109

35

 

 

 

 

 

 

 

 

HY 0) |---- 2-22 nee eee ee ee ee ee ene eee eed
Z
Z
a 5 |e - == 2-2 eee ee nnn enn ee ee ee ee ee eed
OQ
~
a 9 ! \ ] ] L ! | l l L l |
1974 1976 1978 1980 1982 1984 1986 1988
YEARS
—_ <12 yr 12 yr * 13-15 yr >16 yr
Education Education Education 7 Education

FIGURE 5.—Percentage of ever smokers who never tried to quit, by education,

United States, 1974-87
SOURCE: NHISs 1974, 1976, 1978, 1979, 1980, 1987; OSH, unpublished data.
09

&

 

40

30

20 |

—_
Qo

 

 

 

 

PERCENTAGE

 

o

1978 1979 1980 1987
YEAR
Mm OC<12 yr 12 yr 13-15 yr Mm > 16 yr

Education Education Education Education

 

FIGURE 6.—Percentage of persons smoking at 12 months prior to the survey
interview who quit for at least | day during those 12 months,

United States, 1978-80, 1987, by education
SOURCE. NHISS 1978 1979 1980 1987: OSEL. unpublished data.
t09

 

 

PERCENTAGE

 

 

 

0 1 bof a a dt | tg oe |
1965 1970 1975 1980 1985
YEAR
<12 yr 12 yr x 13-15 yr 2 16yr
Education © Education Education = Educanon

FIGURE 7.—Percentage of ever smokers who had been abstinent for less than

1 year, United States, 1966-87, by education
SOURCE: NHISs 1966, 1970, 1978, 1979, 1980, 1983, 1985, 1987; OSH, unpublished data.

1990
09

 

 

 

 

 

 

yD pene nn cee cee een cece eee eee ene ee een neem eee aren cera nee ene en arene nanan ennwnmananneenseeenennanuanenneees es
2
e
Zz
ty
eo LI pope Pop
1965 1970 1975 1980 1985 1990
YEAR

S 12 12 yr 13-15 yr > 216 yr

Education Education = Education Education

FIGURE 8.—Percentage of ever smokers who had been abstinent for 1—4 years,

United States, 1966-87, by education
SOURCE: NHISs 1966, 1970, 1978, 1979, 1980, 1983, 1985, 1987: OSH, unpublished data.
S09

 

50

 

 

 

 

w
g
e
Zz
za]
O
eZ
SB git bi py tp
1965 1970 1975 1980 1985
YEARS
<12 yr 12 yr * 13-15 yr 216 yr
Education + Education Education = Education

FIGURE 9.—Percentage of ever smokers who had been abstinent for 5 years or

more, United States, 1966-87, by education
SOURCE: NHISs 1966, 1970, 1978, 1979, 1980, 1983, 1985, 1987; OSH, unpublished data.

1990
Percentage of Those Smoking at 12 Months Prior to a Survey Interview Who
Quit for at Least 1 Day During Those 12 Months

The percentage of those smoking at [2 months prior to a survey interview who
stopped for at least | day during those |2 months is a measure of quitting activity—that
is, quitting attempts—independent of the success of those attempts. Trend data show
that this percentage was slightly higher in 1987 than in the 3 earlier years (1978, 1979,
and 1980) in all educational strata (Figure 6).

Data show an effect of all demographic variables (gender, race, education, and age)
on quitting for at least | day (Table 5). Females are significantly more tikely to be in
this category than are males. Blacks, more than whites, are more likely to have been
abstinent for | day or more. Although the effect of education is not statistically
significant, the data suggest a positive trend. Overall, the likelihood of being abstinent
for at least | day tends to be higher in the more highly educated groups (Figure 6),
especially in 1987, Finally, there is a J-shaped relationship between quitting for at least
I day and age. The proportion in this category is highest in the two younger age groups,
lowest in the 45--64-year-old group. and intermediate in the oldest age group.

