State of the Union on Youth Smoking ‘Clearly Not Good’

WASHINGTON—The most comprehensive survey of tobacco use among young people has found that 12.8% of middle school students and 34.8% of those in high school reported using some form of tobacco product in the month prior to answering a questionnaire. Cigarettes were favored by most of the students, with cigars second.

The National Youth Tobacco Survey of more than 15,000 students was funded by the American Legacy Foundation (ALF) and released in collaboration with the National Foundation for the Centers for Disease Control and Prevention (NFCDC) on the day President Clinton delivered his State of the Union address. “The State of the Union on youth tobacco use is clearly not good,” ALF president Cheryl Healton, DrPH, said in a news release.

The survey was the first to measure current use of tobacco products nationally among middle school students and the first to assess the use of “bidis” and “kreteks,” two types of cigarettes gaining popularity among youth smokers.

“The results provide clear evidence that teenage tobacco use continues to be a major public health problem and that states need to fully implement CDC’s best practice guidelines for comprehensive tobacco prevention and control,” said Michael P. Eriksen, ScD, director of CDC’s Office of Smoking and Health.

The survey found that 9.2% of middle school students were current cigarette smokers (9.6% of males and 8.8% of females). Among high school students, 28.4% were current smokers (28.7% of males and 28.2% of females).

Black high school students had a significant lower rate of cigarette smoking, 15.8% vs 32.8% for whites and 25.8% for Hispanics (see Figure). Among middle school students, rates were similar—blacks, 9.0%; whites, 8.8%; and Hispanics, 11.0%.

“We do not know why there was no difference between smoking rates of blacks and other students in middle school, especially since black high school students smoke at much lower rates than their white and Hispanic peers,” said former AMA president Lonnie Bristow, MD, a member of the ALF board. “What we do know is that we must monitor this trend through research and hope to counter the appeal and social acceptance of tobacco use among all young people.”

ALF was established in November 1998 as part of the agreement that settled lawsuits against the tobacco industry by 46 states and five US territories. The foundation’s purpose is to support studies and programs to reduce youth tobacco use, and to study tobacco-related diseases and develop educational programs to prevent them. NFCDC is a nonprofit organization established by Congress to support CDC in its public health mission.

The survey was administered to students in grades 6 through 12 at 131 schools nationwide by Macro International, Inc. of Calverton, Md, and achieved a 93% response rate.

Among the survey’s other findings on tobacco products:

Cigars: Both middle school and high school students made cigars their second most favored tobacco product. Among high school students, 15.3% reported smoking cigars in the past month, with twice as many males (20.3%) as females (10.2%) acknowledging such use. Cigar smoking among middle school students was 6.1%, with blacks (8.8%) and Hispanics (7.6%) more likely to smoke cigars than whites (4.9%).

Smokeless tobacco: Snuff and chewing tobacco use stood at 6.6% for high school students, with a distinct gender gap: 11.6% of the high school males reported smokeless tobacco use vs 1.5% of the females. Among middle school students, the smokeless tobacco rate was 2.7% (4.2% of males; 1.3% of females).

Pipes: Pipe smoking was reported by 2.8% of high school students—4.2% of males and 1.4% of females. Overall, 2.4% of middle school students reported smoking pipe tobacco, with males at 3.5% and females at 1.4%.

Novel tobacco products: The survey also looked at the use of bidis and kreteks, two increasingly popular tobacco products among teens. Bidis (or beedies) are tiny, flavored cigarettes from India, often obtained through the Internet. Kreteks are also known as clove cigarettes. Among high school students, 5% smoked bidis and 5.8% smoked kreteks. In middle school, 2.4% reported bidis use and 1.9% reported smoking kreteks.

“This survey again shows the clear need for comprehensive programs to reduce tobacco use among young people,” said Matthew L. Myers, president, Campaign for Tobacco-Free Kids. “It is critical that state legislatures allocate a significant portion of the funds from the tobacco settlement to programs to discourage tobacco use. We have growing evidence in the few states that have implemented them that such programs work.”