Cigarette Use Among High School Students --- United States, 1991--2005
Cigarette use is the leading preventable cause of death in the United States (1). A national health objective for 2010 is to reduce the prevalence of current cigarette use among high school students to <16% (objective no. 27-2b) (1). To examine changes in cigarette use among high school students in the United States during 1991--2005, CDC analyzed data from the national Youth Risk Behavior Survey (YRBS). This report summarizes the results of that analysis, which indicated that, although lifetime, current, and current frequent cigarette use was stable or increased during the 1990s and then decreased significantly from the late 1990s to 2003, prevalence was unchanged during 2003--2005. To achieve the 2010 objective, the downward trend in youth smoking must resume.
The biennial national YRBS, a component of CDC's Youth Risk Behavior Surveillance System, used independent, three-stage cluster samples for the 1991--2005 surveys to obtain cross-sectional data representative of public and private school students in grades 9--12 in all 50 states and the District of Columbia. Sample sizes ranged from 10,904 to 16,296. For each cross-sectional national survey, students completed anonymous, self-administered questionnaires that included identically worded questions about cigarette use. School response rates ranged from 70% to 81%, and student response rates ranged from 83% to 90%; therefore, overall response rates for the surveys ranged from 60% to 70%.
For this analysis, temporal changes for three behaviors were assessed: lifetime cigarette use (i.e., ever tried cigarette smoking, even one or two puffs), current cigarette use (i.e., smoked cigarettes on >1 of the 30 days preceding the survey), and current frequent cigarette use (i.e., smoked cigarettes on >20 of the 30 days preceding the survey). Race/ethnicity data are presented only for non-Hispanic black, non-Hispanic white, and Hispanic students (who might be of any race); the numbers of students from other racial/ethnic groups were too small for meaningful analysis.
Data were weighted to provide national estimates, and the statistical software used for all data analyses accounted for the complex sample design. Temporal changes were analyzed using logistic regression analyses, which controlled for sex, race/ethnicity, and grade and also simultaneously assessed linear and quadratic time effects. Quadratic trends indicate a significant but nonlinear trend in the data over time (e.g., a leveling off or statistically significant change in direction). Trends that include significant quadratic and linear components demonstrate nonlinear variation in addition to an overall increase or decrease over time. Differences in lifetime, current, and current frequent cigarette use comparing 2003 with 2005 were assessed for statistical significance using t tests.
Significant linear and quadratic trends were detected for lifetime, current, and current frequent cigarette use (Table 1). The prevalence of lifetime cigarette use was stable during 1991--1999 and then declined significantly from 70.4% in 1999 to 54.3% in 2005. The prevalence of current cigarette use increased from 27.5% in 1991 to 36.4% in 1997 and then declined significantly to 23.0% in 2005. The prevalence of current frequent cigarette use increased from 12.7% in 1991 to 16.8% in 1999 and then declined significantly to 9.4% in 2005. No statistically significant differences in lifetime, current, or current frequent cigarette use overall were detected between 2003 and 2005.
For current cigarette use, significant linear and quadratic trends were detected among all sex and grade subgroups and among white and Hispanic students, with patterns of use during 1991--2005 similar to those for current cigarette use overall (Table 2). Among black students, a significant quadratic but not linear trend was detected. The prevalence of current cigarette use among black students increased from 12.6% in 1991 to 22.7% in 1997 and then declined to 12.9% in 2005. Current cigarette use among white females and males and Hispanic females and males demonstrated significant linear and quadratic trends, whereas among black females and males, only a significant quadratic trend was found. Comparison of current cigarette use between 2003 and 2005 for all subgroups revealed no significant differences, except among black males, whose current cigarette use declined from 19.3% to 14.0% (p<0.05).
Reported by: Office on Smoking and Health, Div of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.
The findings in this report that the prevalence of lifetime, current, and current frequent cigarette use among high school students was unchanged from 2003 to 2005 is consistent with trends observed in other national school-based surveys, suggesting that the national decline in youth smoking observed during 1997--2003 might have stalled (2--3). Factors that might have contributed to this lack of continued decline include smaller annual increases in the retail price of cigarettes during 2003--2005 compared with 1997--2003, based on the Consumer Price Index (4); potentially less exposure or availability among youths to mass media smoking-prevention campaigns funded by states or the American Legacy Foundation (5); less funding for comprehensive statewide tobacco-use prevention programs (5); and substantial increases in tobacco industry expenditures on tobacco advertising and promotion in the United States from $5.7 billion in 1997 to $15.2 billion in 2003 (6). Additionally, after decades of decline, smoking in movies, which has been linked to youth smoking, increased rapidly beginning in the early 1990s and by 2002 was at levels observed in 1950 (7).
The findings in this report are subject to at least two limitations. First, these data only include youths who attend school and thus are not representative of all persons in this age group. Nationwide in 2001, approximately 5% of youths aged 16--17 years were not enrolled in a high school program and had not completed high school (8). Second, the extent of underreporting or overreporting behaviors cannot be determined, although the survey questions have demonstrated good test-retest reliability (9).
The national health objective for 2010 of reducing current cigarette use among high school students to <16% to reduce smoking-associated morbidity and mortality can be achieved only if the annual rate of decline observed during 1997--2003 resumes. Evidence-based strategies that can increase the rate of decline in youth smoking include greater exposure to effective media campaigns, comprehensive school-based tobacco-use prevention policies and programs in conjunction with supportive community activities, and higher retail prices for tobacco products (10).
- US Department of Health and Human Services. Healthy people 2010: understanding and improving health. 2nd ed. Washington, DC: US Department of Health and Human Services; 2000. Available at http://www.health.gov/healthypeople.
- Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Monitoring the future: national results on adolescent drug use---overview of key findings 2005. Bethesda, MD: National Institute on Drug Abuse; 2006. NIH publication no. 06-5882.
- CDC. Tobacco use, access, and exposure to tobacco in media among middle and high school students---United States, 2004. MMWR 2005;54:297--301.
- US Department of Labor. Consumer price index---all urban consumers. U.S. city average, cigarettes. Washington, DC: US Department of Labor, Bureau of Labor Statistics; 2005. Available at http://data.bls.gov/labjava/outside.jsp?survey=cu.
- Campaign for Tobacco-Free Kids, American Lung Association, American Cancer Society, American Heart Association. A broken promise to our children: the 1998 state tobacco settlement seven years later. Washington, DC: National Center for Tobacco-Free Kids; 2005. Available at http://www.tobaccofreekids.org/reports/settlements/2006/fullreport.pdf.
- Federal Trade Commission. Cigarette report for 2003. Washington, DC: Federal Trade Commission; 2005. Available at http://www.ftc.gov/reports/cigarette05/050809cigrpt.pdf.
- Charlesworth A, Glantz SA. Smoking in the movies increases adolescent smoking: a review. Pediatrics 2005;116:1516--28.
- Kaufman P, Alt MN, Chapman C. Dropout rates in the United States: 2001. Washington, DC: US Department of Education, National Center for Education Statistics; 2004. Publication no. NCES 2005--046.
- Brener ND, Kann L, McManus T, Kinchen SA, Sundberg EC, Ross JG. Reliability of the 1999 Youth Risk Behavior Survey questionnaire. J Adolesc Health 2002;31:336--42.
- Zaza S, Briss PA, Harris KW, eds. The guide to community preventive services: what works to promote health? New York, NY: Oxford University Press; 2005.
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