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Cancer Trends Progress Report – 2011/2012 Update

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In the Report
Summary Tables
Smoking Initiation
Youth Smoking
> Adult Smoking
Quitting Smoking
Clinicians’ Advice to Quit Smoking
Medicaid Coverage of Tobacco Dependence Treatments
Fruit and Vegetable Consumption
Red Meat Consumption
Fat Consumption
Alcohol Consumption
Physical Activity
Sun Protection
Secondhand Smoke
Tobacco Company Marketing Expenditures
Early Detection
Life After Cancer
End of Life

Adult Smoking
Prevention: Behavioral Factors

Adult cigarette smoking has slowly fallen since 1991. While the percentage of male smokers has constantly trended downward, the percentage of female smokers trended downward from 1991 to 2005, followed by no change in cigarette smoking from 2005 to 2010. Among 18 to 24-year-olds, there was a rise, followed by a fall in smoking prevalence from 1998 to 2010. The lack of change in overall cigarette smoking from 2005 to 2010 for females is apparently because of the lack of change in smoking among females 25 years of age and older.

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Smoking and Cancer

Cigarette smoking is the leading preventable cause of death in the United States. It causes approximately 30 percent of all U.S. cancer deaths each year (more than 173,000 estimated deaths projected for 2012, American Cancer Society Facts & Figures 2012).

Cigarette smoking causes cancers of the lung, larynx, mouth, esophagus, pharynx, bladder, pancreas, kidney, cervix, stomach, and acute myeloid leukemia.

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Percentage of adults who were current cigarette smokers: Adults aged 18 and older who reported smoking 100 or more cigarettes in their lifetimes and who, at the time of the interview, continued to smoke every day or some days.

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Period – 1991–2010

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There is a long-term trend for decreased smoking rates for both men and women aged 18 years and older. There was a more accelerated reduction in smoking rates in women from 2000 to 2005, after which smoking rates did not change from 2005 to 2010. In contrast, men had a more gradual downward trend in smoking from 1991 to 2010. Among 18 to 24 year-olds, smoking trends rose and then fell. The decline among women began in 1999, approximately two years later than among men. In contrast, in the group aged 25 years and older, men showed a steady fall over the entire time period from 1991 to 2010, while women had a decrease in smoking from 1991 to 2007, after which smoking rates remained stable.

Current cigarette smoking prevalence showed similar declines from 1991 to 2010 by race/ethnicity. Among adults aged 25 years and older, smoking prevalence declined significantly for all three levels of education. However, smoking declines for those with only a high school education were more shallow than for those with less than a high school education or those with greater than a high school education. Those living below and above 200 percent of the poverty level experienced similar falling trends in smoking prevalence.

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Most Recent Estimates

In 2010, 19.3 percent of adults aged 18 and older—21.2 percent of men and 17.5 percent of women—were current cigarette smokers. In this same group, 5.4 percent of men and 0.2 percent of women were current users of smokeless tobacco. Cigarette smoking prevalence was similar for non-Hispanic whites (21.7 percent) and non-Hispanic blacks (19.9 percent) but was lower for Hispanics (12.2 percent).

Among adults aged 18 to 24 years, 20.0 percent—22.7 percent of men and 17.3 percent of women—were current cigarette smokers. Among adults aged 25 years and older, 19.2 percent—21.0 percent of men and 17.5 percent of women—were current cigarette smokers.

In 2010, there were similar smoking rates among adults aged 25 and older who had less than a high school education (26.9 percent) and a high school education (27.0 percent). Those with greater than a high school education smoked at the lowest level (14.4 percent) among the three education groups.

Among adults living below 200 percent of the federal poverty level, 26.8 percent smoked cigarettes, while 15.9 percent of adults living at or above 200 percent of the federal poverty level smoked cigarettes.

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Healthy People 2020 Targets

Reduce to 12 percent the proportion of adult current cigarette smokers.

Reduce to 0.3 percent the proportion of adult current smokeless tobacco users.

Reduce to 0.2 percent the proportion of adult current cigar smokers.

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Groups at High Risk for Smoking

Men are more likely than women to smoke cigarettes and cigars. American Indian/Alaska Natives are more likely to smoke cigarettes than non-Hispanic whites and non-Hispanic blacks, who in turn are more likely to smoke cigarettes than Hispanics and Asians.

