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NCHS

Overview of Tobacco-Related Topics

Tobacco use questions for adults have been included in the National Health Interview Survey periodically since 1965 and annually since 1997. A description of the major tobacco-related topics for adults follows.

Cigarette Smoking

  • Questions about cigarette smoking were first asked in the National Health Interview Survey in fiscal year (FY) 1965. Information on smoking was collected for all family members aged 17 years and over. Proxy reporting was permitted if the person was not available at the time of interview. Questions included lifetime and current cigarette smoking (at least 100 cigarettes in lifetime), including the number of cigarettes smoked. Identical questions were asked again in FY 1966.
  • In 1970, an expanded set of smoking questions was included in the NHIS as a supplement to the core questionnaire. In addition to the questions asked in earlier years, information was collected on characteristics of the cigarettes (size/filter) as well as reasons for quitting for those who had quit. As with the prior years, questions were asked of all persons aged 17 years and over and proxy reporting was permitted.
  • Information on cigarette smoking status was next collected in the NHIS in 1974 as part of a Hypertension Supplement. At this point, the NHIS began requiring self-response to the questions about smoking and other special health topics. The 1974 Hypertension Supplement included a short set of questions asked about lifetime and current smoking status, amount smoked, attempts to quit and receipt of medical advice to quit, and health conditions, if any, that prompted this advice. Questions were asked of persons aged 17 years and over.
  • The 1976 Health Habits Supplement contained the same set of smoking questions that were asked in 1974, although these were limited to adults aged 20 years and over.
  • In 1977, cigarette smoking status was included in another Health Habits Supplement, asked of one adult per family, aged 20 years or over.
  • During the years 1978-1980, an expanded set of cigarette smoking questions were added to the NHIS in Smoking Supplements, asked of one adult per family aged 17 years or over. Identical questions were asked in 1978 (quarters 3-4 only), 1979 (quarters 1-4), and 1980 (quarters 3-4 only). The smoking status questions were the same as in prior years, but questions about brand and type of cigarettes as well as attempts to quit were also asked.
  • In 1983, cigarette smoking questions including lifetime and current smoking, and attempts to quit (including methods used) were asked as part of a major supplement, the “Alcohol and Health Practices Supplement,” primarily designed to assess alcohol use among U.S. adults. From 1983 forward, all tobacco use questions were asked of adults aged 18 years and over.
  • In 1985, the first NHIS Health Promotion and Disease Prevention Supplement (HPDP) was fielded. It included questions about cigarette smoking. Questions were asked of one adult aged 18 years and over in each family. This was the beginning of monitoring progress toward achieving National Health Objectives for smoking and other health risks that were developed by the U.S. Department of Health and Human Services in 1980. Smoking-related questions included lifetime and current smoking status (including amount smoked), knowledge of the health risks associated with cigarette smoking, and receiving medical advice to quit. Major health promotion and disease prevention supplements containing smoking questions were also fielded in 1990, 1991, and 1998.
  • The first comprehensive NHIS supplement on cancer was fielded in 1987, consisting of two questionnaires — Cancer Epidemiology and Cancer Control. Data were collected on a wide range of tobacco-related issues. The Cancer Epidemiology questionnaire included only basic questions on cigarette smoking status, along with a question about total number of years respondent was a regular smoker in his or her lifetime. The Cancer Control questionnaire also included basic smoking prevalence and in addition, it contained a range of smoking-related questions, including knowledge of health risks associated with smoking, types of cigarettes smoked, reasons for smoking, quit attempts and methods, and reasons for quitting or attempting to quit. Major NHIS cancer supplements containing smoking questions were fielded in 1992 (quarters 1-2), 2000, 2005, 2010 and 2015.

Other Smoking: Cigars, Pipes, Bidis

  • For males only, lifetime and current use of cigars (10 or more in lifetime) and pipes (at least 3 packages in lifetime) — including amounts, were part of the first NHIS smoking questions in FY 1965. These questions were repeated in FY 1966.
  • In 1970, questions about cigar and pipe smoking were expanded to include women. In addition to basic prevalence, the 1970 questionnaire included questions about size, reasons for quitting for those who had quit, duration since quitting and amount smoked 12 months ago. Unlike earlier years, in 1970, lifetime use of cigars was asked in terms of having smoked at least 50 cigars in one’s lifetime. The pipe smoking questions remained the same as in the earlier years. Cigar and pipe questions were asked of all persons aged 17 years and over, and proxy reporting was permitted in each of these data years.
  • Questions about cigar and pipe smoking were next asked as part of the 1987 Cancer Control Supplement. In contrast to earlier years, this questionnaire contained screener (yes/no) questions that asked if the respondent ever smoked a cigar or ever smoked a pipe. A “yes” reply was followed by questions asking if they smoked “at least 50 cigars” or smoked “a pipe at least 50 times.” The minimum number of cigars was the same as when it was previously asked in 1970. However, the minimum amount for pipes was substantially higher than previously. This 1987 Cancer Control Supplement also included questions on age first smoked pipes and cigars, total months or years that these products had been smoked, days per month that respondents smoked, and amounts they smoked on those days.
  • Questions about cigar and pipe smoking status were subsequently included in the NHIS at closer intervals — 1991 (Health Promotion and Disease Prevention Supplement), 1992 (Cancer Control Supplement), 1998 (Sample Adult Prevention Supplement), the 2000, 2005, 2010 and 2015 (Cancer Supplements) and the 2016 Sample Adult (AHB) questionnaire. Question wording and context changed over the years and questionnaires should be carefully examined for differences.
  • Questions related to smoking bidis (lifetime and current status) were first asked in the NHIS in the 2000 Cancer Supplement and repeated in the 2005 Cancer Supplement (the last time they were asked).
  • In 2012-2014, questions about lifetime and current use of non-cigarette combustible tobacco were asked in the Sample Adult questionnaire. The questions did not specify type but examples included cigars, pipes, bidis —any tobacco product that is smoked. Respondents were instructed not to include e-cigarettes.

