Changes in Adult Smoking Behavior in the United States: 1955 to 1983

NOT FOR QUOTATION WITHOUT THE PERMISSION OF THE AUTHOR

CHANGES

IN ADULT

SMOKING

BEHAVIOR IN THE UNITED

SATES:

1955 TO 1983

MzchaeL A. S t o t o

This work was s u p p o r t e d by t h e Division of C a n c e r P r e v e n t i o n and Con- t r o l of t h e U.S. National Cancer I n s t i t u t e .

Working P a p e r s a r e interim r e p o r t s on work of t h e I n t e r n a t i o n a l I n s t i t u t e f o r Applied Systems Analysis a n d h a v e r e c e i v e d only limited review. Views or opinions e x p r e s s e d h e r e i n d o n o t n e c e s s a r i l y r e p r e s e n t t h o s e of t h e I n s t i t u t e or of i t s National Member Organizations.

1NTE;RNATIONAL INSTITUTE FOR APPLIED SYSTEMS ANALYSIS 2361 L a x e n b u r g , A u s t r i a

ABSTRACT

A new method f o r analyzing d a t a from two s u r v e y s , applied

to

questions on smoking in t h e C u r r e n t Population Survey and t h e Health Interview Survey, shows t h a t t h e n e t rate at which adults have been quitting smoking has increased in t h e l a s t t h r e e decades. Two periods, t h e l a t e 1960s and t h e l a t e 1970s, had especially high rates. Quit rates a r e higher f o r o l d e r people and males but not markedly s o f o r whites. The number of light and moderate smokers h a s been decreasing, but t h e number of heavy smokers h a s been increasing.

CHANGE

m ADULT

S M O ~ G

BEHAVIOR IN THE UNITED = A m : 1955 TO 1983

Michael A. S t o t o

Institute f o r t h e Study of Smoking Behavior and Policy

Harvard University

Cambridge, Massachusetts 02138 USA

In t h e l a s t t h r e e decades, smoking h a b i t s in t h e United S t a t e s have changed t o a r e m a r k a b l e e x t e n t . Nearly everyone i s now aware in a g e n e r a l way of t h e ha- z a r d s of smoking, and t h e proportion of adults who smoke r e g u l a r l y dropped from 38 p e r c e n t in 1955 t o 32 p e r c e n t in 1983. But behind t h e s e summary s t a t i s t i c s l u r k vast d i f f e r e n c e s between young and old, men and women, black and white, and many o t h e r demographic and socioeconomic groups. For instance, while t h e p r o p o r t i o n of men who smoke declined s h a r p l y from 52 t o 35 p e r c e n t , t h e proportion of f e - males i n c r e a s e d from 25 t o 34 p e r c e n t in 1965 and h a s declined only slightly in re- c e n t y e a r s t o 30 p e r c e n t . In 1980, 52 p e r c e n t of black men between 25 and 35 smoked, compared to only 42 p e r c e n t of white men (DHEW, 1979, DHHS, 1984).

W e know with l i t t l e c e r t a i n t y about t h e demographic c h a r a c t e r i s t i c s of smok- ing change in t h e United S t a t e s o r o t h e r c o u n t r i e s , because, e x c e p t f o r v e r y s e l e c t experimental populations, f e w studies have followed individuals o v e r time and r e c o r d e d changes in t h e i r smoking behavior. Similarly f e w population-based studies h a v e r e t r o s p e c t i v e l y r e p o r t e d changes in individual smoking b e h a v i o r within a fixed r e f e r e n c e period. The b e s t information t h a t w e have about c o h o r t changes in smoking behavior comes f r o m a single study based on a r e t r o s p e c t i v e smoking h i s t o r y t a k e n in a 1978-80 survey ( H a r r i s , 1983).

The m o s t consistent, nationally r e p r e s e n t a t i v e d a t a on smoking change in t h e United S t a t e s i s of sample-based estimates, in various y e a r s , of t h e p r o p o r t i o n of t h e population in v a r i o u s a g e , s e x , r a c e , and sometimes socioeconomic s u b g r o u p s t h a t smokes. The National Center for Health Statistics' r e g u l a r Health Interview Survey, which provides estimates of t h e p r o p o r t i o n of t h e population in v a r i o u s a g e g r o u p s at f o u r points in time between 1965 and 1983 (DHHS, 1984) is t h e long- est s e r i e s of t h i s kind. Given t h e paucity of o t h e r d a t a , t h e s e d a t a provide valu-

