Smoking among some adults dropped dramatically in past three decades

The Minnesota Heart Survey, a population-based, serial cross-sectional study of trends in cardiovascular risk factors, included between 3,000 and 6,000 participants in each of its six surveys. Examining the smoking trends in adults 25 to 74 years old in the Minneapolis/St. Paul metropolitan area from 1980 to 2009, researchers found:

• The number of current smokers was cut in half, decreasing from 32.8 percent to 15.5 percent in men and from 32.7 percent to 12.2 percent in women, with greater decreases among adults with higher income and more education.
• Current smokers were smoking less. The age-adjusted average number of cigarettes smoked per day decreased from 23.5 to 13.5 in men and 21.1 to 10.0 in women.
• Fewer Americans picked up the habit, with ever-smokers dropping from 71.6 percent to 44.2 percent in men and from 54.7 percent to 39.6 percent in women.
• Men continued to start smoking regularly at an average age of just under 18 years over the study period.
• While women have also decreased cigarette use, the age they start smoking regularly has dropped from 19 to just under 18.

"The proportion of people who smoke cigarettes has decreased dramatically in the past 30 years," said Kristian B. Filion, Ph.D., lead author of the study and Postdoctoral Associate in the Division of Epidemiology and Community Health at the University of Minnesota in Minneapolis. "One interesting finding was the differences in the subgroups. Individuals with more education had much greater decreases in smoking than those with less education."

The percent of current smokers among men with more than high school education decreased from 29 percent to 11 percent. In contrast, current smoking in men who had just completed high school or had less education decreased from 42 percent to 31 percent.

In women the numbers were different, but the trend was similar.

Limitations of this work included the exclusion of people aged 18 to 24 years and the study of a population that was predominantly white and fairly educated.

The study didn't address the impact of legislative changes such as increases in cigarette taxes. Smoking cessation efforts have made an impact; however, more emphasis needs to be placed on individuals in lower income brackets and those with less education, Filion said.

"Present interventions are less effective in those of lower socioeconomic status," he said. "This group may not have the same access to medical care or the public health messages in the news media just aren't reaching them."

There also needs to be a focus on younger women because societal changes and advertising may be having a negative influence, he said. "The prevalence of smoking has been decreasing, but it remains a public health issue. We need to have a better grasp on designing specific interventions for specific groups. A one-size-fits-all approach to stop smoking may not be as successful in some groups."

Co-authors are: Lyn M. Steffen, Ph.D.; Sue Duval, Ph.D.; David R. Jacobs Jr., Ph.D.; Henry Blackburn, M.D.; and Russell V. Luepker, M.D., M.S. Author disclosures are on the abstract.

The National Institutes of Health, Heart and Stroke Foundation of Canada, and Fonds de la Recherche en Santé du Québec (Quebec Foundation for Health Research) funded the study.