March 23rd, 2011

Prevalence of Heavy Smoking Has Declined in the U.S.


Between 1965 and 2007, the prevalence of heavy smoking declined dramatically in the United States. These results were published in the Journal of the American Medical Association.

Cigarette smoking is responsible for an estimated 443,000 deaths each year in the United States, with more than 49,000 of these deaths due to secondhand smoke. Smoking causes most cases of chronic obstructive lung disease, greatly increases the risk of heart disease, and increases the risk of several types of cancer. Cancers that are linked with smoking include lung cancer as well as cancers of the throat, mouth, nasal cavity, esophagus, stomach, pancreas, kidney, bladder, and cervix, and acute myeloid leukemia.

The first Surgeon General’s report on the health effects of smoking was released in 1964. In the decades that followed the report, the prevalence of smoking has declined in the United States, although nearly 21% of US adults continue to smoke.

Among smokers, smoking intensity (number of cigarettes smoked per day) influences health outcomes. To evaluate trends in smoking intensity, researchers evaluated information from health surveys that span the years from 1965 to 2007. These surveys included information from more than 1.8 million people.

The researchers—based in California—compared smoking patterns in California with smoking patterns in the rest of the United States.

High-intensity smoking was defined as 20 or more cigarettes per day.

  • In 1965, 23% of adults were high-intensity smokers. The rates of high-intensity smoking in California were similar to the rates in the rest of the United States.
  • In 2007, 2.6% of adults in California and 7.2% of adults in the rest of the United States were high-intensity smokers.

The researchers conclude that high-intensity smoking declined greatly in the US between 1965 and 1967. The greater decline in California may be related to that state’s comprehensive tobacco control programs.


National Cancer Institute. Tobacco Facts. Last updated: 11/12/2010.

Pierce JP, Messer K, White MM, Cowling DW, Thomas DP. Prevalence of Heavy Smoking in California and the United States, 1965-2007.

Journal of the American Medical Association. 2011;305(11):1106-1112

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