a b l e information a b o u t a p e r i o d of d r a m a t i c c h a n g e s in smoking b e h a v i o r . These d a t a , h o w e v e r , p r e s e n t a difficult a n a l y t i c a l c h a l l e n g e b e c a u s e of t h e problem of c o h o r t p r o g r e s s i o n : t h e p r o p o r t i o n of t h e population a g e d 25 t o 34 t h a t smokes in 1980 c a n n o t simply b e compared t o whose 25 t o 34 in 1976. The two population g r o u p s r e p r e s e n t d i f f e r e n t c o h o r t s , which h a v e d i f f e r e n t h i s t o r i e s of smoking b e h a v i o r , a n d t h e d i f f e r e n c e between 1976 a n d 1980 r e f l e c t s t h e s e d i f f e r e n t his- t o r i e s as well as a c t u a l c h a n g e t h a t o c c u r r e d d u r i n g t h a t time.

Using a new method developed to d e a l with t h i s kind of estimation problem, t h i s p a p e r p r e s e n t s a new analysis of national s u r v e y d a t a o n smoking h a b i t s in t h e United S t a t e s between 1955 a n d 1983. The f o c u s i s on estimating n e t rates at which new s m o k e r s begin, c u r r e n t s m o k e r s switch to f o r m e r s m o k e r s , a n d at which smok- ers switch among light, m o d e r a t e , a n d heavy amounts. The p a p e r p r e s e n t s d a t a f o r f i v e d i s c r e t e time p e r i o d s from 1955 t o 1983, f o r males and females, b l a c k s a n d whites, a n d f o r v a r i o u s a g e g r o u p s in t h e population.

DATA

AND

METHODS

Two s e r i e s of s u r v e y s with questions a b o u t c u r r e n t a n d f o r m e r c i g a r e t t e smoking b e h a v i o r p r o v i d e t h e d a t a f o r t h i s study. The f i r s t i s t h e C u r r e n t Popula- tion S u r v e y (CPS), c a r r i e d o u t by t h e Bureau of t h e Census, which included ques- tions a n smoking b e h a v i o r in 1955 a n d 1966. In e a c h y e a r , a b o u t 75,000 r e s p o n - d e n t s w e r e interviewed in p e r s o n . In both s u r v e y s , a smoker was defined as some- o n e who h a s e v e r smoked more t h a n 100 c i g a r e t t e s a n d who c u r r e n t l y smokes. The p r o p o r t i o n of t h e population who are c u r r e n t o r f o r m e r s m o k e r s w a s t a b u l a t e d by s e x a n d t h e following a g e groups: 18-24, 25-34, 35-44, 45-54, 55-64, a n d 65+

(DHEW, 1970).

A s e r i e s of smoking supplements t o t h e National C e n t e r f o r Health S t a t i s t i c ' s Health Interview S u r v e y (HIS) in 1965, 1976, 1978-80, a n d 1983 i s t h e s e c o n d source of d a t a . In e a c h of t h e s e y e a r s , between 50,000 a n d 75,000 individuals were interviewed in p e r s o n a b o u t a l a r g e number of h e a l t h r e l a t e d f a c t o r s . E x c e p t as noted below, I a g g r e g a t e d t h e d a t a from r e l a t i v e l y small samples in 1978-80 i n t o o n e s e r i e s of p r o p o r t i o n s r e p r e s e n t i n g 1979. The questions v a r i e d f r o m y e a r to y e a r , b u t a l l of t h e supplements a s k e d a b o u t c u r r e n t a n d f o r m e r smoking s t a t u s a n d used t h e same definition of smoking as in t h e CPS. In v a r i o u s s o u r c e s , t h e d a t a are t a b u l a t e d by s e x a n d t h e following a g e g r o u p s : 20-24, 25-34, 35-44, 45-64, a n d 65+. F o r 1965, 1976, a n d 1978-80, t h e d a t a were a l s o tabulated by race. F o r 1965,

1976, and 1980 (not 1978-80), t h e d a t a were tabulated by t h e a v e r a g e number of c i g a r e t t e s smoked p e r day in t h e following groups: <15, 15-24, and 2 5 + (DHEW, 1979, 1980, DHHS, 1984).

