Trends In Tobacco Use Among Adolescents: 2002 to 2008

By Christopher Fisher, PhD on November 26, 2009 in Public Health

Among adult smokers, more than half had their ﬁrst cigarette before age 18, and more than half became daily smokers before that age*. Given the substantial lifetime health and economic burden from the use of cigarettes and other tobacco products, preventing and reducing adolescent use of these products continue to be important public health goals. A variety of approaches have been undertaken to address this problem. Schools offer health education programs targeting the use and abuse of licit and illicit substances, including tobacco. Substantial tax increases on tobacco products have been levied at the local, State, and Federal levels. States also have increased their enforcement of the Synar Amendment, which requires States to have laws in place prohibiting the sale and distribution of tobacco products to persons under age 18 and to enforce those laws effectively. In 2008, the national retailer violation rate was 9.9 percent – the lowest rate since the program began in 1996**. Despite these efforts, adolescents continue to use tobacco products. Understanding trends in tobacco product use and the shifting demographics of adolescent users can help to further reﬁne educational and enforcement efforts.

The National Survey on Drug Use and Health Data

Figure 1 (click to enlarge). Difference between this estimate and the 2008 estimate is statistically significant at the .05 level. Source: 2002 to 2008 SAMHSA National Surveys on Drug Use and Health (NSDUHs).

The National Survey on Drug Use and Health (NSDUH) asks persons aged 12 or older about their substance use, including their use of tobacco products. The questions on tobacco products focus on cigarettes, cigars, pipe tobacco, and smokeless tobacco (i.e., chewing tobacco and snuff). Respondents who have used these substances are asked when they ﬁrst used them, and data from these questions are used to identify persons who initiated use in the 12 months prior to the survey interview. The data presented herein focuses on trends in past month use and past year initiation of tobacco products among adolescents (i.e., youths aged 12 to 17) with special emphasis on use of cigarettes. NSDUH data from 2002 to 2008 are used.

Trends In The Use Of Tobacco Products

Figure 2 (click to enlarge). Difference between this estimate and the 2008 estimate is statistically significant at the .05 level. Source: 2002 to 2008 SAMHSA National Surveys on Drug Use and Health (NSDUHs).

The prevalence of past month use of any tobacco product among adolescents declined between 2002 and 2008, from 15.2 to 11.4 percent (Figure 1). The decline in past month tobacco use can be attributed primarily to a decline in past month cigarette use – the most frequently used tobacco product – with 13.0 percent of adolescents using cigarettes in 2002 compared with 9.1 percent in 2008. The rate of past month cigar use in 2008 (3.8 percent) was lower than in 2002, 2003, and 2004, but similar to rates in 2005, 2006, and 2007. Past month use of smokeless tobacco and pipe tobacco remained relatively stable during the 7-year period covered in this report, with 2.2 percent of adolescents using smokeless tobacco and 0.7 percent using pipe tobacco in 2008.

Trends In Cigarette Use, By Gender
Past month cigarette use decreased for both female and male adolescents between 2002 and 2008 (Figure 2). Among females, cigarette use decreased from 13.6 percent in 2002 to 9.2 percent in 2008; among males, it decreased from 12.3 to 9.0 percent, respectively.

Trends In Initiation Of Cigarette Use

Figure 3 (click to enlarge). Source: 2002 to 2008 SAMHSA National Surveys on Drug Use and Health (NSDUHs).

Although past month use of cigarettes generally has been declining among adolescents, the rate of recent initiation of cigarette use (i.e., ﬁrst-time use of cigarettes
in the 12 months before the survey interview among adolescents who had not previously used them) remained relatively stable at 6.7 percent in 2002 and 6.2 percent in
2008 (Figure 3). Considered by gender, 2008 data showed that 6.7 percent of females who had never smoked previously initiated use in the year before the survey, as did 5.7 percent of their male counterparts. However, these rates did not differ signiﬁcantly from corresponding rates between 2002 and 2007.

Discussion
The ﬁndings in the report present mixed results on trends in adolescent tobacco use. On one hand, the prevalence of past month use of any tobacco products among adolescents has generally declined since 2002. This decline is accounted for by decreases in past month cigarette use—the most frequently used tobacco product. On the other hand, rates of use of other tobacco products generally have remained stable, as have rates of recent initiation of cigarette use. These ﬁndings suggest that efforts that encourage adolescents to stop smoking are working, and efforts to reduce cigarette initiation may need to be bolstered. Additionally, these ﬁndings suggest that prevention and cessation efforts need to continue to be directed toward use of other tobacco products, such as cigars, smokeless tobacco, and pipe tobacco.

Adapted from NSDUH Report by CFisher

Reference:
Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (October 15, 2009). The NSDUH Report: Trends in Tobacco Use among Adolescents: 2002 to 2008. Rockville, MD.

End Notes
*U.S. Department of Health and Human Services. (2000, November). Healthy People 2010: Understanding and improving health (2nd ed.). Washington, DC: U.S. Government Printing Office. [Available as a PDF at http://www.healthypeople.gov/Publications/]

**Center for Substance Abuse Prevention. (2009). FFY 2008 Annual Synar Reports: Youth tobacco sales. Rockville, MD: Substance Abuse and Mental Health Services Administration. [Available as a PDF at http://prevention.samhsa.gov/tobacco/default.aspx]

About Christopher Fisher, PhD

Dr. Christopher Fisher, Managing Editor for The Behavioral Medicine Report, received his PhD in Clinical Health Psychology & Behavioral Medicine from University of North Texas. His clinical training emphasized biopsychosocial approaches to health and wellness, including Cognitive Behavioral Therapy (CBT), neurofeedback, biofeedback, cranial electrical stimulation (CES), and QEEG. He is Board Certified in Neurofeedback (BCN) by BCIA. Dr. Fisher also received a master’s degree in Clinical Psychology from Texas A&M - Corpus Christi. Dr. Fisher maintains a private practice in Corpus Christi, Texas, and offers individual therapy, group therapy, peripheral biofeedback, and neurofeedback. You can learn more at http://www.christopherfisherphd.com. He also maintains an informational website for panic attacks (panic disorder) here: http://www.panicintervention.com Dr. Fisher enjoys spending time with family, watching sports and movies, and outdoor activities.

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