Race/Ethnic Variations in Quitline Use Among US Adult Tobacco Users in 45 States, 2011-2013.

INTRODUCTION: State quitlines provide free telephone-based cessation services and are available in all states. However, quitlines presently reach 1% of US cigarette smokers. We assessed variations in quitline reach by race/ethnicity across 45 US states included in the National Quitline Data Warehouse, a repository on non-identifiable data reported by state quitlines. METHODS: During 2011 to 2013, we analyzed 1 220 171 records from the National Quitline Data Warehouse. Annual quitline reach was defined as the proportion of cigarette smokers and smokeless tobacco users who utilized quitline services during each year, and was calculated by dividing the number of state-specific quitline registrants in each year by the number of adult cigarette smokers and smokeless tobacco users in the state. RESULTS: Average annual reach ranged from: 0.08% (Tennessee) to 3.42% (Hawaii) among non-Hispanic whites; 0.17% (Tennessee) to 3.85% (Delaware) among non-Hispanic blacks; 0.27% (Nevada) to 9.98% (Delaware) among non-Hispanic American Indians/Alaska Native; 0.03% (Alabama) to 2.43% (Hawaii) among non-Hispanic Asian/Pacific Islanders; and from 0.08% (Tennessee) to 3.18% (Maine) among Hispanics. Average annual reach was highest among non-Hispanic American Indians/Alaska Native in 27 states, non-Hispanic blacks in 14 states, and non-Hispanic whites in four states. CONCLUSIONS: Quitlines appear to be reaching minority populations; however, overall reach remains low and variations in quitline reach exist by race/ethnicity. Opportunities exist to increase the utilization of quitlines and other effective cessation treatments among racial/ethnic minority populations. IMPLICATIONS: Some studies have assessed quitline reach across demographic groups in individual states; however, no studies have provided multistate data about quitline reach across race/ethnic groups. Ongoing monitoring of the use of state quitlines can help guide targeted outreach to particular race/ethnic groups with the goal of increasing the overall proportion and number of tobacco users that use quitlines. These efforts should be complemented by comprehensive tobacco control initiatives that increase cessation including mass media campaigns, smoke-free policies, increased tobacco prices, expansion of health insurance coverage, and health systems change.

Clustering of Five Health-Related Behaviors for Chronic Disease Prevention Among Adults, United States, 2013.

INTRODUCTION: Five key health-related behaviors for chronic disease prevention are never smoking, getting regular physical activity, consuming no alcohol or only moderate amounts, maintaining a normal body weight, and obtaining daily sufficient sleep. The objective of this study was to estimate the clustering of these 5 health-related behaviors among adults aged 21 years or older in each state and the District of Columbia and to assess geographic variation in clustering. METHODS: We used data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) to assess the clustering of the 5 behaviors among 395,343 BRFSS respondents aged 21 years or older. The 5 behaviors were defined as currently not smoking cigarettes, meeting the aerobic physical activity recommendation, consuming no alcohol or only moderate amounts, maintaining a normal body mass index (BMI), and sleeping at least 7 hours per 24-hour period. Prevalence of having 4 or 5 of these behaviors, by state, was also examined. RESULTS: Among US adults, 81.6% were current nonsmokers, 63.9% obtained 7 hours or more sleep per day, 63.1% reported moderate or no alcohol consumption, 50.4% met physical activity recommendations, and 32.5% had a normal BMI. Only 1.4% of respondents engaged in none of the 5 behaviors; 8.4%, 1 behavior; 24.3%, 2 behaviors; 35.4%, 3 behaviors; and 24.3%, 4 behaviors; only 6.3% reported engaging in all 5 behaviors. The highest prevalence of engaging in 4 or 5 behaviors was clustered in the Pacific and Rocky Mountain states. Lowest prevalence was in the southern states and along the Ohio River. CONCLUSION: Additional efforts are needed to increase the proportion of the population that engages in all 5 health-related behaviors and to eliminate geographic variation. Collaborative efforts in health care systems, communities, work sites, and schools can promote all 5 behaviors and produce population-wide changes, especially among the socioeconomically disadvantaged.

National Trends in Frequency and Amount of Nondaily Smoking, and Relation to Quit Attempts, 2000-2012.

