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Epidemiology of Tobacco Use and Cessation
Gary A. Giovino, Ph.D., M.S.Roswell Park Cancer Institute
Buffalo, New York
Consumer Demand Round Table
Washington, DC
December 7, 2005
Oral Cancer in a 20 Year-Old Man Who Used ST
Tobacco Control Model of Nicotine Addiction
Agent
Vector Host
Tobacco Products
Tobacco Product Manufacturers;
Other Users
Smoker/ChewerIncidental Host
EnvironmentFamilial, Social,
Cultural, Political, Economic, Historical,
Media
Involuntary Smoker
Source: Orleans & Slade, 1993
Russell’s Motivation/Dependence Model of Quitting
Source: Progress in Smoking Cessation; Schwartz JL (ed); ACS/WHO, 1978
Trends in Per Capita Consumption of Various Tobacco Products – United
States, 1880-2003
Source: Tobacco Situation and Outlook Report, U.S. Department of Agriculture, U.S. CensusNote: Among persons > 18 years old.
Beginning in 1982, fine-cut chewing tobacco was reclassified as snuff. Estimates for 2002 and 2003 are preliminary.
0
2
4
6
8
10
12
14
16
1880
1885
1890
1895
1900
1905
1910
1915
1920
1925
1930
1935
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
YEAR
PO
UN
DS
Cigarettes Cigars Pipe/Roll your own Chewing Snuff
Current Use Among U.S. Adults of Various Tobacco Products, by Sex – National Health
Interview Survey, 2000
0
5
10
15
20
25
30
35
Any Use Cigarettes Cigars Pipes Snuff ChewingTobacco
Bidis
PE
RC
EN
T
Males
Females
Note: Current users report using either every day or on some days Source: National Center for Health Statistics
31.3
21.3
25.7
21.0
4.5
0.2 1.0 0.1
2.5 0.1 0.1
2.50.10.2
Men
Women
0
10
20
30
40
50
60
1955 1960 1965 1970 1975 1980 1985 1990 1995 2000
YEAR
% C
UR
RE
NT
SM
OK
ER
STrends in cigarette smoking* among adults aged
>18 years, by sex - United States, 1955-2004
Source: 1955 Current Population Survey; 1965-2004 National Health Interview Surveys.
*Before 1992, current smokers were defined as persons who reported having smoked >100 cigarettes and who currently smoked. Since 1992, current smokers were defined as persons who reported having smoked >100 cigarettes during their lifetime and who reported now smoking every day day or some days.
23.4%
18.5%
0
10
20
30
40
50
6019
65
1967
1969
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
Year
Per
cen
t
Percentage of Ever Smokers* Who Have Quit, Adults Aged > 18 Years, by Sex-United States,
1965 - 2004
Source: National Health Interview Surveys, 1965-2004; Centers for Disease Control and Prevention: National Center for Health Statistics and Office on Smoking and Health. *Ever-smoked >100 cigarettes, Also known as the quit ratio. Note: estimates since 1992 incorporate same-day smoking
Men
Women
51.4%
49.7%
0
10
20
30
40
50
6019
65
1967
1969
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
Year
18-24 25-44 45-64 >=65
Per
cen
t
Trends in cigarette smoking* by age - United States, 1965-2004
*Before 1992, current smokers were defined as persons who reported having smoked >100 cigarettes and who currently smoked. Since 1992, current smokers were defined as persons who reported having smoked >100 cigarettes during their lifetime and who reported now smoking every day day or some days.
Source: various National Health Interview Surveys from 1965 - 2002, National Center for Health Statistics
0
10
20
30
40
50
60
70
80
1965 69 73 77 1981 1985 89 93 97 2001Year
18-24 25-44 45-64 >=65
% F
orm
er S
mok
ers
Source: various National Health Interview Surveys, 1966 - 2004*Ever-smoked 100 + Cigarettes Also known as the “quit ratio”, estimates since 1992 incorporates same-day smoking
Percentage of Ever Smokers* Who Have Quit , by Age – United States, 1965 -2004
05
101520253035404550
19
65
19
67
19
69
19
71
19
73
19
75
19
77
19
79
19
81
19
83
19
85
19
87
19
89
19
91
19
93
19
95
19
97
19
99
20
01
Year <12 years 12 years 13-15 years >=16 years
Per
cen
t
Trends in cigarette smoking* among adults aged >25 years, by education-
United States, 1965-2002
*Before 1992, current smokers were defined as persons who reported having smoked >100 cigarettes and who currently smoked. Since 1992, current smokers were defined as persons who reported having smoked >100 cigarettes during their lifetime and who reported now smoking every day day or some days.