If t h e r e were d a t a o n smoking behavior f o r n - y e a r population a g e g r o u p s in two s u r v e y s t a k e n n y e a r s a p a r t , t h e demographic problem of estimating rates of change would b e relatively simple. The commonly available d a t a , however, p r e s e n t two analytical difficulties. F i r s t , t h e d a t a have been tabulated f o r i r r e g u l a r a g e groups. In t h e HIS d a t a , f o r instance, t h e r e is one 5-year, two 10-year, one 20- y e a r , and an open-ended a g e group. The d a t a were tabulated in t h i s way as a compromise between a d e q u a t e sample sizes and t h e need f o r information a b o u t p a r - t i c u l a r population groups. Second, in most c a s e s , t h e s u r v e y s h a v e been t a k e n at i r r e g u l a r intervals. Even when t h e data are available f o r 5- o r 10-year groups, t h e s u r v e y s are 3, 4, 6, o r 11 y e a r s a p a r t .

The following a p p r o a c h is derived and t e s t e d by S t o t o (1985). I t uses d a t a of t h e form t h e p r o p o r t i o n of t h e population aged a t o a +n t h a t smokes at time

t

l , and Pa ,2 b e t h e same proportion at time

t 2 ,

f o r v a r i o u s a g e s a and i n t e r - vals n. Let

r e p r e s e n t t h e a v e r a g e p r o p o r t i o n of smokers in t h e a g e i n t e r v a l a t o a +n and t h e time i n t e r v a l

t l

t o

t 2 .

After c o r r e c t i n g f o r differential mortality of smokers com- p a r e d to non-smokers and f o r c o h o r t progression as shown below, I use t h e r e l a - tive proportions of smokers in t h e adjacent intervals a t o a +n and b t o b + m t o estimate t h e r e l a t i v e n e t rate of change in t h e number of smokers.

I f i r s t calculate a f a c t o r to c o r r e c t f o r differential mortality of c i g a r e t t e smokers. Let

,La

b e t h e life table function r e p r e s e n t i n g t h e number of p e r s o n y e a r s lived by t h e g e n e r a l population in t h e a g e i n t e r v a l a t o a +n. Similarly, let

,L:

b e t h e same function f o r t h e smoking population. Then, t o compare t h e pro- portions in two a d j a c e n t i n t e r v a l s a t o a + n and b to b +n , w e c a l c u l a t e

For t h e calculations h e r e , I assumed t h a t t h e r e l a t i v e mortality of smokers com- p a r e d to non-smokers w a s as given by Hammond (1966, cited in DHEW, 1979, 1980).

I used age and s e x s p e c i f i c mortality rates from Coale and Demeny (1966) model

l i f e t a b l e s with t h e a p p r o p r i a t e level of mortality t o c a l c u l a t e t h e differential mor- tality c o r r e c t i o n .

The simplest c a s e in when two a d j a c e n t i n t e r v a l s a r e of t h e same width, t h a t is m

=

n . In t h i s case, t h e a v e r a g e rate of change in t h e population of smokers in t h e interval a to b + n i s

The n e t r a t e of c h a n g e when t h e second interval is wider t h a n t h e f i r s t (m

>

n ) is

Finally, when o n e i n t e r v a l is open, such as for t h e population aged 65 and o v e r , de- fine

Pa

+ as t h e p r o p o r t i o n of t h e population aged a a n d o v e r , and s o on, t h e n

In e a c h c a s e , A r e p r e s e n t s t h e a v e r a g e annual r z t e of change for t h e period

t l

t o

t 2

in t h e number of smokers between a g e s a and b +m

.

When applied t o t h e population of c u r r e n t smokers, C , formulas (1) to (4) yield estimates of t h e n e t r a t e of change in t h e number of c u r r e n t smokers, in e a c h a g e g r o u p AC. This n e t r a t e r e f l e c t s a combination of smoiting initiation, smoking cessation, a n d recidivism. After c o r r e c t i o n f o r mortality, however, t h e population of e v e r smokers ( c u r r e n t plus former), E , c a n grow only by smoking initiation.

When applied to t h e population of e v e r smokers, t h e same formulas yield estimates of t h e rate of smoking initiation, AE. Putting t h e s e t o g e t h e r , we c a n estimate a n e t r a t e of t r a n s i t i o n f r o m t h e smoker to f o r m e r smoker c a t e g o r i e s i s e a c h a g e g r o u p as follows:

The r e s u l t i n g "adjusted quit r a t e s " , A, d o not r e f l e c t d i f f e r e n t i a l mortality or c o h o r t history. Instead, t h e y r e p r e s e n t changes in t h e smoking habits of a c o h o r t of individuals a t a p a r t i c u l a r time.