INTRODUCTION: To understand changes occurring in nondaily smoking, we assessed differences in demographics and trends in nondaily smoking, by smoking frequency and amount. METHODS: Participants were 13 966 adult nondaily cigarette smokers (NDS) age 18 years and older responding to the 2000-2012 US National Health Interview Survey, an annual, nationally-representative, cross-sectional, household interview survey. We created a nine-level smoking frequency-amount variable using tertile cut points from the number of days smoked in the past 30 (1-7, 8-14, 15-29 days) and number of cigarettes smoked per day (cpd; 1-2, 3-5, ≥6). We computed weighted frequencies by low-, moderate-, high-frequency use, by low-, moderate-, high-cpd amount, and by demographics. We estimated temporal trends using weighted least squares regression, and the association between groups and past-year quit attempts using logistic regression. RESULTS: Overall prevalence of nondaily smoking among adults remained stable between 2000 to 2012 (P = .62). The most prevalent nondaily smoking frequency-amount groups were: smoking 15-29 days (in the past 30), 3-5 cpd (20.2%); 1-7 days, 1-2 cpd (19.7%); 15-29 days, 1-2 cpd (14.9%); and 15-29 days, ≥6 cpd (12.1%). From 2000 to 2012, low-cpd NDS (1-2 cpd) across moderate (8-14 days) and high (15-29 days) frequency groups increased (P < .01), while moderate frequency-moderate cpd (8-14 days, 3-5 cpd; P < .05) and high frequency-high cpd (15-29 days, ≥6 cpd; P < .01) NDS declined. Adjusting for demographics and year, the lowest frequency-amount groups had the lowest odds of past-year quit attempts. CONCLUSION: Changes occurred in NDS frequency and amount from 2000 to 2012, suggesting that more granular classifications may be important for monitoring NDS patterns. IMPLICATIONS: From 2000 to 2012, low-cpd NDS (1-2 cpd) across moderate- (8-14 days) and high-frequency (15-29 days) groups increased in the United States, while moderate frequency-moderate cpd (8-14 days, 3-5 cpd) and high frequency-high cpd (15-29 days, ≥6 cpd) NDS declined. Demographic differences were found across NDS frequency-amount groups. Adjusting for demographics and year, the lowest frequency-amount groups had the lowest odds of past-year quit attempts. These data can be used to further understand evolving patterns of NDS behavior, and to provide possible targeted groups-both by demographics and smoking frequency/amount-for future research and intervention.

Health-care Provider Screening and Advice for Smoking Cessation Among Smokers With and Without COPD: 2009-2010 National Adult Tobacco Survey.

BACKGROUND: Cigarette smoking is the predominant cause of COPD. Quitting can prevent development of and complications from COPD. The gold standard in clinician delivery of smoking cessation treatments is the 5As (ask, advise, assess, assist, arrange). This study assessed prevalence and correlates of self-reported receipt of the 5A strategies among adult smokers with and without COPD. METHODS: Data were analyzed from 20,021 adult past-year cigarette smokers in the 2009-2010 National Adult Tobacco Survey, a nationally representative telephone survey of US adults 18 years of age and older. Past-year receipt of the 5As was self-reported by participants who saw a clinician in the past year. Logistic regression was used to estimate the likelihood of receipt of each of the 5As by COPD status, adjusted for sociodemographic and smoking characteristics. RESULTS: Among smokers, those with COPD were more likely than those without COPD to report being asked about tobacco use (95.4% vs 85.8%), advised to quit (87.5% vs 59.4%), assessed for readiness to quit (63.8% vs 37.9%), offered any assistance to quit (58.6% vs 34.0%), and offered follow-up (14.9% vs 5.2%). In adjusted logistic regression models, those with COPD were significantly more likely than those without COPD to receive each of the 5As. CONCLUSIONS: Health professionals should continue to prioritize tobacco cessation counseling and treatment to smokers with COPD. Increased system-level changes and insurance coverage for cessation treatments could be used to improve the delivery of brief tobacco cessation counseling to all smokers, regardless of COPD status.

Past Year Quit Attempts and Use of Cessation Resources Among Cigarette-Only Smokers and Cigarette Smokers Who Use Other Tobacco Products.

