Despite the increase in use of e-cigarettes among adolescents, cigarette and smokeless tobacco prevalence declined more rapidly between 2012 and 2019 than in previous periods, according to a new study.

Rafael Meza

The analysis by the University of Michigan and Georgetown University shows that past 30-day and daily use of both cigarettes and smokeless tobacco fell more rapidly since 2012, even as e-cigarette use began to increase—leading to historical low levels of both cigarette use and smokeless tobacco among teens in the United States.

“While the increases in e-cigarettes are indeed concerning and is something we need to address and reverse, the decreases in other tobacco products, in particular, cigarettes—the most concerning form of tobacco use—are accelerating,” said lead researcher Rafael Meza, associate professor of epidemiology and global health at U-M’s School of Public Health.

We are in a stage where cigarette smoking is going away. That’s something that we need to highlight and celebrate.
Rafael Meza

“We are in a stage where cigarette smoking is going away. That’s something that we need to highlight and celebrate. This acceleration in the decrease occurs across grades, across races, across sexes. So it’s really occurring across the board and suggests that it’s a general pattern, that kids are just not into smoking anymore.”

Meza and colleagues wanted to understand long-term and recent trends in cigarette smoking and smokeless tobacco product use among adolescents by grade (8th, 10th, 12th), gender and race. Utilizing data from the nationally representative Monitoring the Future survey at U-M from 1991 to 2019, they examined the use prevalence of tobacco products in the last 30 days among key sociodemographic groups, identifying change of trend years for U.S. secondary and high schools.

Cigarette and smokeless tobacco prevalence declined more rapidly between 2012 and 2019 than in previous periods despite the increase in use of e-cigarettes among adolescents.

They found that daily smoking prevalence among 12th grade boys increased 4.9% annually 1991 to 1998, but saw annual declines of 8% between 1998 and 2006 and 1.6% from 2006 to 2012. However, from 2012 to 2019, prevalence declined at a 17% annual rate. Overall, Daily smoking prevalence among 12th graders fell to about 2% by 2019.

“This is an astoundingly low rate, and our goal from a public health perspective should be to keep smoking at this rate or lower,” said researcher David Levy, of Georgetown University’s Lombardi Comprehensive Cancer Center.

Similar results were observed for both boys and girls in all grades and for both African American and white teens. Smokeless tobacco use showed more variability through 2012, followed by consistent declines in the last five years. MTF data also shows similar rapid decreases in cigar and cigarillo use among adolescents in recent years, suggesting a general pattern across traditional tobacco products.

Cigarette and smokeless tobacco prevalence declined more rapidly between 2012 and 2019 than in previous periods despite the increase in use of e-cigarettes among adolescents.

Meza said the results are important because while e-cigarettes are concerning on their own, there have been concerns that the increase in use of e-cigarettes could result in an uptick in the use of other tobacco products, including cigarette smoking that could potentially upend the declines we’ve seen the last couple of decades.

“But in contrast, what we found is that the decline in smoking has accelerated,” he said. “So I think the good news is that the rapid increase in e-cigarette use has not yet resulted in a reversal of the decreasing trends of cigarette smoking and smokeless tobacco use, and if anything, those trends have accelerated.”

More information:

• Study: Trends in tobacco use among adolescents by grade, sex and race, 1991-2019
• Monitoring the Future
• Rafael Meza