Throughout much of the early history of cigarette smoking in the United
States, consumption was typically 1 pack – about 20 cigarettes – each
day. Since the first surgeon general’s report on smoking and health in 1964,
there has been a major decline in smoking prevalence. During this period,
California has consistently led the United States in using public policies to
reduce cigarette smoking, and there were faster declines in smoking prevalence
in California compared with the remaining United States, as well as in lung
cancer rates, according to background information in the article published in
The Journal of the American Medical Association.
“The intensity of smoking [such as number of cigarettes smoked per
day], not just prevalence, is associated with future health consequences,”
the authors wrote.
John P. Pierce, PhD, of the University of California San Diego, La
Jolla, and colleagues examined trends in smoking intensity for both California
and the remaining United States using two large population-based surveys with
state estimates: National Health Interview Surveys, 1965-1994; and Current
Population Survey Tobacco Supplements, 1992-2007. There were 139,176 total
respondents for California and 1,662,353 for the remaining United States.
The researchers found that in 1965, the prevalence of high intensity of
smoking among California adults did not differ from the remaining United
States; prevalence of high-intensity smoking in California was 23.2% compared
with 22.9% in the remaining United States, and these smokers represented 56% of
all smokers. By 2007, this prevalence was 2.6% or 23% of smokers in California
and 7.2% or 40% of smokers in the remaining United States.
The population prevalence of moderate-intensity smoking in 1965 was
11.1% in California and 10.5% in the remaining United States; in 2007, the
prevalence in California was 3.4% compared with 5.4% in the remaining United
The researchers add that one of the reasons why the decline in
moderate-intensity smoking has been greater in California than in the remaining
United States is its comprehensive tobacco control programs.
The authors note that as expected, the large decline in the prevalence
of pack-a-day smoking has been reflected in declines in lung cancer deaths in
California and the U.S.
“In summary, over the past 40 years patterns of smoking have
changed dramatically in the United States and reflect both reduced initiation
and increased cessation,” the researchers write. “Among younger birth
cohorts, only a small minority of the population is expected to ever attain
cigarette consumption levels of even 10 or more CPD. Further study of these
changes in the intensity of smoking patterns should assess the relative
importance of changes in initiation, cessation, and reduced consumption in the
documented decline of health consequences of smoking in the United