INTRODUCTION: It is unclear how use of other tobacco products impacts cigarette-smoking cessation. We assessed differences in past year cigarette smoking quit attempts and use of counseling and medication among current cigarette-only users, cigarette and cigar users, and cigarette and smokeless tobacco (SLT) users. METHODS: Data came from 24 448 current cigarette-only, 1064 cigarette and cigar only, and 508 cigarette and SLT only users who responded to the 2010-2011 Tobacco Use Supplement to the Current Population Survey. Demographic, smoking, and cessation characteristics were computed by group. Bivariate and multivariable logistic regression models assessed the relationship of tobacco use group to making a past year quit attempt, and use of counseling or medication during the last quit attempt. RESULTS: Dual users of cigarettes and cigars or SLT had similar interest in quitting and prevalence of reported past year quit attempts compared to cigarette-only users. In unadjusted analyses, cigarette and SLT users had higher odds of trying to quit in the past year compared to cigarette-only users (odds ratio [OR] = 1.31, 95% confidence interval [CI] = 1.05, 1.64); no differences were found for cigarette and cigar users. However, adjusting for demographic and cigarette smoking variables, both groups of dual users had similar odds as cigarette-only users for having made a past year cigarette smoking quit attempt, and to have used counseling or medication during the last quit attempt. CONCLUSION: Dual tobacco use was not associated with decreased attempts to quit smoking cigarettes; however, use of evidence-based treatment was sub-optimal among cigarette-only and dual users, and should be increased.

Trends in the Average Age of Quitting Among U.S. Adult Cigarette Smokers.

INTRODUCTION: Quitting smoking at any age confers health benefits. However, studies have suggested that quitting by age 35 years leads to mortality rates similar to never smokers. This study assessed whether the mean and median ages of past-year quitting and prevalence of past-year quit attempts and successful quitting by age group changed over time. METHODS: Data came from 113,599 adult cigarette smokers participating in the 1997-2012 National Health Interview Survey, an annual, cross-sectional household survey of U.S. adults aged ≥18 years. Mean and median ages of past-year successful abstinence (quit 6-12 months) were computed. Orthogonal polynomial logistic regression models tested for trends in quit attempts and successful quitting. Data were analyzed in 2014. RESULTS: The average age of quitting (40.0 years in 1997-1998, 39.5 years in 2011-2012, p=0.80) and median age of quitting (35.9 years in 1997-1998, 36.9 years in 2011-2012, p=0.62) did not change over time. During 1997-2012, the percentage of smokers making a past-year quit attempt increased among those aged 25-34, 35-44, and 45-64 years; the percentage of smokers who reported quitting successfully increased among those aged 25-34 and 35-44 years (p<0.001). CONCLUSIONS: Although the average age of quitting did not change over time, increases in past-year quit attempts and successful quitting occurred among adults aged 25-44 years. Proven population-level interventions--including price increases, mass media campaigns, comprehensive smoke-free policies, and health systems interventions--should be continued to further increase cessation, particularly among younger adults.

Quitline Use and Outcomes among Callers with and without Mental Health Conditions: A 7-Month Follow-Up Evaluation in Three States.

OBJECTIVES: To examine abstinence outcomes among tobacco users with and without a reported mental health condition (MHC) who enrolled in state tobacco quitline programs. METHODS: Data were analyzed from a 7-month follow-up survey (response rate: 41% [3,132/7,459]) of three state-funded telephone quitline programs in the United States that assessed seven self-reported MHCs at quitline registration. We examined 30-day point prevalence tobacco quit rates for callers with any MHC versus none. Data were weighted to adjust for response bias and oversampling. Multivariable logistic regression was used to examine cessation outcomes. RESULTS: Overall, 45.8% of respondents reported ≥ 1 MHC; 57.4% of those reporting a MHC reported ≥ 2 MHCs. The unadjusted quit rate for callers with any MHC was lower than for callers with no MHC (22.0% versus 31.0%, P < 0.001). After adjusting for demographics, nicotine dependence, and program engagement, callers reporting ≥ 1 MHC were less likely to be abstinent at follow-up (adjusted OR = 0.63, 95% CI = 0.51-0.78, P < 0.001). CONCLUSIONS: More intensive or tailored quitline programs may need to be developed among callers with MHCs as their quit rates appear to be lower than callers without MHCs.

Smoking duration, respiratory symptoms, and COPD in adults aged ≥45 years with a smoking history.

