Abstract
Introduction
About 25% of people who currently smoke cigarettes in the United States (US) smoke non-daily, and relatively little is known about their intentions or attempts to quit. Active surveillance is essential to identify services needed to support smoking cessation efforts and reduce the burden of disease.
Methods.
US population-wide estimates of quit attempts and use of cessation aids among adults who smoke cigarettes were calculated using data from the September 2022 wave of the Tobacco Use Supplement to the Current Population Survey. Statistical analyses were conducted in 2024. Weighted percentages and 95% confidence intervals (95%CI) are presented by sociodemographic characteristics and smoking pattern.
Results.
In 2022, nearly 6 million adults (2.59 million women, 3.36 million men) in the US reported smoking non-daily an average of 13.4 days per month (95%CI:12.7-14.1). Compared with adults who smoke daily, the proportion of past-year quit attempts was higher among people who reported smoking on some days of the month (always some days: 41.8%; formerly daily: 58.4%; daily: 32.2%). However, those who smoke some days were less likely to report receiving medical advice to quit (always some days: 49.5%; formerly daily: 58.1%; daily: 72.7%), using pharmacotherapy such as nicotine replacement therapy or a prescribed medication (always some days: 17.9%; formerly daily: 32.4%; daily: 38.7%), or receiving counseling to quit smoking (always some days: 5.8%; formerly daily: 6.9%; daily: 12.0%).
Conclusions.
Given the substantial number of adults who smoke non-daily in the US and their interest in quitting, developing targeted interventions and communication is an important public health priority.
Introduction
Compared with people who have never smoked cigarettes, people who smoke on some days of the month (non-daily) have substantially higher mortality risks,1 and would benefit from quitting smoking. Yet relatively little is known about intentions or attempts to quit among people who smoke non-daily.
Methods
This cross-sectional study used data from 39,558 adult (age ≥18 years) self-respondents from the September 2022 Tobacco Use Supplement to the Current Population Survey (TUS-CPS). 2 Demographic, smoking characteristics and cessation behaviors among people who currently smoke daily, people who currently smoke on some days of the month and who previously smoked daily (formerly daily), and people who had always smoked on some days of the month (always some days) were compared. To account for the complex survey design of TUS-CPS and to maintain population-level totals for age, sex, race, and Hispanic origin, weighted percentages, means, and standard errors were estimated using SAS version 9.4 [SAS Institute Inc] applying non-response adjustment and replicate weights. This study was a secondary analysis of deidentified data and therefore exempt from IRB approval.
Results
In 2022, 9.3% of adults in the US population reported currently smoking cigarettes; 75% (95%CI:73.3%-76.7%) smoke daily, 11.3% (95%CI:10.2%-12.5%) reported currently smoking some days but previously having smoked daily, and 13.1%(95%CI:11.7%-14.6%) reported having always smoked on some days of the month. Among the nearly 6 million adults (2.59 million women, 3.36 million men) who smoke on some days of the month, the average number of days smoked per month was 13.4 (95%CI:12.7-14.1).
Characteristics of adults who smoke cigarettes are shown in Table 1 according to frequency. Smoking always on some days was more common among people aged 18 to 34 years (54.8%; 95%CI:49.3%-60.3%), people of racial/ethnic minority groups (African American 16.0%[95%CI:11.5%-20.5%]; Asian 5.7% [95%CI:2.8%-8.5%]; Hispanic 20.0%[95%CI:14.7%-25.4%]), and people with a college degree (23.5%; 95%CI:18.5%-28.4%).
Table 1.
Characteristics of adults who currently smoke cigarettes. TUS-CPS, United States, 2022.
