Medical Expenditure Panel Survey 

Agency for Healthcare 

Research and Quality 

STATISTICAL BRIEF #101 

October 2005 

Variations in Smoking by Selected 

Demographic, Socioeconomic, 

Insurance, and Health Characteristics, 

United States, 2003 

Kelly Carper, MEd and Steven R. Machlin, MS 

Introduction 

Since 1965, the percentage of adults in the United States who 

smoke has declined by nearly half.* Moreover, the percentage of 

smokers with a routine check-up who were advised by their doctor to 

quit smoking rose in recent years from 57 percent in 2000 to about 

64 percent in 2003. Despite these improvements, the smoking status 

of adults remains a serious concern to citizens, health care providers, and policy makers, as smoking is one of the leading causes 

of preventable death and disease. Data from the Household Component of the 2003 Medical Expenditure Panel Survey (MEPS-HC) 

indicate that more than one-fifth of the adult U.S. civilian noninstitutionalized population currently smoked and that smokers were 

more likely to be in fair or poor health than non-smokers (about 18.0 

versus 11.6 percent). 

This Statistical Brief presents estimates on the smoking status of 

adults, age 18 or older, in the U.S. civilian noninstitutionalized 

(community) population in 2003 by selected characteristics, including 

age, race/ethnicity, sex, education, insurance coverage, and health 

conditions. Additional estimates are provided on routine check-ups 

and smoking cessation counseling. The national estimates are 

derived from the MEPS-HC self-administered questionnaire (SAQ) in 

conjunction with data obtained from the core MEPS-HC questionnaire. All differences between estimates discussed in the text are 

statistically significant at the 0.05 level or better. 

Findings 

Age 

In 2003, 21.7 percent of the adult U.S. civilian noninstitutionalized 

population (46.3 million persons) currently smoked. Persons in the 

18–24 year (22.5 percent), 25–44 year (24.4 percent), and 45–64 

year (23.7 percent) age categories were more than twice as likely 

* National Center for Health Statistics. Health, United States, 2004, with Chartbook on Trends in the Health of Americans. Hyattsville, 

Maryland: 2004. http://www.cdc.gov/nchs/hus.htm 

Highlights 

¢ In 2003, 21.7 percent of the 

adult U.S. civilian noninstitutionalized population (46.3 

million persons) currently 

smoked. 

¢ White non-Hispanics (23.2 

percent) and black nonHispanics (22.5 percent) were 

nearly three times more likely 

to smoke than Asians (7.9 

percent) and about one and a 

half times more likely to 

smoke than Hispanics (15.6 

percent). 

¢ About one-quarter of all adult 

males currently smoked (24.4 

percent) compared to 19.1 

percent of females. 

¢ Adults with fewer than 12 

years of education were about 

twice as likely to smoke as 

adults with more than 12 

years of education (29.9 

percent versus 14.6 percent). 

¢ Persons age18–64 with public 

only insurance (35.1 percent) 

or who were uninsured (33.7 

percent) were considerably 

more likely to smoke than 

those 18–64 with any private 

insurance (20.3 percent). 

¢ Over two-fifths (43.4 percent) 

of persons with emphysema 

were current smokers. 

¢ In 2003, 63.6 percent of 

smokers who had a routine 

check-up in the last 12 

months were counseled by a 

physician to stop smoking. 
to smoke as adults age 65 and over (figure 1). The differences among the subgroups under 65 were not 

significant. 

Race/ethnicity 

White non-Hispanics (23.2 percent) and black non-Hispanics (22.5 percent) were nearly three times more 

likely to smoke than Asians (7.9 percent) and almost 1.5 times more likely to smoke than Hispanics (15.6 

percent) (figure 2). 

Sex 

In 2003, about one-quarter of all adult males smoked (24.4 percent) compared to 19.1 percent of females 

(figure 3). While men in the 18–64 age group were more likely to smoke than women in the same age 

group (26.5 percent versus 21.2 percent), the difference between the rates of smoking of males and 

females in the 65 and over age category were not significant. 

