Teen cigarette, smokeless tobacco uses decline substantially

EDITORS: Results of this survey are scheduled to be announced at a news conference in Washington, D.C., at the Department of Health and Human Services Hubert H. Humphrey Building. Participating in the release of results will be Secretary of Health and Human Services Donna E. Shalala, Director of the Office of National Drug Control Policy Barry R. McCaffrey, Director of the National Institute on Drug Abuse Alan I. Leshner, and the principal investigator of the Monitoring the Future study, Lloyd D. Johnston. For further information on the study, contact Johnston at (734)763-5043.

ANN ARBOR—Cigarette smoking among American adolescents continues its “encouraging ongoing decline,” according to the latest results from the Monitoring the Future study, conducted at the University of Michigan Institute for Social Research (ISR). Reporting on the 26th national survey in the Monitoring the Future series, U-M psychologists Lloyd Johnston, Jerald Bachman, and Patrick O’Malley conclude that the improvements now occurring will have significant long-term consequences for the health and longevity of this generation of adolescents.

In the 2000 survey 15 percent, 24 percent and 31 percent of the 8th-, 10th- and 12th-graders, respectively, indicated smoking at least once in the prior 30 days. The proportions who were daily smokers were 7 percent, 14 percent, and 21 percent.

“Cigarette smoking rose sharply among American teenagers in the ’90s as we have been reporting,” states Johnston, principal investigator of the study, “and we know from our studies and other studies that these young people are now carrying their heavier smoking habits with them into their twenties, and very likely beyond. That’s why it’s so important for teen-agers not to become smokers in the first place.” Cigarette smoking is the leading preventable cause of death and disease in the United States.

After reporting a nearly 50 percent increase in the rate of smoking among younger teens—eighth- and 10th-graders—between 1991 and 1996, the study has been showing a fairly steady reduction in smoking since then. For instance, in 1991, 14.3 percent of eighth-graders said they had smoked at least one cigarette in the prior 30 days (called “current smoking”). The rate rose to 21.0 percent by 1996, but then began falling back, reaching 14.6 percent in 2000, including a 2.8 percentage point decline between 1999 and 2000. Among 10th-graders, the rate of current smoking was 20.8 percent in 1991, rose to 30.4 percent in 1996, and then fell steadily back to 23.9 percent by 2000.

Twelfth-graders showed a similar, but somewhat lagged, pattern of change: they started from a recent low in current smoking of 27.8 percent in 1992, rose steadily to 36.5 percent by 1997, and have since dropped back to 31.4 percent by 2000. All three grade levels showed statistically significant declines this year on one or more of the smoking measures—current smoking, current daily smoking, or current half-pack-a-day smoking.

“We haven’t yet regained all the ground lost early in the nineties, but have nearly done so with the younger teens, who are harbingers of what will be happening among older teens in a few years,” says Johnston.

Monitoring the Future is conducted at the U-M Institute for Social Research. The study has been supported since its inception 26 years ago through a series of investigator-initiated research grants made by the National Institute on Drug Abuse (NIDA), one of the National Institutes of Health in the U.S. Department of Health and Human Services. This year’s survey results are based on nationally representative samples of 8th, 10th, and 12th grade students attending public and private schools in the coterminous United States. In all, 45,200 students located in 435 schools completed the survey in the spring of 2000.

“Just as the earlier increase in smoking was very broad, showing up in virtually every demographic subgroup studied, so has the decline been very broad,” observes Johnston. It can be seen in all grade levels among both males and females, college bound and those not college bound, in all four regions of the country, in urban and non-urban areas, in all three of the largest racial ethnic groups (Blacks, Whites, and Hispanics), and across different levels of socioeconomic status. [Tables 2 and 3 ( links are .PDF files and require Acrobat or other PDF-reading program)]

“There are some major differences across these various groups in terms of their absolute rates of smoking,” says Johnston,” but all groups have been showing a decline.” The study finds smoking rates among African American adolescents to be considerably lower than among their White and Hispanic counterparts. College-bound students are also much less likely to smoke than those not planning to complete college. Smoking tends to be somewhat higher in non-urban areas than in urban areas; and, in the lower grades at least, smoking tends to be inversely related to the parents’ educational level.

