NCHS Data Brief ■ No. 181 ■ January 2015

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Cigarette Smoking and Lung Obstruction Among Adults 

Aged 40–79: United States, 2007–2012 

Ryne Paulose-Ram, Ph.D., M.A.; Timothy Tilert, B.S.; Charles F. Dillon, M.D., Ph.D.; 

and Debra J. Brody, M.P.H.

Key findings 

Data from the National 

Health and Nutrition 

Examination Survey, 

2007–2012

● During 2007–2012, 46.2% 

of adults aged 40–79 with lung 

obstruction currently smoked 

cigarettes. About 41% with 

mild and 55% with moderate or 

worse obstruction were current 

smokers.

● A similar percentage of 

men and women with lung 

obstruction, overall and at 

each level of severity, smoked 

cigarettes.

● A greater percentage of 

adults aged 40–59 with lung 

obstruction, overall and at 

each level of severity, smoked 

cigarettes than those aged 

60–79.

● Cigarette smoking among 

adults with lung obstruction 

varied by race and Hispanic 

origin and by severity of 

obstruction. 

● The percentage of adults 

with lung obstruction, overall 

and at each level of severity, 

who smoked cigarettes declined 

with increasing education.

Lung obstruction is characterized by blocked airflow, shortness of breath, and 

difficulty exhaling. The most common obstructive lung diseases are asthma and 

chronic obstructive pulmonary disease (COPD), which includes emphysema and 

chronic bronchitis. Approximately 15% of U.S. adults aged 40–79 have lung 

obstruction, with about one-third of those having moderate or worse obstruction 

(1). Smoking tobacco increases respiratory symptoms (2), lung function loss (3), 

and the rate of lung function decline (4–6). The benefits of smoking cessation 

are numerous for all adults (6) and especially for those with lung obstruction (5). 

This report presents national estimates of cigarette smoking among adults with 

measured lung obstruction for the period 2007–2012. 

Keywords: obstructive lung disease • lung impairment • spirometry • COPD

What percentage of adults aged 40–79 with and without lung 

obstruction currently smoked cigarettes?

In 2007–2012, approximately 46% of adults aged 40–79 with any lung 

obstruction were current cigarette smokers. This was more than double the 

Figure 1. Cigarette smoking among adults aged 40–79 with and without lung obstruction: 

United States, 2007–2012

1

Significantly different from adults with any lung obstruction for same smoking status group. 

NOTES: Significance testing only conducted between adults with any lung obstruction and those without lung obstruction. 

Access data table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db181_table.pdf#1. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2007–2012.

0

20

40

60

80

100

Former

Current

Never

Moderate

or worse

None Any Mild

Percent

Lung obstruction

1

19.8 46.2 41.2

27.7

31.1

10.8

34.2

55.0

30.1

23.8

26.1

154.1
NCHS Data Brief ■ No. 181 ■ January 2015

■  2  ■

percentage for those without lung obstruction who smoked cigarettes (19.8%) (Figure 1). Among 

adults with mild lung obstruction, 41.2% were current cigarette smokers, and among those with 

moderate or worse lung obstruction, more than one-half (55.0%) were current smokers. 

Among adults aged 40–79 with lung obstruction, did men and women differ 

in the percentage who currently smoked cigarettes?

Among adults aged 40–79 with any lung obstruction, a similar percentage of men (49.3%) and 

women (42.6%) were current cigarette smokers (Figure 2). Rates of cigarette smoking for men 

and women also were similar at each level of obstruction severity. Percent

Figure 2. Percentage of adults aged 40–79 with lung obstruction who currently smoked cigarettes, by sex and severity of 

obstruction: United States, 2007–2012

0

20

40

60

80

NOTE: Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db181_table.pdf#2. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2007–2012.

Men Women

Any Mild Moderate or worse

Lung obstruction

49.3

42.6 44.1

38.0

58.7

50.7
NCHS Data Brief ■ No. 181 ■ January 2015

■  3  ■

Did cigarette smoking among adults aged 40–79 with lung obstruction 

differ by age? 

The percentage of adults aged 40–59 with any lung obstruction who currently smoked cigarettes 

(50.8%) was higher than for those aged 60–79 (38.6%) (Figure 3). This difference by age also 

was similar for adults at each level of obstruction severity. Percent

Figure 3. Percentage of adults aged 40–79 with lung obstruction who currently smoked cigarettes, by age group and 

severity of obstruction: United States, 2007–2012

Any Mild Moderate or worse

Lung obstruction

1

Significantly different from adults aged 60–79.

NOTE: Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db181_table.pdf#3.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2007–2012.

