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CHAPTER 2 OCCUPATION AND SMOKING BEHAVIOR IN THE UNITED STATES: CURRENT ESTIMATES AND RECENT TRENDS 0

CONTENTS Introduction Patterns of Employment Smoking Prevalence Daily Cigarette Consumption Age of Initiation Quitting Behavior Recent Changes in Smoking Behavior Birth Cohorts Race Summary and Conclusions Technical Addendum: National Health Interview Survey Estimates References Appendices 21 0

TABLE 8.-Estimates of average age of initiation of Uhited States, 1978-1980 sex, age, and occupation, aged 20 to 64 years,. smoking among current and former smokers by Total Currently employed whiterollar total l Professional, technical, and kindred warkera Managers and edministraturs, exrept farm Seles workers Cleriral and kindred workere Bluecollar total Ctaftemen and kindred wocken Operatives and! kindred workets Leborers, except farm Service Farm Unemplayed Usual actinty;, homemaking 19.1 180i 21.2. 17,2 169 17.8 19.0 18.1 21.0, 17.3 17.0 17.7 19.1 18.4 20.9 17.9 17.6 18.3 19.4 16.8'. 21.2 18:1 17.7. 18.7 - 18.9 16.1 20.7 17.8 17.6 16.0 19.2 18.0. 21.2' 17:8 17.5 18.4 19.0 18.2 20.9' 17:7 17.3 18.3 18.6 17.4' 21.3' 16.7 16.5 17.1 19.2 17.6 22.9 16.8. 16.5 17.3 18.5 17.4' 21.1 16:6. 16.4 17.1 17.4 17.6 16.5 16.5 16.4 16.6 18.8 17.7 21.4' 17.2 16.9 17,9 18.4 18.4 18.4' 17:0. 16.4 17.5 18.2 17.5 21.1 16,9 16.4 18.2 19.3 17,8 ' 21.3 SOURCE: NaNUnal Center for Health Statlatirs, Netiooel Health Intervlew Surveys, 197R-1989(combined (See TerAnirsl AdtlendumJ p . p ~ is that a substantial fraction of smokers report beginning to smoke at ages when they would be first entering the workforce. This suggests ~ An im ortant inference of the age of initiation re orted in Table 8 that a set of influences'that promoteinitiation may be present in the initiali socialization into the workforce. 32 j 0

Introduction Estimat'es of current smoking behavior reported in thissection of the Surgeon General's Report were obtained from the 1978, 1979; and 1980 National Health Interview Surveys (NHIS). A data tape was prepared by the National Center for Health St'atistics,to allow linkages across surveys,.thereby permitting analyses of the com- bined 1978-1ig80 NHIS (n=49,715). The majority of the analysis presented in this chapter were conducted on the population aged 20 to 64 (n=38,527). Given the large samples and exceptionally high response rates of NHIS, these estimates are generally regarded as the best available estimates of national smoking patterns. To examine recent 10-year changes in smoking behavior by occupation- al category, the 1978-1980 NHIS estimates have also been compared with the 1970 NHIS estimates for selected smoking variables. A more detailed description of the NHIS data base is provided in the Technical Addendum to this section. Patterns of Employment Before characterizing the smoking behavior of the U.S. adult workforce, it wi1L be useful to describe the patterns of employment for men and women. As is shown in Table 1, men are more likely to be employed in professional and technical, management, and blue- collar occupations. Women are more. likely to be employed in professional and technical' and clericall and service occupations or to be homemakers. Although there was an increase in participation by women in white-collar occupations between 1970 and 1980, the ranking of occupational categories by their relative frequency for both sexes remained about the same in 1980 as it did in 1970. Because of their low relative frequency, farm, sales, and clerical workers, laborers, and service workers have less impact on the smoking behavior of the total male workforce, and female farm workers, laborers, craftsmen and kindred workers„ sales workers, and managers. and administrators have a modest impact on the smoking behavior of thetotal female workforce. Smoking Prevalence Surveys have repeatedly shown that blue-collar workers are more likely than white-collar workers to smoke cigarettes (US DHEW 1~979).Recent estimates from NHIS continue to substantiate this finding(Table 2). Overall, smoking rates for blue-collar men (47.1 percent) exceed that of white-collar men (33.0 percent). The same pat'tern holds for women, but is less pronounced,, with smoking rates among blue-collar women (38.1 percent) exceeding that of white- collar women (31.9' percent). Among women, this white-collar-blue- 23