BACKGROUND: The purpose of this study was to assess the relationship of smoking duration with respiratory symptoms and history of chronic obstructive pulmonary disease (COPD) in the South Carolina Behavioral Risk Factor Surveillance System survey in 2012. METHODS: Data from 4,135 adults aged ≥45 years with a smoking history were analyzed using multivariable logistic regression that accounted for sex, age, race/ethnicity, education, and current smoking status, as well as the complex sampling design. RESULTS: The distribution of smoking duration ranged from 19.2% (1-9 years) to 36.2% (≥30 years). Among 1,454 respondents who had smoked for ≥30 years, 58.3% were current smokers, 25.0% had frequent productive cough, 11.2% had frequent shortness of breath, 16.7% strongly agreed that shortness of breath affected physical activity, and 25.6% had been diagnosed with COPD. Prevalence of COPD and each respiratory symptom was lower among former smokers who quit ≥10 years earlier compared with current smokers. Smoking duration had a linear relationship with COPD (P<0.001) and all three respiratory symptoms (P<0.001) after adjusting for smoking status and other covariates. While COPD prevalence increased with prolonged smoking duration in both men and women, women had a higher age-adjusted prevalence of COPD in the 1-9 years, 20-29 years, and ≥30 years duration periods. CONCLUSION: These state population data confirm that prolonged tobacco use is associated with respiratory symptoms and COPD after controlling for current smoking behavior.

Prevalence and correlates of switching to another tobacco product to quit smoking cigarettes.

INTRODUCTION: Using nationally representative data, we assessed the prevalence and correlates of cigarette smokers who tried switching to smokeless tobacco (SLT) or to other combusted tobacco (OCT) products to quit. METHODS: Data came from 12,400 current or former adult smokers who made a quit attempt in the past year and responded to the 2010-2011 Tobacco Use Supplement to the Current Population Survey. Demographics and smoking characteristics were computed among those switching to SLT, switching to OCT, or trying to quit without using either strategy. Bivariate and multinomial logistic regression models identified correlates of using each strategy. RESULTS: Overall, 3.1% of smokers tried switching to SLT to quit, 2.2% tried switching to OCT, and 0.6% tried both strategies. Compared to those not using either switching strategy to try to quit, males were more likely than females to try switching to SLT or OCT; Blacks were less likely than Whites to try switching to SLT, but more likely to try switching to OCT; younger age groups were more likely to try switching to SLT or OCT; current someday smokers were more likely to have try switching to SLT (vs. everyday smokers), while recent former smokers were more likely to have tried switching to OCT. Both switching groups were more likely to have used cessation medication versus those not using switching strategies. CONCLUSION: Data suggest that switching to other tobacco products is a prevalent cessation approach; messages are needed to help clinicians encourage smokers who try to quit by switching to use evidence-based cessation approaches.

Gradual reduction of cigarette consumption as a cessation strategy: prevalence, correlates, and relationship with quitting.

INTRODUCTION: Gradually reducing cigarette consumption is an approach used to quit smoking, but has not been widely studied at a population level. The purpose of this study was to assess the prevalence and demographic characteristics of U.S. adult smokers who tried to reduce to quit, and the relationship between reducing and successful quitting. METHODS: Data came from 12,571 adults in the 2010-2011 Tobacco Use Supplement to the Current Population Survey who tried to quit smoking in the past year. Frequencies and percentages were used to assess prevalence of reducing to quit; bivariate and multiple logistic regression models were used to assess correlates of reducing to quit and successful past year cessation. Analyses were conducted in SAS-callable SUDAAN. RESULTS: Among adults who tried to quit smoking in the past year, 43.0% (n = 5,444) tried reducing to quit. Compared to those who tried to quit without reducing consumption, those reducing to quit had a significantly higher prevalence of using counseling or medication (40.2% vs. 25.0%). In adjusted multivariable models, females (vs. males), Blacks (vs. Whites), current some day smokers (vs. every day smokers), and those who used counseling or medication had greater odds of trying to reduce to quit. Reducing to quit was negatively associated with successful past-year quitting (AOR = 0.59, 95% CI = 0.48, 0.72). CONCLUSION: Reducing to quit is a common cessation strategy and, in these analyses, was associated with lower cessation success rates. More research on reducing to quit in a real-world setting is needed before widely recommending it as a cessation strategy.