0

20

40

60

80

40–59 60–79

1 50.8

38.6

1 45.6

31.4

1 63.6

46.5
NCHS Data Brief ■ No. 181 ■ January 2015

■  4  ■

Did cigarette smoking among adults aged 40–79 with lung obstruction 

differ by race and Hispanic origin?

Current cigarette smoking among adults aged 40–79 with lung obstruction differed by race and 

Hispanic origin. Among adults with mild lung obstruction, a higher percentage of non-Hispanic 

black adults were current cigarette smokers (62.6%) than non-Hispanic white (38.2%) or Hispanic 

(31.9%) adults (Figure 4). For those with moderate or worse lung obstruction, however, a higher 

percentage of non-Hispanic white adults were current cigarette smokers (61.7%) compared with 

non-Hispanic black (45.2%) and Hispanic (24.9%) adults. Percent

Figure 4. Age-adjusted percentage of adults aged 40–79 with lung obstruction who currently smoked cigarettes, by race 

and Hispanic origin and severity of obstruction: United States, 2007–2012

1

Significantly different from Hispanic adults.

2

Significantly different from non-Hispanic black adults.

NOTES: Data are age-adjusted to year 2000 U.S. Census Bureau estimates using age groups 40–59 and 60–79. 

Access data table for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db181_table.pdf#4.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2007–2012.

Any Mild Moderate or worse

Lung obstruction

Non-Hispanic white Non-Hispanic black Hispanic

0

20

40

60

80

1 46.4

1 55.7

29.9

2 38.2

1 62.6

31.9

1,2 61.7

1 45.2

24.9
NCHS Data Brief ■ No. 181 ■ January 2015

■  5  ■

Did cigarette smoking among adults aged 40–79 with lung obstruction 

differ by education?

Among adults aged 40–79, overall and at each level of obstruction severity, the percentage of 

adults who currently smoked declined with increasing levels of education (Figure 5). Of those 

with any lung obstruction, nearly two out of three adults with less than a high school degree were 

currently smoking, compared with 53.2% of high school graduates and 36.0% of those with at 

least some college education. Among adults with mild lung obstruction, almost 55% with less 

than a high school degree currently smoked cigarettes, whereas among those with moderate or 

worse lung obstruction, nearly 74% with less than a high school degree were current smokers. Percent

Figure 5. Percentage of adults aged 40–79 with lung obstruction who currently smoked cigarettes, by education and 

severity of obstruction: United States, 2007–2012

1

Significant linear trend.

NOTE: Access data table for Figure 5 at: http://www.cdc.gov/nchs/data/databriefs/db181_table.pdf#5.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2007–2012. 

Any Mild Moderate or worse

Lung obstruction

0

20

40

60

80

Less than high school High school graduate Some college or more

1 64.4

53.2

36.0

1 54.8

49.4

34.4

1 73.7

58.9

39.9

Summary 

During 2007–2012, about 46% of U.S. adults aged 40–79 with lung obstruction currently smoked 

cigarettes. This was more than double the smoking rate for those without lung obstruction 

(19.8%).

In the United States, a greater percentage of men (20.5%) than women (15.3%) were current 

cigarette smokers in 2013 (7). Some studies (8,9) have suggested that women are more 

susceptible than men to the effects of tobacco smoke. Since 2000, the number of women dying 

from COPD has exceeded the number of men dying from the disease (10). In the present report, 

a similar percentage of men and women overall, and at each level of lung obstruction severity, 

currently smoked cigarettes.
NCHS Data Brief ■ No. 181 ■ January 2015

■ 6  ■

Notable differences were seen in smoking rates by race and Hispanic origin. Among adults aged 

40–79 with mild lung obstruction, a significantly greater percentage of non-Hispanic black adults 

currently smoked cigarettes compared with the two other race and Hispanic origin groups. With 

moderate or worse lung obstruction, however, a significantly greater percentage of non-Hispanic 

white adults currently smoked cigarettes compared with those in the other race and Hispanic 

origin groups. 

Smoking rates among those with lung obstruction also varied by education, with progressively 

higher rates of smoking among those with decreasing levels of education. This inverse 

relationship between smoking and education level is consistent across all severity levels of lung 

obstruction. 

Smoking tobacco can increase respiratory symptoms (2), loss of lung function (3), and the 

progression of COPD (4–6). The data presented here show that during 2007–2012, almost onehalf of U.S. adults aged 40–79 with lung obstruction currently smoked cigarettes. 