People living below 200 percent of the poverty level and those 25 years of age and older with a high school or less than a high school education are also at a higher risk of smoking.

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Key Issues

Although the rate of smoking has dropped by more than half since the Surgeon General’s first report on smoking in 1964 (42 percent of adults were current smokers in 1965), progress has slowed over the past few years, especially for women. It appears that if trends progress at the current pace, only a few subgroups will reach the Healthy People 2020 (HP2020) goal of 12 percent or fewer smokers. Thus far, Hispanic and non-Hispanic Asian women, those 65 years of age and older, and those with an undergraduate degree or higher level of education have reached or are approaching the HP2020 goal. In addition, in fiscal year 2012, only two states, Alaska and North Dakota are funding tobacco control programs at the level recommended by the Centers for Disease Control and Prevention (CDC). Only four other states provide even half the recommended funding, while 33 states and Washington, D.C., provide less than one-quarter, and four states provided no funding this fiscal year. Further decreases in tobacco use could vastly improve the public’s health.

Concurrent with the decrease in adolescent cigarette smoking since 1997 and general decreases in adult smoking, the tobacco industry has increased its tobacco promotion and advertising, targeting young adults who are price- and brand-sensitive consumers. Among adults aged 18 years and older, those aged 18 to 24 had the highest smoking prevalence or were among the highest groups of smokers in most years based on different national surveys and across different definitions of a smoker (e.g., NSDUH and NHIS/TUS-CPS, respectively). In 2010, one out of three young adults younger than age 26 were smokers by the least stringent definition, and almost one out of four young adults 18 to 24 years old were smokers based on the definition of having ever smoked 100 cigarettes. According to the NSDUH survey, 99 percent of adult current smokers began smoking by age 26. Another recent phenomenon is the emergence of young adult use of water pipes to smoke tobacco, especially at specialty cafes near college campuses.

From 1997 to 2007, there was more than a two-fold increase in smoking little or small cigars, while there was a 6 percent decrease in smoking large cigars. In 2009, U.S. retail sales of cigars were more than $8 billion. Large cigar sales accounted for 49 percent, cigarillo sales for 31 percent, and small or little filtered cigars for 19 percent of the total cigar market share. In 2009, 5.4 percent of all adults in the United States—9.1 percentofadult men and 1.9 percent of adult women—used cigars on at least one of the past 30 days. Recent changes in the taxing of various cigar size categories and their relationship to taxing of cigarettes has impacted how the tobacco industry promotes these products. Subsequently, this impacts the use of the various types of cigars by smokers, including use of the little filtered cigars, which most resemble cigarettes and are even sold in packs of 20. Cigar smoking is a popular trend in the United States, especially among young and middle-aged white men with higher-than-average incomes and education. However, the most recent data in 2010 suggests a possible change in pattern by employment status for those 18 years and older, with 9.4 percent of unemployed adults reporting cigar use during the past 30 days compared to 5.9 percent of full-time workers reporting this use. The "cigar culture" is supported by cigar magazines, shops, bars, and clubs.

There is an increasing number of smokeless products being promoted by the tobacco industry, and some are promoted as products to use when it is inconvenient to smoke. Men are more likely than women to use smokeless tobacco; in 2010, the estimate for adult women was 0.2 percent and 5.4 percent for adult men. There was a trend for decreased smokeless tobacco use in men and women aged 18 years and older from 1987 to 2000. However, while smokeless tobacco use continued to decline in women from 2000 to 2010, there has been a recent rising trend in smokeless tobacco use in men from 2005 to 2010.

Although the FDA has banned the sale of characterizing flavored cigarettes (except for menthol), flavored smokeless, flavored cigar products, and menthol cigarettes are still available for purchase. The FDA-CTP TPSAC concluded in its report on the review of the public health consequences of menthol in cigarettes to the FDA and the secretary of Health and Human Services, “The evidence is sufficient to conclude that a relationship is more likely than not that the availability of menthol cigarettes results in lower likelihood of smoking cessation success in African Americans, compared to smoking non-menthol cigarettes. (Above Equipoise).”

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Additional Information on Adult Smoking

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Back: Youth Smoking

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