Pipe smoking in the United States, 1965-1991: Prevalence and attributable mortality

Background. National pipe-smoking prevalence data have rarely been reported, and mortality associated with pipe smoking has not been estimated. Methods. We analyzed National Health Interview Survey data from 1965, 1966, 1970, 1987, and 1991 to estimate adult pipe-smoking prevalence in the United States. For each of these years, we estimated pipe smoking-attributable mortality from chronic obstructive pulmonary disease and cancers of the oral cavity, larynx, esophagus, and lung. Results. From 1965 to 1991, the prevalence of current pipe smoking for men declined 12.1 percentage points (from 14.1% to 2.0%) while pipe smoking remained very uncommon among women. By 1991, pipe smoking was a behavior found primarily among men age 45 years or older. Most men who smoked pipes also used other tobacco products, especially cigarettes. About 830 deaths (range 720-2,495) in 1965 and 1,095 deaths (range 655-2,820) in 1991 were attributable to pipe smoking. Conclusions. If current trends continue, pipe smoking will become extremely rare in the United States by the year 2000. Reasons for the decline in pipe smoking may include the lack of appeal of pipe smoking to women and adolescents or the increasingly unfavorable image of smoking behavior in general. Prevention and cessation efforts need to be directed against all forms of tobacco, including smokeless tobacco use, cigar smoking, and pipe smoking.