigars, and pipes was generally highest in completely rural counties (e.g., 19.2percent of youths were current cigarette smokers vs. 13.3 percent of youths in large metropolitan areas). Similarly, cigarette use among young adults was highest in less urbanized counties (43.8 percent) compared with 37.5 percent in large metropolitan counties.

2.4.6 Education

Among adults aged 18 or older, past month use of cigarettes and smokeless tobacco were higher among those with a high school education or less, as shown in Tables 2.7 to 2.10 in Appendix B. An estimated 32.5 percent of those with less than a high school education were current smokers compared with 31.5 percent of those with a high school education, 28.5 percent of those with some college, and 14.4 percent of college graduates. Smokeless tobacco use was reported by about 4 percent of those with some college or less compared with about 2 percent of college graduates. Education differentials in cigarette smoking were found for each of the age groups, but patterns were not as consistent for use of smokeless tobacco. Pipe use was relatively low among all education groups, and cigar use was slightly lower among those with less than a high school education.

2.4.7 Employment

Current cigarette use was highest by far among unemployed persons, both for persons aged 18 or older and within each age group (as shown in Tables 2.7 through 2.10 in Appendix B). Almost 44 percent of unemployed persons were past month cigarette users compared with 30 percent of those employed full time and 26 percent of those employed part time. Cigar use was also higher among unemployed persons than other employment groups for all age groups except persons aged 35 or older among whom use was highest among those employed full time. Smokeless tobacco use was generally higher among those employed full time, while rates of pipe use were relatively low across all employment groups.

2.4.8 Family Income

Current cigarette use and current pipe use were higher among persons aged 12 or older with lower family incomes than among persons with higher family incomes. Current use of smokeless tobacco and cigars was not consistently related to family income for persons aged 12 or older, as shown in Tables 2.7 to 2.10 in Appendix B. Current cigarette use was almost double among persons with family incomes less than $9,000 (33 percent) compared with those with family incomes of $75,000 or more (18 percent). Cigarette use was also higher among persons from families with lower incomes for youths aged 12 to 17 and persons aged 26 or older. For young adults, however, there was little difference in current cigarette use across income categories.

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