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t k USE OF TOBACCO Practices, Attitudes, Knowledge, and Beliefs United States - Fall 1964 and Spring 1966 Statistics on the incidence of the use of tobacco, particularly the smoking of cigarettes, attitudes toward the use of tobacco, and other related variables. Based on data collected in house- hold interviews in the Fall of 1964 and in the Spring of 1966. U.S. DEPARTMENT OF HEALTH. EDUCATION, AND WELFARE Pablic Ile,ilth Service • 1[ealih Servires nnd'liental Ha~~lth Adniinistratim Nati(ma! Clearinrihousc [or Smakinl- .wd Hcalth ~ ~ July 19G9 ~ W .~ A. ~

I I TABLE OF CONTENTS Foreword . . . . . . . . . . . . . . iii Introduction . . . . . . . . . . . . vii 1964 and 1966 Matched Tables .... 1 1964 Unmatched Tables . . . . . . . 627 1966 Unmatched Tables . . . . . . . 672 Appendix I: Sample Design ..... 784 Appendix II: Interview Schedules . 80ft

FOREWORD This publication reports basic data from two national surveys, the first made in the Fall of 1964, less than a year after publication of the Report of the Surgeon General's Advisory Committee on Smoking and Health, and the other in the Spring of 1966. The first survey was conducted by National Analysts, Inc., and the second divided between National Analysts, Inc. and Opinion Research Corporation. The report presents frequency (and percentage) of response to each question but does not provide analysis and inter- pretation of survey results. Such analyses are at present going on within the Clearinghouse for future publication. Investigators working in this area will find this infor- mation useful, but obviously the answers to many of the questions are most meaningful when related to answers to other questions. In our opinion, differences between responses in the two surveys must be interpreted with caution, since the two surveys are spaced so close to each other in time that meaningful time trends are probably uncommon. It is hoped that a third survey may be made during the coming year which will provide a basis for more significant trend analysis. The surveys were designed by Daniel Horn, Ph.D. and Selwyn Waingrow. This monograph was prepared by the Program Research Section, Dorothy E. Green, Ph.D., Chief, Frederick F. Ikard, M.A., Richard A. Eisinger, M.A. Mrs. Juanita W. Williams, who was the person primarily responsible for preparing the tables and Miss Judith A. Raynor who was responsible for their typing. Persons making use of the data in this report are invited to communicate any comparisons which they make with other surveys, or inform the National Clearinghouse for Smoking and Health of any other use made of this material. Daniel Horn, Ph.D. Director National Clearinghouse for Smoking and Health iii

which smoking behavior takes place, as well as interpersonal influences for continuation or cessation; remedial action questions related to cigarette labeling (general health hazard warning, tar/nicotine listing); restrictions on advertising; action by or directed at manufacturers; the role of government and government action; and restrictions on smoking behavior; and background data (sex, age, education, etc.) about the respondents. Special topics included knowledge of and about the Surgeon General's Report (1964) and the health hazard label on the cigarette package (1966). Description of SuFVey The first sv,ItYey was conducted in the Fall of 1964 approximately nine months after the publication of the Surgeon General's Report on Smoking and Health. It consisted of an interview which lasted from approximately one hour to an hour and a half, depending upon the respondent's smoking history. As part of the research design, the questions were presented differently in four forms used by the interviewers, with the selection of the forms to be used being predetermined on a randomly selected basis so that each respondent theoretically had an equal chance of being given any one particular form. The differences and similarities between the four forms (A, B, C, and D) used in 1964 are as follows: Wording - Some of the questions were worded exactly alike on all four forms; however, the questions concerning attitudes and beliefs were presented conversely in form D. For example, if forms A, B, and C contained the positive version of a statement, then on form D the converse of the statement was presented, that is, a negatively worded version. viii

