Current Trends Cigarette Smoking Among Reproductive-Aged Women -- Behavioral Risk Factor Surveillance System, 1989

Women who smoke cigarettes are at increased risk not only for chronic diseases (e.g., lung cancer and chronic obstructive pulmonary disease) but--if they use oral contraceptives--also for myocardial infarction (1). In addition, cigarette smoking during pregnancy increases the risk for low birth weight and premature infants, miscarriage, stillbirth, sudden infant death syndrome, and infant mortality (2). Because of these risks and other health problems associated with cigarette smoking, one of the national health objectives for the year 2000 is to reduce the prevalence of smoking to 12% among reproductive-aged women (18-44 years of age) (3). This report summarizes data from the 1989 Behavioral Risk Factor Surveillance System (BRFSS) on the prevalence of smoking among reproductive-aged women.

In 1989, health departments in 39 participating states and the District of Columbia used a standard questionnaire to conduct telephone interviews of adults aged greater than or equal to 18 years (4). Current smokers were defined as persons who had smoked at least 100 cigarettes and who reported being a smoker at the time of the interview. Individual responses were weighted to provide estimates representative of the adult population of each participating state. To compare smoking prevalences between states, weighted state-specific prevalences were standardized for the distribution of the 1980 U.S. population by age, race, and educational level. Smoking prevalences for subgroups (age, race, educational level, and pregnancy status) were standardized by adjusting for the other variables.

In 1989, weighted crude prevalences of cigarette smoking among reproductive-aged women varied from 17% in Utah to 32% in Kentucky and Rhode Island (median: 26.5%) (Table 1). Standardized smoking prevalences ranged from 21% in Texas to 37% in Wisconsin. In general, standardized smoking prevalences were highest in the midwestern states and lowest in the Rocky Mountain and midcentral states.

Older women and women with less than a high school education were more likely to smoke (Table 2). Pregnant women were less likely than nonpregnant women to smoke. Smoking prevalences did not vary substantially between white and black women, the only racial groups for which rates could be calculated because the numbers of respondents of other racial/ethnic groups were too small to provide stable estimates.

Among reproductive-aged women who smoked, 84% smoked fewer than 25 cigarettes per day (Table 3). Women aged 35-44 years tended to be heavier smokers than younger women. Approximately 44% of all women who were current smokers had attempted to quit smoking (i.e., quitting for at least 1 week) in the previous year. Women aged 35-44 years were substantially less likely than younger women to have attempted quitting. Reported by the following state BRFSS coordinators: L Eldridge, Alabama; J Contreras, Arizona; W Wright, California; M Adams, Connecticut; M Rivo, District of Columbia; S Hoecherl, Florida; J Smith, Georgia; A Villafuerte, Hawaii; J Mitten, Idaho; B Steiner, Illinois; S Joseph, Indiana; S Schoon, Iowa; K Bramblett, Kentucky; J Sheridan, Maine; A Weinstein, Maryland; R Letter man, Massachusetts; J Thrush, Michigan; N Salem, Minnesota; J Jackson-Thompson, Missouri; M McFarland, Montana; S Spanhake, Nebraska; K Zaso, L Powers, New Hampshire; M Watson, New Mexico; J Marin, O Munshi, New York; C Washington, North Carolina; M Maetzold, North Dakota; E Capwell, Ohio; N Hann, Oklahoma; J Grant-Worley, Oregon; C Becker, Pennsylvania; R Cabral, Rhode Island; M Mace, South Carolina; S Moritz, South Dakota; D Ridings, Tennessee; J Fellows, Texas; L Post-Nilson, Utah; J Bowie, Virginia; K Tollestrup, Washington; R Barker, West Virginia; E Cautley, Wisconsin. Office of Surveillance and Analysis, Div of Reproductive Health, Div of Chronic Disease Control and Community Intervention, and Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: In this report, the state-to-state variations of smoking prevalences among reproductive-aged women may reflect differences in sociodemographic characteristics (e.g., age, race, and educational level) of state populations. However, because these variations persisted after standardization to adjust for these differences, other factors (e.g., occupation, employment status, and family income) may affect state-specific smoking prevalences. These variations may also reflect differences in the intensity of cigarette advertising and in the effectiveness of statewide smoking-control interventions (2,5). In addition, reasons for the lower prevalences of smoking among certain groups could include 1) declining smoking initiation rates in younger cohorts of women (a trend observed previously for white and Hispanic women (6)); 2) decreasing smoking-initiation and increasing smoking-cessation rates over time among women with higher educational levels (7); and 3) the effect of higher smoking-cessation rates for pregnant women (8).

The BRFSS findings regarding amounts of smoking and attempts to quit are consistent with previous reports (2,5). However, the proportion of women who attempted to quit smoking for at least 1 week in the year preceding the survey (44%) was substantially higher than that estimated in 1987 for the proportion of all women in the general U.S. population who had attempted to quit for at least 1 day (32%) (5). Therefore, smoking-cessation education for reproductive-aged women may be more successful than for women aged greater than or equal to 45 years because reproductive-aged women appear to be more willing to attempt to quit smoking.

The 1989 BRFSS determined that the median prevalence of current smoking was 26.5% among reproductive-aged women in the states surveyed; accordingly, nearly all states will require concerted efforts to reduce prevalence of smoking among reproductive-aged women to 12% by the year 2000 (3). Efforts to reduce smoking initiation among adolescent girls and to target young women for smoking-cessation interventions are important priorities to accomplish this objective (2,5).

References

1. Sharpiro S, Slone D, Rosenberg L, et al. Oral contraceptive use in relation to myocardial infarction. Lancet 1979;1:743-7.

2. CDC. Reducing the health consequences of smoking: 25 years of progress--a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411.

3. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives--full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

4. Remington PL, Smith MY, Williamson DF, Anda RF, Gentry EM, Hogelin GC. Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981-1987. Public Health Rep 1988;103:366-75.

5. CDC. The health benefits of smoking cessation: a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)90-8416.

6. Escobedo LG, Remington PL, Anda RF. Long-term secular trends in initiation of cigarette smoking among Hispanics in the United States. Public Health Rep 1989;104:583-7.

7. Pierce JP, Fiore MC, Novotny TE, Hatziandreu EJ, Davis RM. Trends in cigarette smoking in the United States: educational differences are increasing. JAMA 1989;261:56-60.

8. Williamson DF, Serdula MD, Kendrick JS, Binkin NJ. Comparing the prevalence of smoking in pregnant and nonpregnant women, 1985 to 1986. JAMA 1989;261:70-4.

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