0 TABLE 2.-Estimates of the percentage of current smokers by sex, age, and occupation, aged 20 to 64 years, United States, 1978-1980 Tmd (yrren::5 emPloyed Fy,teanhas totel Prateraianal. r.cknical. and Lndred worliers )Lneyers . and sdm~nistrators. .¢.pt fsrm 6Ie. workers (ler'sa1 and Ymdred workers IL.collar tmal'. L7.flsmenand kindrad~ ~rliers Opereuves and k:ndre wor<ers tahorcn, except (arm 3&2 34.2 31.4 33.3 3410' - 31.8 31.9. 31.9' 31.9 - 26.5 26.1 27.9 38.3 37.8 39-2 33.3 33.2 33.5. - 33.2 339 31.4 38.1 41.3'. 31.9 446, 45.4 43D' 37.0 40.2 30.8 36.2 43.0' 14.1' 37.4 39.8 32:7 22.6 31.3' 7:1' 396 41.7 30.4 33.0. 35.1 30.4 40.9 . 414 39.8 39.9 40.9 37.7 33.0 33.5 32.2 25.7 25.3 26.6 36.3 38:9 32.2 40.6 42D 38.0 37.7 -' 36.4 404 47.1 48.7 43.6 4&1 47h 42.6 48.6 50.4 44.5 48.8'. 47.3 45.1 47:5 48.3 46.0 31.5 28.9 34.5 53,1 53,9 60:8 . - - - '! Iq)eeses m the denammntor (unwefghted semplel R1rRCE= XstiunnlCente.r fur Health Stetuti¢e. Nationel Health Interview=Surveye. 197l1-19&1 (combined). 4 T,cYnmel A2d'endum.i For women 20 to 64'years of age, the highest smoking rates are found among craftsmen and kindred workers and managers and edministrators. Among women 20 to 44 years of age, there are also relatively high smoking rates among operatives and kindred work- ers, service workers, and the unemployed. The lowest rates. of current smoking occur among, professional', technical, and kindred *rorkers, regardless o8 age. For homemakers, the category represent- ing nearly 42 percent of alli women aged 20 to 64, the prevalence of emoking among those aged 20 to 44 is midway between the 25

Quitting Behavior Because cigarette smoking usually begins between the ages of 12 and 25 (US DHEW 1979; US PHS 1973, 1976) the prevalence of smoking among people 25 years of age or older is determined in large part by the rate at which they stop smoking (or die). The percentage of former smokers (as a portion of "ever smoked!') by occupational group is reported in Table 9. For men, relatively higher percentages of former smokers are found among professional, technical, and kindred workers (55.2 percent), and managers and administrators (47.7 percent~-the samee occupational groupss reporting lower rates of current smoking (Table.2). The striking feature for women is the uniformly lower percentage of former smokers when compared with men. However, even here the same general pattern can be found; occupations. that have lower rates of current smoking also tend to have a higher percentage of former smokers. In general, there are substantial differences by occupational category, with white-collar workers of both sexes having a higher percentage of former smokers than blue-colhar workers, This white-collar-blue-collar difference is most pronounced among men. Among women, homemakers tendto mirror the pattern of white-collar women. It does.not appear that the lower percentage of former smokers in blue-collar occupations occurs simply because blue-collar workers are less likely than white-collar workers to attempt to quit. Among men, white-collar current smokers are more likely to report "a serious attempt" to quit smoking (Table 10), but these differences are typically only half as large as the white-collar-blue-collar differences in the proportion of former smokers. Among women, the white- collar-blue-collar differences are relatively small and show a mixed pattern. Recent Changes in Smoking Behavior A comparison of smoking estimates for the period 1970-1980 reveals several interesting changes by occupational group and sex (Table 11). Among men, there was a 199 percentproportionate decline in smoking prevalence between 1970 and 1980 for white-collar workers (40.8 vs. 33.0 percent), compared with~ a 14 percent decline for blue-collar workers (55.0 vs. 47.1 percent). Occupations with the largest decline in male smoking include professional, technical, and kindred occupations (21 percent decline), and fa= workers (20.7 percent t decline); the unemployed (3.6 percent')) and servicee workers (10.9 percent)') had the smallest proportionate declines in smoking prevalence. Among white-collar women, there was a proportionate reduction in smoking prevalence of 11.6 percent between 1970 and: 1980 (36.1 33

