TABLE &-Prevalence, awareness, and control rates of
      hypertension, persons 2&74 yeara of age,
      united states, 1964%1992,1974-1975, 1976-19801

YW

Percentage of
population
with hyperten-
  sion '

  Percentage of total with hypertension

      Aware,    Aware,   Aware,'
           medication, medication,
Unaware' u&Zion no control controlled

1960-1962              20.3            51.1     17.6      15.3      16.0

1974-1975              22.1            36.4     29.4      14.6      19.6

19761990              22.0            26.6     17.2      22.1     34.1

' Bate ageadjusted by the direct method to the population at the midpoint of the 19761990 National Health
and Nutrition Examination Survey.

' Systolic blood pressure 160 mm Hg or greater, or di&.olic blood pressure 95 mm Hg or greater. or on
antihypertensive medication.

' Reported never told by phynician of having hypertension.
' Three with hypertension taking antihypstensive medication whose blood p-we wan not hypertensive.
SOURCE: National Center for Health Statistica (32).

TABLE O.-Percentage of adults with serum cholesterol
      levels of 269 mg/199 ml and over, by sex and
      age, United States, Health Examination Survey
      (HES) 1990-1962 and Health and Nutrition
      Examination Survey (HANES) 1971-1974'

Age

HJB, M&1962

Men       Women

HANIB, 1971-1974

Men       Women

Percentage

Total. age 16-74               17.6        22.7        14.7        17.5

16-24                    3.9         4.6         2.8         3.0
2544                    10.4         7.4         8.2         5.6
35-44                    20.2        12.9        17.1         9.6
4a54                    25.7        28.0        24.1        24.6
5664                   23.5        49.7        20.2        35.3
65-74                   21.6        51.0        20.9        40.7

' Age adjusted by the direct method to 1971-1974 civilian noninstitutional&d population.
NOTE: All choleat.eml values have been a&ot.ed to approximate the values of Abel1 et al. (Abell, L.L.. Levy.
G.B., Bralie. B.B., Kendall, F.E. A simplified method for the estimation of total cholesterol in amum. and
demonstration of its epeciricity. Journal of Eiologiml Chemistry 196: 357-265, 19521, the common referenced
metlmd, by reducing the 1960-1962 data by 7.6 percent and the 1971-1974 data by 4.5 percent.
SOURCE: National Center for Health Statistics (24X

socioeconomic level and lesser declines in poorer areas of the country
are also consistent with a favorable impact of smoking prevention or
cessation efforts on CHD mortality, in view of the clearly demon-
strated inverse relationship of male income level and prevalence of
smoking.

351


TABLE 10.-Regression coefficients, risk ratios, and
      statistical significance for the risk of
      cardiovascular disease in 8 years, men and
      women, age 36-74 years, Framingham heart
      study

Risk ratice evaluated

MultiDle
regreiion
coefficient '

T'

at age 55'

Risk
ratio

Flisk factor
difference

Rick factor

c!igamw smoking
Serum cholesterol
Cholesteml/age interaction
Systolic blood p-re
Glucces intolerance

cigarette smoking
senlm eholenterol
Cbolesteml/age interaction
Systolic blood preeeure
Glucose intolerance

MEN

0.580
0.020
4mo1
0.017
0.410

WOMEN

0.233
0.019
-0.001
0.015
0.757

6.46       1.8
3.65       1.3
-2.61       -
9.12       1.4
2.92       1.5

2.37       1.3    Smoker/nonsmoker
2.66       1.2      46 mgldl
-2.77       -         -
6.59       1.4     M-&l
5.40       2.1     Preeentlatwnt

Smoker/nonsmoker
  42 m&ll

20 mm xig
Present/absent

' Unetandardisd meffcient of the multiple risk function for cardiovascular dineme within 8 years with the
independent variables being w-am cholasteml. &&stem1 timea age. syetolie blood premure. cigar&e smoking,
gluame intaleran~> left ventricular hypertrophy on ECG. age, and age sguared; estimati over the age range 3&
74 yean.

' Thme tik fectors are statistically significant for both men and women. The critical value of T ia
appmxbnately equal to 2.0 at a=OM.

' The hypothetical risk of development of cardiovsseular diwase asawiated with the 6,.&&d difference in risk
rector levels when other risk factors in the model are held constant. A ratio greater than 1 reprecenia pmitive
amociation with cardiovancular d&we. For serum cholesterol and systolic blood pressure, the difference chceen
wan one standard deviation of the measurement.
SOURCE: McGee and Abbott Ml.

Some questions remain unanswered regarding the contribution of
smoking cessation to the decline in CHD mortality. The percentage
of smokers who are heavy smokers appears to be increasing,
although it is not known whether this represents a greater cessation
rate among lighter smokers than among heavier smokers. The
percentage decline in CHD mortality for women has been as large as
for men, although proportionately fewer women than men have
given up smoking. Assertions that preventive measures have re-
sulted in smoking changes that caused the decline in CHD mortality
differences by age, socioeconomic status, and geographic area are
based on limited available data.

352


Conclusion

The evidence supports the conclusion that changes in smoking
habits have contributed to substantial improvement in mortality
rates from the cardiovascular diseases in the United States.

353


Technical Notes

International Classification of D&eases

Tables A and B contain the code numbers of the International
Classification of Diseases (ICD) applicable to the causes of death
described in this report (16,20,44, 45). Between each revision of the
ICD there are breaks in the continuity of these classifications,
affecting some diseases more than others. For cardiovascular dis-
ease, the most serious breaks in continuity are between the seventh
and eighth revisions and between the eighth and ninth revisions for
CHD and for hypertensive disease.

The cause of death commonly referred to as coronary heart disease
(CHD) was listed in both the sixth and seventh revisions of the ICD
(1949-1957, 195&1967) as "Arteriosclerotic heart disease, including
coronary heart disease," code 420; in the eighth revision (1968-1978)
as "Ischemic heart disease," codes 410-413; and in the ninth revision
(after 1978) as "Ischemic heart disease," codes 410-414.

Expected Minus Observed Deaths

Multiplying the 1970 age-specific death rates Wyear age groups)
for total cardiovascular diseases times the 1980 census gives an
estimate of the number of cardiovascular disease deaths expected in
1980: 1,294,564 deaths, based on the level of mortality in 1970. An
estimate of the number of cardiovascular disease deaths observed in
1980 is 1,005,692. This latter estimate is made by combining the
estimated 989,000 deaths from major cardiovascular d&eases in 1980
(ICD/S codes 390-448) and the 4,803 deaths from diseases of the
veins in 1980 (ED/S codes 451-459) (27, 29). The difference is
288,872 cardiovascujar disease deaths "averted" in 1980 because of a
decline in mortality from the level in 1970.

Multiplying the 1963 age-specific death rates W&year age groups)
for coronary heart disease (ICD/7 code 420) times the 1979 popula-
tion estimate gives the number of CHD deaths, 804,000, expected in
1980, on the basis of the level of mortality in 1963 (2, 25, 27). The
observed number of deaths from CHD in 1980 for ED/9 codes 410-
414 was 566,000, or 238,000 fewer than expected, based on the level
of mortality in 1963. This procedure assumes reasonably good
comparability of ICD classification of CHD in these 2 years.