RESULTS

Table 1 shows t h e estimated n e t rates of change of t h e c u r r e n t and e v e r smok- ing populations for t h r e e periods of time: 1955 t o 1966, 1965 t o 1976, and 1976 t o 1983. The estimates for t h e f i r s t period come f r o m t h e CPS d a t a , and have esti- mates corresponding t o a g e s 26.5, 35, 45, 55, and 65, t h e midpoints of t h e a g e groups on which t h e y are based. The estimates for t h e o t h e r two periods come f r o m t h e HIS d a t a , in which t h e r e is one l e s s a g e g r o u p , so t h e r e are estimates f o r a g e s 27.5, 35, 50, and 65. E x c e p t for t h e youngest a g e s (26.5 or 27.5), t h e rates of change of t h e e v e r smoking population are c l o s e to z e r o , confirming t h a t people r a r e l y begin t o smoke a f t e r t h e i r mid twenties. The only exception we find refers to women in t h e i r t h i r t i e s and f o r t i e s from 1955 to 1966, as H a r r i s (1983) a l s o found. In t h e r e m a i n d e r of t h i s analysis, adjusted quit rates are calculated using equation (5) for men and women aged 26.5 and 27.5 in a l l t h r e e periods, and f o r women aged 35 and 45 in 1955-1966. For all o t h e r i n t e r v a l s and a g e groups, I as- sume t h a t

AE

i s z e r o and set t h e adjusted quit rate equal to XC.

Figures 1 and 2 show t h e adjusted quit rates f o r men a n d women in each of t h e t h r e e time periods. F o r both s e x e s in e v e r y period. quit rates i n c r e a s e sharply with age. Men in t h e i r s i x t i e s , for instance, are quitting at a b o u t 5 . p e r c e n t p e r y e a r , whereas men in t h e i r twenties are quitting at a b o u t 2 p e r c e n t p e r y e a r . Wom- e n in t h e i r s i x t i e s h a v e adjusted quit rates of a b o u t 2 to 3 p e r c e n t , whereas younger women h a v e rates of 1 to ² percent.

Substantial p r o g r e s s against smoking is evident-with f e w exceptions t h e rates i n c r e a s e monotonically with time. The major exception i s for o l d e r men in t h e la- t e s t period, whose rate d e c r e a s e d . In each time p e r i o d , however, female quit rates have been substantially lower than those f o r men. Only in t h e l a t e s t period have female quit rates matched t h o s e of men in t h e f i r s t p e r i o d , and at a g e 65, they have still not done so.

Table 2 and Figures 3 and 4 p r e s e n t more time d e t a i l , based on additional HIS d a t a for 1970 a n d 1978-80. These r e s u l t s are l e s s r e l i a b l e for two reasons. F i r s t , since equations (3)-(5) a l l involve division by t 2

-

t a fixed amount of sampling variability h a s a b i g g e r a b s o l u t e e f f e c t in s h o r t e r i n t e r v a l s . Second, t h e d a t a f o r 1970 was available only for t h e 25 to ⁴⁴ a g e g r o u p , r a t h e r t h a n for t h e 25 to 34 and 35 t o 44 g r o u p s , and

I

assumed t h a t t h e p r o p o r t i o n s in both g r o u p s were t h e same.

The r e s u l t s , however, are v e r y suggestive. F o r both men and women, adjusted quit rates were substantially h i g h e r in both t h e l a t e 1960's and l a t e 1970's than in surrounding periods. In t h e l a t e 19601s, t h e Federal Communications Commission ( K C ) r e q u i r e d television s t a t i o n s t h a t c a r r i e d c i g a r e t t e commercials t o devote a significant amount of time to anti-smoking advertisements. Warner (1977) found a similar d e c r e a s e at t h i s time in a g g r e g a t e d a t a o n t o b a c c o consumption, and a t t r i - buted i t to t h e e f f e c t s of t h e K C ruling. The r e a s o n f o r t h e i n c r e a s e in t h e quit rates in t h e l a t e 19701s, and t h e i r subsequent decline in r e c e n t y e a r s , i s not so clear. These changes could possibly r e f l e c t a n i n c r e a s e d r e l u c t a n c e t o r e p o r t smoking behavior in t h e 1978-80 s u r v e y and a r e t u r n t o normal in t h e 1983 s u r v e y . But given t h e consistency of t h e p a t t e r n across a l l a g e s , and t h e similarity to t h e e a r l i e r i n c r e a s e , t h i s seems unlikely.

