Heavy Smoking Declines in U.S.

Biggest drops in California because of tobacco control programs, researchers say

By Steven Reinberg
HealthDay Reporter

TUESDAY, March 15 (HealthDay News) -- The number of people who smoke a pack or more a day has dropped significantly in the United States, and perhaps nowhere more than in California, a new study finds.

The number of people smoking less than a pack but at least 10 cigarettes a day has also dropped significantly, added the researchers, who examined national data on smoking rates from 1965 to 2007 to come to their conclusion.

"Public health advocacy can have a major impact on social norms and lead to major changes in population behavior," said lead researcher John P. Pierce, a professor of family and preventive medicine at the University of California San Diego.

In addition, there has been a significant decline in lung cancer rates in California, and those rates will continue to drop faster than in the rest of the country over the next 15 years, he noted.

"The Tobacco Control Program in California has aimed to change social norms in the population, and this has had a major impact," Pierce said. "Such programs need to be disseminated more widely. The change in social norms in California impacted both initiation and cessation."

The report is published in the March 16 issue of the Journal of the American Medical Association.

For the study, Pierce's team collected data on 1,801,529 people who took part in the National Health Interview Surveys, 1965-1994 and the Current Population Survey Tobacco Supplements, 1992-2007.

A total of 139,176 responders were in California, and 1,662,353 were located throughout the rest of the United States.

In 1965, 56 percent of all smokers in the United States smoked a pack (20 cigarettes) a day or more. In California, this represented 23.2 percent of smokers while in the rest of the country the prevalence of heavy smokers was 22.9 percent, the researchers found.

By 2007, this prevalence of heavy smokers was 2.6 percent in California and 7.2 percent in other states, they added.

For those who smoked 10 to 19 cigarettes a day, the prevalence in 1965 was 11.1 percent in California and 10.5 percent in the rest of the country. By 2007, the prevalence in California was 3.4 percent while it was 5.4 percent in the rest of the United States, the researchers noted.

"This decline has not been accompanied by higher rates of lower-intensity smoking," Pierce said. "This decline in intensity of smoking has come about by a major change in the number of young people who have taken up even a half-pack per day habit."

There has also been a major cessation effect, Pierce added.

Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids, noted that "California has reduced overall smoking and high-intensity smoking much faster than the rest of the country, and this has led to declines in lung cancer rates that are larger than the rest of the country -- saving lives and health-care dollars."

California has achieved these lifesaving gains because it has put in place those policies and programs proven to reduce tobacco use, including the nation's longest running prevention and cessation program, the nation's first statewide smoke-free law and, in earlier years, higher tobacco taxes, McGoldrick said. "Every state should follow California's example," he said.

However, these gains are in jeopardy, as California has fallen behind its funding of tobacco control programs, McGoldrick said.

"To continue its progress, California must raise its tobacco tax, which has fallen well below the national average, and use some of the new revenue to increase funding for its model prevention and cessation program, which has declined significantly in recent years," McGoldrick said.

Dr. Norman H. Edelman, scientific consultant for the American Lung Association, said that "this is validation of all of our efforts."

These findings show that both prevention programs and programs to help people quit are essential, he said. In addition, laws passed that prevent public smoking have also played an important role in the decline in smoking, Edelman noted.

"The ban on public smoking seems to help people quit," he said. "But, the job is not over -- 20 percent of Americans still smoke, so there is still a long way to go. But we have begun to turn the tide in lung cancer and it looks like it's happening in chronic obstructive pulmonary disease (COPD)."

More information

For more information on quitting smoking, visit Smokefree.gov.

SOURCES: John P. Pierce, Ph.D., professor, family and preventive medicine, University of California San Diego, La Jolla; Danny McGoldrick, vice president, research, Campaign for Tobacco-Free Kids; Norman H. Edelman, M.D., scientific consultant, American Lung Association; March 16, 2011, Journal of the American Medical Association

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