Education 

Adults with fewer than 12 years of education were about twice as likely to smoke as adults with more than 

12 years of education (29.9 percent versus 14.6 percent) (figure 4). Persons with 12 years of education 

were slightly less likely to smoke than those with fewer than 12 years of education (27.0 percent versus 

29.9 percent) but were nearly twice as likely to smoke as persons with more than 12 years of education 

(27.0 percent versus 14.6 percent). 

Insurance status 

Persons 18–64 years of age with public only insurance (35.1 percent) or who were uninsured (33.7 

percent) were considerably more likely than persons in the same age group with private insurance (20.3 

percent) to smoke (figure 5). 

Chronic conditions 

A significant number of persons with reported physician-diagnosed chronic conditions currently smoked. 

Of the six chronic conditions examined, persons with emphysema were most likely to currently smoke 

(43.4 percent) (figure 6). About 22.2 percent of persons with asthma, 21.3 percent of persons who had a 

stroke, 19.9 percent of persons with cardiovascular problems, 17.9 percent of persons with hypertension, 

and 16.0 percent of persons with diabetes reported that they currently smoked. 

Routine check-ups/counseling 

Slightly less than half of smokers (47.8 percent) had a routine check-up within the last year compared to 

61.1 percent of non-smokers (estimates not shown in a figure). Nearly two-thirds (63.6 percent) of 

smokers who had a routine check-up in the last year were counseled by a physician to stop smoking. 

Data Source 

The estimates in this Statistical Brief are based upon data from the MEPS 2003 Full Year Population 

Characteristics data file (HC-073). 

Definitions 

Racial and ethnic classifications 

Classification by race and ethnicity is based on information reported for each family member. 

Respondents were asked if each family member’s race was best described as American Indian, Alaska 

Native, Asian or Pacific Islander, black, white, or other. They also were asked if each family member’s 

main national origin or ancestry was Puerto Rican; Cuban; Mexican, Mexicano, Mexican American, or 

Chicano; other Latin American; or other Spanish. All persons whose main national origin or ancestry was 

reported in one of these Hispanic groups, regardless of racial background, were classified as Hispanic. 

Since the Hispanic grouping can include black Hispanic, white Hispanic, Asian and Pacific Islanders 

Hispanic, and other Hispanic, the race categories of black, white, Asian and Pacific Islanders, and other 

do not include Hispanic. MEPS respondents who reported other single or multiple races and were nonHispanic were included in the other category. 
Health insurance status 

Individuals under age 65 were classified in the following three insurance categories, based on household 

responses to health insurance status questions: 

– Any private health insurance: Individuals who, at any time during the year, had insurance that provides 

coverage for hospital and physician care (other than Medicare, Medicaid, or other public 

hospital/physician coverage) were classified as having private insurance. Coverage by TRICARE 

(Armed Forces–related coverage) was also included as private health insurance. Insurance that 

provides coverage for a single service only, such as dental or vision coverage, was not included. 

– Public coverage only: Individuals were considered to have public coverage only if they met both of the 

following criteria: 1) they were not covered by private insurance at any time during the year, 2) they 

were covered by one of the following public programs at any point during the year: Medicare, Medicaid, 

or other public hospital/physician coverage. 

– Uninsured: The uninsured were defined as people not covered by private hospital/physician insurance, 

Medicare, TRICARE, Medicaid, or other public hospital/physician programs at any time during the entire 

year or period of eligibility for the survey. 

Chronic conditions 

Information on chronic conditions was obtained from responses to questions asked in the Priority 

Conditions section of the MEPS-HC questionnaire. For each of the priority conditions, the following 

question was asked: “(Have/Has) PERSON ever been told by a doctor or other health professional that 

PERSON had [condition].” 

About MEPS-HC 

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health 

care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, 

demographic, and economic characteristics for the civilian noninstitutionalized population. It is 

cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health 

Statistics. 

For more information about MEPS, call the MEPS information coordinator at AHRQ (301-427-1656) or 

visit the MEPS Web site at http://www.meps.ahrq.gov/. 

