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To assess progress toward achieving the Healthy People 2020 objective of reducing the percentage of U. The percentage of U. Among daily cigarette smokers, declines were observed in the percentage who smoked 20—29 cigarettes per day from 34. Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, high impact mass media campaigns, and barrier-free access to quitting assistance, are critical to reduce cigarette smoking and smoking-related disease and death among U.
The NHIS core questionnaire is administered to a randomly selected adult in each sampled family. Data were adjusted for differences in the probability of selection and nonresponse, and weighted to provide nationally representative estimates.
Logistic regression was used to analyze trends using annual NHIS data from 2005 through 2014. Percentage changes in prevalence rates between 2005 and 2014 were calculated. Current cigarette smoking among U. Cigarette smoking was significantly lower in 2014 16. In 2014, prevalence was higher among males 18. Persons living below the poverty level had a higher smoking prevalence 26.
Census region, prevalence was highest in the Midwest 20. Adults reporting a disability or limitation had a higher smoking prevalence 21. Prevalence also was higher among lesbian, gay, or bisexual adults 23.
From 2005 to 2014, the percentage of adults who were former cigarette smokers did not change significantly 21. Overall in 2014, higher smoking prevalences were reported among persons insured by Medicaid only 29. Among those covered by Medicaid only, prevalences were higher among adults aged 25—44 years 35.
Among current smokers during 2005—2014, the number of daily smokers decreased from 36. Among daily smokers, the mean number of cigarettes smoked per day declined from 16. During 2005—2014, increases occurred in the percentage of daily smokers who smoked 1—9 16. Discussion During 2005—2014, the prevalence of cigarette smoking among U.
Adults aged 18—24 years experienced the greatest decrease in cigarette smoking prevalence; however, recent reports suggest that use of noncigarette tobacco products, including e-cigarettes and hookahs, is common among youth and young adults 2 , 3. The extent to which emerging tobacco products, such as e-cigarettes, might have contributed to the observed decline in cigarette smoking in recent years is uncertain.
E-cigarette use was first assessed in NHIS in 2014, so it is not possible to assess long term patterns of e-cigarette use relative to cigarette use with this dataset; in 2014, 3. E-cigarettes have been promoted for smoking cessation 1 ; however, the U. Preventive Services Task Force has concluded that the current evidence is insufficient to recommend e-cigarettes for tobacco cessation in adults, including pregnant women.
Observed disparities in smoking prevalence are consistent with previous studies 5. Differences in prevalence among persons with different types of health insurance coverage might be partly attributable to variations in tobacco cessation treatment coverage and access to evidence-based cessation treatments across health insurance types 7.
Higher prevalences among persons with disabilities and limitations might be related, in part, to smoking-attributable disability in smokers and possible higher stress associated with disabilities 8. These disparities underscore the importance of enhanced implementation of proven strategies to prevent and reduce tobacco use. Ongoing changes in the U.
The Patient Protection and Affordable Care Act of 2010 ACA is increasing the number of Americans with health insurance and is expected to improve tobacco cessation coverage 7. The ACA requires most private insurers to cover tobacco cessation 7 ; a guidance document issued in May 2014 further clarified this ACA provision.
In 2015, although all 50 state Medicaid programs covered some tobacco cessation treatments for some Medicaid enrollees, only nine states covered individual and group counseling and all seven FDA-approved cessation medications for all Medicaid enrollees 9.
Cessation coverage has the greatest impact when promoted to smokers and health care providers 7, 9. The findings in this report are subject to at least five limitations. First, smoking status was self-reported and not validated by biochemical testing; however, self-reported smoking status correlates highly with serum cotinine levels 10.
Second, because NHIS does not include institutionalized populations and persons in the military, results are not generalizable to these groups. Third, the NHIS response rate of 58. Fourth, the questionnaire did not assess gender identity; including transgender persons might yield higher smoking estimates among sexual minorities. Finally, these estimates might differ from other surveys on tobacco use. These differences in estimates can be partially explained by varying survey methodologies, types of surveys administered, and definitions of current smoking; however, trends in prevalence are comparable across surveys.
Sustained comprehensive state tobacco control programs funded at CDC-recommended levels could accelerate progress toward reducing the health and economic burden of tobacco-related diseases in the United States 1. Implementation of comprehensive tobacco control interventions can result in substantial reductions in tobacco-related morbidity and mortality and billions of dollars in savings from averted medical costs 1.
Additionally, states can work with health care systems, insurers, and purchasers of health insurance to improve coverage and utilization of tobacco cessation treatments and to implement health systems changes that make tobacco dependence treatment a standard of clinical care 7, 9.
Ahmed Jamal, ajamal cdc. The health consequences of smoking—50 years of progress: Tobacco use among middle and high school students—United States, 2011—2014. Schoenborn C, Gindi RM. Electronic cigarette use among adults: NCHS data brief no. Current cigarette smoking among adults—United States, 2005—2013. Socioeconomic and country variations in knowledge of health risks of tobacco smoking and toxic constituents of smoke: Tob Control 2006;15 Suppl 3: Helping smokers quit—opportunities created by the Affordable Care Act.
N Engl J Med 2015;372: Methods used to quit smoking by people with physical disabilities. State Medicaid coverage for tobacco cessation treatments and barriers to coverage—United States, 2014—2015. Factors associated with discrepancies between self-reports on cigarette smoking and measured serum cotinine levels among persons aged 17 years or older: Am J Epidemiol 2001;153: Additional information available at https: Census Bureau, and 2014 estimates are based on reported family income and 2013 poverty thresholds published by the U.
Anyone reporting having Medicaid coverage, but no other insurance coverage, at the time of the interview. Persons reporting both Medicaid and "private insurance" were included in the "private insurance" category. Anyone reporting having Medicare coverage, but no other insurance coverage, at the time of the interview. Persons reporting both Medicare and "private insurance" were included in the "private insurance" category.
Any comprehensive private insurance plan including health maintenance and preferred provider organizations , obtained through an employer, purchased directly, or purchased through local or community programs, and excludes plans that pay for only one type of service, such as accidents or dental care. A small number of persons 132 respondents were covered by both "other public insurance" and private plans and were included in both categories.
For 2014, this group also included plans purchased through the Health Insurance Marketplace or a state-based exchange. This does not include anyone reporting any Medicare or Medicaid coverage. Those who were dual eligible enrolled in both Medicaid and Medicare or reported Medicaid or Medicare and any other coverage were excluded unless they also had "private" insurance coverage. Limitations in performing activities of daily living defined based on response to the question, "Because of a physical, mental, or emotional problem, does [person] need the help of other persons with personal care needs, such as eating, bathing, dressing, or getting around inside this home?
In 2014, the American Community Survey questions were asked of a random half of the respondents from the 2014 Person File. For population estimates, the specific adult disability weight was doubled to account for the half of respondents who were not asked these questions.
To determine sexual orientation, adult respondents were asked, "Which of the following best represents how you think of yourself? Broken Promises to Our Children: Robert Wood Johnson Foundation; December 2014. Summary What is already known on this topic? What is added by this report? Cigarette smoking among U. However, disparities in smoking prevalence persist. In 2014, cigarette smoking prevalence was higher among adults on Medicaid 29. What are the implications for public health practice?
Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, high-impact tobacco education mass media campaigns, and barrier-free access to quitting assistance, are critical to reduce cigarette smoking and smoking-related disease and death among U.
The figure above is a line chart showing the percentage of adults who were current cigarette smokers, overall and by sex, in the United States during 2005-2014. The figure above is a bar chart showing the percentage of adults who were current cigarette smokers, by health insurance status and age group, in the United States during 2014.