Changes in cigarette smoking initiation, cessation, and relapse among U.S. adults: a comparison of two longitudinal samples.
BACKGROUND
The tobacco epidemic in the U.S. has matured in the past decade. However, due to rapidly changing social policy and commercial environments, tailored prevention and interventions are needed to support further reduction in smoking.


METHODS
Using Tobacco Use Supplement to the Current Population Survey (TUS-CPS) 2002-2003 and 2010-2011 longitudinal cohorts, five smoking states are defined including daily-heavy, daily-light, non-daily, former and non-smoker. We quantified the changes between smoking states for the two longitudinal cohorts, and used a series of multivariable logistic regression models to examine the association of socio-demographic attributes and initial smoking states on smoking initiation, cessation, and relapse between waves within each cohort.


RESULTS
The prevalence of adult heavy smoking decreased from 9.9% (95% CI: 9.6%, 10.2%) in 2002 to 7.1% (95% CI: 6.9%, 7.4%) in 2010. Non-daily smokers were less likely to quit in the 2010-2011 cohort than the 2002-2003 cohort (37.0% vs. 44.9%). Gender, age group, smoker type, race and marital status exhibit similar patterns in terms of their association to the odds of initiation, cessation and relapse between the two cohorts, while education groups showed some inconsistent results between the two cohorts regarding the odds of cessation.


CONCLUSIONS
Transitions between smoking states are complex and increasingly unstable, requiring a holistic, population-based perspective to understand the stocks and flows that ultimately dictate the public health impact of cigarette smoking behavior. This knowledge helps to identify groups in need of increased tobacco control prevention and intervention efforts.
Operations Research Graduate Program, North Carolina State University, Raleigh, NC USA.
Zinan
Z
Yi
Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC USA.
Maria E
ME
Mayorga
Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105E McGavran-Greenberg HallCB #7411, Chapel Hill, NC 27599-7411 USA.
Kristen
K
Hassmiller Lich
Schroeder Institute for Tobacco Research & Policy Studies, Truth Initiative, Washington, DC USA.|Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
Jennifer L
JL
Pearson
Cessation; Cigarette; Initiation; Relapse; Smoking