October 15, 2009

Trends in Tobacco Use among Adolescents: 2002 to 2008

Among adult smokers, more than half had their first cigarette before age 18, and more than half became daily smokers before that age.¹ 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 1996.² 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 (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.

This issue of The NSDUH Report presents information 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.

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

Figure 1. Past Month Tobacco Use among Youths Aged 12 to 17: 2002 to 2008

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.

Figure 2. Past Month Cigarette Use among Youths Aged 12 to 17, by Gender: 2002 to 2008

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.

Figure 3. Past Year Cigarette Initiation among Youths Aged 12 to 17 Who Had Never Smoked Prior to the Past Year, by Gender: 2002 to 2008

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.