Smokeless Tobacco

  • Questions about smokeless tobacco (chewing tobacco and snuff) were first asked in the NHIS in the 1970 NHIS core questionnaire for persons aged 17 years and over. These questions were limited to asking about any current use of chewing, snuff, or other tobacco.
  • Smokeless tobacco was next included in the NHIS in the 1987 Cancer Control Supplement. At that time, questions were expanded to ask about lifetime and current use, including frequency and amount, and age of first use for each tobacco product. The same questions were repeated in the 1992 Cancer Control Supplement. In addition, in 1992, questions about receipt of medical advice to stop using chewing tobacco or snuff were added.
  • Smokeless tobacco questions were subsequently asked in the 2000, 2005, 2010 and 2015 Cancer Supplements and in 2012-2014 and 2016 special topic non-cigarette tobacco supplements, with questions about lifetime and current use. Beginning in 2000, the questions to determine current smokeless tobacco use status changed from “Do you use {chewing tobacco/snuff} now?” to “Do you now use {chewing tobacco/snuff} everyday, some days, or not at all?” This change is consistent with a change made in the early 1990s to the questions about current cigarette smoking status.

Environmental Tobacco Smoke (ETS)

  • Questions about exposure to environmental tobacco smoke (ETS) in the workplace were first asked in the NHIS in the 1987 Cancer Control Supplement. Related questions were subsequently included in 1988 (Occupational Health Supplement), 1991 (Health Promotion/Disease Prevention/Healthy People Supplement), 1992 (Cancer Control Supplement), 1993, and 1994 (Year 2000 Objectives Supplements), 2000 (Cancer Control Supplement), and 2015 (Sample Adult (ASD) supplement question).
  • ETS exposure in the home was first asked in the 1988 Occupational Health Supplement subsequently included in the 1991, 1993, 1994, and 1998 Health Promotion/Disease Prevention/Healthy People Supplements and the 2000, 2005, and 2010 Cancer Supplements. They were not asked in the 2015 Cancer supplement.

Pregnancy and Smoking

  • In 1985, questions about smoking during pregnancy were asked in the NHIS for the first time as part of the Health Promotion and Disease Prevention Supplement (HPDP). All women aged 18-44 years who either were pregnant or had given birth in the past five years were asked a series of questions about lifetime and current cigarette smoking status, amount currently smoked, whether they smoked during their most recent pregnancy, amount smoked before and after they found out they were pregnant, and receipt of medical advice to quit smoking.
  • The same questions were subsequently asked in the 1990 Health Promotion and Disease Prevention Supplement.
  • In 1991 (Health Promotion and Disease Prevention Supplement) and 1998 (Family Prevention Supplement – Pregnancy and Smoking Section), questions about smoking during pregnancy were asked of all female family members aged 18-49 years (thus including women five years older than in the 1985 and 1990 supplements).
  • Pregnancy and smoking questions were asked as part of the 2005, 2010 and 2015 Cancer Supplements, with the questions asked only of female adults aged 18-49 years who had been selected as the sample adult respondent.

Other Tobacco Topics

In addition to the measures highlighted above of cigarette use, other tobacco use and exposure, the NHIS has periodically included questions related to the broader context of the study of tobacco use, its correlates and consequences. Many of these have been included in the survey to measure progress toward specific national health promotion objectives. These additional tobacco-related topics include:

  • Knowledge of the health risks associated with tobacco use (1985, 1990, and 1992)
  • Attitudes toward smoking (1987, 1992, and 2000)
  • Reasons for smoking (1987)
  • Medical surveillance, including doctor questions about smoking and other tobacco use habits (1993, 1994, 2000, and 2005) and advice to quit (1974, 1976, 1985,1987, 1990-1992, 2000, 2001, 2005, 2010, 2011-2016)
  • Workplace smoking policies (1988, 1992-1994, 1998, and 2000), availability of workplace smoking cessation programs (1992-1994, 1998), and participation in such programs (1992, 1994, and 1998)

Adolescent Smoking

The National Health Interview Survey’s data on adolescent tobacco use is limited and not current. The Teen-age Attitudes and Practices Surveys (TAPS I and II) were conducted in 1989 and 1991, administered to adolescents in their homes over the telephone. The only other adolescent survey was the 1992 Youth Risk Behavior Survey (YRBS), conducted using audio-CASI technology, which was carried out as a follow-back survey with youth identified in the NHIS family interviews. These data files and documentation can be accessed from Internet-Available Datasets and Related Documentation 1996-prior.

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