Health care provider advice for adolescent tobacco use: results from the 2011 National Youth Tobacco Survey.

BACKGROUND: Health care providers play an important role in promoting tobacco use abstinence among adolescents. This study aimed to provide nationally representative data on the prevalence of provider tobacco use screening and advice delivered to adolescents. Cessation behaviors and correlates of past year quit attempts among current smokers are also explored. METHODS: Data came from the 2011 National Youth Tobacco Survey, a nationally representative school-based survey of adolescents in grades 6 through 12 (n = 18385). Provider screening and advice were assessed by smoking status and demographic characteristics. Logistic regression was used to assess the association between advice and past year quit attempt. RESULTS: The overall prevalence of current tobacco use was 16.6%; 10.8% were current cigarette smokers (3.6% were established smokers, 7.2% were nonestablished smokers); 17.3% were former smokers; and 71.9% were never smokers (22.6% high susceptibility, 77.4% low susceptibility). Among all respondents, the prevalence of being asked about tobacco use by a health care provider was 32.2%; the prevalence of being advised to quit or avoid tobacco was 31.4%. Established smokers were more likely than other groups to report provider assessment of tobacco use and advice. Receipt of advice was associated with a higher adjusted odds of having made a past year quit attempt (odds ratio: 1.47, 95% confidence interval: 1.18-1.82). CONCLUSIONS: Less than one-third of adolescents report being asked about tobacco use or being advised not to use tobacco. Increased tobacco use intervention by health care providers is needed to prevent initiation and increase cessation.

Youth tobacco cessation: quitting intentions and past-year quit attempts.

BACKGROUND: Despite declining use of conventional tobacco products, youth use of non-cigarette tobacco has become prevalent; however, quitting behaviors remain largely unexplored. PURPOSE: To examine nationally representative data on quit intentions and past-year attempts to quit all tobacco use among current youth tobacco users. METHODS: In 2013, data were analyzed from the 2012 National Youth Tobacco Survey (NYTS). Weighted prevalence estimates of quit intentions and past-year quit attempts for current youth tobacco users are presented. RESULTS: Prevalence of quit intentions and past-year attempts to quit all tobacco use were 52.8% and 51.5%, respectively, among current youth tobacco users. Among non-mutually exclusive groups, current cigarette smokers had the highest prevalence of quit intentions (56.8%) and past-year quit attempts (52.5%), whereas current hookah users had the lowest prevalence of quit intentions (41.5%) and past-year quit attempts (43.7%). Quit intentions among black, non-Hispanics (65.0%) and Hispanics (60.4%) were significantly higher versus white, non-Hispanics (47.5%). Youth reporting parental advice against tobacco had significantly higher prevalence of quit intentions (56.7%) and past-year quit attempts (55.0%) than those not reporting parental advice. Youth who agreed all tobacco products are dangerous (58.5%) had significantly higher prevalence of quit intentions than those who disagreed (37.0%). CONCLUSIONS: Continued efforts are needed to better understand youth motivation for quitting all tobacco products. Public health messaging about the dangers of all tobacco and cessation efforts should be aimed at the full range of tobacco products, not just cigarettes, and tailored to meet the needs of youth polytobacco users.

Smoking prevalence and cessation characteristics among U.S. adults with and without COPD: findings from the 2011 Behavioral Risk Factor Surveillance System.

INTRODUCTION: Cigarette smoking is a major cause of chronic obstructive pulmonary disease, (COPD) but many persons with COPD continue to smoke. Quitting can help prevent the development of and complications from COPD. This study examined whether smoking and cessation behaviors differed among adults with a) COPD, b) asthma, c) other chronic conditions only, or d) no chronic conditions. METHODS: Smoking and chronic disease status was obtained from 488,909 adults aged > 18 years using the Behavioral Risk Factor Surveillance System; 9,476 current smokers and recent quitters in 5 states responded to additional questions about cessation. We computed age-adjusted prevalence of smoking and past-year quit attempts, and used bivariate and multivariable logistic regression to identify correlates of past-year quit attempts. RESULTS: Similar to the overall sample, in the 5-state sample, 47.3% of adults with COPD were current smokers versus 23.1% of those with asthma, 28.8% of adults with other chronic conditions, and 20.0% of those with no chronic conditions. Those with COPD did not differ significantly from those with asthma, other chronic diseases, or no chronic disease in having made a past-year quit attempt (59.7% versus 64.0%, 61.5%, and 53.9%, respectively). Smokers with COPD were significantly more likely than those with no chronic disease to have used cessation treatment resources, including a quitline, counseling, or medication (p < 0.001). CONCLUSIONS: Adults with COPD were just as likely as those without COPD to make a past-year quit attempt; however, approximately 40% of smokers with COPD did not try to quit.

