II. Alcohol and Cigarette Use Surveys

Two recent surveys with information on the use of cigarettes and alcohol are the 1994 National Health Interview Survey Year 2000 Objectives Supplement (NHIS-2000) and the National Longitudinal Alcohol Epidemiologic Survey (NLAES).

The results of the NHIS-2000 were published in July 1996 (CDC 1996a). This survey of approximately 20,000 adults was conducted by the Bureau of the Census for the National Center for Health Statistics. The survey estimated that, in 1994, 25.5 percent of the population age 18 and over were current smokers, and that this rate was unchanged from 1993. Current smokers are defined as those who have smoked at least 100 cigarettes in their lifetime and answer that they currently smoke, including those who smoke only on some days. This definition is somewhat different from the NHSDA definition of current smoking (any use in the past month) which resulted in a prevalence of 29.8 percent for adults in 1994. The 1995 NHSDA estimate for adults was also 29.8 percent.

School-based surveys have shown increases in smoking rates among students from 1991 to 1995. Past-month smoking rates found in the Monitoring the Future Study (MTF) were 14.3 percent in 1991 and 19.1 percent in 1995 for 8th graders. For tenth graders, rates were 20.8 percent in 1991 and 27.9 percent in 1995. For 12th graders, rates were 28.3 percent in 1991 and 33.5 percent in 1995. Small but statistically significant increases were found among 10th and 12th graders between 1994 and 1995 (USDHHS 1995). The Youth Risk Behavior Survey also found increases in current cigarette use among students in grades 9-12 from 27.5 percent in 1991 to 34.8 percent in 1995 (CDC 1996b). While the NHSDA trend for youth (age 12-17) smoking has not shown these increases, the NHSDA estimates for years prior to 1994 were apparently substantial underestimates because the data were collected without private self-administered answer sheets. When the NHSDA converted to the use of these answer sheets in 1994, the smoking rate for adolescents approximately doubled. This raises questions about the accuracy of the NHSDA measurement of the trend prior to 1994, even after adjustments are made to account for the effect of the new questionnaire.

The Surgeon General's Report on Smoking and Health (US DHHS 1994b) included smoking prevalence data from a number of sources, including the NHSDA. Comparisons between the various sources were made and methodological differences were assessed. These comparisons were based on NHSDA data prior to 1994, which were based on the interviewer-administered smoking questions, and thus show low rates of smoking in the NHSDA, particularly among youth.

Alcohol supplements sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and included on the NHIS have also provided estimates of alcohol use, including DSM-III-R abuse and dependence (Grant et al 1991).

NLAES was conducted by the Bureau of the Census for the NIAAA in 1992. Face-to-face interviews were conducted with 42,862 respondents age 18 and older in the contiguous U.S. It was designed to study the drinking practices, behaviors, and related problems in the general public. The survey included an extensive set of questions designed to assess the presence of symptoms of alcohol abuse and dependence during the prior 12 months, based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994). NLAES estimated that 4.4 percent of adults were alcohol dependent and another 3.0 percent were classified as abusing alcohol, but not dependent, within the past year (Grant et al 1995).

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