TABLE 5.-Estimates of average daily cigarette consumption among current smokers by sex, age, and occupation, aged 20 to 64 years; United States, 1978-1980 Occupation Total Currently employEd, Whitecoilar total Professional, technical, and kindred workers. Managers.and - admiitistrators, except.farm Sales workers Clericsl and kindted workers Bluecrollar total Craftamen and kindred wonke,s. Operatives and kindred workers laborers, except farm SErvice. Ferm Unemployed Usual acttvity, homemaking Women Men Total 20-44 45-64 Total 20-44 45-64 19.3 19.1 19.8 23.2 22.2 25.1 192 19,0 19.8 23.4 22.4 25.6 19.5 19.1 20.4 7.1.0 22.6 26.9' 18.3 17:9' 19.3 21.5 19.8 25.4 21.1 20.6 220 26.2 25.2 28.1 19.1 18:0 21.0 25.1 22.7 30.3 19.6 194 20.1 22.3 21.8 23.2 198 19.9 19.4~ 23.3 22.6 25.1 22.4 22.3 22.5 24.4 23.7 26,1 19.2 19.5 18:4 22.4 21.7 24.2 18.9 18.1 25.6' 21.5 20.9 23.6 19.0 190 18.9' 21.5 19.9 24.7 18.0 18.0. 18:0 2019 20.2 21.7 21.2 21.2' 218 21.5 20.1 26.0 19.4 19.4 19:4 ~ - - - SOURCE: YatlonaliCente. for Health Stat'arics: Naponal Haslth Imerview Sur.veye, 199B-19e0 (wmbined)~ (Bee Technical Addendum.l _ . to report a higher percentage of heavy smokers than their 20- to 44- year-old counterparts. Age of Initiation Men employed as blue-collar workers initiate smoking approxi- mately 1,4 months'earlier, on the average,, than men employed in white-collar occupations (Table 8)i The earliest ages of initiation are 29 0 a

TABLE 1.-Estimates of the occupational distribution of men and women, aged 20 to 64 years, United States, 1970-1980 Men Wamen Occupatian 1970' 1978~0 1970 1978-80 Currently employed 87.8 85.1 47.9 57.3 White<ollartotal 39.2' 39.2 31.1 40:5 Proferoionall, technical, and kindred workers 14.2 14.9 7.9 11.4 Managers.and adminiatrators, except.farm 8ales workers 10.3' 5.0 13.5. 5.3: 2.6 3.4 4:9 3.6 Clerical and kindred warkers 6.8 5.5 171 20.6 Bluetdlar tatal 43.1 40.8 9.0 9.3 CrafYsmen und kindred workers 19.9 20.'! 0.$ 15 Operativeaand kindred; workers 18:1 14.6 8.0 7.2~ Lsborers, except farm, S i 5.1 5 5.6 6 0.2 0.6 ' erv ce Farm Unemployed .4 3.7 36 .1 2.9 4.1 10;3 0.5 32 10.8 0$ 4.3 Ueual actlvity, homemaking - - 62:5 41.7 NOTE:.T6c whitecollar, bluecollar,aenice, end Ysrm occupationel rateqoriee ure mutually exdusive; hawever; thoee claaelBed es "Homemaking" or"tUnemployad"may alen he clessified in an «<upatlonal igroup an the hasls of erx.ont or part timeji,b, resulting in eamoll degree ofnverlep betrean racegories. SOURCE. NotionuliCenter for Health5tatience; NetionalHealth [ntervlew Surveye, 19/0 and 197~19gp. (combinedL (See TeahniesliAddendum.) ) collar difference exists only for the younger age group (aged 200 to 44); for older women (aged 45 to 64) there is virtually no difference in smoking prevalence between these two categories of workers. For men, the highest rates of current smoking occur among craftsmen and kindred workers, operatives and kindred workers, laborers, service workers, and the unemployed. The lowest smoking rates for men occur among professional, technical, and kindred workers, managers and administrators, clerical and kindred work- ers, and farm workers. 24

