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Health Objectives for the Nation Tobacco Use Among High School Students -- United States, 1990

Tobacco use is the single most preventable cause of death in the United States (1). Approximately half of smokers start smoking regularly before 18 years of age; however, among recent birth cohorts, age of smoking initiation has declined, especially among females (1). Data on tobacco use among adolescents help identify high-risk populations, design tobacco-prevention programs for these populations, and evaluate the effectiveness of broad efforts to prevent tobacco use among youth. This report examines the prevalence of self-reported current tobacco use and frequent cigarette smoking among U.S. students in grades 9-12 during 1990.

The national school-based Youth Risk Behavior Survey (YRBS) is a component of the Youth Risk Behavior Surveillance System, which periodically measures the prevalence of health-risk behaviors among youth through comparable national, state, and local surveys (2). The 1990 national school-based YRBS used a three-stage sample design to obtain a representative sample of 11,631 students in grades 9-12 in the 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands. The YRBS included the following questions on tobacco use: "On how many of the past 30 days did you smoke cigarettes?" and "On how many of the past 30 days did you use chewing tobacco or snuff?" Current tobacco use was divided into four categories: any tobacco use, cigarette use, frequent cigarette use, and smokeless tobacco use. Cigarette use was defined as smoking at any time during the 30 days preceding the survey, and frequent cigarette use was defined as smoking on more than 25 of the 30 days preceding the survey.

More than one third (36.0%) of all students in grades 9-12 reported tobacco use during the 30 days preceding the survey (Table 1). Cigarette use was the most prevalent form of tobacco use (32.3%); 10.1% of students used smokeless tobacco. The prevalence of tobacco use was significantly greater among male students (40.4%) than among female students (31.7%), especially for smokeless tobacco use (males, 19.1%; females, 1.4%). The prevalence of tobacco use also was significantly greater among white students (41.2%) than among Hispanic (32.0%) or black (16.8%) students. Tobacco use increased by grade of student, from 32.1% of 9th-grade students to 41.2% of 12th-grade students.

Thirteen percent of students used cigarettes frequently (Table 1). The differences in cigarette use between racial/ethnic groups and between grades were accentuated for frequent cigarette users. The prevalence of frequent cigarette use among white students (15.9%) was approximately seven times that among black students (2.3%) and approximately twice that among Hispanic students (7.4%). Among 12th-grade students, the prevalence of frequent cigarette use (17.7%) was almost twice that among 9th- grade students (9.9%). Reported by: Office on Smoking and Health, and Div of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Two of the national health promotion and disease prevention objectives for the year 2000 are to "reduce the initiation of cigarette smoking by children and youth so that no more than 15 percent have become regular cigarette smokers by age 20" (objective 3.5) and to "reduce smokeless tobacco use by males aged 12 through 24 to a prevalence of no more than 4 percent" (objective 3.9) (3). To achieve these objectives, programs for preventing tobacco use should be provided in all elementary, middle, and secondary schools--ideally, as part of quality school health education efforts and in conjunction with the establishment of tobacco-free environments on school premises (objective 3.10) (3). Carefully designed and implemented school- based programs for preventing tobacco use have proven effective in delaying onset of smoking among students (4). The National Cancer Institute has developed a guide for implementing effective school-based programs to prevent smoking (5).*

In addition to school-based programs, the national objectives call for the enactment and enforcement of laws prohibiting the sale and distribution of tobacco products to persons <19 years of age (objective 3.13) (3). By June 1991, 47 states and the District of Columbia had enacted laws restricting the sale of tobacco products to minors (CDC, unpublished data, 1991); however, these laws rarely are enforced (6). Other effective strategies may include raising state excise taxes on tobacco products (1), restricting tobacco-product advertising and promotion that target youth <18 years of age (objective 3.15) (3), and banning the sale of cigarettes through vending machines (7,8). A recent survey in 10 communities indicated widespread support for policies that limit minors' access to, and use of, tobacco products (9). The reduction of tobacco use among adolescents will require cooperative efforts by local and state health and education officials, parents, physicians, media, legislators, regulatory agencies, and community youth organizations to implement these strategies.


  1. CDC. Reducing the health consequences of smoking: 25 years of progress--a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411.

  2. Kolbe LJ. An epidemiological surveillance system to monitor the prevalence of youth behaviors that most affect health. Health Education 1990;21:44-7.

  3. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives--full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991:143-52; DHHS publication no. (PHS)91-50212.

  4. Glynn TJ. Essential elements of school-based smoking prevention programs. J School Health 1989;59:181-8.

  5. Glynn TJ. School programs to prevent smoking: the National Cancer Institute guide to strategies that succeed. Washington, DC: US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1990; DHHS publication no. (NIH)90-500.

  6. CDC. State laws restricting minors' access to tobacco. MMWR 1990;39:349-53.

  7. CDC. Cigarette advertising--United States, 1988. MMWR 1990;39:261-5.

  8. Public Health Service. Model Sale of Tobacco Products to Minors Control Act. Washington, DC: US Department of Health and Human Services, Public Health Service, 1990.

  9. CDC. Public attitudes regarding limits on public smoking and regulation of tobacco sales and advertising--10 U.S. communities, 1989. MMWR 1991;40:344-5,351-3.

    • One to three copies can be obtained from the National Cancer Institute (NCI); telephone (800) 422-6237 ([800] 4-CANCER). For four or more copies, write NCI, Building 31, Room 10A-24, 9000 Rockville Pike, Bethesda, MD 20892.

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