Changing age-specific patterns of cigarette consumption in the United States, 1992-2002: association with smoke-free homes and state-level tobacco control activity.

INTRODUCTION: During the 1990s, both prevalence and average cigarette consumption declined in the United States, but age-specific changes have not been reported.
METHOD: All four of the nationally and state representative U.S. Current Population Surveys-Tobacco Use Supplements from 1991-2002 (n = 542,470) were analyzed for trends in cigarette consumption among smokers in three age groups: 18-29, 30-44, and 45-64 years. A strength of tobacco control index ranking state of residence was added and weighted logistic regression analyses undertaken.
RESULTS: Over the decade, both prevalence and average consumption declined. Moderate-heavy smoking (> or =15 cigarettes/day [CPD]) prevalence fell strongly over the period in all three age groups. For those aged > or =30 years, this reduction was accompanied by a similar drop in total smoking prevalence. For those aged 18-29 years, this reduction was associated with an increase in very light smoking (<5 CPD; 12% daily and 88% intermittent smokers) to 22.5% of current smokers with a much smaller reduction in prevalence. Smoke-free homes more than doubled in each age group and mediated the increase in very light smoking levels. Smoke-free workplaces and the strength of tobacco control in the state were also important predictors. Very light smoking was particularly prevalent among college students and graduates. DISCUSSION: The marked reduction in prevalence of moderate-heavy smoking across age groups should translate into a reduced population risk of smoking-related disease in the near term. That this reduction is offset by an increase in light and intermittent smoking in young adults suggests the effectiveness of tobacco industry marketing and needs further research.