Table 3 p r e s e n t s r e s u l t s from t h e

HIS

d a t a by race. Figure 5, for 1965 td 1976, shows h i g h e r rates f o r males than females for e a c h race. Black m a l e s lag slightly behind white males, and t h e same for females, but t h e d i f f e r e n c e i s gen- e r a l l y not l a r g e . Figure 6 , for 1976 to 1979, shows t h a t black quit rates generally exceeded t h o s e of whites, b u t t h e d a t a are less r e l i a b l e because of smaller sample sizes and t h e s h o r t e r time interval. In 1980, a l a r g e r f r a c t i o n of blacks t h a n whites in e v e r y male a g e g r o u p smoked, and in almost e v e r y female a g e group.

These f i g u r e s s u g g e s t t h a t t h o s e d i f f e r e n c e s a r i s e not because whites are more successful in quitting, b u t t h a t a l a r g e r f r a c t i o n of black c o h o r t s were smoking in t h e 1960's and even though t h e i r quit rates h a v e not been substantially d i f f e r e n t than t h o s e for whites, they h a v e not y e t c a u g h t up.

Table 4 provides d a t a on t h e n e t rate of c h a n g e in t h e number of light smokers (less than 15 c i g a r e t t e s p e r day on a v e r a g e ) , moderate smokers (15 to 24 c i g a r e t t e s ) , and heavy smokers (25 or more c i g a r e t t e s ) , based on t h e 1965, 1976, and 1980 HIS smoking supplements. The d a t a show t h a t t h e number of light smokers i s d e c r e a s i n g at e v e r y a g e , and t h a t t h e rates are slightly h i g h e r at t h e younger ages. The number of moderate smokers i s a l s o d e c r e a s i n g , b u t rates tend to b e h i g h e r for o l d e r a g e s . Heavy smokers show negative r a t e s at m o s t a g e s which im- ply t h a t numbers of heavy smokers are increasing. In both periods, t h e number of heavy smokers among men in t h e i r twenties a n d t h i r t i e s i n c r e a s e d , b u t t h e number among o l d e r men d e c r e a s e d . The number of female heavy smokers, on t h e o t h e r hand, h a s continued t o i n c r e a s e s until women were in t h e i r fifties.

These d a t a d o n o t distinguish, though, between m o d e r a t e s m o k e r s who quit a n d moderate s m o k e r s who become heavy smokers. The l a c k of d a t a o n t h e number of transitions among t h e s e g r o u p s , from t h e non-smoker g r o u p , o r t o t h e f o r m e r smoker g r o u p makes i t impossible t o c a l c u l a t e more s p e c i f i c t r a n s i t i o n rates. In o r d e r to gain some insight i n t o t h e possible explanations, F i g u r e s 7 t o 1 0 display t h e same rates which h a v e b e e n r e s c a l e d so t h a t t h e y r e p r e s e n t t h e number of t r a n s i t i o n s p e r y e a r divided by t h e t o t a l population of s m o k e r s . In t h e new s c a l e , t h e sum of t h e rates of c h a n g e of t h e light, m o d e r a t e , and h e a v y s m o k e r s i s e q u a l t o t h e rate of c h a n g e of t h e smoking population.

Comparing F i g u r e s 7 a n d 8, t h e rates of c h a n g e of t h e m o d e r a t e and heavy smokers are a b o u t t h e same in t h e f i r s t and s e c o n d p e r i o d s . The number of moderate s m o k e r s d e c r e a s e s at a l l a g e s , a n d t h e number of h e a v y s m o k e r s in- creases at t h e y o u n g e r a g e s b u t d e c r e a s e s at o l d e r a g e s . Most Likely, p a r t of t h e d d e c r e a s e in t h e number of m o d e r a t e s m o k e r s at t h e y o u n g e r a g e s r e p r e s e n t s s h i f t s to t h e heavy smoking c a t a g o r y , s o t h e quit rate of both g r o u p s i n c r e a s e s with age. The rate of c h a n g e of t h e light smokers, however, is v e r y d i f f e r e n t in t h e two p e r i o d s . In 1976-80, when o v e r a l l q u i t rates were r e l a t i v e l y high, light smokers w e r e d e c r e a s i n g in number much f a s t e r t h a n i n t h e e a r l i e r period. Be- c a u s e of t h e r e l a t i v e s t a b i l i t y of t h e r a t e s f o r t h e o t h e r g r o u p s , t h e simplest ex- planation i s t h a t t h e l i g h t s m o k e r s provided t h e "swing group" t h a t led

to

t h e h i g h e r o v e r a l l quit rates in t h e second period.

