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Perspectives in Disease Prevention and Health Promotion Cigarette Smoking among Public High School Students -- Rhode Island

From July 1983 through December 1984, as part of a health-risk survey, information was obtained from 11,657 Rhode Island public high school students about their cigarette smoking practices. Overall, 22.3% of these students reported that they smoked cigarettes. Cigarette smoking increased by grade and was more common among females (26.5%) than among males (17.5%). The difference between females and males was due primarily to a larger proportion of females who reported smoking less than one pack per day (Figure 1).

During this period, 19 (63.3%) of the 30 public high schools in Rhode Island took part in this health-risk assessment program. The ongoing program provides both prevalence estimates of cigarette smoking and other health-related behaviors and counseling to students with unhealthy behaviors. More than 99% of the students attending the 19 schools participated in the program. The 11,657 participants constituted 26.3% of all public high school students in Rhode Island. The participating students were demographically similar to all Rhode Island public high school students but were somewhat more likely to be female, other than white, and from low-income communities (Table 1). Reported by HD Scott, MD, L Marciano, MEd, R Cabral, PhD, Office of Health Promotion, Rhode Island Dept of Health; Behavioral Epidemiology and Evaluation Br, Div of Health Education, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: Cigarette smoking is presently the largest single cause of preventable morbidity and mortality in the United States (1). The prevalence of smoking has slowly declined over the past 2 decades, and over 30 million Americans have quit smoking since the first Surgeon General's report on smoking and health was released in 1964 (2). It has been estimated that, from 1964 to 1978, more than 200,000 premature deaths were prevented because some people stopped smoking, and others did not start (3). Nevertheless, approximately one-third of the U.S. adult population still smokes cigarettes, and there is some evidence that the prevalence of smoking is actually increasing among young white females (4). In addition, it has been estimated that at least 12 million people used smokeless tobacco (snuff and chewing tobacco) in the United States in 1985 (5). Use is increasing, especially among male adolescents and young male adults. Therefore, continued and even greater efforts to prevent the initiation of any tobacco use and to assist in the cessation of tobacco use are needed.

Smoking is an addictive behavior. Experimentation and adoption of the habit usually occur during adolescence; therefore, prevention programs frequently focus on this group. Rhode Island's data-collection system represents one approach to collecting data on smoking habits of teenagers. The data are self-reported and may underestimate the true prevalence of cigarette smoking. Although not a state-wide random sample, the demographic characteristics of the participants are similar to those of all public high school students, and the data probably are a good representation for the state-wide public school population.

The National Institute on Drug Abuse (NIDA) collects data each year on a national cross-section of public and private high schools (6). Among high school seniors in 1983, NIDA estimates a prevalence of daily cigarette smoking of 19% for males and 22% for females. This gender difference is less than that seen in Rhode Island. However, the categories of number of cigarettes smoked in the NIDA survey and the Rhode Island program are different, so direct comparison is not possible.

The Rhode Island data confirm that smoking among high school students is more common among young females than young males. Continued efforts to prevent the onset of smoking among young people are necessary. Because of the growing use of smokeless tobacco among children and adolescents (5), these efforts should also be directed toward preventing the use of smokeless tobacco products in this age group. The Rhode Island program is an example of one method to monitor the overall effect of these efforts.


  1. Fielding JE. Smoking: health effects and control (1). N Engl J Med 1985;313:491-8.

  2. Office on Smoking and Health. Smoking and health. A report of the Surgeon General. Rockville, Maryland: US Department of Health, Education, and Welfare, Public Health Service, 1979. DHEW publication no. (PHS) 79-50066.

  3. Warner KE, Murt HA. Premature deaths avoided by the antismoking campaign. Am J Public Health 1983;73:672-7.

  4. Remington PL, Forman MR, Gentry EM, Marks JS, Hogelin GC, Trowbridge FL. Current smoking trends in the United States. The 1981-1983 behavioral risk factor surveys. JAMA 1985;253:2975-8.

  5. Public Health Service. The health consequences of using smokeless tobacco. A report of the Advisory Committee to the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service. NIH publication no. 86-2874.

  6. Johnston LD, O'Malley PM, Bachman JG. Drugs and American high school students, 1975-1983. Rockville, Maryland: National Institute on Drug Abuse, 1984. DHHS publication no. (ADM) 85-1374.

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