Age-Adjusted Rates

Age adjustment for this Report is by the direct method. Age-
specific death rates in l@year age groups are multiplied by the
"standard million" for 1940-the U.S. population by age as enumer-
ated in that year.

354


TABLE A.-Codes of the 6th, 7th, 8th, and 9th revisions of the International Classification of Diseases
      for Selected Diagnoses

Diagnosis

   1949-1967                     1966-1978                     1979
6th and 7th revisions                 6th revision                 9th revision

Cardiovascular diseases                  330-334,400460
Coronary heart disease                   420
  Acute myocardial infarction            no code for this diagnosis
  Other coronary heart disease           no code for this diagnosis
Cerebrovascular diseases                  330-334
Hypertensive disease                    440-M7
Other diseases of arteries                 450-456
  Atherosclerosis                      450
  Aortic aneurysm                     451
  Other                           452456
All other cardiovascular disease            403-416. 421-434, 460-460
Lung cancer                       162, 163
Other cancers                     140-161, 164-205
Diabetes mellitus                       260
Influenza and pneumonia                   4so493
Chronic obstructive pulmonary disease         500, 501, 527.1
Cirrhosis of the liver                     561
Accidents, poisonings, and violence             FBOO-Em5

390-456
410-413
410
411413
430-436

44cM48
440
441
442-448
390-390. 420-429, 450-456
162
14Si61. X3-209
250
47&474, 400-46
493-492, 519.3
571
E9oa-E999'

390-459
410-414
410
411414
4zQ-436
401-405
440440
440
441
442-440
390-398, 415-429, 451-459
162
140-161, 163-205
2.54
480-487
490492, 494-496
571
EI4mo-E999

SOURCE: World Health Organization (44,45), National Center for Health Statistica (20).


TABLE B.-Iutmnational classification of diseases codes for
       cardiovascular-renal diseases1 and
      cardiovascular diseases*, 1900-1979

                   YearS
Revieion              inuse             codes

1St
2nd
3rd

4th

5th                193%1946
6th               194%1966
7th                1959-1967
8th               1966-1978
9th               197%

190&1909
1910-1920
1921-1929

I%?#-1936

47,64-a, 77-66,120, 142
47, 64-66, 77-66, 120, 142
51, 74, 75, 03. 87-90.
9lb, 91c, 9%96, 129, 151
56, 82.9&95.97-103,
131. 132

' Thmugb 6th revision.
' After 6th revision.

SOURCEz Moriyama et al. (16-h National Center for Health 6tatietia Cm). World Health Chgmizatior, (&)b).

Population Estimates

Death rates for census years and for years prior to 1961 are based
on the resident or census population estimates that were available at
the time the official U.S. vital statistics were prepared. Rates for
1961 to 1969, however, are based on estimates of the resident
population revised to reflect the 1970 census, and rates for 1971 to
1979 are based on estimates of the resident population revised to
reflect the 1980 census (I, 2).

356


References

(I) BUREAU OF THE CENSUS. Estimates of the population of the United
    States, by age, sex, and race: April 1, 1960 to July 1, 1973. Current
    Population Reports, Population Estimates, and Rejections. U.S. Department
    of Commerce, Social and Economic Statistics Administration, Bureau of the
    Census. Series P-25, No. 519, April 1974,79 pp.
  (2) BUREAU OF THE CENSUS. P re 1 iminary estimates of the population of the
    United States, by age, sex, and race: 1970 to 1981. Current Population
    Reports. U.S. Department of Commerce, Social and Economic Statistics
    Administration, Bureau of the Census. Series P-25, No. 917, July 1982, 65
     PP.
(3) ELVEBACK, L.R. Coronary heart disease in Rochester, Minn., 1950-1975:
    Incidence and survivorship. In: Havlik, R.J., Feinleib, M., Thorn, T., Krames,
    B., Sharretta, A.R., Garrison, R. (Editors). Proceedings of the Conference on
    the Decline in Coronary Heart Disease Mortality, Bethesda, Maryland,
    October 24-25, 1978. Department of Health, Education, and Welfare, Public
    Health Service, National Institutes of Health, NIH Publication No. 79-1610,
    May 1979, pp. 116122.
  (4) FEINLEIB, M., THOM, T.J., HAVLIK, R.J. Decline in coronary heart disease
    mortality in the United States. In: Gotto, A.M., Jr., Paoletti, R. (Editors).
    Athemsclemsis Reviews. Volume 9. New York, Raven Press, 1982. pp. 29-42.
(S, FRIEDMAN, G.D. Decline in hospitalizations for coronary heart disease and
    stroke: The Kaiser-Permanente experience in northern California, 1971-
     1977. In: Havlik, R.J., Feinleib, M., Thorn, T., Krames, B., Sharretta, A.R.,
    Garrison, R. (Editors). proceedings of the Conference on the Decline in
    Comnary Heart Diseae Mortality, Bethesda, Maryland, October 24-25,1978.
    U.S. Department of Health, Education, and Welfare, Public Health Service,
    National Institutes of Health, NH-I Publication No. 79-1610, May 1979, pp.
      109-115.
(61 GARRAWAY, W.M., WHISNANT, J.P., FURLAN, A.J., PHILLIPS, L.H. II,
    KURLAND. L.T., G'FALLGN, W.M. The declining incidence of stroke. New
    England Journal of Medicine 300(g): 449452, March 1,1979.
(7) GILLUM, R.F., BLACKBURN, H., FEINLEIB, M. Current strategies for
    explaining the decline in ischemic heart disease mortality. Journal of
    Chronic Diseases 35(6): 467-474,1962.
(8) HAVLIK, R.J., FEINLEIB, M., THOM, T., KRAMES, B., SHARREX-I'A, A.R.,
    GARRISON, R. (Editors). Prwcee&ngs of the Conference on the &dine in
    Coronary Heart D&ease Mortality, Bethesda, Maryland, October 24-25,197s.
    U.S. Department of Health, Education, and Welfare, Public Health Service,
    National Institutes of Health, NIH Publication No. 7%1610, May 1979,399
      PP.
(9) KANNEL, W.B. Meaning of the downward trend in cardiovascular mortality.
    Journal of the American Medical Association 247(6): 877-680, February
     1982.
(10) KANNEL, W.B., THOM, T.J. Implications of the recent decline in cardiovas-
    cular mortality. Cardiovascular Medicine 4(9): 963-997, September 1979.
(II) KLEINMAN, J.C. The potential impact of risk factor modification on
    coronary heart disease mortality in middle-aged men. In: Healthy People:
    The Surgeon GenemlS Report on Health Promotion and Disease Prevention:
    Background Papers, 1979, U.S. Department of Health, Education, and
    Welfare, Public Health Service, Office of the Assistant Secretary for Health
    and Surgeon General, DHEW Publication No. (PHS)79-55071A, 1979, pp.
     187-194.