prevalence rates for whitecollar and blue-collar occupations: How' 2 school teachers have the lowest rates of current smoking, all unde contrast, electrical and electronic engineers, lawyers, and second more cases in the 1978-1980 NHIS), each exceeding 50 percent. highest rates of current.smoking.(among occupations having 100'a carpenters, aut'o mechanics, and guards and watchmen have the'_ (Table 3) shows that painters, truck drivers, construction worke Among men, a more detailed breakdown of smoking by occupati6 lence. homemakers all having approximately the. same smoking preva by occupational group (with the single exception of managers an administrators); with white collar-workers, blue-collar workers, an ever, among women 45 to 64 years of age, smoking rates vary little practical nurses have among the highest rates (Table 4). Because of the exemplar role of physicians and nurses in regard toi health, their smoking rates are of special interest. Although the; sample is relatively small, physicians have among the lowest rates oiz current smoking. (18.1 percent). Among nurses, the pattern of smoking reflects the white-collar-service worker distinction; regis~ tered nurses have among the lowest rates of current smoking, but ers, bank t'ellers; and sewers and stitchers. or surpass 40 percent. The lowest rates of smoking occur among women employed as elementary school teachers, food service workj and wrappers-all of whom have rates of current smoking that equ blers, nurses aides, machine operators, practical nurses, and packers smoking than other groups (Table 4), followed by cashiers, assem= Among women, waitresses have a noticeably higher rate of curren 25 percent, smokers consume 19.5 cigarettes per day, compared with 19.8 collar and blue-collar smokers. On the average, white-collar female For women~ no difference in consumption is found between white~ occupationalcategories.. as there may be a substantial underreporting of cigarette consump: tion, and the tendency to underreport may not be constant across cigarette consumption and need to be interpreted with some caution; administrators and sales workers. These numbers represent daily groups, adult men report an average daily consumption exceeding 20 cigarettes: Consumption levels are highest among managers and essentially the same as the.number of cigarettes consumed hyblue• collar smokers (23.3) (Table 5). In virtually all occupationali sub; For men, occupational differences in cigarette consumption do not' follow the same patterns observed for prevalence. On the.average;~ adult male white•collar smokers consume 24 cigarettes per day,i Daily Cigarette Consumption

rPABLE 3.---Specific occupations with highest and lowest estimates of current smoking, men, aged 20 to 64 years, United States, 1978-1980 Occupatiom. Current smokets (percentage) Highest rate.s. 1. Painters, construction and maintenance (510) 651 2. Truck drivels(715). 53.6 3. Constructiom labaress, euept carpenters' helpers (751) 53.0 4. Carpenters (416) 50.8 5. Auto mechanics (473) 50.5 6. Guards and wutchmen (962) 50.5 7. Janitors and sextnne (903) 49.8 8. Assemblets.(602)' 48.7 9. Electricians (430) 48.3 10. Sales,representatives, wholesale trade (282) 48.1 Lowest'~ ratea~. 11 Electrical and elect'ronic engineers (012) 16.2 2. Iawyers(031). 2119 3. Sewndary scLool teachers (144) 24.9 4. Accountants. (001) 26.8 5. Real estate agents and brokera (B70)'. 27.8 6. Farmets (8f/]) 281 NQTE: Adapted from Table 22in TecFnira4Addendum.Only those.occupations with at lemt 100 men iaged RO m 64i in the 1978-18@0 NHIS are includedl Num6ere in parentheses denote eode.values from theC.S. Bureau of the C:nsns 1970.c1aasifieaHOmof oaeupetiem. C+OE!RCEe National Center for Heatthstatistiie, National Health Interview Surveys, 197~1980 icombined). (6ee TnNnlml iAddendLm.) cigarettes for blue-collar smokers, 19.4 cigarettes for homemakers, and 19.0 cigarettes for service workers. Female smokers employed as managers or administrators or as craftsmen or kindred: workers report the highest censumption levels, averaging more than 20 cigarettes per day; women employed in professional,, technical, or kindied occupations report lower average daily consumption. How- ever, like the men, these differences are.notlarge; averaging.fewer than two to four cigarettes per day. The higher the average daily consumptionn of cigaretteswithin an occupational group, the more likely it is. that this group will also contain a higher percentage of heavy smokers (more than 20 or more than 40 cigarettes a day). Overall, 72 percent of the male smokers employed: in white-collar occupations reported smoking more than 20 27