While the increase in youth smoking in the early ’90s was accompanied by some decline in the proportion of students seeing a great risk associated with pack-a-day smoking, after 1995 this belief began to rise steadily at all three grade levels. This increase in perceived risk continued into 2000. Between 1995 and 2000, the proportion of students saying there is a “great risk” in pack-a-day smoking rose from 50 percent to 59 percent at eighth-grade, from 57 percent to 66 percent at 10th-grade, and from 66 percent to 73 percent at 12th-grade.

“Unfortunately the younger teens are not as aware of the dangers of smoking as the older ones,” Johnston says, “but this has been true for a long time. I think this change in perceived risk, which preceded the downturn in teen smoking by one to two years, may have been an important determinant of that downturn. And disapproval of cigarette smoking among teens, which also had been on the decline in the first part of the ’90s, began to rise a year or two after perceived risk turned around. It, too, may have contributed.”

What has caused these changes in teen attitudes and beliefs about smoking is open to conjecture. “I have to believe that all of the adverse publicity suffered by the industry during the sequence of political and legal events that finally led to the tobacco settlement with the states, had an influence,” observes Johnston. “Further, a number of states initiated vigorous efforts to reduce teen smoking during this time with ad campaigns and other efforts. Finally, the Joe Camel ad campaign folded its tent, and billboard advertising of cigarettes was ended. Any and all of those things may well have played a role in changing attitudes about smoking. Also, there have been some important increases in the price of cigarettes in the last few years, which undoubtedly contributed to the decline in use.”

For the younger teens, still another factor
Smokeless Tobacco

Cigarettes are not the only tobacco product showing a downward trend among youth. Rates of smokeless tobacco consumption by American teens have declined by even larger proportions. In the ’90s, peak rates of smokeless tobacco use among eighth- and 10th-graders were reached in 1994, when 7.7 percent of eighth-graders and 10.5 percent of 10th-graders indicated using in the prior 30 days. Use peaked among 12th-graders a year later, in 1995, when 12.2 percent of the 12th-graders indicated such use. Since those peak years, use has fallen fairly steadily, dropping by 45 percent among eighth-graders, 42 percent among 10th-graders, and 38 percent so far among 12th- graders. All grades showed some continued decline in 2000, though none of these one-year changes was large enough to be statistically significant. [Figure 2 (link is .PDF file and requires Acrobat or other PDF-reading program)]

Because boys are the predominant users of smokeless tobacco, their rates of use are considerably higher than the overall rates. Current use rates for boys in 2000 are 6.7 percent in eighth-grade, 11.4 percent in 10th-grade, and 14.4 percent (or one in every seven) in 12th-grade. Boys’ daily use rates at the three grade levels are 1.5 percent, 3.9 percent, and 6.5 percent, respectively.

“Smokeless tobacco can cause lip, throat, and tongue cancer and a number of other serious health problems,” notes Johnston, “so I see this large decline in its use by our young people to be a very positive development. Using smokeless or ‘spit’ tobacco also may well establish a dependence on nicotine which then leads to later cigarette smoking, when spitting all the time becomes intolerable to the user’s spouse and fellow employees.”

In addition to being heavily concentrated among boys, smokeless tobacco use is considerably higher among those not planning to attend college compared to the college-bound. It also tends to be disproportionately concentrated in more rural areas, in the South and North Central regions of the country, among Whites as opposed to Blacks and Hispanics, and in those coming from less educated families. Substantial declines in use are to be found in all groups, however, suggesting that there are culture-wide influences at work here.

As was true for cigarettes, students at all three grade levels have shown a steady increase since 1995 in the level of risk perceived to be associated with using smokeless tobacco regularly. And since 1996 the proportion of students disapproving of its use has been increasing, as well.

The annual surveys of high school seniors in the Monitoring the Future study were begun in 1975, and the annual surveys of eighth- and 10th-grade students were added, starting in 1991. At each grade level students are drawn to be representative of all students in public and private schools in the coterminous United States. They complete self-administered, optically-scanned questionnaires given to them in their classrooms in the spring of the year by U-M personnel. In 2000 the sample sizes for eighth-, 10th-, and 12th-grades, respectively, were 17,311, 14,576, and 13,286. In all about 45,200 students in 435 schools participated in the study.