References 

For a detailed description of the MEPS survey design, sample design, and methods used to minimize 

sources of nonsampling error, see the following publications: 

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Design Strategies and Innovations in the Medical Expenditure Panel Survey. Medical Care, 

July 2003: 41(7) Supplement: III-5–III-12. 

Suggested Citation 

Carper, K. and Machlin, S. R. Variations in Smoking by Selected Demographic, Socioeconomic, 

Insurance, and Health Characteristics, United States, 2003. Statistical Brief #101. October 2005. Agency 

for Healthcare Research and Quality, Rockville, Md. 

http://meps.ahrq.gov/mepsweb/datafiles/publications/st101/stat101.pdf
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AHRQ welcomes questions and comments from readers of this publication who are interested in 

obtaining more information about access, cost, use, financing, and quality of health care in the United 

States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and 

tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. 

Please e-mail us at mepspd@ahrq.gov or send a letter to the address below: 

Steven B. Cohen, PhD 

Director 

Center for Financing, Access, and Cost Trends 

Agency for Healthcare Research and Quality 

540 Gaither Road 

Rockville, MD 20850 
i i l i l i l 

0 

( ) 

Source: Center for F nanc ng, Access, and Cost Trends, AHRQ, Househo d Component of the Med ca Expend ture Pane Survey, 2003 

Figure 1. Percentage of adults 18 years or older who 

currently smoked, by age, 2003 

21.7 22.5 

24.4 23.7 

10.9 

10 

20 

30 

40 

Overall 

18 and over

18-24 years 25-44 years 45-64 years 65 years and 

over 

Percent 

i i l i l i l 

/

0 

/

Source: Center for F nanc ng, Access, and Cost Trends, AHRQ, Househo d Component of the Med ca Expend ture Pane Survey, 2003 

Figure 2. Percentage of adults 18 years or older 

who currently smoked, by race ethnicity, 2003 

23.2 

15.6 

22.5 

7.9 

30.6 

10 

20 

30 

40 

White, not 

Hispanic or 

Latino, single 

race 

Hispanic or 

Latino 

Black, not 

Hispanic or 

Latino, single 

race 

Asian, not 

Hispanic or 

Latino, single 

race 

Other single 

race multiple race, 

not Hispanic or 

Latino 

Percent 
i i l i l i l 

0 

Source: Center for F nanc ng, Access, and Cost Trends, AHRQ, Househo d Component of the Med ca Expend ture Pane Survey, 2003 

Figure 3. Percentage of adults 18 years or older 

who currently smoked, by sex and age, 2003 

24.4 

26.5 

12.3 

21.2 

19.1 

9.9 

10 

20 

30 

40 

18 years and over 18-64 years 65 years and over 

male female 

Percent 

i i l i l i l 

0 

Source: Center for F nanc ng, Access, and Cost Trends, AHRQ, Househo d Component of the Med ca Expend ture Pane Survey, 2003 

Figure 4. Percentage of adults 18 years or older who 

currently smoked, by educational attainment, 2003 

29.9 

27.0 

14.6 

10 

20 

30 

40 

<12 years 12 years >12 years 

Percent 
i i l i l i l 

0 

Source: Center for F nanc ng, Access, and Cost Trends, AHRQ, Househo d Component of the Med ca Expend ture Pane Survey, 2003 

Figure 5. Percentage of adults age 18-64 who 

currently smoked, by health insurance status, 2003 

20.3 

35.1 33.7 

10 

20 

30 

40 

Private Public only Uninsured 

Percent 

i i l i l i l 

0 

Source: Center for F nanc ng, Access, and Cost Trends, AHRQ, Househo d Component of the Med ca Expend ture Pane Survey, 2003 

Figure 6. Percentage of adults 18 years or older who 

currently smoked, by selected chronic conditions, 2003 

43.4 

22.2 21.3 19.9 

17.9 16.0 

10 

20 

30 

40 

50 

Emphysema Asthma Stroke Cardiovascular 

problems 

Hypertension Diabetes 

Percent