Percentage of Ever Smokers Who Had Been Abstinent for Less Than 1 Year

The data in Figure 7 show trends. analyzed according to education, in the proportion
of ever smokers who. at the time of the survey, had been abstinent for less than 1 year.
In general, no stable trend over the years or absolute change in this proportion from
1965 to 1987 is seen. This lack of a consistent pattern is also evident when the data are
classified by gender, race, and age. In every subgroup, the proportion of ever smokers
who had been abstinent for less than | year in 1985 increased: the reason for this increase
is unclear. Data from the 1988 NHIS, which were not available when this Report was
prepared, should help clarify recent trends in this measure of quitting.

The data show effects of most of the demographic variables on the tikelihood of being
in this category (Table 5). In general, the two younger age groups are more likely than
the two older age groups to have been abstinent for less than | year. A higher proportion
of whites than blacks have been abstinent for less than | year. However, given that the
trend in this proportion has been generally stable for whites and increasing for blacks,
the gap between the races has closed with time. The level of education is positively
associated with the likelihood of being in this category. Those with the least education
(<12 years) are slightly less likely to be recent quitters compared with other education
groups. There is no difference between the sexes in the likelihood of being in this
category.

Percentage of Ever Smokers Who Had Been Abstinent for | to 4 Years

Figure 8 presents data on trends in the proportion of ever smokers, who at the time
of the survey had been abstinent from | to 4 years, are stratified by education. While
no consistent patterns appear across time, the data show that education is positively
associated with being abstinent for | to 4 years. Those with the highest education level

606
(16+ years) are the most likely to have quit | to 4 years earlier, and those with the lowest
educational level (<12 years) are the least likely.

The data also show that for 1965-1978, the proportion of males who had been
abstinent for | to 4 years is slightly higher than that for females (although across the
entire time period 1965-87, there is no difference in the proportions between the sexes).
Given that the proportion off cigarettes for | to 4 years has been increasing significantly
tor females and remained stable for males with time, the gap between the genders has
closed (Table 5). Whites are more likely than blacks to have been abstinent for | to 4
years. The data do not show any consistent patterns with respect to age. Across time.
on average, the proportion of those in the 45—64-year age group in this category 1s
slightly lower than in the other age groups.

Percentage of Ever Smokers Who Had Been Abstinent for at Least 5 Years

Data on the proportion of ever smokers who, at the time of the survey. had been
abstinent for 5 years or more show positive trends with time for the overall population
and for every population subgroup (trends across education shown in Figure 9).
Overall, the proportion of ever smokers in this category has more than doubled from
12.4 percent in 1965 to 29.8 percent in 1987. Data from the 1955 Current Population
Survey (the first large survey of tobacco use conducted among a probability sample of
the U.S. population) indicate that 5.0 percent of those who ever smoked cigarettes were
abstinent for at least 4.5 years in 1955 (Haenszel, Shimkin, Miller 1956).

The data also show strong effects of all four demographic variables on the likelihood
of being abstinent for at least 5 years. Figure 9 shows that those with the most education
(16+ years) are the most likely to have been abstinent for 5 years or more than those in
the other categories. On average, over time, the data show that increasing education
is associated with increasing likelihood of being in this category (Table 5). Also seen
in the data are a gender effect (males are more likely than females to have been abstinent
for 5+ years), a race effect (whites are more likely than blacks to be in this category).
and a strong effect of age (increasing age is associated with increasing likelihood of
being abstinent for at least 5 years). The age effect is due, at least in part. to the fact
that older persons have had a longer opportunity to quit and maintain long-term
abstinence compared with younger persons. The gaps between the races and across age
groups (and to a lesser extent, across education) have been increasing with time.

Interpretation of Continuum Findings

In the period spanned by these data, a slightly increasing proportion of smokers are
attempting to quit and are maintaining abstinence. Slightly less than a third of the
people who were smoking at 12 months before the 1987 survey quit smoking for at least
1 day during those 12 months. Trends categorized by sociodemographic subgroups
show that females. blacks, younger persons, and more highly educated persons are more
likely than the appropriate comparison groups to have quit for at least 1 day during the
last year.

