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Special Commentary by the Director of the Smoking Cessation Leadership Center on the CDC's 2009 Smoking Prevalence Data
 It is disappointing that the new CDC data show that the prevalence of smoking in the United States did not decline in 2009
despite the April 2009 62 cent per pack tax on cigarettes. The
smoking rate remains at 20.6%. Of those who smoke,
78% do it daily, while 22% do it less frequently. The concentration
of smokers remains most intense among those with low socioeconomic
status, as measured by educational level. And great state variations remain, ranging from a low of 9.8% in Utah to a high of 25.6% in
Kentucky and West Virginia.
What should we make of these data?
It looks as though instead of reducing the numbers of smokers, the new tax merely reduced the number of cigarettes that smokers smoked. One can base this assumption on two findings. First, the actual numbers of cigarettes purchased in the United States are declining much faster than the smoking prevalence rates. Second, the percentage of daily smokers has dropped nationally from 82% in 2004 to 78% in 2009, with a proportionate increase in the percentage of nondaily smokers. Here in California, this shift to lighter smoking has been profound. In 1990, 18% of smokers were "heavy" smokers, (more than 25 daily cigarettes) and 45% were light or intermittent smokers (fewer than 15 cigarettes per day); by 2005 those proportion had shifted to 7% and 67%, respectively. Unfortunately, little health benefit accrues from cutting down on smoking, especially since it is likely that those who have cut back for economic reasons are smoking those fewer cigarettes in a more intense manner.
What do these new CDC data tell us?
The most important message is that tobacco is still the nation's number one killer, and that absent meaningful progress we will consign millions of Americans to premature death. One hypothesis for the lack of effect of the 2009 tobacco tax is that it was offset by concerns about the recession that might have impelled some people to start smoking and smokers to resist quitting. And certainly the recent declines in state tobacco control budgets have not helped. It is comforting to assert that, without the valiant efforts of those of you working on tobacco control and prevention, the prevalence might even have increased. Whether or not that's the case, the fact is that we have much to do. What can we do?
The bad news is that progress is coming far too slowly. The good news is that our efforts are needed more than ever. We need to push as hard as possible to invigorate those strategies that we know work to prevent initiation of smoking and to help smokers quit (Schroeder SA and Warner KE, 2010). We need to adjust our thinking about cessation and to generate new knowledge about those who smoke less than 10 cigarettes daily, for whom the evidence base regarding successful cessation strategies is meager (Fiore et al., 2008). Finally, we need to work collaboratively to concentrate our cessation efforts on groups with the highest prevalence: persons of low socioeconomic status, people with mental health or addictive disorders, and the LGBT population.
Nobody said that reducing the tobacco use was going to be easy, especially when the tobacco industry spends $15 billion annually promoting its products. But it is hard to think of a more worthy cause than to help smokers quit. I know that you will not be discouraged by these recent data. Thank you for all that you have done and will continue to do.
Sincerely,
Steven A. Schroeder, MD
Distinguished Professor of Health and Health Care,
Department of Medicine
Director, Smoking Cessation Leadership Center
University of California, San Francisco
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Smoking Cessation Leadership Center
University of California, San Francisco
Please continue to send us your updates (ie. Newsletter articles, provider traiings, presentations, etc.)
We will collect all the information, share with all partners, and post updates on the SCLC website.
Questions or Comments?
Contact [email protected]
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