Per-pack price reductions available from different cigarette purchasing strategies: United States, 2009-2010.

OBJECTIVE: Following cigarette excise tax increases, smokers may use cigarette price minimization strategies to continue their usual cigarette consumption rather than reducing consumption or quitting. This reduces the public health benefits of the tax increase. This paper estimates the price reductions for a wide-range of strategies, compensating for overlapping strategies. METHOD: We performed regression analysis on the 2009-2010 National Adult Tobacco Survey (N=13,394) to explore price reductions that smokers in the United States obtained from purchasing cigarettes. We examined five cigarette price minimization strategies: 1) purchasing discount brand cigarettes, 2) using price promotions, 3) purchasing cartons, 4) purchasing on Indian reservations, and 5) purchasing online. Price reductions from these strategies were estimated jointly to compensate for overlapping strategies. RESULTS: Each strategy provided price reductions between 26 and 99cents per pack. Combined price reductions were possible. Additionally, price promotions were used with regular brands to obtain larger price reductions than when price promotions were used with generic brands. CONCLUSION: Smokers can realize large price reductions from price minimization strategies, and there are many strategies available. Policymakers and public health officials should be aware of the extent that these strategies can reduce cigarette prices.

Prevalence and correlates of quitline awareness and utilization in the United States: an update from the 2009-2010 National Adult Tobacco Survey.

INTRODUCTION: Tobacco quitlines are evidence-based cessation resources that have been underutilized. The purpose of this study is to provide population-level data about quitline awareness and utilization in the United States and to assess correlates of awareness and utilization. METHODS: Data were from the 2009-2010 National Adult Tobacco Survey. Descriptive statistics were produced for national- and state-level quitline awareness and for national quitline utilization. Bivariate and multivariable logistic regressions were used to identify correlates of quitline awareness and utilization. RESULTS: Quitline awareness among the total sample was 33.9% (current smokers 53.9%, former smokers 34.0%, never-smokers 27.0%). Awareness varied by state (range: 35.8%-84.6% for current smokers). Among current smokers who tried to quit in the past year, correlates of lower awareness included being Black, non-Hispanic, and making <$50,000 annually; correlates of higher awareness included having seen a health professional, higher state tobacco program expenditures, and being female. Among smokers who made at least one quit attempt in the previous year and were aware of the quitline, quitline utilization was 7.8%. Higher state tobacco program expenditure, health professional advice, and being Black, non-Hispanic were correlated with higher utilization; older age was correlated with lower utilization. Awareness was significantly associated with use at the state level (r = .98, p < .01). CONCLUSION: Although the majority of smokers in the United States are aware of quitlines, only a small percentage of those trying to quit utilize them. State tobacco program expenditures and receipt of advice from a health professional were associated with both higher quitline awareness and higher utilization.

Differences in smoking and cessation characteristics among adult nondaily smokers in the United States: findings from the 2009-2010 National Adult Tobacco Survey.

INTRODUCTION: Nondaily smoking in the United States is increasing. Although differences in smoking and cessation behaviors between daily and nondaily smokers have been documented, differences among nondaily smokers are poorly understood. This study provides updated national data on smoking and cessation characteristics among nondaily versus daily smokers and between subgroups of nondaily smokers. METHODS: Data were obtained from the 2009-2010 National Adult Tobacco Survey, a stratified, dual-frame telephone survey conducted in the United States. Participants were categorized into daily smokers, never-daily nondaily smokers (NDNS), recently converted (≤1 year) nondaily smokers (RCNS), and established-converted (>1 year) nondaily smokers (ECNS). Chi-square tests were used to assess differences across groups, and multivariable logistic regression was used to identify factors associated with past-year quit attempts. RESULTS: Among nondaily smokers (17.8% of the total sample), 27.1% were NDNS, 37.4% were RCNS, and 35.4% were ECNS. RCNS were the most likely to report ever having tried to quit (p < .0001), having tried to quit in the past year (p < .0001), having used cessation treatment during their last quit attempt (p < .05), and wanting to quit smoking for good (p < .001). Compared with NDNS, RCNS had more than twice the odds of trying to quit in the past year after adjusting for demographics and smoking characteristics (adjusted odds ratio = 2.1, 95% confidence interval = 1.3-3.2). No significant differences existed between NDNS and ECNS. CONCLUSIONS: RCNS are potentially more interested in quitting and should be specifically targeted with cessation interventions to avoid relapse to daily or long-term nondaily smoking.