607
One way to determine whether these quit attempts have been successful is to examine
trends in the proportion of ever smokers who have been abstinent for | to 4 years.
Although blacks are more likely than whites to have quit for | day or more, whites are
more likely to have successfully maintained abstinence for | to 4 years. Younger
smokers are more likely to have quit for | day or more than older smokers; however,
there are only small absolute differences across age groups in the percentage who have
been abstinent for 1 to 4 years. The positive trend across educational categories with
respect to quitting for | day or more parallels important differences seen in the
likelihood of being abstinent for | to 4 years. Those with the lowest level of education
were the least likely to make an attempt to quit and the least likely to maintain long-term
abstinence. Those with the highest level of education were the most likely to have made
a quit attempt and the most likely to maintain long-term abstinence. Finally. although
females were more likely than males to have quit for at least | day, there were no gender
differences in abstinence for | to 4 years.

The data on the increasing proportion of ever smokers who have been off cigarettes
for at least 5 years show that more ever smokers are entering this category by
successfully quitting and abstaining than are exiting by death or relapse. Overall, this
proportion has increased 242 percent between 1965 and 1987. Consistent with other
data showing that males began quitting earlier than females (Fiore et al. 1989),
proportionately more males than females are in this category. Similarly, whites began
quitting earlier, and are therefore, more likely than blacks to have stopped smoking for
5 years or more. There is also evidence that those with the highest level of education
have been abstinent for a longer period than those with less education. Finally, older
people were more likely to have been abstinent for at least 5 years. This positive
relationship reflects the accumulation of successful quitters with age and, probably to
some extent, the benefits of cessation on survival.

OTHER MEASURES RELATED TO SMOKING CESSATION

Intention to Smoke in 5 Years

Intention to smoke or quit is a predictor of future smoking behavior (Collins, Emont,
Zywiak, in press: Cummings et al. 1988; Pierce, Dwyer et al. 1987; Pederson, Basker-
ville, Wanklin 1982). Current and former smokers responding to the five OSH-spon-
sored surveys of tobacco. use were asked to assess the likelihood that they would be
smoking in 5 years. There is litte change in the responses of former smokers since
1964. In each survey year, fewer than 3.2 percent of all former smokers responded that
they would be smoking again in 5 years. Thus, former smokers overestimate the
likelihood that they will remain abstinent. (See the previous Section, Long-Term
Abstinence and Relapse.)

In Table 6, the predicted likelihood of future smoking behavior among current
smokers is presented for each survey year by gender. The sharp dropoffs that occurred
between 1966 and 1970 may have occurred as a result of the widespread television
broadcast of antismoking public service announcements (PSAs) from 1968 to 1970

608
TABLE 6.—Percentage of those intending to smoke in 5 years, by gender,
AUTSs, United States, 1964-86, current smokers aged 21

 

 

 

and older
Definitely will be smoking Probably will be smoking Total (definitely + probably)
Year Male Female Male Female Male Female
1964 25.2 20.1 50.6 54.4 75.8 74.5
1966 22.3 15.6 53.7 55.4 76.0 71.0
1970 10.9 10.2 39.) 41.1 $0.0 51.3
1975 1L.7 12.0 44.2 45.9 55.9 57.9
1986 7.3 6.4 35.2 38.8 42.6 45.3

 

NOTE: AUTS=Adult Use of Tobacco Survey.
SOURCE: AUTSs 1964, 1966, 1970, 1975, 1986.

under the Federal Communications Commission's Fairness Doctrine (US DHHS
1989a). Longitudinal data collected between 1964 and 1975 supported the hypothesis
that the Fairness Doctrine PSAs influenced smokers’ attitudes about quitting (Horn
1979). The percentage of smokers who “thought seriously about giving up smoking”
increased from 56 percent before the PSAs to about 85 percent at the end of. and 5 years
after, the PSAs. The proportion of smokers who tried to quit and the overall cessation
rate also increased over the same timeframe.