Definitions

Lung obstruction: Based on lung function values obtained from a pre-bronchodilator spirometry 

examination, lung obstruction was defined as a forced expiratory volume in the first second 

(FEV1) to forced vital capacity (FVC) ratio less than the lower limit of normal (11). Persons 

were also defined as having lung obstruction based on a positive response to use of daytime 

supplemental oxygen and ever having been diagnosed with emphysema or still having chronic 

bronchitis. As defined here, approximately 14.7% of U.S. adults aged 40–79 had measured lung 

obstruction in 2007–2012 (1).

Severity of lung obstruction: Mild lung obstruction was defined as an FEV1 greater than 70% 

predicted among those with lung obstruction. Moderate or worse lung obstruction was defined 

as an FEV1 less than or equal to 70% predicted among those with lung obstruction (11). Persons 

who were identified as having lung obstruction based on supplemental oxygen use were defined 

as having moderate or worse lung obstruction. Applying these definitions, approximately 9.4% 

of U.S. adults aged 40–79 had mild lung obstruction and 5.3% had moderate or worse lung 

obstruction in 2007–2012 (1). 

Smoking status: A current smoker reported smoking at least 100 cigarettes in his or her lifetime, 

and at the time of the household interview reported currently smoking every day or some days, 

or was defined by a measured serum cotinine value greater than 10 ng/mL (12) (cotinine is a 

metabolite of nicotine that reflects recent exposure). A former smoker reported smoking at least 

100 cigarettes during his or her lifetime but currently did not smoke. A never smoker reported 

smoking fewer than 100 cigarettes during his or her lifetime. 

Data source and methods

Data from the National Health and Nutrition Examination Surveys (NHANES) 2007–2012 

(available from: http://www.cdc.gov/nchs/nhanes.htm) were used for these analyses. NHANES 

is a cross-sectional survey designed to monitor the health and nutritional status of the civilian 

noninstitutionalized resident population of the United States. The survey consists of interviews 
NCHS Data Brief ■ No. 181 ■ January 2015

■  7  ■

conducted in participants’ homes and standardized physical examinations conducted in mobile 

examination centers (MECs), where blood and urine specimens are collected.

The NHANES sample is selected through a complex, multistage probability design. Data 

collection is based on a representative sample covering all ages of the target population. During 

2007–2010, non-Hispanic black and Hispanic persons were oversampled to obtain more reliable 

estimates of the health of these population subgroups. During 2011–2012, non-Hispanic Asian 

persons were also oversampled. Public-use data files are released in 2-year cycles (available from: 

http://www.cdc.gov/nchs/nhanes.htm).

During NHANES 2007–2012, spirometry data were collected in the MEC from survey 

participants aged 6–79 years. Details of the NHANES spirometry examination procedures and 

data collection are available elsewhere (13). Lung obstruction may be defined using multiple 

criteria. This report uses American Thoracic Society/European Respiratory Society (ATS/ERS) 

diagnostic criteria and follows the data and analytic methodology used by Tilert et al. (1). 

Examination sample weights were used to account for differential probabilities of selection, 

nonresponse, and noncoverage and were incorporated into the estimation process. Standard errors 

of the percentages were estimated using Taylor series linearization, a method that incorporates 

the sample weights and accounts for the complex survey design. Estimates for race and Hispanic 

origin were age-adjusted by the direct method to the year 2000 projected U.S. standard population 

using two age groups: 40–59 and 60–79. Differences between groups were tested using Student’s 

t statistic at the p < 0.05 significance level. To test for linear trends, the null hypothesis of a 

nonlinear trend was examined using orthogonal polynomials. Statistical analyses were conducted 

using STATA, version 12.1 (StataCorp, College Station, Tex.). 

About the authors

Ryne Paulose-Ram, Timothy Tilert, Charles F. Dillon, and Debra J. Brody are with CDC’s 

National Center for Health Statistics, Division of Health and Nutrition Examination Surveys. 

References

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NCHS Data Brief ■ No. 181 ■ January 2015

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strategy for the diagnosis, management, and prevention of COPD (updated 

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12. Hukkanen J, Jacob P III, Benowitz NL. Metabolism and disposition 

kinetics of nicotine. Pharmacol Rev 57(1):79–115. 2005.

13. NCHS. National Health and Nutrition Examination Survey: Respiratory 

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Suggested citation

Paulose-Ram R, Tilert T, Dillon CF, Brody 

DJ. Cigarette smoking and lung obstruction 

among adults aged 40–79: United States, 

2007–2012. NCHS data brief, no 181. 

Hyattsville, MD: National Center for Health 

Statistics. 2015.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health and Nutrition 

Examination Surveys

Kathryn S. Porter, M.D., M.S., Director

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