Office of the Vice President for Global Communications

Wednesday, December 19, 2012

Decline in teen smoking continues into 2012

The 2012 national survey results from the Monitoring the Future study show a continuation of the declines in teen smoking in all three grades under study — grades eight, 10, and 12.


Related story
Use of most illicit drugs by teenagers holding steady; possible turnaround seen in alcohol use

• Learn more about the study at the Monitoring the Future website.

Based on annual surveys of 45,000 to 50,000 students, the researchers found that the percentage saying that they smoked at all in the prior 30 days fell for the three grades combined, from 11.7 percent to 10.6 percent — a statistically significant drop.

"A one-percentage-point decline may not sound like a lot, but it represents about a 9 percent reduction in a single year in the number of teens currently smoking," said Lloyd Johnston, the principal investigator of the study. "Such a reduction can translate eventually into thousands of premature deaths being prevented, as well as tens of thousands of serious diseases."

More than 400,000 Americans per year are estimated to die prematurely as a result of their smoking cigarettes, and most smokers begin their habit in adolescence.

There was some evidence from the study that in 2010 the long-term decline in teen smoking might have come to a halt, but the decline resumed in 2011 and has continued into 2012 with statistically significant declines both years. An increase in the federal tax on tobacco products, instituted in 2009, may have contributed to this recent decline in smoking in this age group, according to the investigators.

The Monitoring the Future study, which has been tracking teen smoking in the United States for the past 38 years, found that between 2011 and 2012 the percentage of students reporting any cigarette smoking in the prior 30 days has decreased among eighth-graders from 6.1 percent to 4.9 percent, among 10th-graders from 11.8 percent to 10.8 percent, and among 12th-graders from 18.7 percent to 17.1 percent.

"While the improvement in the smoking numbers for just this one year is important, the longer term declines have been really striking," Johnston said. "Since teen smoking reached a peak around 1996-97, the rates of current smoking have fallen by about three-fourths among eighth-graders, two-thirds among 10th-graders, and half among 12th-graders."

One reason that the current-smoking rates have declined so sharply is that the proportion of students who ever tried smoking has fallen quite dramatically. In 1996, 49 percent of eighth-graders had tried cigarettes, but by 2012 only 16 percent had done so, a two-thirds drop in smoking initiation during the past 16 years. Further, the initiation of smoking still is falling significantly among eighth- and 10th-graders.

These estimates come from the study's national surveys of 45,000 to 50,000 students in about 400 secondary schools each year. The study was designed by and is directed by a team of research professors at the Institute for Social Research, and since its inception has been funded through research grants from the National Institute on Drug Abuse, one of the National Institutes of Health.

Smoking-related topics covered in the survey include:

Perceived Availability

Eighth- and 10th-grade students are asked how difficult they think it would be for them to get cigarettes, if they wanted them. This perceived availability has shown substantial declines since 1996. The eighth-graders have shown the sharpest decline — from 77 percent saying they could get cigarettes "fairly easily" or "very easily" in 1996 to 51 percent in 2012. Perceived availability among 10th-graders fell from 91 percent to 73 percent over the same interval.

"Although there has been some real progress made in reducing the availability of cigarettes to those who are underage — particularly to the youngest teens — it is clear that the majority of teens still think they can get cigarettes fairly easily," Johnston said.

Attitudes and beliefs about smoking

Nearly two-thirds of eighth-graders and about three-quarters of 10th- and 12th-graders in 2012 said they see a great risk of harm to the user from pack-a-day smoking. These figures have increased substantially since the mid-1990s, when perceived risk was at its recent lowest levels. The 2012 figures are the highest ever recorded for all three grade levels. The percentages of teens saying this year that they personally disapprove of smoking are also at the highest levels seen in this study: 89 percent, 86 percent, and 84 percent for grades eight, 10, and 12 respectively.

Other attitudes toward smoking and smokers have changed in important ways, as well, during much of the period of decline in cigarette use. These changes included increases in preferring to date nonsmokers, strongly disliking being around people who are smoking, thinking that becoming a smoker reflects poor judgment, and believing that smoking is a dirty habit. All of these negative attitudes about smoking and smokers rose to high levels by 2007, but they have either leveled or begun to reverse since then.

"Future progress in lowering teen smoking rates is likely to depend on there being further changes in the external environment — changes such as raising cigarette taxes, further limiting where smoking is permitted, bringing back broad-based anti-smoking ad campaigns, and making quit-smoking programs more available," Johnston said.

Smokeless tobacco

The use of smokeless tobacco (which includes snuff, plug, dipping tobacco, chewing tobacco, and more recently "snus") also is assessed in the study. From the mid-1990s to the early 2000s, there was a substantial decline in smokeless tobacco use among teens — 30-day prevalence fell by one-third to one-half in all grades — but the declines ended and a rebound in use developed from the mid-2000s through 2010. Since 2010, however, there have been modest declines in all three grades. The two-year declines are not statistically significant at any grade level, nor are the one-year or two-year declines for the three grades combined.