The slight increases in intention to smoke from 1970 to 1975 might reflect a decay
effect after the removal of the antismoking commercials. The reduction between 1975
and 1986 could reflect an increase in antismoking activity, such as the growth of the
nonsmokers’ rights movement (US DHHS 1989a).

Receipt of Advice to Quit from a Doctor

Advice to quit smoking by a doctor increases patient cessation rates (Glynn, Manley,
Pechacek, 1990; Kottke et al. 1988; Schwartz 1987; US Preventive Services Task Force
1989). Data from Table 7 show that the percentage of current smokers who report
having ever been advised by a doctor to stop smoking increased steadily for both
genders between 1964 and 1987. Male current smokers were 3.1 times more likely to
report having received advice from a doctor to stop smoking in 1987 than in 1964;
female current smokers were 3.2 times more likely to have reported receipt of such
advice in 1987 than in 1964.

The data for former smokers, while less consistent, also show increases with time.
Male former smokers were 1.5 times more likely to report having received advice from
a doctor to stop smoking in 1987 than in 1964. Female former smokers were 2.1 times
more likely to report having received such advice in 1987 than in 1964.

In summary, large increases in the percentages of current and former smokers who
reported having received advice to quit occurred between 1976 and 1987.

609
TABLE 7.—Percentage who report having ever received advice to quit froma
doctor, by smoking status and gender, United States, 1964-87,
adults aged 21 and older

 

 

Current smokers Former smokers
Surves Male Female Male Female
AUTS 1964 18.0 16.6 22.3 15.9
AUTS 1966 16.9 [8.8 27.8 21.8
ALTS 1970 21.8 25.0 20.0 20.1
NHIS 1974 25.2 27.8 22.6 18.9
AUTS 1975 26.2 28.2 24,2 23,7
NHIS 1976 26.8 30.2 24.4 19,3
AUTS 1986 40.0 53.1 26.4 27.8
NHIS 1987 46.6 53.8 33.6 32.8

 

NOTE: AUTS=Adult Use of Tobacco Survey: NHIS=National Health Interview Survey.

CONCLUSIONS

1. By 1987. more than 38 million Americans had quit smoking cigarettes, nearly half

of all living adults who ever smoked.

tw

The percentage of ever cigarette smokers who are former cigarette smokers (quit

ratio) has increased from 29.6 percent in 1965 to 44.8 percent in 1987 at an average
rate of 0.68 percentage points per year. The quit ratio has increased among men
and women, among blacks and whites, and among all age and education subgroups.
Between 1966 and 1987, the rate of increase in the quit ratio among college

graduates was twice the rate among high school dropouts.

3. About one-third of all former cigarette smokers who have maintained abstinence for
at least 1 year may eventually relapse. As the duration of abstinence increases,

relapse becomes less likely.

4. Quitting activity, as measured by the proportion of people smoking at 12 months
before a survey who quit for at least | day during those 12 months, has increased
slightly over time. Between 1978 and 1987, this proportion increased from 27.8 to

31.6 percent.

an

. Female smokers were more likely than male smokers to have quit smoking cigarettes

for at least 1 day during the previous year. however, there were no gender differen-
ces in the proportion abstinent for | to 4 years. Men were more likely than women
to have been abstinent for 5 years or more. These findings do not take into account

the use of tobacco products other than cigarettes.

610
10.

. Black smokers were more likely than white smokers to have quit for at least 1 day

during the previous year. Blacks, however, were less likely than whites to have
been abstinent for } year or more.

. Younger smokers (aged 20 to 44) were more likely than older smokers to have quit

for at least | day during the previous year.

. Smokers with less education tend to be less likely to have quit for at least | day

during the previous year compared with those having more education. In addition,
those with lower levels of education are less likely to have been abstinent for | year
or more.

