Examining trends in quantity smoked.

Although the quantity smoked is known to affect smokers' health risks and likelihood of cessation, little is known about trends in quantity smoked and the role of policies in affecting those trends. We examined trends in quantity smoked using a new measure derived from U.S. Department of Agriculture per-capita cigarette consumption (PCC) and smoking prevalence data. We compared this measure to a survey measure of mean cigarettes smoked per day from the National Health Interview Survey (NHIS). Using our measure, we examined trends in quantity smoked at the national level from 1974 to 2004 and for two states, California and Massachusetts. We used regression analysis to distinguish price and other policy-related trends from long-term trends. The derived measure of quantity tracked well with the NHIS measure. Through 1990, changes in quantity were well explained by price changes, with no residual trend in quantity smoked. Since 1990, price showed similar effects, but a downward trend was observed. In California and Massachusetts the initiation of a comprehensive tobacco program as well as price and tax changes were found to explain trends in quantity smoked. Continued progress in reducing the quantity smoked is likely to require the consistent implementation of current policies and the introduction of new policies. Although sustained reductions in quantity smoked may take a long time to affect smokers' health outcomes, sustained reductions appear to be related to cessation. The measure developed in the present study provides a useful tool for tracking trends in quantity smoked.