Source: various National Health Interview Surveys from 1965 - 2002, National Center for Health Statistics
0
10
20
30
40
50
60
70
80
1966 1970 1974 1978 1982 1986 1990 1994 1998 2002
Year
<12 12 13 - 15 > = 16
% F
orm
er S
mok
ers
Source: various National Health Interview Surveys, 1966 -2002*Ever-smoked 100 + Cigarettes Also known as the “quit ratio”, estimates since 1992 incorporates same-day smoking
Percentage of Ever Smokers* Who Have Quit , by Education, Adults Aged > 25 Years –
United States, 1966 -2002
Percentage of Adults Who Smoke Cigarettes by Race/Ethnicity - United States, 2004
0
5
10
15
20
25
30
35
40
White Afr Amer Hispanic Native Asian/PI
MalesFemales
Source: National Center for Health Statistics, 2004 National Health Interview Survey
Cigarette Use and Nicotine Dependence, by Age: 2003 (National Survey on Drug Use and Health)
0.0
10.0
20.0
30.0
40.0
50.0 Cigarette Use (No Dependence)
Nicotine (Cigarette) Dependence
Age in Years
12-13 14-15 16-17 18-20 21-25 26-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
Percent in Past Month
2.5
11.0
23.2
38.141.6
36.8
30.929.0
31.128.9
25.021.8
16.5
10.0
3.8
9.7
16.720.3 18.1 16.5
19.1 21.4 19.2 18.1 15.912.0
6.40.6
The good news is…most smokers want to quit
90% regret ever having started to smoke
89% plan to quit; only 3% don’t want to quit
89% believe health will improve if quit
84% have tried to quit in the past
27% try to quit each year…
2004/2005 Assessing Hard Core Smoking Survey of US smokers ages 25+ years (n = 1,000)
Intentions to quit
22% within next 30 days
38% within 6 months, but not in next 30 days
29% after 6 months
6% don’t have plans, but believe should quit
6% don’t have plans, happy to remain smoking
2004/2005 Assessing Hard Core Smoking Survey of US smokers ages 25+ years (n = 1,000)
Assessing Hard Core Smoking Survey
Have you ever used/tried…
1%
12%
17%
41%
Cigarette PREP
Cessation clinic/class
Zyban/Bupropion
NRT
Percent of baseline smokers (ages 25+ years)
Assessing Hard Core Smoking Survey
Smokers are very concerned about…
22%
26%
38%
41%
47%
51%
52%
54%
Smoking controlling their lives
Gaining weight if quit
Hair/clothes smelling
ETS harming others
Amount of money spent on cigarettes
Smoking affecting breathing/energy
Smoking shortening their lives
Setting a bad example
Percent of baseline smokers (ages 25+ years)
Assessing Hard Core Smoking Survey
Smoking helps…
14%
28%
33%
64%
69%
83%
Go to bathroom in AM
Avoid depression
Feel more confidentsocially
Control anger
Deal with boredom
Calm down whenstressed/upset
Percent of baseline smokers (ages 25+ years)
Smokers’ Beliefs that May Impede Quitting - United States, 2004/2005
0
5
10
15
20
25
30
35
40
Lights/ultrasless tar
My genesprotective
Exercisereduces risk
Vitaminsreduce risk
Source: Assessing Hard Core Smoking Survey (ages 25+ years); n = 1,000
11%
24%
35%
30%
0% 10% 20% 30% 40%
Are patches morelikely to cause a
heart attack
More likely As likely Less likely Don't know
Only one-third of smokers correctly Only one-third of smokers correctly report that patches are less likely to report that patches are less likely to cause a heart attack than cigarettes...cause a heart attack than cigarettes...
Smoker Misperceptions About the Characteristics of Different Nicotine Delivery Devices. HSmoker Misperceptions About the Characteristics of Different Nicotine Delivery Devices. Hyland A, Cummings KM, Giovino GA, Bansal M, Bauer J, Hastrup J, Yost B. Society for Research Nicotine on Tobacco Annual Meeting, February 2002.
Atlanta Tampa
Human experimentation without consent