(12) KLEINMAN, J.C.. FELDMAN, J.J., MONK, M.A. Trends in smoking and
  iechemic heart disease mortality. In: Havlik, R.J., Feinleib, M., Thorn, T.,
   Kramer, B., Sharretta, A.R., Carrieon, R. (Editors). proceedings of the
   Conference on the Decline in Conwuwy Heart Lkease Mortality, Bethesda,
   Maryland, October 24-26,1978. U.S. Department of Health, Education, and
   Welfare, Public Health Service, National Institutes of Health, NIH Publica-
   tion No. 79-1610, May 1979, pp. 195-211.
(13) LEAVERTON, P. , KLEINMAN, J.C., THOM, T.J., GlTI'EISOHN. A.H.
  Coronary Heart Dieease Mortality by States. Preeented at the Annual
   Meeting of the Society for Epidemiologic Research, Minneapolis, June 19,
   1980.

(14) MCGEE, D., ABBWIT, R.D. The Probability of Lhebping Certain Gdiovus-
  cular Dieasa in Eight Yecrra at Specified Values of Some Chamcterigtice.
   Unpublished data of Section 34 of the Framingham Study: An Epidemiologi-
   cal Investigation of Cardiovaecular Dieeaee. Feinleib. M. (Editor). U.S.
   Department of Health and Human Services, Public Health Service, Nation-
  al In&it&s of Health, National Heart, Lung, and Blood Institute, March
    1992.
(25) MJiTROPOLlTAN LIFE INSURANCE COMPANY. Recent trende in mortali-
  ty from cardiovascular diaeaae. Stat&id Bulletin 60(2): 2-6, AprilJune
    1979.

(16) MORIYAMA, I.M., KRUEGER, D.E., STAMLER, J. Cknfiouasculur Diseases
  in the United States. Cambridge, Harvard University Prese, 1971, 496 pp.
(17) NATIONAL CENTER FOR HEALTH STATISTICS. Vital Statistics of the
   United States. 1960 Volume II, Mortality, Part A. U.S. Department of
   Health, Education, and Welfare, Public Health Service, National Center for
   Health Statietice, National Vital Statietica Division, 1963.
(18) NATIONAL CENTER FOR HEALTH STATISTICS. Mortulity f;tpm Diaeoses
  A.swciated With Smoking: United States, 195&H. U.S. Department of
   Health, Education, and Welfare, Public Health Service, National Center for
   Health Statistica,Divikon of Vital Statistics. PHS Publication No. 1000,
   Series 20, No. 4, October 1966,45 pp.

(19) NATIONAL CENTER FOR HEALTH STATISTICS. Vital Statietics of the
   United States, I%%. Volume II, Mortality, Part A. U.S. Department of
   Health, Education, and Welfare, Public Health Service, National Center for
   Health Statistice. National Vital Statistica Division, 1967.

(20) NATIONAL CENTER FOR HEALTH STATISIICS. Eighth Reuiuion of the
  International G&&cation of LXsewea Adapted for U8e in the United
   St&es. Volume 1. U.S. Department of Health, Education, and Welfare,
   Public Health Service, Of&e of Health Reeearch, Statistica, end Technol+
  gy, DHEW Publication No. (PHS)1693.1969,478 pp.
(21) NATIONAL CENTER FOR HEALTH STATISTICS. Mortality trend tables for
   Ieuding causea and selected components, United States, l&1969. (Unpubl-
   ished).

(22) NATIONAL CENTER FOR HEALTH STATISTICS. Mortality trends Age,
   color, and sex. United Stake-1950-1969. Vital and Health Statistics. U.S.
   Department of Health, Education, and Welfare, Public Health Service,
   Health Resourcee Administration, National Center for Health Statistics,
   DHF.W Publication No. (HRA)74-1352, Series 20, No. 15, November 1973.40

    PP.

358


(23) NATIONAL CENTER FOR HEALTH STATISTICS. Mortality trends for
   leading causes of death. United States-195&1969. Vital and Health
   Statistics. U.S. Department of Health, Education, and Welfare, Public
   Health Service, Health Resources Administration, National Center for
   Health Statistics. DHEW Publication No. (HRA)74-1853, Series 20, No. 16,
   March 1974,75 pp.
(24) NATIONAL CENTER FOR HEALTH STATISTICS. Total serum cholesterol
   levels of adults 18-74 years. United States, 1971-1974. Vital and Health
   Statistics. U.S. Department of Health, Education, and Welfare, Public
   Health Service, National Center for Health Statistics, Division of Health
   Examination and Statistics, DHEW Publication No. (PHS)7%1652, Series
   11, Number 265, April 1978,31 pp.
(25) NATIONAL CENTER FOR HEALTH STATISTICS. Chartbook for the
   Conference on the Decline in Coronary Heart Disease Mortality. Comparabili-
   ty of causeofdeath statistics, figures and tables, and technical notes
   describing trends in ischemic heart disease mortality. U.S. Department of
   Health, Education, and Welfare, Public Health Service, National Center for
   Health Statistics, Division of Vital Statistics, August 1978,42 pp.
(26) NATIONAL CENTER FOR HEALTH STATISTICS. Hmpital Discharge
   Survey. 1970-1978. (Unpublished).
(27) NATIONAL CENTER FOR HEALTH STATISTICS. Vital Statistics-Mortal-
   ity Cause of Death Summary. Public use tapes for data years 1968-1979.
(2s) NATIONAL CENTER FOR HEALTH STATISTICS. Health, United States,
   1979. U.S. Department of Health, Education, and Welfare, Public Health
   Service, National Center for Health Statistics, DHEW Publication No.
   (PHSx39-1232.1981.
(29) NATIONAL CENTER FOR HEALTH STATISTICS. Annual summary of
   births, deaths, marriages, and divorcee: United States, 1980. Monthly Vital
   Statistics Report. U.S. Department of Health and Human Services, Public
   Health Service, Office of Health Research, Statistics, and Technology,
   DHHS Publication No. fPHS)81-1126, Volume 29, No. 13, September 17,
   1981,31 pp.
(30) NATIONAL CENTER FOR HEALTH STATISTICS. Mortality from diseases
   associated with smoking: United States, 1969-77. Vital and Health Statis-
   tics. U.S. Department of Health and Human Servicee, Public Health Service,
   Ofike of Health Research, Statistics, and Technology, DHHS Publication
   No. (pHS)92-1854, Series 20, No. 17, January 1982,71 pp.
(31) NATIONAL CENTER FOR HEALTH STATISTICS. Utilization of short-stay
   hospitals: Annual summary for the United States, 1980. Vital and Health
   Statistics. U.S. Department of Health and Human Services, Public Health
   Service, Office of Health Research, Statistics, and Technology, DHHS
   Publication No. (pHS)E@-1725, Series 13, No. 64, March 1982,66 pp.
(32) NATIONAL CENTER FOR HEALTH STATISTICS. Blood pressure levels and
   hypertension in persons ages 674 years: United States, 1976-86. Advanced
   Data from Vital and Health Statistics. Number 84, U.S. Department of
   Health and Human Services, Public Health Service, National Center for
   Health Statistics, DHHS Publication No. (PHS&?-1250, October 8, 1982.
(33) PELL, S., FAYERWEATHER, W.E. Mortality trends in myocardial infarction
   in a large employed population, 1975-1979. CVD Epidemiology Newsletter
   31: 56,1982.
(34) RICE, D.P. Statement of Dorothy P. Rice. In: Hearings Before the Zntergowrn-
   mental Relations and Human Resources Subcommittee Committee on
   Government Operations. June 14,1977. U.S. House of Representatives.
(35) STERN, M.P. The recent decline in ischemic heart disease mortality. Annals
   of Znternal Medicine 91(4): -0, October 1979.


