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CDC Telebriefing Transcript
Teen Smoking Rates Decline Significantly

May 16, 2002

CDC MODERATOR: Good afternoon and welcome to today's telebriefing. Today, Dr. Terry Pechacek will be discussing the article entitled "Trends in Cigarette Smoking Among High School Students--United States, 1991 through 2001" that is appearing in today's "Mortality and Morbidity Weekly Report."

Dr. Pechacek will open with comments, followed by questions and answers.

Dr. Pechacek, are you ready to begin?

DR. PECHACEK: Yes. Good morning.

We are very pleased to report today that our analysis of the youth risk behavior surveillance system data from the Youth Risk Behavior Survey, which is conducted nationwide every two years, since 1991, has indicated that rates of smoking among high school students are declining significantly.

As many of you are aware, during the 1990's, we were very concerned about the fact that smoking rates among students in several surveys, several national surveys, have been showing that the rates were continuing to increase.

This increase continued into the late 1990's. This survey, the Youth Risk Behavior Survey, is the tracking survey on which the national health objectives are based and is our primary surveillance for progress we're making in this leading health indicator of smoking rates among teens.

This rate of smoking among teens, and the YRBS had increased from 1991 through 1997, and rates have increased from 27.5 percent in 1991 up to 36.4 percent in 1991 [sic. The accurate date is 1997].

We're very pleased to see that now that rates have declined in 2001 down to 28.5. So the increase that we saw throughout the 90's is being reversed, and the pattern that we're seeing in 1991 and in 2001 indicate that if this downward trend continues, the U.S. could reach its 2010 national health objective of reducing current smoking rates among teenage students to 16 percent or less, which is our national objective.

This could have major health implications and we are encouraged by this decline through 2001, but we also think it's important to focus on the fact that continued reduction in cigarette smoking among youth will require us to maximize our current efforts, and continue our current efforts at the state, federal, and local level to ensure that comprehensive programs are being implemented.

We feel like that we're making a lot of progress, but a few things cause us to be of continuing concern. One of the facts, we are seeing a decline across all groups, and that is good, but we're seeing that the rates of smoking are still highest among white and Hispanic students, and that the rates among black students are lower, but that the rate of decline is less in the, particularly the black females.

They start starting to tend down, but in several groups we see the increase continuing on through 1999. So that the progress is much more recent in some groups.

This is all the types of indicators that indicate to us that while we're making progress, and while the rates are starting to turn down, that we need continued effort both in increasing price, in countermarketing, in limiting the exposure of youth to advertising, but particularly in school programs and school policies, where we feel like that we're starting to make progress but we want to see more progress.

So this is what the good news is and as well as what we see as the challenge for the future.

CDC MODERATOR: Thank you, Dr. Pechacek. We're now ready to take questions.

AT&T OPERATOR: Thank you. Ladies and gentlemen, if you wish to ask a question please press one on your touchtone phone. You will hear a tone indicating you've been placed in queue, and you may remove yourself from queue at any time by pressing the pound key.

If using a speaker-phone, please pick up your handset before pressing the number.

Once again, if you do have a question or a comment, please press the one on your touchtone phone at this time.

Our first question will come from the line of Adam Marcus at HealthScout. Please go ahead.

MR. MARCUS: Hi. Thanks for holding the briefing. I had a question about the relationship, if any, between tobacco use among adolescents and the overall economic picture, and whether the downturn in the economy might be expected to lead to any changes in teen smoking rates?

DR. PECHACEK: Well, we don't specifically measure a number of those variables in this survey. What we know from the general literature is that price has a very large effect on youth and that price did increase during this period between December '97 and 2001, spring 2001. There was about a 70-percent increase in their average retail price of cigarettes.

In this survey, we do not monitor youth disposable income. Some other studies have suggested that youth disposable income is related to levels of smoking. And therefore, as the employment picture becomes a little tighter or there may be less disposable income, and at the same time price of cigarettes are increasing, the other data would suggest that that could be one of the factors related to this decline in smoking.

QUESTION: Thank you.

CDC MODERATOR: Thanks, Adam.

Could we have our next question?

AT&T OPERATOR: Our next question will come from the line of Steve Mitchell at United Press. Please go ahead.

QUESTION: Hi. My question concerns price. That seems to be one of the major factors for the downturn here. Is that something that we can continue to increase or is that going to, at some point, reach a threshold?

The other thing is can you sort of elaborate on what might explain the racial differences.

DR. PECHACEK: Question No. 1, with respect to price, we do have a national health objective to increase the average excise tax on cigarettes to $2 by the year 2010. Now we are currently about 84 cents, so that that other health objective, if we continue to make progress toward higher average excise tax, would suggest that price could remain a factor.

