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