The r e s u l t s f o r women in Figures 9 and 1 0 show a d i f f e r e n t p a t t e r n . In both p e r i o d s t h e numbers of both light and moderate s m o k e r s d e c r e a s e at all a g e s , and t h e number of h e a v y s m o k e r s i n c r e a s e s at a l l but t h e o l d e s t a g e . The d i f f e r e n c e between t h e f i r s t a n d s e c o n d p e r i o d , though, is s t r i k i n g . In 1976-80, when o v e r a l l quit rates were h i g h e r , t h e rates of d e c r e a s e f o r both t h e light and m o d e r a t e smokers were h i g h e r t h a n in t h e e a r l i e r p e r i o d . But t h e rate of i n c ~ e a s e in t h e heavy s m o k e r s a l s o i n c r e a s e d . Thus, i t seems t h a t two things happened in t h e l a t e 1970's: o v e r a l l q u i t rates f o r women i n c r e a s e d , but m o r e women were becoming heavy smokers. The biggest i n c r e a s e in t h e growth rate of heavy smokers came f o r women ln t h e i r t h i r t i e s .

DISCUSSION

From a p u b l i c h e a l t h p e r s p e c t i v e , r e l i a b l e national e s t i m a t e s of c h a n g e s in smoking b e h a v i o r , with a d e q u a t e demographic d e t a i l , s e r v e two p u r p o s e s . F i r s t , s i n c e many of t h e f a c t o r s t h a t e f f e c t smoking behavior-government warnings, ad- v e r t i s i n g b a n s , tax policy, a n d s o c i a l norms, f o r instance--are national in s c a l e , w e need nationally r e p r e s e n t a t i v e e s t i m a t e s of c h a n g e s in smoking b e h a v i o r to assess t h e i r e f f e c t s . And s i n c e government a c t i o n s may d i f f e r e n t i a l l y a f f e c t demographic a n d socio-economic g r o u p s , policy a n a l y s t s n e e d t h e d a t a in s u f f i c i e n t demographic detail. S e c o n d , in o r d e r t o l o c a t e and t a r g e t g r o u p s in t h e population t h a t are ei- t h e r s u s c e p t i b l e to anti-smoking i n t e r v e n t i o n s or in need of s u c h p r o g r a m s , w e need r e l i a b l e a n d demographically d e t a i l e d on both c u r r e n t smoking s t a t u s a n d t r a n s i t i o n s .

The r e s u l t s in t h i s p a p e r show t h a t c h a n g e s in a d u l t smoking b e h a v i o r in t h e United States in t h e l a s t t h r e e d e c a d e s h a v e b e e n f a r from uniform. A t a n y given time, men h a v e b e e n m o r e likely t o q u i t smoking t h a n women, a n d o l d e r people m o r e likely t h a n y o u n g e r people. All of t h e population g r o u p s , though, are s u s c e p t i b l e to c h a n g e . These r e s u l t s s u g g e s t t h a t p u b l i c h e a l t h e x p e r t s must work h a r d e r to develop i n t e r v e n t i o n p r o g r a m s t h a t are m o r e e f f e c t i v e f o r young people a n d wom- en.

F u r t h e r m o r e , t h e r e h a v e b e e n s u b s t a n t i a l d i f f e r e n c e s in t h e rates of c h a n g e of l i g h t , m o d e r a t e , a n d h e a v y s m o k e r s . Between 1 9 6 5 a n d 1980, t h e number of l i g h t a n d m o d e r a t e s m o k e r s h a s declined, b u t t h e numbers of h e a v y s m o k e r s at a l l b u t t h e h i g h e s t a g e s h a v e i n c r e a s e d . The rates of c h a n g e f o r t h e l i g h t and m o d e r a t e s m o k e r s h a v e v a r i e d with time, b u t t h e rates f o r t h e h e a v y s m o k e r s h a v e b e e n re- latively c o n s t a n t . A t a l l b u t t h e o l d e s t a g e s , t h e number of h e a v y s m o k e r s h a s in- c r e a s e d n o t only as a p r o p o r t i o n of a l l s m o k e r s , b u t also as a p r o p o r t i o n of t h e po- pulation at l a r g e . A t o n e level, t h i s s u g g e s t s t h e need f o r more e f f e c t i v e i n t e r v e n - tion p r o g r a m s f o r h e a v y smokers. I t may b e , however, t h a t t h e c o s t of intervening with h e a v y s m o k e r s i s s o high, a n d t h e h e a l t h b e n e f i t s s o low, t h a t o u r r e s o u r c e s would b e used m o r e effectively on o t h e r population s u b g r o u p s .

