Current Trends Differences in the Age of Smoking Initiation Between Blacks and Whites -- United States

In 1988, an estimated 434,175 premature deaths in the United States were attributed to cigarette smoking; for blacks, the rate of years of potential life lost before age 65 (YPLL) attributed to smoking (2471.8 YPLL per 100,000 population) was twice that for whites (1224.7 YPLL per 100,000 population) (1). In the United States, black adolescents are less likely than white adolescents to smoke (2,3); however, black adults are more likely than white adults to begin smoking after adolescence (4). This report summarizes trends in the age at initiation of regular cigarette smoking by race* and sex, through analyses by birth cohort from 1910 through 1959; the report is based on data from CDC's National Health Interview Surveys (NHISs) for 1987 and 1988.

*Numbers from racial groups other than white and black were too small to provide separate estimates.

The NHIS interviews persons aged greater than or equal to 18 years selected from representative national samples of the U.S. civilian, noninstitutionalized population. Approximately 88,000 persons (44,000 each year) were interviewed during 1987 and 1988. In 1987, persons who had smoked at least 100 cigarettes were asked, "How old were you when you first started smoking cigarettes fairly regularly?"; in 1988, persons were asked, "About how old were you when you first started smoking cigarettes fairly regularly?" Those who said they had never smoked regularly were excluded. Responses from 38,906 (44%) ever regular smokers were used in this report. The data were weighted to provide national estimates. Ninety-five percent confidence intervals were calculated using SESUDAAN (5).

The overall proportion of persons who became regular smokers before ages 16, 18, 21, 25, and 30 years increased across successive birth cohorts (Table 1); however, among blacks, increases occurred only before ages 21, 25, and 30. More than 80% of smokers born after 1930 began smoking regularly by age 21.

The overall average age at which smokers began smoking cigarettes regularly decreased from 19.7 years among persons born from 1910 through 1919 to 17.4 years among those born from 1950 through 1959 (Table 2). Among the successive birth cohorts in this study, the average age at smoking initiation decreased 2.4 years for whites and 1.3 years for blacks. The average age at initiation decreased substantially for white and black women (5.4 and 4.6 years, respectively), decreased slightly for white men (0.5 years), and increased slightly for black men (0.7 years). Reported by: HN Giebel, MD, Riverside General Hospital, Riverside, California. SL Mills, MD, National Cancer Institute; SE Marcus, PhD, National Institute of Dental Research, National Institutes of Health. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion; Div of Health Interview Statistics, National Center for Health Statistics; Surveillance Br, Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note: The findings in this analysis are consistent with previous reports that indicate smokers in the United States are smoking regularly at an earlier age (6,7); in addition, the secular patterns of age at which smoking begins have changed substantially over time by both sex and race.

One potential limitation of this analysis is that respondents were asked to recall an event (i.e., age at onset of regular smoking) that may have occurred decades earlier. In addition, since mortality is higher for smokers who begin smoking regularly at earlier ages, the average age at initiation among persons born in the earlier cohorts may be artificially inflated (1). However, the overall trend of decreasing age at initiation is evident even among those born since 1930.

Since 1976, the prevalence of cigarette smoking has decreased markedly among black high school seniors (6; J.G. Bachman, L.D. Johnston, P.M. O'Malley, University of Michigan, unpublished data, 1990)--possibly because blacks begin smoking at older ages than whites. Although the findings from NHIS are consistent with this trend, current differences in adolescent smoking by race suggest the prevalence of smoking among black adolescents as they mature will not attain the same prevalence as that among whites of the same age group. Additional efforts are needed to determine the factors that affect cigarette smoking initiation by race and sex.

Monitoring trends in age at smoking initiation and in smoking prevalence of current adolescents as they mature may enable their smoking behavior patterns in later adult life to be understood more clearly. In 1974, 38.6% of whites and 47.1% of blacks aged 20-24 years were current smokers (6); however, by 1988, the proportions of whites and blacks in this age group who were current smokers had decreased to 28.5% and 24.8%, respectively (CDC, unpublished data), with black smokers decreasing at a higher rate (22.3 percentage points) than white smokers (10.1 percentage points). Although this trend suggests smoking-related morbidity and mortality could decline among blacks, the greater likelihood of relapse among black smokers indicates that smoking-cessation efforts targeted toward black smokers need to be intensified (8).

The successive birth cohort data in this report suggest that the average age at which women begin smoking is continuing to decline for both blacks and whites. Persons who begin smoking at younger ages are more likely to become heavier smokers (9) and are at increased risk for smoking-attributed illness or death (6).

One of the national health objectives for the year 2000 is to reduce the initiation of cigarette smoking by children and youth so that no more than 15% have become regular smokers by age 20 years (objective 3.5). To decrease initiation of smoking among younger age groups, the following measures should be considered: 1) implementation of health education programs on tobacco use in schools (objective 3.10); 2) establishment of tobacco-free environments in schools (objective 3.10); 3) enactment and enforcement of laws prohibiting the sale and distribution of tobacco products to minors (objective 3.13); 4) elimination or restriction of tobacco product advertising to which youth are likely to be exposed (objective 3.15); and 5) increasing to 50 the number of states with plans to reduce tobacco use, especially among youth (objective 3.14) (10).

References

1. CDC. Smoking-attributable mortality and years of potential life lost--United States, 1988. MMWR 1991;40:62-3,69-71.

2. CDC. Cigarette smoking among youth--United States, 1989. MMWR 1991;40:712-5.

3. CDC. Tobacco use among high school students--United States, 1990. MMWR 1991;40:617-9.

4. Escobedo LG, Anda RF, Smith PF, Remington PL, Mast EE. Sociodemographic characteristics of cigarette smoking initiation in the United States--implications for smoking-prevention policy. JAMA 1990;264:1550-5.

5. Shah BV. SESUDAAN: standard errors program for computing of standardized rates from sample survey data. Research Triangle Park, North Carolina: Research Triangle Institute, 1981.

6. CDC. Reducing the health consequences of smoking: 25 years of progress--a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411.

7. Office on Smoking and Health. The health consequences of smoking for women--a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Office of the Assistant Secretary for Health, 1980.

8. CDC. The health benefits of smoking cessation: a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1990; DHHS publication no. (CDC)90-8416.

9. Taioli E, Wynder EL. Effect of the age at which smoking begins on frequency of smoking in adulthood. N Engl J Med 1991;325:968-9.

10. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives--full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

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