(36) STRONG, J.P., GUZMAN, M.A. Decrease in coronary atheroecleroeia in New
  Orleans. Laboratory Investigation 43(3): 297-301, September 1980.
(37) THOM. T.J., KANNEL, W.B., FEINLEIB, M. Factors associated with the
  decline in coronary heart disease mortality in the United States. In: Connor,
  W.F., Bristow, J.D. (Editors). Coronury Heart Disease: Complications, Prwen-
  tion, and Treatment. J.B. Lippincott Co., Philadelphia, in press.
(38) U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Arteriosclerw-
  sis 1981: Report of the Working Group on Arteriosclemsis of the National
  Heart, Lung, and Blood Institute. Volume 1. Summary, Conclueions, and
  Recommendations. U.S. Department of Health end Human Services, Public
  Health Service, National Institutes of Health, NIH Publication No.
   (NIH)82-2034, July 1981,62 pp.
(39) U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. The HeaEth
  Consequences of Smoking: Cancer. A Report of the Surgeon General. U.S.
   Department of Health and Human Servicee, Public He&h Service, Office of
  the Assistant Secretary for Health, Of?&. on Smoking and Health. DHHS
   Publication No. (PHS)8%!50179,1982,302 pp.
(40) U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE. Death
  rates by age, race, and sex, United States, 1900-1953: Major cardiovaecular-
  renal diseases. Vital Statistics SpecirrZ Reports. U.S. Department of Health,
   Education, and Welfare, Public Health Service, National office of Vital
   Statistics, Volume 43, No. 12, July 30,1956, pp. 187-201.
(41) U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE. Vital
  Statistics of the United S&&a, 1955. Volume II, Mortality Date. U.S.
  Department of Health, Education, and Welfare, Public Health Service,
   National Office of Vital Statistics, 1957.
(42) U.S. DEPARTMENT OF HEALTH. EDUCATION, AND WELFARE. 2%
  Health Consequence of Smoking for Women: A Report of the Surgeon
   GVWMZ. U.S. Department of Health, Education, and Welfare, Public Health
  Service, Office of the Assistant Secretary for Health, Office on Smoking and
   Health. 1980,359 pp.
(43) WEINBLA'IT. E.,- GOLDBERG. J.D., RUBERMAN. W., FRANK, C.W.,
  MONK, M.A., CHAUDHARY, B.S. Mortality after first myocardiai infarc-
  tion. Search for a secular trend. Journal of the American Medical Associa-
   tion 247(11): 15761581, March 9.1982.
(44) WORLD HEALTH ORGANIZATION. Manual of the International Statistical
  Ciassif~ation of ZXseases, Znjurks, and Causes of Death. Volume 1. Geneva,
   World Health Organization, 1957,393 pp.
(45) WORLD HEALTH ORGANIZATION. Manual of the Intern&&al Statistical
   Classification of Diseases, Znjuti, and Causes of Death. Volume 1. Geneva,
   World Health Organization, 1977,669 pp.
(46) WORLD HEALTH ORGANIZATION. World Health Statistics AnnuaZ. Gene-
   va, Switzerland. Published for each data year, 1969 to 1978.


APPENDIX B: TRENDS IN U.S.
        CIGARETTE USE, 1965
          TO 1980


introduction

This discussion of national trends in adult cigarette smoking over
recent years in the United States includes data on prevalence,
consumption, and cessation. It focuses on adult cigarette smoking
patterns and cessation by age and sex cohorts. Data were drawn from
an analysis of three national surveys by the National Center for
Health Statistics (NCHS) and three other national surveys on adult
use of tobacco conducted by the former National Clearinghouse for
Smoking and Health over the period from 1965 through 1980 (6, 7,s).
A brief description of the data sources is presented, followed by a
discussion of the data.

Surveys of Tobacco Use
The 1999 Survey on the Use of Tobacco

Two separate national probability sample surveys on adult usage
of and attitudes toward tobacco conducted by the National Clearing-
house for Smoking and Health in 1966 have been combined and are
treated here as a single survey.

One study design imposed a two-way stratification on all house-
holds in the continental United States, classifying each household by
three types of population and nine geographic areas. The other
design divided the entire area of the United States into approximate-
ly 1,700 primary sampling units PSUs). Weighting procedures
resulted in the selection of 5,770 respondents.

Within each household, the first eligible respondent (age `21 or
older) was the person interviewed; all current and former smokers
were also interviewed, but only a subsample of those who had never
smoked was interviewed. Weighting procedures were used to bring
the three groups into balance.

The 1970 and 1975 Surveys on the Adult Use of Tobacco

The 1970 and 1975 surveys sponsored by the National Clearing-
house for Smoking and Health employed the same sampling and
interviewing methodologies. Where possible, questions were phrased
similarly. The questionnaires for current, former, and never smokers
differed slightly.

In both surveys, the sample design consisted of two parts: a
national probability sample of telephone households and a national
probability sample of nontelephone households.
The respondent selection procedure was designed to produce 75
percent of the interviews with "ever" smokers and 25 percent with
"never" smokers. Weighting procedures were used to compensate for
this oversampling of ever versus never smokers. Other weighting
factors were used to adjust for age, sex, and smoker mix of the


household. The weighted number of respondents (age 21 or older)
was 5,875 in 1970 and 12,079 in 1975.

Smoking Supplement to the National Health Interview
Survey

The National Health Interview Survey (NHIS), a continuous
nationwide sample personal household interview survey by the
National Center for Health Statistics, included questions on ciga-
rette smoking in 1965,1966, 1970, 1974,1976,1977, 1978, 1979, and
1980. Information is routinely obtained on personal and demograph-
ic characteristics. Questions focused primarily on such characteris-
tics as present smoking status, amount smoked daily, and in more
recent years, attempts to quit, and on tar and nicotine levels of
cigarettes smoked. Information was not obtained on opinions,
attitudes, or beliefs related to smoking.

The universe for the NHIS is the civilian noninstitutionalized
population of the United States. The survey is based on a multistage
probability sample of primary sampling units in about 42,000
households containing about 85,000 persons. A one-third subsample
of the adult respondents is interviewed for the smoking supplement
(during 1965 and 1966 smoking data were obtained for all adults).

