According to the Centers for Disease Control and Prevention, more than one in five adults in the U.S. (20.9%) are current smokers (CDC 2005, 2006) – or an estimated 45.1 million people.  Cigarette smoking accounts for approximately one of every five deaths in the U.S. each year (or 438,000 people), and it remains the leading preventable cause of death in the U.S..

The Great American Smokeout was established to promote the benefits of, and help individuals move towards, quitting smoking.  This year, the Great American Smokeout will take place on Thursday, November 15, 2007.  Accordingly, this month the Community Health Data Base takes a look at the prevalence of cigarette smoking in our region, as compared to nationwide.  This article will use data from the 2006 Southeastern Pennsylvania (SEPA) Household Health Survey to examine the population of current smokers in the region and attempts at smoking cessation. 

CURRENT SMOKERS IN SEPA

According to the 2006 Household Health Survey, about one out of five (20.8%) adults 18 and older in the five-counties of Southeastern Pennsylvania are current smokers.  This represents about 610,000 adults in the region, and is comparable to the national prevalence of 20.9% (CDC, 2006).  However, a breakdown of smoking by county reveals that Montgomery, Chester, and Bucks Counties have lower proportions of smokers than the national estimate (16.1, 16.5, and 18.9%, respectively), while Delaware County is equivalent to the national estimate (20.7%).  Philadelphia, on the other hand, has a higher proportion of smokers than the rest of the country, with over one in four Philadelphia adults reporting current smoking (25.8%, or 282,000 adults). 

The population of smokers in Southeastern Pennsylvania has a number of similarities to and a few differences from national estimates:

 - In SEPA, younger adults (18-24) are three times more likely to smoke than older adults (65+).  The age distribution of smokers in SEPA is similar to the national distribution (Table 1).  

Table 1. Current Smokers in the U.S. and Southeastern Pennsylvania by Age Group, 2006

Age	U.S.	SEPA
18-24	24.4%	27.3%
25-44	24.1%	23.8%
45-64	21.9%	21.9%
65+	9.6%	10.2%

 - Education level is associated with smoking status both nationally and in SEPA.  In SEPA, the prevalence of smoking is highest among those with less than a high school diploma (32.6%), followed by those with a diploma or GED (27.7%), and those who attended some college (24.8%) (Figure 1).  Smoking prevalence is lowest among those who graduated college (12.6%) and those with post-college education (8.3%).  This distribution is similar to national findings.
 - Cigarette smoking estimates in SEPA are highest among Native American/American Indian adults (37.2%), followed by Black/African-American (26.6%), Latino (22.1%), Multiracial (21.8%), White (19.1%), and Asian adults (13.5%).  These prevalences are similar to those nationwide; however, in SEPA Black/African-American and Latino adults have higher smoking prevalence than the national average (21.5% of Black/African-American and 16.2% of Latino adults are smokers).
- Unlike national findings, which suggest that cigarette smoking is more common among men than women (CDC 2006), in SEPA men and women are equally likely to be current smokers (20.8% for each group). 

In addition to the cigarette use described above, about 4% of adults (18+) in SEPA report using other kinds of non-cigarette tobacco products (such as, cigars, pipes, chew tobacco, and others).  This represents approximately 118,000 adults in SEPA.  The prevalence of using these other forms of tobacco does not vary across the five counties, but does vary significantly by gender: approximately 89% of those who use other forms of tobacco are men, with women comprising only about 11% of those who use other tobacco products.

SMOKING PREVALENCE TRENDS IN SEPA, 1991-2006

According to the 2006 Household Health Survey, about a quarter of adults (26.4%) in SEPA have smoked at some point (at least 100 cigarettes), but are no longer current smokers (representing about 780,000 people).  Since 1991, there has been an overall decline in the prevalence of smoking in Southeastern Pennsylvania (Figure 2).  In 1991, about 26.8% of the population were current smokers, compared to 20.8% in 2006.  However, since 1998, the decline appears to have slowed, such that prevalence has remained steady in the past eight years.  In 2006, SEPA is far from meeting the national Healthy People 2010 goal of a 12% smoking prevalence.

SMOKING CESSATION IN SEPA

The many health problems associated with cigarette smoking and other forms of tobacco use are well known and include heart disease, aneurysms, emphysema, stroke, and many forms of cancer.  Each year in the U.S., about 440,000 die from illnesses related to cigarette smoking.  Although there are many benefits to quitting smoking and other tobacco use, reducing and/or ending use of tobacco can be a slow and challenging process.  Many smokers will quit smoking for varying periods of time and later return to smoking again.   The 2006 Household Health Survey sought to collect information about quit attempts as well as smoking prevalence, in order to better understand this complex process for smokers in our region. 

More than half of adult smokers in SEPA (56.4%) report that they had tried to quit smoking in the previous year; this represents about 346,000 adults.  Nearly two-thirds of smokers who had a doctor visit in the previous year (65.6%) reported that they had been advised to quit smoking by a doctor or other medical professional.  And about 61% of those who were advised by a doctor to quit smoking made at least one quit attempt in the year, as compared to 50% of those who were not advised by a doctor to quit smoking.

Of those who did attempt to quit, the majority (64%) did not rely on any support method for quitting, instead going “cold turkey.”  The second most widely used method involved using a nicotine patch, nicotine gum, or some other form of medication (27%).   

SUMMARY

Overall, the demographic distribution of those who smoke in Southeastern Pennsylvania is by and large similar to national estimates.  Younger adults, adults with lower levels of education, and adults in Philadelphia are more likely to smoke than their counterparts.  The racial/ethnic distribution of smoking in the SEPA region diverges from U.S. distributions, and, unlike the national picture, in SEPA women are as likely to smoke as men.  Smokers who have attempted to quit smoking and who have recently quit smoking are important populations from a public health perspective, as they may be most able to make use of additional smoking cessation support.  Many resources for quitting – such as those highlighted by Great American Smokeout events – are now available to the general public and to those designing and implementing smoking cessation programs.

For more information about the Great American Smokeout or resources for quitting, visit the Smokeout website or call the Pennsylvania Free Quitline: 1-800-QUIT-NOW.

For more information about this article or the Community Health Data Base, contact staff member Allegra Gordon at agordon@phmc.org.

REFERENCES

Centers for Disease Control and Prevention. Adult Cigarette Smoking in the United States: Current Estimates. (November 2006).  [cited Oct 5 2007].  Available from: http://www.cdc.gov/tobacco/data_statistics/Factsheets/adult_cig_smoking.htm

Centers for Disease Control and Prevention. Tobacco Use Among Adults—United States, 2005. Morbidity and Mortality Weekly Report [serial online]. 2006;55(42):1145–1148 [cited Oct 5 2007]. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5542a1.htm.