The d a t a r e v e a l more similarity between b l a c k s a n d whites in q u i t rates t h a n in l e v e l s of c u r r e n t smokers. Although m o r e b l a c k s t h a n whites smoked in t h e 1960's, t h e i r n e t q u i t rates between 1966 a n d 1 9 7 9 were n o t markedly d i f f e r e n t t h a n t h o s e of whites. Whatever c a u s e d some whites to s t o p smoking seems t o h a v e h a d a similar e f f e c t o n b l a c k s , b u t b l a c k s h a v e f a r t h e r to go.

The rate of d e c l i n e in c i g a r e t t e smoking h a s n o t b e e n uniform in t h e l a s t t h r e e d e c a d e s . In t h e l a t e 1 9 6 0 1 s , p r o b a b l y d u e to t h e FCC's r u l i n g s o n television a d - v e r t i s i n g , n e t q u i t rates f o r a l l a g e s a n d both s e x e s i n c r e a s e d r e l a t i v e to e a r l i e r a n d l a t e r p e r i o d s . In t h e l a t e 1970's. t h e r e was a s i m i l a r uniform i n c r e a s e in q u i t rates, b u t t h e c a u s e i s l e s s evident. Understanding why t h i s o c c u r r e d should b e a high p r i o r i t y f o r public h e a l t h e x p e r t s .

Another i n t e r p r e t a t i o n of t h e s e d a t a i s t h a t e a c h major i n c r e a s e in n e t q u i t rates was followed by a d e c r e a s e a few y e a r s l a t e r . This could b e d u e to recidiv- i s m , or b e c a u s e in t h e later p e r i o d t h e smoking population contained a h i g h e r p r o - p o r t i o n of p e o p l e who found i t difficult to quit. B e t t e r d a t a o n t r a n s i t i o n s , espe- cially individual-level longitudinal d a t a , is n e e d e d to u n d e r s t a n d t h e dynamics of t h e s e changes.

T a b l e 1. Q u i t r a t e s , s t a r t r a t e s , a n d a d j l - ~ s t e d q u i t r a t e s U n i t e d S t a t e s , 1955 t a 1?9Z

CPS

d a t a

--- ---

H I S d a t a .

AJ e t-la1 e Feina 1 e AS e Male Fema1.e Ma1 P F e i n a l e

S t a r t 2 6 . 5 2.45 2 . 9 0 2 7 . 5 (11.27 i:).63 -i:).26 ill.23

.

(2 (1)

.

^{4 8 -c}

r a t e z.5. i i .,-s .-,

.

^{(1) - i ( ) (2}

.

⁽¹¹⁹

^-(I) -

^{1 (1) -(-:I - , -,- is -,}

45

.

^i:) -i:).27 i;).gl 5i:). i2 - (1)

.

^{! J 4} - ⁽¹⁾

.

(34 -0.44 -1.12

C C - . .

.J .J

.

^(-) - \ : I . 27 ^-(I). 1,s 65. (:I i 9 (11.33

-(I).

34 -0. 53

65.Q -i:).41 -(1).(1)8

A d j u s t e d 26.5 1..30 0.45 27.5

.

2.03 1.55 2.36 l.iIi'7

qc!i t r a t e Z 5 . (1) 1.(35 (3.26 -= .-.a

.

^{(-) - 2 - 2 7 1.23 2.a6 1.70}

45. ^i? 1.64 i3.77 ^C J(-1 ^-

.

^{i:) 3.14 1.71 3.46 2.5&}

55. (1) 2.69 1.a9 6 5

.

^{(1) 5.36 2.8.5 4.a5 4.23}

65. i? 4.94 2.76

T a b l e 2. A d j u s t e d q u i t r a t e s fc7r f i v e time p e r i o d s , 1955-1903

Table 3. A d j u s t e d q u i t rates f a r i3lac~:s 2 n d ~ h i t e s , 1365-1.?73

----

^{Ma1 e}

----

--- ^{Femal e---}

----

_e

---- ---

^F~rnal e--- A g e

T a b l e 4. Net r a t e s o f c h a n j e f o r l i g h t , moderate, and heavy smokers

Age L i g h t M o d e r a t e Heavy 27.5

z .