| Currently smoke on some days of the month | ||||||||
|---|---|---|---|---|---|---|---|---|
| Currently smoke daily | Previously smoked daily | I had always smoked some days | Total a | |||||
| Group | Unweighted No. |
Weighted No(%)[95%CI] | Unweighted No. |
Weighted No(%)[95%CI] | Unweighted No. |
Weighted No(%)[95%CI] | Unweighted No. |
Weighted No(%)[95%CI] |
| Overall | 3067 | 17,868,065(75.0)[73.3,76.7] | 443 | 2,676,457(11.3)[10.2,12.5] | 441 | 3,105,556(13.1)[11.7,14.6] | 909 | 5,965,008(25.0)[23.3,26.7] |
| Sex | ||||||||
| Female | 1515 | 8,340,012(46.7)[44.7,48.6] | 223 | 1,246,606(46.6)[40.9,52.2] | 201 | 1,309,419(42.2)[36.7,47.7] | 431 | 2,599,959(43.6)[39.5,47.7] |
| Male | 1552 | 9,528,053(53.3)[51.4,55.3] | 220 | 1,429,852(53.4)[47.8,59.1] | 240 | 1,796,137(57.8)[52.3,63.3] | 478 | 3,365,049(56.4)[52.3,60.5] |
| Age, years | ||||||||
| 18-34 | 951 | 6,529,623(36.5)[34.3,38.8] | 164 | 1,181,093(44.1)[38.3,50.0] | 211 | 1,702,990(54.8)[49.3,60.3] | 386 | 2,984,347(50.0)[46.1,54.0] |
| 35-64 | 1375 | 8,080,955(45.2)[43.1,47.4] | 184 | 1,054,745(39.4)[34.0,44.8] | 144 | 992,888(32.0)[26.5,37.5] | 339 | 2,117,118(35.5)[31.8,39.2] |
| >65 | 741 | 3,257,487(18.2)[16.7,19.7] | 95 | 440,620(16.5)[13.0,19.9] | 86 | 409,679(13.2)[10.2,16.2] | 184 | 863,543(14.5)[12.3,16.6] |
| Race/ethnicity b | ||||||||
| African American | 348 | 2,323,748(13.0)[11.5,14.5] | 44 | 350,147(13.1)[8.7,17.5] | 72 | 497,670(16.0)[11.5,20.5] | 121 | 890,803(14.9)[12.0,17.8] |
| American Indian/Alaska Native | 55 | 296,857(1.7)[1.1,2.2] | 9 | 62,616(2.3)[0.1,4.5] | 15 | 79,802(2.6)[1.0,4.2] | 25 | 145,439(2.4)[1.2,3.7] |
| Asian | 52 | 391,994(2.2)[1.5,2.9] | 15 | 101,151(3.8)[1.7,5.9] | 22 | 175,911(5.7)[2.8,8.5] | 40 | 300,230(5.0)[3.2,6.9] |
| Hispanic c | 171 | 1,554,325(8.7)[7.4,10.0] | 43 | 350,276(13.1)[9.0,17.2] | 60 | 621,477(20.0)[14.7,25.4] | 107 | 1,010,669(16.9)[13.7,20.2] |
| Multiracial d | 57 | 259,934(1.5)[0.9,2.0] | 10 | 105,633(3.9)[0.8,7.0] | 14 | 125,418(4.0)[1.8,6.3] | 24 | 231,051(3.9)[2.1,5.6] |
| White | 2375 | 13,024,256(72.9)[70.9,74.9] | 321 | 1,685,912(63.0)[56.8,69.2] | 254 | 1,550,558(49.9)[44.2,55.7] | 587 | 3,311,373(55.5)[51.7,59.4] |
| Education | ||||||||
| Less than high school | 421 | 2,679,802(15.0)[13.4,16.6] | 38 | 255,766(9.6)[6.3,12.8] | 52 | 407,458(13.1)[8.6,17.6] | 95 | 715,650(12.0)[9.1,14.9] |
| High school degree | 1269 | 7,708,225(43.1)[40.8,45.5] | 158 | 1,004,770(37.5)[32.6,42.5] | 129 | 1,019,799(32.8)[27.4,38.3] | 294 | 2,060,113(34.5)[31.0,38.1] |
| Some college | 963 | 5,152,573(28.8)[26.7,30.9] | 157 | 944,287(35.3)[30.1,40.4] | 142 | 949,229(30.6)[25.0,36.1] | 306 | 1,951,961(32.7)[29.2,36.3] |
| College degree | 414 | 2,327,465(13.0)[11.6,14.5] | 90 | 471,634(17.6)[13.5,21.8] | 118 | 729,071(23.5)[18.5,28.4] | 214 | 1,237,285(20.7)[17.4,24.1] |
| Past-year quit attempt e | 925 | 5,601,593(32.2)[30.0,34.4] | 258 | 1,526,531(58.4)[52.3,64.4] | 202 | 1,289,842(41.8)[35.9,47.6] | 462 | 2,829,977(49.3)[45.2,53.4] |
| Any attempt to quit f | 1651 | 9,516,951(54.7)[52.4,57.0] | 337 | 2,025,799(77.0)[72.1,81.9] | 255 | 1,696,288(55.0)[49.3,60.6] | 594 | 3,735,692(64.9)[61.0,68.8] |
| Received medical advice to quit smoking g | 1493 | 8,567,380(72.7)[70.3,75.2] | 177 | 1,041,192(58.1)[51.9,64.4] | 127 | 863,259(49.5)[41.8,57.3] | 305 | 1,909,909(53.6)[48.5,58.6] |
| Use of any cessation method h | 458 | 2,863,447(51.4)[47.2,55.5] | 141 | 804,178(53.2)[46.2,60.1] | 73 | 447,430(35.0)[27.0,43.0] | 215 | 1,257,065(44.8)[39.7,49.9] |
| Pharmaceutical aids | 344 | 2,155,432(38.7)[34.5,42.8] | 92 | 489,884(32.4)[26.1,38.7] | 39 | 229,048(17.9)[11.1,24.7] | 132 | 724,389(25.8)[21.5,30.1] |
| Support services | 114 | 669,076(12.0)[9.5,14.5] | 24 | 103,756(6.9)[3.4,10.3] | 14 | 74,058(5.8)[2.2,9.4] | 39 | 183,272(6.5)[4.1,9.0] |
| Electronic cigarettes i | 159 | 1,128,737(20.3)[17.0,23.6] | 69 | 438,747(29.1)[22.8,35.4] | 37 | 260,025(20.3)[13.6,27.1] | 106 | 698,771(25.0)[20.1,29.8] |
| Considering quitting within the next 6 months j | 1117 | 6,427,225(37.8)[35.5,40.2] | 242 | 1,419,179(56.2)[50.2,62.1] | 201 | 1,375,533(46.3)[40.2,52.3] | 444 | 2,800,170(50.6)[46.5,54.7] |
| Planning to quit within the next 30 days j | 398 | 2,344,848(37.9)[34.3,41.5] | 141 | 815,866(60.3)[52.2,68.4] | 111 | 754,418(58.5)[51.5,65.5] | 252 | 1,570,283(59.4)[53.9,64.8] |
Note:
There were 25 adults with missing values for previous daily smoking that are not presented in the table.