Patterns of Smoking Prevalence and Cessation
Prevalence of Cigarette Smoking

The percentage of adults who report being current regular
smokers, defined as persons who have smoked at least 100 cigarettes
and who were smokers at the time of interview, has been declining
steadily over the last _15 years (Table 1). For the total white male
population, this decline has been from 51.3 percent in 1965 to 37.1
percent in 1980, and for white females, from 34.5 to 30.0 percent.
Among black adults a similar pattern was seen-for males a decline
from 59.6 to 44.9 percent, and for females, from 32.7 to 30.6 percent.
Conversely, the percentage of the white adult male population who
reported being former smokers increased between 1965 to 1980 from
21.2 to 31.9 percent, and of white females, from 8.5 to 16.3 percent by
1980. Again, a similar trend was observed among blacks, with the
percentage of former smokers increasing from 12.6 to 20.6 percent of
males, and from 5.9 to 11.8 percent of females. This increase in the
percentage of former smokers is more marked among males (20.3 to
30.5 percent) than among females (8.2 to 15.7 percent), although the
proportion among males increased by a factor of 1.5, while that
among females doubled.

In addition to this increase in percentage of former smokers over
the E-year period, among most of the sex, race, and age groups there
also appears to be an increase in the percentage of persons who

364


TABLE I.-Percentage distribution of adult current and
     former cigarette smokers, according to sex,
      race, and age, in 1965, 1976, and 1980

Current smoker' @wcent)         Former smoker (percent)
1965    1976 1960'          1965     1976    1980=

    MALE
Total 3.'
All agea>m
20-2-i
2534
3544
45-64
t=
White
All ages>20'
20-24
25-34
3544
45-64
265
Black
All agea>20"
20-24
2.534
3544
45-64
t=

52.1     41.6     37.9          20.3     29.6     30.5
59.2     45.9     36.7           9.0     12.2     12.1
60.7     46.5     43.1          14.7     18.3     20.6
58.2     47.6     42.6          20.6     27.3     27.6
51.9     41.3     40.8          24.1     37.1     36.9
28.5     23.0     17.9          28.1     44.4     47.4

51.3     41.0     37.1          21.2     30.7     31.9
56.1     46.3     39.0           9.6     13.3     12.2
60.1     47.7     42.0          15.5     18.9     21.9
57.3     46.8     42.4          21.5     28.9     28.8
51.3     46.6     40.0        25.1     36.1     38.4
27.7     22.8     16.6          26.7     45.6     50.1

59.6     50.1     44.9          12.6     20.2     20.6
67.4     52.8     45.5           3.8     4.1     10.6
68.4     59.4     52.0           6.7     11.8     11.9
67.3     59.8     44.2          12.3     13.8     21.2
57.9     49.7     46.8          15.3     26.6     26.3
36.4     26.4     27.9          21.5     33.0     26.6

34.2    32.5     29.8           a.2     13.9     15.7
41.9     34.2     32.7           7.3     10.4     11.0
43.7    37.5     31.6           9.9     12.9     14.4
43.7     38.2     34.9           9.6     15.6     18.9
32.0    34.8     30.8           8.6     15.9     17.1
9.6     12.8     16.6           4.5     11.7     14.2

34.5     32.4     Xl.0           8.5     14.6     16.3
41.9     34.4     33.3           8.0     11.4     12.5
43.4     37.1     31.6          10.3     13.7     14.7
43.9     38.1     35.6           9.9     17.0     20.2
32.7     34.7     30.6           8.B     16.4     17.4
9.8    13.2     17.4           4.5     11.5     14.3

32.7     34.7     30.6           5.9     10.2     11.6
44.2     34.9     32.3           2.5     5.0     2.2
47.6    42.5     34.2           6.7     8.9     11.6
42.0    41.3    36.5          7.0     9.6     12.5
26.7     36.1     34.3           6.6     11.9     14.1
7.1     9.2     9.4           4.5     13.3     14.1

' A current smoker haa amoked at kast 100 eieustta, rod now smokea; includes -ional smokers.
`Knalestimatas.Basedondarsforthe~Gmonthsofl~.
J Bane of percentage excludea peraau with unknown smoking status.
`lnCluded all other - not ohown rpuately.
o A@z odjuntad by the direct me&cd to the 1970 civilian noninstitutionalized population using 5 age gn~~p.
NOTE: Percentagea do not add up to 100 because of "never smoken" in the survey population.
SOURCE: Data from the National He&h Interview Swvey, National Center for Health Statistics. 1965.1976.
and 1960, baaed on household interviewa with a aample oftbe civilian noninstitutiioaalized population.

report never having smoked. In males, this is demonstrated by both
races and by the age groups younger than 45 years of age. In females,

365


TABLE 2.-Average number of cigarettes smoked per day
      by current and former smokers, by sex, age,
      and educational level, in 1970, 1975, and 1980

   1970 '             1975 '             1980'
Current Former     Current Former      Current Former
smoker  smoker      emoker  smoker      smoker  smoker

Total
Alla@ 221

Male
All agea 221
21-24
25-34
3544
45-54
5544
2%

Female
Au ages 221
21-24
25-34
35-44
45-54
5544
265

Educational level
o-8
9-11
12
13-15
216

20.0    22.6        21.2    24.5        21.7    25.0

21.8    25.0        22.8    n.2        23.4    28.1
20.8    16.2        18.9    20.8        19.4    18.7
21.0    23.4        22.1    24.0        22.1    24.0
23.0    27.7        23.4    28.0        25.6    28.7
24.2    25.4        W.l    29.5        27.2    31.6
21.6    n.7        25.0    28.1        23.3    31.3
17.2    25.3        20.3    28.0        20.9    n.1

17.7    17.3        19.1    18.8        19.7    19.8
16.1    13.8        18.6    14.7        17.8    17.6
18.1    16.7        18.5    17.7        19.4    20.3
18.6    18.2        20.1    19.5        22.5    19.8
18.4    19.0        20.3    20.8        20.7    22.4
17.0    15.4        19.0    20.8        20.0    20.4
14.0    14.6        16.1    17.1        15.6    17.2

18.1
20.3
20.2
20.3
20.8 d

21.7        21.7    25.9        20.5    26.2
22.2        21.6    25.0        22.3    n.a
22.8        20.8    24.2        21.9    24.4
22.5        21.3    25.1        22.1    24.3
23.2        20.6    22.1        21.1    24.0

' National Survey on Adult Use of Tobacco. PHS. 1970.
`National Health Interview Survey Smoking Supplement, PHS, 19&l.
NOTE: Data from 1966 National Survey were not compatible with other years

the increase in percentage of persons who report never having
smoked is limited to the age groups younger than 35 years.

Average Daily Consumption of Cigarettes

Table 2 shows data on the average number of cigarettes smoked
daily during three survey periods (1970, 1975, and 1980) for both
current and former smokers.

Overall, current smokers reported an increased consumption, from
a mean of 20.0 cigarettes per day in 1970 to 21.7 cigarettes per day in
1980. The 1970 to 1980 increase in mean number of cigarettes
smoked daily was slightly greater for females than for males (2.0
versus 1.2), a finding consistent with the increasingly similar
smoking behavior in females and males. Thus, although males
continue to smoke a greater average number of cigarettes per day


than do females, the difference in daily consumption between the
sexes for current smokers in 1980 was less than that observed a
decade earlier.