94 2 - 5 5 -5.29 3 5

.

^{(1) 1.28 4}

.

^{2 (11 -2. 2(:)}

st:) .

^{i:) i:)}

.

^{3 3}

z .

46 2 - 2 6 4 0

.

^{(1) i:)}

.

^{3 6 5 . 3 6 8 . (:)El}

L i g h t M o d e r a t e Heavy 4.69 -!:I

.

^{(1) 9 -7.25}

3. 1 4 ^(:)

.

^{Sf; -1.74}

T c

1.57

.->

-

10

. .

^{I.-) C C .4 J ~ 2.48 -<:I 1.27}

.

⁷²

e L i g h t M o d e r a t e Heavy 27.5 6.71 3.55 -4.

l a

35. [:I 9 . ?4 3.57 -1.45

3:)

.

^{i:) 2.48 5. i74 1}

.

^O(3

60

.

^{(3 4.29 8.43 6.25}

L i g h t M o d e r a t e Heavy 5 . 8 8 3

.

^{i:) 2 - 4 . C)O}

6.37 5 . 5 9 -4.68 7.36 4

.

^{0 4 -1.87}

1.43 1.88 1

.

⁰⁶

Fig. 2 - Adjusted q u i t r a t e s

Pcmulcs '66-'83

6 1

I

I

Fig. 3 - Adjusted q u i t r a t e s

Fig. 4 - Adjusted q u i t rates

Pcmklcs 1866- 1883

-

Year

3 27.5

+

315 b 60 2 66

Fig. 5 - A d j u s t e d quit rates 1965-1976

Blacka and Whites

k c

+

^{8-P b} W-M A ;1-P

&c

+

8-P Q W-M A W-P

Fig. 7 - ^Males ' 6 5 - ' 7 6

Annual r r t e o f chanrc

-

-

\- F L

u

+

k c

Light

+

^{Mod Q}

^{H e . -}

I 1 I

36 46

Lkht

+

^Mod dcc

Light

Fig. 9 - Females '65-'76

&a

+

Mad 3

a -

1

-#

0

-1

-

-a -.

-a -

-4

Fig. 10 - Females '769'80

Bnnu~l r~bc of chmre

a

Bnnurl rate of change

\

^\

+.-

1

~

-4.

1 I 1 I 1 1 I

as

^{36 46 66 66}

&e

Lirht

+

Mod 4 Heavg

REFEEENCES

Coale, Ansley J. and Paul Demeny (1966) Regional Model Lire Tables a n d Stable Po- p u l a t i o n s . P r i n c e t o n , N.J.: Princeton University P r e s s .

Hammond, E. C. (1966) Smoking in Relation to Death R a t e s of One Million Men and Women. P a g e s 127-204 in Epidemiological Approaches to t h e S t u d y of C a n e e r a n d Other C h r o n i c Diseases. edited by W. Haenszel. National Cancer In- s t i t u t e Monogmph 1 9 , U.S. Department of Health, Education, and Welfare, N a - tional C a n c e r Institute.

S t o t o , Michael A. (1985) Changes in Adult Smoking B e h a v i o r in t h e United States: 2955 to 2983. Laxenburg, Austria: International Institute for Applied Systems Analysis. Forthcoming Working P a p e r .

Warner, K.E. (1977) The E f f e c t s of t h e Anti-smoking Campaign on C i g a r e t t e Con- sumption. American J o u r n a l of ALblic Health 67(7):645-650 (JulyJ.

U.S. Department of Health Education and Welfare (DHEW) (1970) Changes in Cigarette S m o k i n g Habits Between 2955 a n d 1965. Natlonal C e n t e r for Health S t a t i s t i c s , Vital and Health S t a t i s t i c s , S e r i e s 1 0 , N o . 59.

U.S. Department of Health Education and Welfare (DHEW) (1979) S m o k i n g a n d Health: A Report of t h e S u r g e o n General. Office of t h e Assistant S e c r e t a r y for Health, Washington D.C.

U.S. Department of Health Education and Welfare @HEW) (1980) The Health Come- quences o f S m o k i n g f o r Women: A report of the S u r g e o n General. Office of t h e Assistant S e c r e t a r y f o r Health, Washington D.C.

LT.S. Department of Health and Human S e r v i c e s (DHHS) (1984) Health L7.S. 1984.

Nationa! C e n t e r f o r Health S t a t i s t i c s , Washington

D.G.