Smokers and education

Adults with 16 or more years of education had the lowest smoking prevalence (11.3 percent). Adults with 9 to 11 years of education had higher smoking prevalence (36.8 percent) compared to adults with fewer or more years of education.

Smokers by socio-economic status

Smoking prevalence was higher among adults living below the poverty level (32.3 percent) than those living at or above the poverty level (23.5 percent).

Smokers by states

State-specific smoking prevalence among adults varied more than twofold in 1999, ranging from a low of 13.9 percent in Utah to a high of 31.5 percent in Nevada.

The states with the highest current smoking prevalence among adults were Nevada (31.5 percent), Kentucky (29.7 percent) and Ohio (27.6 percent). The lowest smoking prevalence rates among adults were found in Utah (13.9 percent), followed by Hawaii (18.6 percent), California (18.7 percent), Massachusetts (19.4 percent) and Minnesota (19.5 percent). Smoking prevalence in Puerto Rico (13.7 percent) was lower than in any of the 50 states.

Smokers by ethnicity/race

Smoking prevalence remained at the highest among American Indians/Alaska Natives at 40 percent in 1998. Prevalence among African-Americans (24.7 percent) and Caucasians (25.0 percent) remained higher than among Hispanics (19.1 percent) and Asians/Pacific Islanders (13.7 percent). Smoking prevalence among racial/ethnic populations has remained fairly stable in recent years. As smoking has declined among the white non-Hispanic population, tobacco companies have targeted both African Americans and Hispanics with intensive merchandising, which includes billboards, advertising and media oriented to these communities, and sponsorship of civic groups and athletic, cultural, and entertainment events.

Hispanic – There are approximately 31.3 million Hispanic Americans living in the United States, comprising 11.2 percent of the total population. Hispanics are less likely to be smokers (20.4 percent) than non-Hispanic whites (25.3 percent) and African Americans (26.7 percent). Among Hispanics, the proportion of men who smoke (26.2 percent) is higher than that of women (14.1 percent). Hispanic smokers (both male and female) tend to smoke fewer cigarettes per day (a half a pack daily or less) than non-Hispanic whites.

Lung cancer is the leading cause of cancer deaths among Hispanics. Lung cancer deaths are about three times higher for Hispanic men (23.1 per 100,000) than for Hispanic women (7.7 per 100,000).

African Americans – In 1997, about 6.7 million African American adults smoked cigarettes, accounting for approximately 14 percent of the 48 million adult smokers in the United States. The prevalence of current smoking among African Americans is 26.7 percent, compared with 25.3 percent for Caucasians. Cigarette smoking is more common among African American males than white males (32.1 percent versus 27.4 percent). Although African Americans smoke fewer cigarettes, on average, they tend to smoke brands with higher nicotine and tar levels. African Americans are also more likely to smoke mentholated cigarettes.

About 76 percent of African American cigarette smokers smoke menthol cigarettes as compared to 23 percent of Caucasians. These brands contain enough menthol to produce a cool sensation in the throat when smoke is inhaled. People who smoke menthol cigarettes can inhale more deeply or hold the smoke inside longer than smokers of non-menthol cigarettes. This may explain why African Americans, are more likely than Caucasians to die from smoking related diseases like lung cancer, heart disease and stroke. African Americans have higher lung cancer and oral cancer incidence, as well as higher mortality rates than whites.

Asians/Pacific Islanders – Asians/Pacific Islanders are the fastest growing segment of the U.S. population, nearly tripling in size from 1980 to 2000. Recent prevalence data show that Asian American and Pacific Islander men (21.6 percent) smoked less than white men (27.4 percent). In addition, smoking prevalence was substantially lower among Asian American and Pacific Islander women (12.4 percent) compared with white women (23.3 percent).

There are significant variations in smoking rates among Asian Americans and Pacific Islander groups. Much higher smoking rates are seen among population groups from Southeast Asia (e.g. Vietnam, Cambodia, Laos) than among population groups from other locations (e.g. Philippines, China, Japan). Smoking rates are much higher among Asian American and Pacific Islander men than among Asian American and Pacific Islander women, regardless of country of origin. While in the general population smoking among women decreases with age, smoking rates among Asian American and Pacific Islander women increase with age.
American Indians/Alaska Natives – Among racial and ethnic groups, the prevalence of current smoking is highest among American Indians/Alaska Natives (34.1 percent). Smoking rates among American Indians and Alaska Natives vary by region and state. Smoking rates are highest in Alaska (45.1 percent) and the North Plains (44.2 percent) and lowest in the southwest (17.0 percent). The rate of smoking among American Indian and Alaska Native women of reproductive age (18-44) in 1994-95 was 44.3 percent, compared with 29.4 percent of white, 23.4 percent of African American, 16.4 percent of Hispanic and 5.7 percent of Asian American and Pacific Islander women of reproductive age.

American Indian and Alaska Native lands are sovereign nations and are not subject to state laws prohibiting the sale and promotion of tobacco products to minors. As a result, American Indian and Alaska Native youth have access to tobacco products at a very young age.

Smokers by gender

“Tobacco kills more than half a million women per year worldwide. This number is expected to double by 2020. Internationally, women are increasingly targeted by tobacco marketing.”