INTRODUCTION The tables presented in this report show the results of two national surveys of adults conducted in 1964 and 1966 under the direction of the U. 5. Public Health Service. Content of Survey Respondents were asked questions concerning a number of topics felt to be related to cigarette smoking and cigarette smoking control. Included were ques\ ns related to: Smoking behavior, past and present, including attempte~at stopping and/or cutting down cigarette smoking; attempts at similar types of behavior change (coffee, tea, alcohol, and fattening foods); the relationship of weight control to cigarette smoking control; use of drugs and medicines; self-estimations of future smoking behavior; beliefs about ability to change, and will- ingness to change; current smoking behavior; rationale and rationaliza- tions for cigarette smoking behavior; dimensions of the saliency of the topic of smoking and health to the individual; attitudes and behavior related to health and preventive health behavior; attitudes and beliefs about smoking as a health hazard in general, and to the respondent in particular; and the relationship of smoking to four diseases, including beliefs about certain dimensions of these diseases; attitude and beliefs about specific possible rewards in smoking. In 1966 a series of questions was asked concerning the gratifications derived from, and psychological uses of cigarette smoking; images of smoking and smokers; attitudes and beliefs about setting 'good" examples by self and others (parents, teachers, doctors, and health professionals); some role expectations, role performances, and the image of the physician in smoking and health; some environmental influences, including some social forces and contexts within vii I

Position With Interview Schedule - The order of presentation of the questions within the various sections of the interview schedule itself, differed depending on the form. The questions were presented in the same sections on forms A and B, but they differed from forms C and D, which were also like each other. Order Within a Particular Series - The questions were presented in identical order in forms A, C, and D; but were reversed in form B. The differences between the four forms can be illustrated by question 34 k (form A), in which the respondent was asked to agree or disagree along a five point scale with the statement that smoking cigarettes is harmful to health. The statement is identically phrased in forms B and C; however, in form B the order in which it was asked is reversed and it appears 13th in this particular series of items instead of llth. It is still asked 11th among the group of statements in form C, but the position of this group of statements within the interview schedule changes and it is asked in the middle sections of the questionnaire as question 57 k (for those who never smoked cigarettes), 96 k (for former cigarette smokers), and 167 k (for current cigarette smokers). Finally, in form D, the statement is also part of the middle sections and as in form C, appears as question 57 k, 96 k, and 167 k, but unlike form C, it is now phrased in the negative, that is, "Smoking cigarettes is NOT harmful to health." In the Spring of 1966 a second national survey was conducted. The sampling procedure was essentially the same as in 1964 (see appendix I); however, the new survey differed from its predecessor in that it was conducted by two independent research firms. Each contractor indepen- dently constructed a national probability sample while using the same interview schedule. The results of the two samples were subsequently combined and treated as a single survey. ix

Although the questionnaires used in 1964 and 1966 were essentially the same, alterations were made in 1966 (form A for 1964 and 1966 are given in Appendix II). Whereas four forms, as described above, were employed in 1964, only two forms were used in 1966, identical in the ordering of questions but with some questions differing in the order of presentation of response categories and other questions differing as to whether they were worded positively or negatively. Furthermore, some questions were deleted, some revised, and some added to the 1966 schedule. The rationale for these additions, revisions, and deletions was based upon a proposed testing of hypotheses, a number of which were formulated following the 1964 survey. In making these changes, it was felt that they would significantly contribute to a better understanding of smoking behavior without disrupting the continuity of the test - retest design. Presentation of Tables The tables presented in this report are arranged in order of their appearance in the 1964 questionnaire, beginning with question 1. Follow- ing each 1964 table is the corresponding table for 1966. The tables for 1964 and 1966 which do not have a match, that is, questions which were asked in only one of the two surveys, or were asked in both but with changes in wording, are to be found at the end of the tables for the matched questions. Questions relating to brand name of cigarettes are not included in the following tables. The numbers of these questions in 1964 are 75, 78, 80, 93, 94, 136, 139, 141, 154, and 155. The corresponding questions for 1966 are 104, 107, 111, 126, 127, 177, 180, 184, 199, and 200. Brand ~ W names were used only to assess tar and nicotine content. It is also noted ~ CP that tables for questions 198, 200, 219, and 220 are missing from the 1964 ,1 V series. These open end questions were asked to improve the flow of the interview, and were neither coded nor tabulated. x