In 1964, about three-fourths of all current smokers predicted that they would
“definitely” or “probably” be smoking in 5 years. In 1986, fewer than half of all
current smokers felt the same way. Moreover, while more than 20 percent of current
smokers in 1964 predicted that they would “definitely” be smoking in 5 years, only
about 7 percent of current smokers in 1986 so predicted.

Current smokers in 1987 were more than three times as likely as current smokers
in 1964 to report having received advice from a doctor to stop smoking.

611
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DHEW Publication No. (PHS) 79-50066, 1979.

615
U.S. PREVENTIVE SERVICES TASK FORCE. Guide to Clinical Preventive Services. U.S.
Department of Health and Human Services, Public Health Service. Office of the Assistant
Secretary of Health. Office of Disease Prevention and Health Promotion, Baltimore: Wil-
fiams and Wilkins, 1989, pp. 193-197.

WEST. D.W.. GRAHAM. S.. SWANSON. M.. WILKINSON. G. Five year follow-up of a
smoking withdrawal clinic population. American Journal of Public Health 67(6):536-544,
1977.

616
AARP
ACS
AR
AUTS
BM
BMI
BP
BPS
BRFSS
BUPA
CASS
CC
CCDPHP

CDC
CHD
Cl

cig
CNS
co
COHb
COPD
CPS
CPS-I
CPS-I
CV
CVD
DBP
DHEW
DHHS
DLcoSB
DPA
DSM-III-R
FEV|
FVC|
HANES

GLOSSARY

American Association of Retired Persons
American Cancer Society
attributable risk
Adult Use of Tobacco Survey
bone mass
body mass index
blood pressure
Baseline Prevalence Survey
Behavioral Risk Factor Surveillance System
British United Providence Association
Coronary Artery Surgery Study
closing capacity
Center for Chronic Disease Prevention
and Health Promotion
Centers for Disease Control
coronary heart disease
confidence interval
cigarettes
central nervous system
carbon monoxide
carbox yhemoglobin
chronic obstructive pulmonary disease
Center for Preventive Services
Cancer Prevention Study I
Cancer Prevention Study II
closing volume
cardiovascular disease
diastolic blood pressure
Department of Health, Education, and Welfare
Department of Health and Human Services
carbon monoxide diffusing capacity
dual photon absorptiometry
Diagnostic and Statistical Manual of Mental Disorders
t-sec forced expiratory volume
l-sec forced vital capacity
Health and Nutrition Examination Survey

617
HB.Ag
HCN
HDL-C
HMO
HR
IARC
LDL-C
MI
MMEF
MRC
MRFIT
NCHS
NCI
NHANES-1
NHEFS
NHIS
NHLBI
NNS
OSH
PBI
PCA
pDL
PEF
PHS
POMS
PPA
ppd
PSA
REE
RR
SBP
SCN ~
SD
SES
SGA
SIDS
SPA
ST
STD
TLC
TQ

VC
WHO
WHR

618

hepatitis B surface antigen

hydrogen cyanide

high-density lipoprotein cholesterol
health maintenance organization

heart rate

International Agency for Research on Cancer
low-density lipoprotein cholesterol
myocardial infarction

mid-maximum expiratory flow
Medical Research Council

Multiple Risk Factor Intervention Trial
National Center for Health Statistics
National Cancer Institute

National Health and Nutrition Examination Survey I
NHANES Epidemiologic Followup Study
National Health Interview Survey
National Heart, Lung, and Blood Institute
National Natality Survey

Office on Smoking and Health

penile brachial index

percent cortical area

predicted diffusing capacity

peak expiratory flow

Public Health Service

Profile of Mood States
phenylpropanolamine

packs per day

public service announcement

resting energy expenditure

relative risk

systolic blood pressure

thiocyanate

standard deviation

socioeconomic status

small gestational age

sudden infant death syndrome

single photon absorptiometry
smokeless tobacco

sexually transmitted disease

total lung capacity

Fagerstrom Tolerance Scale

vital capacity

World Health Organization

ratio of waist to hip circumference