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New Horizons in Health: An Integrative Approach
DHEW, 1964), to 25 percent in 1997 (CDC, 1999c). Based on projections of the demographics of smoking, even in the absence of stronger tobacco control education and policy, and assuming no change in youth initiation of smoking, prevalence should continue to fall over the next 20 years, leveling off at approximately 18 percent of adults (Mendez and Warner, 1998; see also).
Of adult Americans, 24.7 percent were smokers in 1997 (CDC, 1999c). Although a greater percentage of men smoke than women (27.6 percent and 22.1 percent, respectively), the gap between the two genders has declined gradually over time. Racial and ethnic differences in smoking prevalence are substantial, ranging from 16.9 percent for Asians and Pacific Islanders to 34.1 percent for Native Americans and Native Alaskans. Smoking rates vary substantially by age, with prevalence declining in the fourth and subsequent decades of life. Smoking cessation, the principal determinant of the decline in prevalence with age, rises significantly with age.
An important research challenge for demographers is the development of more effective ways of assessing smoking initiation. In the 1999 Monitoring the Future Survey, 34.6 percent of high school seniors had smoked within the previous 30 days. 3 The comparable figures for tenth and eighth graders were 25.7 percent and 17.5 percent, respectively. The interpretive problem with these figures, from the point of view of health risk, is that, while 30-day prevalence rates were rising during the 1990s, measures of regular and heavy smoking (e.g., half a pack or more per day) were not. While the latter clearly point to increased health risk, it is unclear what risks follow from the 30-day prevalence rates among youth.
Since the inception of the antismoking campaign in 1964, the most notable change in smoking prevalence is by education class. In 1965, the year following the first Surgeon General's report, less than 3 percentage points separated the prevalence of smoking among college graduates (33.7 percent) from that of Americans who did not graduate from high school (U.S. DHHS, 1989). By 1997 prevalence among college graduates had fallen by nearly two-thirds to 11.6 percent. Among people without a high school diploma, in contrast, prevalence had fallen by only one-sixth (to 30.4 percent; CDC, 1999c; Warner, 2000). Although considerable speculation has been put forth about the reasons for this disparity, this is an important future research direction, directly linked to those of and Chapter 7, where the social and behavioral sciences are particularly prominent.
Dietary factors and sedentary activity patterns together account for at least 300,000 deaths each year (McGinnis and Foege, 1993). Dietary fac-