The heaviest daily consumption is observed in the middle-aged
groups (35 to 64 years). A greater mean increase from 1970 to 1980
was observed among women aged 35 to 64.

Male former smokers generally reported greater daily cigarette
consumption than did current smokers in each survey. This trend
was not found in females. This finding is contrary to the widely held
belief that those who smoke fewer cigarettes per day are more likely
to quit. It may be due in part to a tendency of former smokers to
overestimate their consumption and of current smokers to underesti-
mate their consumption or both.

Among former smokers of both sexes, average daily consumption
rates increased with age, peaking at the 45- to ELI-year-old age
~tegory.

No trend over time is discernible by educational level in the
overall mean daily consumption among current smokers. There was,
however, an increase in the daily cigarette consumption of former
smokers with 8 or fewer years of education, from 21.7 in 1970 to 26.2
in 1980. Within each survey year, there is also no discernible trend
between level of education and daily cigarette consumption. The
greater reported average daily consumption by educational status
for former smokers than for current smokers may reflect cognitive
dissonance, or changing social pressures that result in reporting bias.

Table 3 displays the percentage distribution of current smokers by
grouped number of cigarettes smoked daily, over the 1965,1976, and
1980 NHIS surveys. Cigarette smokers had a tendency to round off
their reported number of cigarettes smoked per day (3) (Table 4).
Approximately one-third of the smokers reported smoking exactly 20
cigarettes (one pack) a day in each of the survey years. The
proportion of current smokers reporting consumption levels of 21 to
29 or 31 to 39 cigarettes per day remained relatively constant
between 1970 and 1980.

Although the proportion of smokers who report consumption
levels of 20 to 39 cigarettes per day has remained fairly stable over
the last 10 years (46.6 vs. 49.31, a clear difference is observed at the
more extreme ends of the distribution, i.e., among those smoking
fewer than 20 cigarettes and those smoking 40 or more cigarettes per
hY-

In 1970, only 11.4 percent of the respondents reported smoking 40
or more cigarettes per day; by 1980, 16.8 percent reported smoking
40 or more cigarettes per day. During the same period, smokers
reporting consumption levels of less than 20 cigarettes per day
decreased from 39.8 percent in 1970 to 33.8 percent in 1980 (Table 4).

367


TABLE 3.-Percentage distribution of adult current
     smokers' by grouped number of cigarettes
     smoked per day by sex, race, and age, 1965,
      1976, and 1980

Ciittea smoked rer dav

                 <15             15-24           225
Sex, race, and age    1965   1976   1930'    1965   1976  1960'   1965   1976  1960'

    MALE
Total 3.'
All ages>20
2&a
25-34
35-M
4544
L-65
white
All ages>20
20-24
25-34
35-44
4564
>a
Black
All agee>
20-U
25-34
35-U
45-a
>a

    FEMAJ.5
Total 3.'
All ages>20
20-24
iE
45-64
>=J
white
All agee>
20-24
25-34
3544
45-64
t=
Black
All ages>20
2&24
2534
3544
4564
>a

28.3   24.2   23.1    46.3   44.8   42.7    25.4   31.0   34.1
34.9   31.6   32.0    49.1   49.9   47.8    15.4   18.5   20.2
25.1   25.5   23.6    50.0   45.8   46.5    24.3   28.7   29.9
23.7   19.6   15.8    44.8   41.2   42.3    31.5   39.2   41.9
26.7   18.5   21.6    45.3   44.1   36.4    28.0   37.4   42.0
47.1   39.1   29.2    39.0   42.7   46.1    13.8   16.2   24.7

25.9   21.4   19.1     46.8   44.9   43.6    27.4   33.7   37.4
32.3   27.5   27.1     50.8   62.8   50.4    16.9   19.7   22.4
22.8   22.1   19.5    51.1   46.5   41.4    26.1   31.4   33.1
21.3   17.2   12.8    44.6   40.4   42.1    33.9   42.5   45.1
24.6   16.2   17.3    45.4   43.3   37.4    30.0   40.4   45.3
44.6   37.5   26.1     40.3   42.2   46.2    15.1   20.4   27.7

48.1   43.8   46.7     42.6   44.0   40.3     9.3
52.7   56.9   66.6    41.9   34.2   36.7     5.3
47.8   46.0   44.4    41.7   43.5   46.2    10.5
42.5   38.5   45.6    45.5   44.8   41.1    12.0
46.9   35.9   51.1     43.7   50.8   35.0     9.4
64.9   53.0   41.1     31.9   47.0   47.2     3.2

11.5
8.9
10.5
16.7
13.3

10.9
6.8
9.6
13.2
14.1
11.1

43.6   36.5   34.2    42.2   43.8   42.0    14.2   19.6   23.7
48.4   43.1   42.0    41.9   42.4   41.1     9.7   14.5   16.1
41.4   34.3   33.5     43.1   45.2   41.9    15.5   20.5   24.6
39.1   33.8   27.8    43.7   44.4   39.3    17.1   21.8   33.0
44.4   34.3   29.8    42.0   44.2   45.9    13.6   21.5   24.2
62.6   4t3   48.9    31.0   38.9   37.7     6.4   11.8   13.4

41.0   33.2   30.6    43.9   45.2   4.8    15.1   21.6   25.6
45.3   39.3   37.4     44.4   44.3   44.1    10.4   16.4   18.5
37.9   30.6   28.6    45.4   46.8   44.9    16.7   22.6   26.5
36.2   29.5   24.6    45.3   45.4   39.9    16.4   25.1   35.5
42.4   32.0   26.4    43.2   45.1   47.0    14.5   23.0   25.9
61.5   45.7   46.1    31.8   41.7   37.7     6.8   12.6   14.2

67.7   60.0   61.1    26.4
73.4   65.7   78.0    22.1
66.2   58.8   61.9    25.1
63.4   60.4   555.6    30.4
69.4   53.2   53.8     26.9
63.2   loo.0   66.3    16.8

33.8
31.3
33.6
39.1
36.7

28.9
22.0
22.0
35.6
34.2
34.7

5.9   6.1
4.5   3.0
8.7    7.7
6.2    1.4
3.6   10.1

10.0

16.2
8.8
12.0

' A current smoker has smoked at least 100 cigarettes and now amokeq include occasional smokers.
' Based on data for the last 6 months of 1980.
*Base of percentage excludes unknown amount smoked.
`Includes all -not shown seperate$.
SOURCE: Data from the National Health Interview Survey. National Center for Health Statistics. 1965.1976,
and 1980, based on household interviewa with a aample of the civilian noninstitutionaIized population.