Hawaiian/Pacific Islander results are not presented because of small cell sizes.
Hispanics may be any race.
Multiracial refers to individuals self-classified as having two or more races.
Adults who smoke some days and <12 days in the past month were asked “During the past 12 months, have you tried to quit smoking completely?” and adults who smoke some days and ≥12 days in the past month were asked the same question as those who reported daily smoking: “During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?” A positive response to either question was considered a past-year quit attempt.
Adults who smoke some days and <12 days in the past month were asked “Have you ever tried to quit smoking completely?” and adults who smoke some days and ≥12 days in the past month were asked the same question as those who reported daily smoking: “Have you ever made a serious attempt to stop smoking because you were trying to quit – even if you stopped for less than a day?” A positive report of past-year quit attempt or ever-quit attempt was defined as any attempt to quit
Among those who reported seeing a medical doctor in the past 12 months.
Thinking back to the last time you tried to quit in the past 12 months, did you use any of the following? i) pharmaceutical aids such as nicotine replacement therapy (patch, gum, lozenge, nasal spray, or inhaler) and prescription pills (Chantix, Varenicline, Zyban, Bupropion or Wellbutrin); ii) support service such as quit line, in person counseling, support group, internet or web-based program and text messaging programs.
The last time you tried to quit smoking in the past 12 months, did you try to quit by switching to electronic cigarette or e-cigarettes?
Are you seriously considering quitting smoking within the next 6 months? Are you planning to quit within the next 30 days.
Compared with people who smoke daily, adults who smoke some days were more likely to report considering quitting within the next 6 months (always some days: 46.3%; formerly daily: 56.2%; daily: 37.8%) and planning to quit within the next 30 days (always some days: 58.5%; formerly daily: 60.3%; daily: 37.9%). The proportion of past-year quit attempts was also higher in the group who reported smoking on some days of the month (always some days: 41.8%; formerly daily: 58.4%; daily: 32.2%).
Yet, compared to people who smoke daily, adults who smoke some days were less likely to receive medical advice to quit (always some days: 49.5%; formerly daily: 58.1%; daily: 72.7%), use pharmacotherapy such as nicotine replacement therapy or a prescribed medication (always some days: 17.9%; formerly daily: 32.4%; daily: 38.7%), or receive smoking cessation counseling (always some days: 5.8%; formerly daily: 6.9%; daily: 12.0%).
Discussion
Consistent with surveys administered >10 years ago, 3 adults who smoke on some days of the month were more interested in quitting and were more likely to have tried to quit in the past year than people who smoke daily. Higher prevalences were found in the group that reported currently smoking some days but previously smoked daily. However, more than 40% of those who had always smoked some days reported a past year quit attempt and nearly 60% planned to quit in the next 30 days.
Regarding the use of cessation aids, people who smoke some days were less likely to report receiving medical advice to quit than people who smoke daily, reflecting the lack of effective screening for non-daily smoking at the medical visit,4 which may prevent access to support services to achieve cessation.5 Furthermore, existing clinical practice guidelines6 do not contain specific recommendations for people who smoke some days, including the effectiveness of pharmaceutical aids or smoking cessation counseling. Limitations of this analysis include a cross-sectional design and self-reported data. Strengths of this study include recency of the data and a nationally representative sample, which makes the results generalizable to the US adult population.
Conclusions
Given the substantial number of adults who smoke on some days of the month in the US and the documented interest in quitting, developing targeted interventions and communication strategies to support cessation among adults who smoke some days is critical to reduce disease burden.
Acknowledgements
This study was supported by National Cancer Institute, Intramural Research Program. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
The authors declare no potential conflicts of interest. No financial disclosures have been reported by the authors of this paper. The comments and opinions expressed in this paper are those of the authors and does not reflect the official policy of the Department of Health and Human Services, National Institutes of Health, and National Cancer Institute.
Footnotes
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CRediT Author Statement. Daniela S. Gutiérrez-Torres: Conceptualization, Methodology, Software, Validation, Formal analysis, Writing-Original draft, Writing-review and editing. Carolyn Reyes-Guzman: Writing-review and editing. Margaret Mayer: Writing-review and editing. Yvonne M. Prutzman: Writing-review and editing. Neal D. Freedman: Conceptualization, Methodology, Writing-review and editing, Supervision, Funding acquisition.
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