1% disease, lung cancer, polio, and emphysema-bronchitis--are repeated for each disease. More than one response was permitted the respondent in answering certain questions. In this situation, the total number of responses within a table may exceed the marginal totals given at the bottom of the table. A footnote accompanies all tables where more than one response is permitted. The data in these tables are frequency counts and percentages, reported by smoking category and sex and represent the combined totals for all forms used in a particular survey. Analyses of some of the data that will probe some of the interrelationships are planned. Abbreviated versions of the actual questions asked of respondents appear in some tables. The complete questions can be found in the inter- view schedules (see Appendix II). Order of Tables . The tables are in order of the 1964 questionnaire, with matching 1964 and 1966 tables facing. Where the question was not asked in both surveys, or the wording of the question.was different in the two surveys, the data are reported in NON-MATCHING TABLES, with 1964 data reported first, followed by 1966 data. The number and order of these tables are listed below. Non-Matching Tables - Numerical Order 1964 1966 1966 10 (4 tables) Q• 2 (1 table) Q. 72 12 13 (4 tables) (4 tables) 3 4 73 74 O C..' .I W x ~ 29 (12 tables) 22 (3 tables) 78 Cl z xiii

, respondents are reported for males and females as a function of their smoking status: "Never smoker," "Ever smoker," "Former smoker," and "Current smoker." Questions asked only of individuals with a particular smoking history are presented in abbreviated tables throughout the report. The three smoking categories were defined by a set of three screening questions: 1. Have you ever smoked any cigarettes? 2. Have you smoked at least as many as five packs of cigarettes, that is, 100 cigarettes, during your entire life? 3. Do you now smoke cigarettes? In order to be classified as a"Current.smoker" an individual had to answer "yes" to all three questions. Former smokers had to answer "yes" to the first two and "no" to the last question. The "Ever smoker" is any Former or Current smoker. "Never smokers" included those who answered "no" to question 1, and those who answered "yes" to question 1, combined with a"no" response to questions 2 and 3. What is referred to as a "Selected total" will be found on a number of tables. This notation merely indicates that not all of the respondents sampled were asked that question. For example, question 8 (1964) was only asked of individuals who have ever had a physical examination. This was determined by the preceding question (7). Thus, individuals who never had a physical examination were systematically excluded from the table. Questions relating to a number of diseases, people, or events which were asked in sequence for each disease, person, or event are presented in that order in the monograph. For example, questions 12 thru 17 which were asked in 1964 in regard to each of four diseases--coronary heart xir

Errors in printing on the original interview schedule make interpretation of a number of items difficult. Table 167 (a thru 1), asked of Former smokers in the 1966 survey, which appears in both the "matched" and "unmatched" sections in combination with question 96 and 263, should be interpreted with caution. The placement of "strongly disagree" and "mildly disagree" as response alternatives was mistakenly reversed for this question. As a consequence, these two categories should be combined in interpreting the data for Former and Ever smokers. Additional errors may exist within this monograph. If errors are detected, notification of such errors to the National Clearinghouse for Smoking and Health is requested. . In a few cases (e.g., 1964 question 73 and corresponding 1966 question 102) questions worded in a slightly different manner were included in the "matched" section because of the value in comparing the data. Some additional cautions in interpretation of results should be noted. In a number of instances matching questions were placed in dif- ferent parts of the interview schedule, irrespective of form (e.g., questions 218, 240, and 242 in 1964 and questions 52, 14, and 15 in 1966) and were therefore responded to at different times during the interview. Also, interviewers were instructed via special memorandum in 1964 to ". .. not accept a 'don't know' or 'no answer' without first trying to obtain the respondent's best guess or estimate." This instruction applied particularly to questions 11, 27, 221, and 224. Although the identical instruction was presented to interviewers in 1966, it was contained in interviewer instruction manuals rather than presented via special memorandum. O W ~ The data presented in this report were classified according to the W ~ ~ respondents' sex and smoking history. Questions that were asked of all V ..7 xi