“More than 152,000 women died from smoking related diseases in 1994.”

Currently about 22 million (22 percent) of women 18 years and older, and at least 1.5 million adolescent girls in the United States smoke cigarettes. Daily smoking rates among female high school seniors have increased from 17.9 percent in 1991 to 23.6 percent in 1997. The gap in smoking prevalence between men and women has narrowed dramatically in recent years. Although male smoking prevalence dropped 24 percentage points between 1965 and 1993, the prevalence of female smoking dropped only 11 percentage points during the same period. Women are beginning to smoke at younger ages, increasing their risks of developing smoking related diseases.

Smoking among U.S. women 18 years and older varies considerably by racial/ethnic groups: American Indian/Alaskan Native, 35 percent; Caucasian, 24 percent; African American, 24 percent; Chicano/Latino, 15 percent; and Asian/Pacific Islander, 4 percent.

Education also affects smoking rates. The more formal education a woman receives, the less likely she is to be a smoker. In 1995, 40 percent of women between the ages of 25 and 44 who did not finish high school were smokers; 34 percent of high school graduates were smokers; 24 percent of those with some college were smokers; and only 14 percent of those who graduated from college were smokers.

Between 1960 and 1990, the death rate from lung cancer among women increased by more than 400 percent, and the rate is continuing to increase. In 1987, lung cancer surpassed breast cancer as the number one cause of cancer deaths among women. The American Cancer Society estimated that in 1998, lung cancer killed 67,000 women, while breast cancer killed 43,500 women.

Smoking has a damaging effect on women’s reproductive health and is associated with reduced fertility and early menopause. Women who smoke during pregnancy subject themselves and their developing fetus and newborn to special risks, including pregnancy complications, premature birth, low birth weight infants, stillbirth and infant mortality. Research also suggests that intrauterine exposure to secondhand smoke after pregnancy is associated with an increased risk of Sudden Infant Death Syndrome (SIDS) in infants. For every dollar invested in smoking cessation for pregnant women, about $6 dollars is saved in neonatal intensive care costs and long-term care associated with low birth weight deliveries.

Between 8,000 and 26,000 children are diagnosed with asthma every year in the United States. The odds of developing asthma are twice as high among children whose mothers smoke at least 10 cigarettes a day. Between 400,000 and 1,000,000 asthmatic children have their condition worsened by exposure to secondhand smoke.

Smokers by age

“Each day, approximately 6,000 young persons try their first cigarette and approximately 3,000 become daily smokers.”

“About half of all nicotine users start by age 13, …nicotine addiction is a pediatric disease” – Dr. David Kessler (U.S FDA, 1996).

Middle School Students – The 1999 National Youth Tobacco Survey estimates that about one in eight (12.8 percent) middle school students reported using some form of tobacco (cigarettes, smokeless, cigars, pipes, bidis or kreteks) in the past month. Current cigarette use among middle school students was 9.2 percent (9.6 percent for males, and 8.8 percent for females). The rate of smoking among middle school students by race/ethnic groups was relatively equal, with about one in ten African American (9.0 percent), Caucasian (8.8 percent) and Chicano/Latino (11.0 percent) middle school students reporting smoking cigarettes in the past month.

Cigar use was the second most preferred tobacco product used in middle school, with 6.1 percent of students reporting smoking cigars in the past month. African American middle students (8.8 percent) were significantly more likely to smoke cigars than Caucasian students (4.9 percent). Current smokeless tobacco prevalence among middle school students was 2.7 percent – 4.2 percent in males and 1.3 percent for females. Pipe tobacco use among middle school students was 2.4 percent – 3.5 percent for males and 1.4 percent for females.

Current use of novel tobacco products, such as bidis (or beedies) and kreteks (also called clove cigarettes) was 2.4 percent and 1.9 percent, respectively among middle school students. There was no statistically significant difference in bidi or kretek use among race/ethnic groups.

High School Students – More than one-third (34.8 percent) of high school students reported using some form of tobacco in the past month. More than a quarter (28.4 percent) of high school students were current cigarette smokers, with male and female students smoking at equal rates – 28.7 and 28.2 percent respectively. Current cigarette smoking prevalence use by race/ethnic groups was higher among Caucasian high school students (32.8 percent) followed by Chicano/Latino (25.8 percent) and African American (15.8 percent) students.

Cigar use among high school students was 15.3 percent. An estimated one in 5 male students (20.3 percent) had used cigars compared to about 1 in 10 female students (10.2 percent) in the past month. Males (11.6 percent) were significantly more likely to use smokeless tobacco products than female (1.5 percent) high school students. The use of bidis (5.0 percent) and kreteks (5.8 percent) among high school students nearly equaled the use of smokeless tobacco (6.6 percent).

Young Adults – Current smoking prevalence among young adults aged 18-24 years was 25. 8 percent in 1993, 28.7 percent in 1997 and 27.9 percent in 1998. The data suggests that smoking prevalence among 18-24 year olds now equals that of 25 to 44 years olds (27.5 percent). In earlier years, smoking prevalence among young adults was lower that that of 25 to 44 year olds. There was no significant change in smoking among adults aged 25-44 years for the same period.