foodconsumer.org: Cigarette smoking kills 443,000 Americans each year - CDC report

Cigarette smoking kills 443,000 Americans each year - CDC report
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admin on 09/08/2010 09:56:00
 
MORBIDITY AND MORTALITY WEEKLY REPORT (MMWR)
VITAL SIGNS: CURRENT CIGARETTE SMOKING AMONG ADULTS AGED ≥18 YEARS --- UNITED
STATES, 2009
EARLY RELEASE
September 7, 2010 / 59(Early Release);1-6
ABSTRACT
Background: Cigarette smoking continues to be the leading cause of preventable
morbidity and mortality in the United States, causing approximately 443,000
premature deaths annually.
Methods: The 2009 National Health Interview Survey and the 2009 Behavioral Risk
Factor Surveillance System were used to estimate national and state adult
smoking prevalence, respectively. Cigarette smokers were defined as adults aged
≥18 years who reported having smoked ≥100 cigarettes in their lifetime and
now smoke every day or some days.
Results: In 2009, 20.6% of U.S. adults aged ≥18 years were current cigarette
smokers. Men (23.5%) were more likely than women (17.9%) to be current smokers.
The prevalence of smoking was 31.1% among persons below the federal poverty
level. For adults aged ≥25 years, the prevalence of smoking was 28.5% among
persons with less than a high school diploma, compared with 5.6% among those
with a graduate degree. Regional differences were observed, with the West having
the lowest prevalence (16.4%) and higher prevalences being observed in the South
(21.8%) and Midwest (23.1%). From 2005 to 2009, the proportion of U.S. adults
who were current cigarette smokers did not change (20.9% in 2005 and 20.6% in
2009).
Conclusions: Previous declines in smoking prevalence in the United States have
stalled during the past 5 years; the burden of cigarette smoking continues to be
high, especially in persons living below the federal poverty level and with low
educational attainment. Sustained, adequately funded, comprehensive tobacco
control programs could reduce adult smoking.
Implications for Public Health Practice: To further reduce disease and death
from cigarette smoking, declines in cigarette smoking among adults must
accelerate. The Patient Protection and Affordable Care Act is expected to expand
access to evidence-based smoking-cessation services and treatments; this likely
will result in additional use of these services and reductions of current
smoking and its adverse effects among U.S. adults. Population-based prevention
strategies such as tobacco taxes, media campaigns, and smoke-free policies, in
concert with clinical cessation interventions, can help adults quit and prevent
the uptake of tobacco use, furthering the reduction in the current prevalence of
tobacco use in the United States across age groups.
Cigarette smoking continues to be the leading cause of preventable morbidity and
mortality in the United States. The negative health consequences of cigarette
smoking have been well-documented and include cardiovascular disease, multiple
cancers, pulmonary disease, adverse reproductive outcomes, and exacerbation of
other chronic health conditions (1). Cigarette smoking causes approximately
443,000 premature deaths in the United States annually and $193 billion in
direct health-care expenditures and productivity losses because of premature
mortality each year.*
Despite significant declines during the past 30 years, cigarette smoking in the
United States continues to be widespread; in 2008, one in five U.S. adults
(20.6%) were current smokers (2). Year-to-year decreases in smoking prevalence
have been observed only sporadically in recent years. For example, a slight
decrease occurred from 2006 to 2007 but not from 2007 to 2008 (2). Monitoring
tobacco use is essential in the effort to curb the epidemic of tobacco use.†
To assess progress toward the Healthy People 2010 objective of reducing the
prevalence of cigarette smoking among adults to ≤12% (objective 27-1a),§ this
report provides the most recent national estimates of smoking prevalence among
adults aged ≥18 years, based on data from the 2009 National Health Interview
Survey (NHIS), and provides state-level estimates based on data from the 2009
Behavioral Risk Factor Surveillance System (BRFSS) survey.
Methods
The 2009 NHIS adult core questionnaire collects national health information on
illness and disability. The questionnaire was administered by in-person
interview and included a random probability sample of 27,731
noninstitutionalized civilian adults aged ≥18 years; the overall response rate
was 65.4%. Of the 27,731, a total of 128 were excluded because of unknown
smoking status; thus, the final sample size used in the analyses was 27,603. The
BRFSS survey is a state-based, random-digit--dialed telephone survey of the
noninstitutionalized civilian adult population and collects information on
preventive health practices, health-risk behaviors, and health-care access in
the United States. The core questionnaire includes questions on current
cigarette smoking; the Council of American Survey and Research Organizations
(CASRO) median response rate was 52.5% (from 38.0% in Oregon to 66.9% in
Nebraska), and the median cooperation rate was 75.0% (55.5% in California to
88.0% in Kentucky).¶
Smoking status was defined identically for both surveillance systems by using
two questions, "Have you smoked at least 100 cigarettes in your entire life?"
and "Do you now smoke cigarettes every day, some days, or not at all?"
Respondents who had smoked at least 100 cigarettes during their lifetime and, at
the time of interview, reported smoking every day or some days were classified
as current smokers. Smoking status was examined by race/ethnicity, age group,
education (among persons aged ≥25 years), poverty status, and region (overall
and by sex). Starting in 2007, income-related follow-up questions were added to
NHIS to reduce the number of responses with unknown values.** For this report,
poverty status was defined using 2008 poverty thresholds published by the U.S.
Census Bureau in 2009; family income was reported by the family respondent, who
might or might not have been the same as the sample adult respondent from whom
smoking information was collected.
Data from the 2009 NHIS were adjusted for nonresponse and weighted to provide
national estimates of cigarette smoking prevalence; 95% confidence intervals
were calculated to account for the survey's multistage probability sample
design. Data from the 2009 BRFSS were weighted to adjust for differences in
probability of selection and nonresponse, as well as noncoverage (e.g.,
households lacking landlines), and these sampling weights were used to calculate
all estimates. Using NHIS data, the Wald test from logistic regression analysis
was used to analyze temporal changes in current smoking prevalence during
2005--2009, overall and by region. For this 5-year trend analysis, results were
adjusted for sex, age, and race/ethnicity; a p-value of