Thirty-day prevalence rates are now down by 64 percent from their peaks in the mid-1990s among eighth-graders, and by 39 percent and 35 percent among 10th- and 12th-graders, respectively. Thirty-day prevalence of smokeless tobacco use in 2012 is 2.8 percent, 6.4 percent, and 7.9 percent, among eighth-, 10th-, and 12th-graders, respectively. The rates in each of the three grades are considerably higher for boys — 4.0 percent, 11.2 percent, and 13.5 percent — than for girls — 1.5 percent, 1.9 percent, and1.6 percent. Use continues to be particularly concentrated in the South and Midwest and in non-urban areas.

Perceived risk, which the study has shown to be an important determinant of trends for many forms of substance use, including cigarette use, also appears to have played an important role in the decline of smokeless tobacco use. In all three grades, perceived risk for smokeless tobacco rose fairly steadily from 1995 through 2004, as use was falling.

However, there was not a great deal of fall-off in perceived risk subsequently, between 2004 and 2010, suggesting that other factors may have led to the increases in smokeless tobacco use in that time interval. These factors might include increased promotion of these products, a proliferation of types of smokeless tobacco products available, and increased restrictions on places where cigarette smoking is permitted. The leveling in smokeless use since 2010 may be attributable, at least in part, to the 2009 increase in federal taxes on tobacco. Perceived risk declined significantly in 2012 among both eighth- and 10th-graders, however, which could portend a future rise in use.

Hookahs and small cigars

Two of the latest developments to raise public health concern are the smoking of tobacco by using hookah water pipes, and the smoking of small cigars. The concern is that, as cigarette smoking continues to decline among adolescents, they will be enticed to smoke tobacco in these other forms, which still carry serious health risks.

Questions about these forms of tobacco use in the prior 12 months — or annual prevalence — were included in the survey of 12th-graders for the first time in 2010, when 17.1 percent of 12th-graders said they had used a hookah to smoke tobacco in the prior 12 months. This rate rose slightly to 18.5 percent in 2011 and then stabilized at 18.3 percent in 2012. Only 11 percent of 12th-grade students in 2012 reported smoking with a hookah more than two times during the year, suggesting a considerable amount of light or experimental use. Males had only a slightly higher annual prevalence rate than females — 20 percent versus 17 percent.

Smoking small cigars is about as prevalent a behavior as hookah smoking, with 12th-graders having an annual prevalence rate of 20 percent in 2012. This is unchanged from 2011 and less than the 23.1 percent reading on these products in 2010. Only 12 percent of the past-year users in 2012 indicated use on more than two occasions during the year. There is a larger gender difference for this form of tobacco use than for hookah smoking, with an annual prevalence of 27 percent among males compared with 13 percent among females.

"We will continue to monitor these two forms of tobacco consumption to see if they represent a growing problem among youth, and we will be examining their use among young adults, as well," Johnston said.

Snus and dissolvable tobacco

In 2011, questions were introduced dealing with two more recent forms of tobacco use: snus and dissolvable tobacco.

The question about snus — a moist form of snuff that is placed under the upper lip — asks on how many occasions in the past 12 month the student "...used snus (a small packet of tobacco that is put in the mouth)." Among 12th-graders in 2011, 7.9 percent reported having used snus in the last 12 months; this rate remained unchanged in 2012. The proportion using more than two times was 5.2 percent in 2012.

Clearly, snus made some inroads among 12th-graders, but that seems not to be continuing. In 2012, the question about use of snus was added to the questionnaires given to eighth- and 10th-graders, and their annual prevalence rates are 2.4 percent and 6.9 percent. The pattern of use by subgroups of 12th-grade students follows the pattern for all smokeless products generally, with use being much higher among males (14.1 percent versus 1.2 percent among females), noncollege-bound students (12.2 percent versus 6.6 percent among the college-bound), and those living in non-metropolitan areas (10.8 percent versus about 6.1 percent in large cities).

The question about dissolvable tobacco products asks on how many occasions in the past 12 month the student "... used dissolvable tobacco products (Ariva, Stonewall, Orbs)." These products, in the form of pellets, strips, or sticks actually dissolve in the mouth, unlike other forms of chewing tobacco.

Among 12th-graders in 2011, only 1.5 percent reported having used in the prior 12 months and in 2012 it was 1.6 percent. The question was introduced for the lower grades in 2012, and the annual prevalence rates there were 1.0 percent in grade eight and 1.6 percent in grade 10. It appears that these products have not yet made significant inroads among secondary school students.