We do know that in a large number of states that excise taxes have been increased since 2001 over this last legislative cycle, and other states are considering it, and that the average retail price of cigarettes continues to go up. In fact, there was news from the Consumer Price Index today about the fact that cigarettes continue to increase in price.

We are cautious about the effect that--how much we can expect price to be a primary contributing factor on our continuing decline, and that's why we're stressing the need for sustained, comprehensive program efforts.

A couple of the factors that we feel like have contributed beyond price are the fact that effective countermarketing campaigns are much more available to youth in recent years, both state campaigns in many of the large states, such as California and Florida, Texas, as well as Arizona, Massachusetts, Oregon, but also the American Legacy has now had a national truth campaign to focus on youth smoking preventions since February 2000. We need to maintain those kinds of countermarketing campaigns to offset the large multi-billion-dollar advertising campaigns of the tobacco industry.

Additionally, we have seen school programs increasing in recent years, both in the teaching of tobacco use prevention, as well as the increase of tobacco-free policies, and we feel like those are very important types of environments that reach all youth of the target ages, middle and high school programs and policies.

So there's a variety of things that we feel like are necessary.

Now, with respect to the racial/ethnic differences, there's been a variety of analyses, and no definitive conclusion, as to why the African American rates were lower and dropped in the 1980s, and then were lower coming into the '90s. Unfortunately, the African American rates did continue to increase, from a lower point, but they were increasing as rapidly or more rapidly on a percentage basis than in white and Hispanic.

This increase cut back on much of the success we had seen in the early '90s in the African American--we know that there were, from the basic research being done, that there were some broad cultural differences in how parents, and families, and social groups were treating tobacco. Specifically, African American families tended to treat nicotine as any other drug. In other words, nicotine was as bad as marijuana, as bad as cocaine, and was treated as a dangerous drug. Whereas, the non-Hispanic white families tended to put tobacco in a bad, but not as bad-type category. In other words, my adolescent is smoking, but at least he's not using cocaine. And that type of difference I think may be one of the factors that's important.

CDC MODERATOR: Thanks, Steve.

Next question?

AT&T OPERATOR: The next question will come from the line of Aaron McClean at Associated Press. Please go ahead.

QUESTION: Hi. Thanks very much. I was wondering, first of all, if you could give me the sample size for the 2001 survey. I don't see it in the report.

Secondly, I was talking to a tobacco industry spokesman earlier today, and he said that it's his belief that raising the cigarette tax doesn't really cut down on smoking, the teens just go and look for cheaper cigarettes and keep on smoking.

I was wondering if you have had good data that shows a direct link between raising the price and a decrease in the smoking rate.

DR. PECHACEK: Well, first of all, on the sample size, the sample size in 2001 was 13,601. The sample sizes across the years 1991 through 2001 have varied from about 11,000 up to 16,000, and response rates, the overall response rate in 2001 was 63 percent and has been over 60 percent for all of the years.

With respect to the efficacy of price preventing youth smoking, there is a very large literature base. What the health economists who carefully looked at this have found is that the increase in price does impact youth smokers. It particularly impacts those smokers who are at risk for transitioning from occasional smoking to regular or more frequent smoking. "Frequent" we define as 20 or more days in the past 30 days. Some other people would define it as daily smoking or almost daily smoking.

And that transition is where price particularly impacts youth. Youth will tend to find cigarettes for experimentation by borrowing, stealing it from parents, from friends, so that that might be less price sensitive. But once they're forced into regularly buying their own cigarettes, they are, in fact, more price sensitive than adults, the research finds.

While there has been this suggestion by some that they would go to cheaper cigarettes, in fact, when we are tracking the brands of cigarettes that they buy, they continue to buy the premium brands of cigarettes. The image of which brand they are smoking is very important, and it's very rare, less than 5 percent of youth, are smoking the generic-type-brand cigarettes. It's almost none are smoking the discount brands of cigarettes.

QUESTION: Thank you.

CDC MODERATOR: Thanks, Aaron.

Next question, please?

AT&T OPERATOR: Once again, ladies and gentlemen, if you do have a question or comment, please press the one at this time.

We have nobody queuing up at this time. Please continue with your presentation.

CDC MODERATOR: Well, since we have no more questions, we'd certainly like to thank everybody for joining us on the telebriefing. The transcript will be available on-line this afternoon at on the media relations page.

Also, please, for more information on the CDC's tobacco control activities, please visit the CDC's OSH website at

Thank you, again, for joining us this afternoon.

[Whereupon, the teleconference concluded.]

Listen to the telebriefing

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