TABLE 4.-Percentage distribution of adult current
      smokers who reported smoking specific
      numbers of cigarettes per day, in 1970, 1975,
       and 1980

Percentage of current smokers

Number of cigarettes/day            1970 '         1975 '        1980'

l-9                    15.8         13.5         13.1
              39.81       37,O 1       33.81
l&19                   24.0         23.5         20.7
20                     34.9         32.0         34.8
21-29                    3.1          2.8          2.3
30                     9.6         12.1         11.5
31-39                    1.0          0.8          0.7
40                     8.8         10.7         11.1
              11.41       15.2 1       16.8 1
41+                     2.6          4.5          5.7

' National Survey on Adult Use of Tobecm. PHS, 1970 and 1975.
' Natiind Health Interview Survey Smoking Supplement, PHS W'reliminary). 1990.
NOTE: Data from 1966 National Survey are not compatible with other yean.

These findings may be due to several factors, including (1)
increased smoking (possibly among those who have switched to lower
tar cigarettes), (2) a higher cessation rate among persons smoking
fewer cigarettes, (3) the entry of new smokers of greater numbers of
cigarettes, or (4) some combination of these factors.

Number of Attempts to Quit Smoking

Survey data have shown that the majority of current smokers
have made at least one serious but unsuccessful attempt to quit (4).

Table 5 shows the percentage of current smokers who reported
having made three or more attempts to quit. Similar data are shown
for former smokers for two of the survey years. A modest downward
trend is observed in the percentage of current smokers who reported
making three or more attempts to quit (from 41.2 percent in 1966 to
38.7 percent in 1980), but the proportion of former smokers reporting
three or more attempts to quit increased from 36.0 percent to 53.2
percent over the period from 1966 to 1975; this increase is seen in
most of the sex, race, and age groups.

Comparing the proportion of current smokers who had made three
or more attempts to quit by years of education showed a general
downward trend over time for all education levels except in the less
than 8 years of education group, where the proportion increased
from 38.9 percent in 1966 to 47.0 percent in 1980. Among the most
educated current smokers, the decline was from 59.8 to 39.4 percent.


TABLE S-Percentage of current and former smokers who
     made three or more attempts to quit, by sex,
      age, and educational level, in 1996, 1975, and
       1980

   1966'             1975 '             1980'
Current Former'     Current Former'     Current Former'
smoker  emoker      smoker  smoker      smoker  smoker

All ages 221         41.2    36.0        40.5    53.2        30.7

Male
All e&et3 221
21-24
2&34
3544
4l5-54
56-64
>_=

40.7    36.9        36.4    55.1        38.8
35.4    21.6        39.0    50.0        31.5
37.4    50.0        38.2    43.7        38.7
41.8    36.6        37.1    43.8        35.0
42.9    36.8        44.1    58.4        39.8
44.1    34.1        45.6    63.3        42.0
46.9    30.1        31.0    61.9        52.6

Female
Allegw 221
21-24
2544
35-44
45-54
55-64
>a

41.5    34.0        42.0    49.1        38.7
28.6    35.3        32.3    52.9       31.3
34.5    36.1        39.5    47.2        31.0
43.5    33.3        45.1    42.7        42.5
56.7    23.9        44.0    57.0        37.1
36.6    43.6        44.7    50.9        49.2
43.5    28.6        46.9    46.4        46.1

Educational level
o-6
9-11
12
13-15
216

38.9    32.3        44.3
42.7    30.0        40.8
36.4    36.2        40.0
37.7  _  42.0        36.4
59.8    36.0        41.4

56.5        41.0
53.6        30.4
56.3        37.2
46.8        35.2
62.2        36.4

`National Survey on Adult Use 0fTobac.x~. PHS, 1966 and 1975.
`National Health Interview Survey Smoking Supplement. PIiS fl'reliminary), 19&J.
* Inclu&a the last s-ful attempt.
o 1980 former lunoker data not availblc.

Recent Attempt to Quit

Data in Table 6 show the percentage of current and former
smokers who reported an attempt to quit in the 12 months prior to
the interview. Although there was little change overall from 1966 to
1975 in the percentage of current smokers who reported making an
attempt to quit smoking in the previous year (1.5 percent), from 1975
to 1980 there was an increase of almost 10 percent. This increase is
shown consistently for all the sex, race, and age groups. Among those
who had attempted to quit, proportionately more young persons
(under 35 years) than older persons reported attempting to quit
during the previous 12 months.

370


TABLE 6.-Percentage of current and former smokers who
      attempted to quit during the last year, by sex,
      age, and educational level, in 1966, 1975, and
       1966

sex, age.
and education

   1966'             1975 '             1980'
Current Former     Current Former      Current Former'
smoker  smoker      smoker  smoker      smoker  smoker

Total
Allegea 221

Male
All ages 221
21-24
25-34
3644
u
5664
2-a

Female
Allages 221
21-24
26-34
3644
45-54
55-64
265

Edueationd level
o-8
9-11
12
13-15
> 16

26.0

23.3    12.1        25.5     8.2        33.4
44.0     6.7        44.0    29.2        52.5
23.8    20.4        20.7    15.8        37.3
19.4    11.2        19.1    6.3        26.9
19.1    14.8        20.0    7.0        27.3
12.2    13.1        25.3     1.9        29.9
15.6     1.8        19.3     3.1        29.2

29.4    17.2        30.0    12.7        40.6
40.0    33.3        50.8    27.5        55.1
35.7    24.2       33.0    aI.        47.1
25.0    12.5        29.1    11.7        39.5
25.2    13.0       19.8     9.3        30.0
17.9    11.4        23.6     6.4        31.8
27.8    17.9        26.2     4.2        37.0

26.4    12.1        27.6     4.2        36.7
25.9    15.5        28.0     9.9        38.8
268    15.1        26.1    10.0        37.7
25.0    10.2       29.1    13.4        31.3
26.1    15.5        27.5     9.3        38.4

13.8        27.5

9.8        36.7

' Nationni Survey on Adult Ua of Tobaax,, PEE?.. 19M aad 1976.
*National Health Interview Survey Smoking Supplement, PISS (Reliminnry), 1980.
* lseo former smoker da&i not ._vaileble.

Relationship of Tar Yields to Smoking Behavior

In 1972, the Public Health Service classified tar as one of the
"most likely" contributors to the health hazards posed by cigarettes,
and studies have confirmed its carcinogenicity (4). In response to this
finding, a major change occurred in the cigarette products manufac-
tured and actually used. Over the last two decades, the proportion of
domestically consumed cigarettes yielding 15 mg or less of tar has
increased from 15 percent in 1968 to 66.9 percent in 1981(7).

