Comparison of smoking cessation between education groups: findings from 2 US National Surveys over 2 decades

Abstract

Objectives: We examined smoking cessation rate by education and determined how much of the difference can be attributed to the rate of quit attempts and how much to the success of these attempts.

Methods: We analyzed data from the National Health Interview Survey (NHIS, 1991-2010) and the Tobacco Use Supplement to the Current Population Survey (TUS-CPS, 1992-2011). Smokers (≥ 25 years) were divided into lower- and higher-education groups (≤ 12 years and >12 years).

Results: A significant difference in cessation rate between the lower- and the higher-education groups persisted over the last 2 decades. On average, the annual cessation rate for the former was about two thirds that of the latter (3.5% vs 5.2%; P<.001, for both NHIS and TUS-CPS). About half the difference in cessation rate can be attributed to the difference in quit attempt rate and half to the difference in success rate.

Conclusions: Smokers in the lower-education group have consistently lagged behind their higher-education counterparts in quitting. In addition to the usual concern about improving their success in quitting, tobacco control programs need to find ways to increase quit attempts in this group.

FIGURE 1—

Smoking cessation rates by education groups among (a) all smokers from the NHIS, (b) all smokers from the TUS-CPS, (c) non-Hispanic Whites from the NHIS, and (d) non-Hispanic Whites from the TUS-CPS: NHIS, 1991–2010, and TUS-CPS, 1992–2011. Note. high = high education; low = low education; NHIS = National Health Interview Survey; TUS-CPS = Tobacco Use Supplement to the Current Population Survey. The confidence intervals are 95%, pointwise. The denominator for each cessation rate is the number of current and recent former smokers, and the numerator is the number of recent former smokers who have quit for 3 months. The 1992 NHIS data were adjusted to account for missing data caused by a skip pattern error in survey implementation.

FIGURE 2—

Difference in annual smoking cessation rates by education groups among (a) all smokers from the NHIS, (b) all smokers from the TUS-CPS, (c) non-Hispanic Whites from the NHIS, and (d) non-Hispanic Whites from the TUS-CPS: NHIS, 1991–2010, and TUS-CPS, 1992–2011. Note. NHIS = National Health Interview Survey; TUS-CPS = Tobacco Use Supplement to the Current Population Survey. The smoothed confidence band is shown in light gray, the estimated trend in solid line, and the overall mean in dashed line. To reach an overall 95% confidence level, estimates in each year were adjusted to the level of 99.72% in the NHIS and 99.27% in the TUS-CPS.

FIGURE 3—

Success rate of given quit attempts by education groups among (a) all smokers and (b) non-Hispanic Whites: Tobacco Use Supplement to the Current Population Survey, United States, 2001–2011. Note. AB = percentage abstinent; CI = confidence interval; high = high education; low = low education.