June 2010

State Estimates of Adolescent Cigarette Use and Perceptions of Risk from Smoking

Cigarette smoking causes more than 400,000 deaths every year and imposes substantial health and financial costs on our Nation and States.¹ Preventing adolescents from starting to smoke may be the most effective way to reduce the health and economic burden of tobacco-related disease in the future. In recent years, significant progress has been made in reducing adolescent smoking,² but there is still much work left to be done.

States have been at the center of efforts to reduce adolescent smoking through cigarette taxation, enactment of laws that restrict smoking in public places, enforcement of laws that prohibit the sale and distribution of tobacco products to adolescents, and funding smoking prevention and cessation programs. Many prevention programs focus on teaching youths about the harm that smoking may do to their health and social life, and longitudinal research has shown that smoking initiation is directly related to perceptions of risks and benefits from smoking.³ State-level information about cigarette use and attitudes about smoking can provide States with vital data to monitor changes over time and to inform enforcement, educational, and prevention efforts.

This issue of The NSDUH Report uses data from the combined 2007 and 2008 National Surveys on Drug Use and Health (NSDUHs) to present estimates for the States and the District of Columbia of past month cigarette use and perceptions of great risk of harm from smoking one or more packs of cigarettes per day among persons aged 12 to 17.^{4, 5} These estimates are rank ordered from highest to lowest and divided into quintiles (fifths).⁶ Additionally, the combined 2007 and 2008 data are compared with the combined 2002 and 2003 data to examine changes in these measures over time.

Combined 2007 and 2008 data indicate that about 1 in 10 (9.46 percent) adolescents smoked cigarettes in the past month. Rates of past month cigarette use ranged from a low of 5.77 percent in Utah to a high of 14.47 percent in Kentucky (Figure 1).

Figure 1. Percentages of Past Month Cigarette Use among Youths Aged 12 to 17, by State: 2007 and 2008

Of the 10 States with the highest rates of past month cigarette use, 5 were in the Midwest (Indiana, North Dakota, Ohio, South Dakota, and Wisconsin), 4 were in the South (Arkansas, Kentucky, Oklahoma, and West Virginia), and 1 was in the West (Wyoming).⁷ Of the 10 States and jurisdictions with the lowest rates of past month cigarette use, 3 were in the Northeast (Massachusetts, New Jersey, and New York), 4 were in the West (California, Hawaii, Idaho, and Utah), and 3 were in the South (Maryland, Texas, and the District of Columbia).

Combined 2007 and 2008 data indicate that about 7 in 10 (69.26 percent) adolescents perceived great risk of harm from smoking one or more packs of cigarettes per day. The rate of perceived great risk ranged from a low of 63.30 percent in Alabama to a high of 77.00 percent in Utah (Figure 2).

Figure 2. Percentages of Perceptions of Great Risk of Harm from Smoking One or More Packs of Cigarettes Per Day among Youths Aged 12 to 17, by State: 2007 and 2008

Of the 10 States with the highest rates of perceived great risk, 5 were in the Northeast (Connecticut, New Jersey, New York, Rhode Island, and Vermont), 4 were in the West (Alaska, Arizona, Hawaii, and Utah), and 1 was in the South (Delaware). Of the 10 States with the lowest rates of perceived great risk, 6 were in the South (Alabama, Arkansas, Kentucky, Mississippi, Oklahoma, and Tennessee), 3 were in the Midwest (Kansas, Michigan, and Wisconsin), and 1 was in the Northeast (New Hampshire).

When combined 2002 and 2003 data are compared with data combined from 2007 and 2008, the Nation as a whole experienced a statistically significant reduction in the rate of past month cigarette use among adolescents (from 12.57 to 9.46 percent) and an increase in the rate of perceived great risk of harm from smoking one or more packs of cigarettes per day (from 63.67 to 69.26 percent). Similarly, 27 States showed both a decrease in the rate of use and an increase in the rate of perceived great risk (Figure 3). Eight States had a decrease in the rate of use but no increase in the rate of perceived great risk, and eight States and the District of Columbia had an increase in the rate of perceived great risk but no decrease in the rate of use. Seven States had no statistically significant change for either measure, and no States had an increase in use or a decrease in perceived great risk.⁸

Figure 3. States with Significant Change in Past Month Cigarette Use and Perceptions of Great Risk of Harm from Smoking One or More Packs of Cigarettes Per Day among Youths Aged 12 to 17: 2002 and 2003 versus 2007 and 2008

Cigarette use plays a major role in the health of the citizens of every State in the Nation. These findings suggest that efforts to reduce smoking and to change attitudes about smoking among adolescents have resulted in considerable progress, although this progress was not uniform across all States. These successes will improve the Nation's health in both the short term and the long term. Highlighting the prevalence of cigarette use and attitudes toward use in each State, as well as monitoring changes, may help State and Federal policymakers continue to plan for and improve prevention efforts.