Reactions of adult smokers and former smokers to current US warning labels.

OBJECTIVE: To assess current and former smokers' reactions to US warning labels as a baseline for comparison to new labels. METHODS: The mail-in Consumer-Styles survey was sent to a representative sample of US adult consumers in 2010 (N = 10,328). RESULTS: Among current smokers, 51.5% (95% CI: 47.5-55.5) reported that they had 'never/rarely' seen or looked closely at the labels in the past 30 days. Current smokers (91.1%) reported that warning labels never stopped them from having a cigarette (95% CI: 89.1-93.1) and that the labels had no effect on their likelihood of quitting (75.5%; 95% CI: 71.6-79.4). CONCLUSIONS: Current warning labels do not make smokers think about the risks of smoking or have an effect on their likelihood of forgoing cigarettes or quitting.

Cigarette price-minimization strategies by U.S. smokers.

BACKGROUND: Smokers may react to cigarette excise tax increases by engaging in price-minimization strategies (i.e., finding ways to reduce the cost of cigarette smoking) rather than by quitting or reducing their cigarette use, thereby reducing the public health benefits of such tax increases. PURPOSE: To evaluate the state and national prevalence of five common cigarette price-minimization strategies and the size of price reductions obtained from these strategies. METHODS: Using data from the 2009-2010 National Adult Tobacco Survey, the prevalence of five common price-minimization strategies by type of strategy and by smoker's cigarette consumption level were estimated. The price reductions associated with these price-minimization strategies also were evaluated. Analyses took place in November 2012. RESULTS: Approximately 55.4% of U.S. adult smokers used at least one of five price-minimization strategies in the previous year, with an average reduction of $1.27 per pack (22.0%). Results varied widely by state. CONCLUSIONS: Cigarette price-minimization strategies are practiced widely among current smokers, and resulting price reductions are relatively large. Policies that decrease opportunities to effectively apply cigarette price-minimization strategies would increase the public health gains of cigarette excise tax increases.

Tobacco use screening and counseling during physician office visits among adults--National Ambulatory Medical Care Survey and National Health Interview Survey, United States, 2005-2009.

Tobacco use continues to be the leading cause of preventable disease and death in the United States; cigarette smoking accounts for approximately 443,000 premature deaths annually. In 2009, the prevalence of smoking among U.S. adults was 20.6% (46 million smokers), with no significant change since 2005 (20.9%). In 2010, approximately 69% of smokers in the United States reported that they wanted to quit smoking. Approximately 44% reported that they tried to quit in the past year for ≥1 day; however, only 4%-7% were successful each year. Tobacco dependence has many features of a chronic disease: most patients do not achieve abstinence after their first attempt to quit, they have periods of relapse, and they often require repeated cessation interventions. At least 70% of smokers visit a physician each year, and other smokers visit other health-care professionals, providing key opportunities for intervention. The 2008 update to the U.S. Public Health Service (PHS) Clinical Practice Guideline: Treating Tobacco Use and Dependence recommends that clinicians and health-care delivery systems consistently identify and document tobacco use status and treat every tobacco user seen in a health-care setting using the 5 A's model: 1) ask about tobacco use, 2) advise tobacco users to quit, 3) assess willingness to make a quit attempt, 4) assist in quit attempt, and 5) arrange for follow-up. The PHS guideline also recommends the following as effective methods for increasing successful cessation attempts: individual, group, and telephone counseling; any of the seven first-line medications for tobacco dependence that are approved by the Food and Drug Administration (FDA); and provision of coverage for these treatments by health-care systems, insurers, and purchasers. However, clinicians and health-care systems often do not screen for and treat tobacco use consistently and effectively.