The cigarette industry has also increased its promotional activities
in marketing brands yielding 15 mg or less tar. The percentage of
dollars expended in the United States on advertising and promotion
of cigarettes yielding 15 mg or less tar has increased from 19.6
percent in 1975 to 48.1 percent in 1978. These factors may account,


TABLE 7.-Percentage distribution of current regular
      smokers by tar level of primary brand of
      cigarettes, by sex and age, in 1975 and 1989

Sex and age

       1975 '                    1980'
     Tar level                   Tar level

<5   5-9 lo-14 15-19 2fJ+    <5   5-9 lo-14 15-19 20+
mg w mg mg mg    w w me me mg

Total
All ages 221     0.8   0.6    9.5   67.9   20.2    6.3   13.1   26.4   44.0   10.4

Male
AllageE 221     0.5   0.6   9.5   63.6   25.8    4.1   10.6   22.6   49.6   13.3
21-24          -    -   a.4   79.0   12.6    2.6   8.1   22.2   66.0    1.0
25-34         0.5    0.8   10.3   70.6   17.9    3.9   10.2   23.7   50.4   3.7
3544         1.1    0.2   8.5   65.8   24.4    3.8   10.9   25.3   45.0   14.9
45-54          -   0.5   12.1   56.1   31.3    5.0   10.1   22.2   39.0   23.6
55-64         1.2    1.6   8.5   50.2   38.5    5.4   11.6   19.6   39.8   23.6
t=          0.4   0.8   6.7   49.3   42.1     3.7   15.6   16.2   38.3   26.3

Female
Au ages 221     1.1    0.6   11.7   73.2   13.4    8.9   15.9   28.7   39.4    7.1
21-24         1.2    0.3   11.7   80.4    6.4    5.5    8.5   32.5   51.9    1.7
25-34         0.6   0.4   10.9   78.4   9.7     6.7   18.9   28.9   44.5   0.9
35-44         1.2    0.9   13.0   74.6   10.3    13.6   15.2   29.1   37.1    5.1
4I5-54         1.5    0.3   10.8   65.6   21.9     8.1   17.8   29.9   32.5   11.7
55-64         0.8    -   12.6   70.3   16.3    9.7   13.7   24.2   37.6   14.9
$5          2.1    3.1   12.5   63.9   18.5    9.6   18.6   26.6   30.2   14.9

' National Survey on Adult Use of Tolmcco, PHS, 1975.
' National Health Interview Survey Smoking Supplement, PIiS (preliminary). 1980.

in part, for the ever-in&easing use by current smokers of lower tar
cigarettes.

The definition of cigarettes as "lower tar" at 15 mg is arbitrary.
Nonetheless, this breakpoint has gained general acceptance. Special
note should be taken, however, that tar yields vary continuously, and
groupings by relative yield measurements do not automatically
imply differences in either the type or the magnitude of their
biological effects.

The percentage distribution of current regular smokers by tar
level of their primary brand of cigarette is presented in Table 8. A
clear trend toward increased use of lower tar products is apparent.
The 1975 data on brands were coded to the 1975 Federal Trade
Commission (FTC) values for tar yield, and the 1980 data were coded
to the 1979 FTC values. As tar values have bean progressively
declining, the 1980 data probably represent slightly higher values of
tar yields than were actually being used at that time.


Conclusions

1. The proportion of current regular smokers declined steadily
  between 1965 and 1980. The decline was steeper among males
  (from 52.1 to 37.9 percent) than among females (from 34.2 to
  29.8 percent).
2. The proportion of never smokers increased steadily from 1965
  to 1980 among males (27.6 to 31.6 percent), except those 45
  years old and older. Among females, only 20- to 34-year-olds
  showed an increase in proportion of never smokers.
3. The mean number of cigarettes smoked per day by current
  smokers increased slightly from 1970 to 1980 (from 20 to 21.7
  cigarettes).
4. Males smoked a higher mean number of cigarettes throughout
  the 1970-1980 period, but the number for males and females
   increased about the same amount.
5. Heaviest daily consumption was in the middle-aged group (35-
  65 years). The greatest mean increase was observed among
  women aged 35 to 44.
6. The proportion of current smokers who smoked less than 20
  cigarettes per day decreased between 1970 and 1980 (39.8 to
  33.8 percent); the proportion smoking one pack exactly (20
  cigarettes) remained constant (34.9 to 34.8 percent); the propor-
  tion smoking from 21 to 39 cigarettes increased slightly (13.7 to
  14.5 percent); and the proportion smoking two or more packs
  per day increased (11.4 to 16.8 percent).
7. The proportion of current smokers who attempted to quit three
  or more times decreased slightly from 1966 to 1980 (41.2 to 38.7
  percent).
8. The proportion of former smokers having made three or more
  attempts to quit increased sharply (36 to 53.2 percent) from
   1966 to 1975.
9. The proportion of current smokers who had attempted to quit
  during the past year increased from 1966 to 1980 (26.0 to 36.7
  percent).
10. Among current smokers, younger persons and females were
  more likely than older persons and males to have attempted to
  quit during the previous 12 months.
11. The proportion of former smokers who had attempted to quit
  during the previous 12 months decreased from 1966 to 1975
  (13.8 to 9.8 percent).
12. Among former smokers, younger persons and females were
  more likely than older persons and males to have quit during
  the previous 12 months.


References

(I) MAXWELL, J.C., Jr. Maxwell estimates 1981 cigarette s&a up 2.6 percent.
    United Stutea Tolxxco JournuI209@3-24): 1,6,8,50, December 6-22, 1961.
(2) NATIONAL CENTER FOR HEALTH STATISTICS. He&h, United States,
    1981. U.S. Department of Health and Human Services, Public Health
    Service, National Center for Health Statistics, National Center for Health
    Services Research, DHHS Publication No. (PHS)&X?+1232, December 1981,
    337 PP.
  (3) U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. The Changing
    Cigarette: A Report of the Surgeon Gxeml. U.S. Department of Health and
    Human Services, Public Health Service, Ofke of the Aseietant Secretary for
    Health, Office on Smoking and Health, DHHS Publication No. @VIS)61-
    !50156,1981,262 pp.
  (4,I U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE. Smoking
    and Health: A Report of the Surgeon General. U.S. Department of Health,
    Education, and Welfare. Public Health Service, Of&e of the Ae&tant
    Secretary for Health, Office on Smoking and Health, DHEW Publication No.
    @`HS)7940066,1979,1136 pp.
(5) U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE. The
    Health C~nwquencea of Smoking for Worn... A Report of the Surgeon
    Ceneml. U.S. Department of Health, Education, and Welfare, Public Health
    Service, Office of the Assistant Secretary for Health, Oftice on Smoking and
    Health, 1960,359 pp.
(6) U.S. PUBLIC HEALTH SERVICE. Use of Tobacco, Pm&ices, Attitudes,
    KmwMge, wuf Beliefs, United States: Fall 1964 and Spring 1966. U.S.
    Department of Health, Education, and Welfare, National clearinghouse for
    Smoking and Health, July 1969,607 pp.
(7) U.S. PUBLIC HEALTH SERVICE. Adult Use of Tobacco, 1970. U.S. Depart-
    ment of Heakh, Education, and Welfare, Public Health Service, Center for
    Disease Control, National Clearinghouse for Smoking and Health, DHEW
    Publication No. (I-ISMj73-6727, June 1973,129 pp.
(8) U.S. PUBLIC HEALTH SERVICE. Adult Use of Tobacco, 1975. U.S. Depart-
    ment of Health, Education, and Welfare, Public Health Service, Center for
    Diseaee Control. National clearinghouse for Smoking and Health, June
      1976.