Smoking Prevalence Among Adults

National Estimates

It is estimated that one in five (20.9%) adults (44.5 million people) smoke cigarettes in the United States (click here for more information).

State-Specific Estimates

According to results from the National Survey on Drug Use and Health (NSDUH), Utah and California reported the lowest prevalence rates for cigarette use (17%) and Kentucky reported the highest prevalence rate (33%), in the United States.

It should be noted that these state prevalence rates also include underage youth (12 to 17 years).

For more information on other states, please see,

• tobacco
• cigarette

Maryland State Smoking Data (Cessation)

Prevalence of tobacco use experiences and/or the number of cigarettes smoked by individuals are commonly used measures to monitor the effectiveness of tobacco control, prevention, and cessation efforts.

However, prevalence of cigarette smoking, either in one's lifetime or in the last 30 days, is a rather insensitive measure of the activities and experiences that facilitate the process of change that moves a person toward smoking initiation or cessation.

The Stages of Change for Smoking Cessation take into account smoking-related attitudes, intentions, and behaviors and offer a more sensitive measure of change than smoking prevalence rates alone.

• These stages of change for cessation have been examined in the State of Maryland, using data derived from the 2000 and 2002 Maryland Adult Tobacco Survey (MATS)
• Click on the links below for more detailed information on surveys of Maryland State Specific Prevalence Data:
• Initial Findings from the Baseline Tobacco Study
• First Annual Tobacco Study
• Monitoring Changing Tobacco Use Behaviors in Maryland

Stages of Change for Smoking Cessation

Description

Quitting smoking is a complex health behavior change. The process of quitting smoking can be conceptualized as progressing through a series of stages of change according to the Transtheoretical Model developed by Dr. DiClemente in collaboration with colleagues.^{1, 2} Once individuals become dependent on nicotine individuals move through five sequential stages in order to achieve long-term sustained health behavior change. These five stages are Precontemplation, Contemplation, Preparation, Action, and Maintenance.

Precontemplation

The Precontemplation stage encompasses individuals who are not seriously considering changing their smoking in the foreseeable future (next 6 months or a year) either because they unconvinced of the problem, see change as impossible, or are unwilling to change.

Contemplation

In the Contemplation stage, individuals are seriously considering the problem that smoking poses to their health and the possibility of change. Typically they are engaged in a risk reward analysis and are evaluating the pros and cons of both their smoking behavior and the aftermath of quitting.

Preparation

Once a decision is made individuals move into the Preparation stage where they need to make a firm commitment and a plan to quit smoking in the near future.

Action

The Action stage represents the implementation of the change plan and the actual behavioral change (i.e., quitting smoking).

Maintenance

If successful action is continued for 6 months, individuals move into the Maintenance stage of change when the behavior change (abstinence from smoking) becomes an integral part of the individual’s new lifestyle.

These stages represent important tasks that need to be accomplished adequately in order to establish successful smoking abstinence. Their sequence is often not linear but cyclical with success achieved only after recycling through the stages several times until the smoker finally successfully masters the tasks needed to quit smoking and become a maintained abstainer who can terminate the cycle of change.^{2, 3}

Algorithm

Stages of Change (Smoking Cessation)

1. Are you currently a smoker?

Smokers only:
2. In the last year, how many times have you quit smoking for at least 24 hours?

3. Are you seriously thinking of quitting smoking?

Cessation Tables

Using data derived from the 2000 and 2002 Maryland Adult Tobacco Survey (MATS), respondents were classified into one of the five Stages of Change for Smoking Cessation according to the Stages of Change algorithm.

Survey Methodology

• 2000 MATS
  The 2000 MATS survey was conducted via telephone from October 2000 through January 2001. 16,596 Maryland adults participated in the survey. 44.9% of eligible volunteers chose to participate.
• 2002 MATS
  There were both base and supplemental surveys collected in 2002. The base survey collected data from all 24 jurisdictions (i.e., 23 counties and Baltimore City). The supplemental survey oversampled target minorities in 16 jurisdictions in order to obtain more precise estimates. The base survey was administered between October 2002 and January 2003. The supplemental survey was administered between November 2002 and February 2003. 27,192 Maryland adults participated in the survey. 43.3% of eligible volunteers chose to participate.
• 2006 MATS
  The 2000 MATS survey was conducted via telephone from October 2006 through January 2007. 21,799 Maryland adults participated in the survey. 55.9% of eligible volunteers chose to participate.  

Weighting

For the adult data, a sampling weight was used (see Initial Findings from the Baseline Tobacco Study (2001) and the Supplemental Appendices for more detailed information on weighting procedures) in order to take information from the sample and generalize it to the general state population. Weighted data was analyzed at the county level only.

Limitations of Survey

Because the MATS was a telephone survey, the results underrepresented individuals who do not live in a stable environment, those without phones, those who screen calls, and those who did not elect to participate in the survey. Also, minority groups are underrepresented because the sample was too small to be descriptive of an entire ethnic population.

Distribution of the Stages of Change for Smoking Cessation

Table 1 presents the distribution of the Stages of Change for Smoking Cessation for the 2000, 2002 and 2006 Maryland Adult Tobacco Surveys (MATS). At all time points, more than one-quarter of the sample were former smokers (i.e., in Action or Maintenance). A significant percentage of individuals were in the Precontemplation Stage at all time points, suggesting there are still a significant number of individuals who are unwilling or unable to change their smoking behavior.

Stage of Change for Smoking Cessation and County of Residence: Change Over Time

Table 2 shows the distribution of the Stage of Change for Smoking Cessation for current smokers (i.e., Precontemplation, Contemplation, and Preparation) in 2000, 2002 and 2006.

Interpreting Table 2:

You want to see decreases over time in the percentage of individuals in Precontemplation (i.e., not thinking about quitting) and increases in the percentage of individuals in Contemplation (i.e., considering a quit attempt) and Preparation (i.e., planning on making a quit attempt within the next 30 days).