Smoking continues gradual decline among U.S. teens, smokeless tobacco threatens a comeback

( -- Teen smoking reached its recent peak levels around 1996 and 1997, followed by a sharp decline for about six years and a continued more gradual decline ever since, according to the latest Monitoring the Future study of the nation's young people.

"Over the past two years we have seen the smoking rates among young people continue to decline only very gradually, at rates much slower than were occurring previously," said University of Michigan researcher Lloyd Johnston, principal investigator of the Monitoring the Future study. "The proportions of students seeing a great risk associated with being a smoker has leveled off in the past several years, as has the proportion of teens who say they disapprove of smoking."

Monitoring the Future has been conducting annual, nationwide surveys of U.S. teens in school for the past 35 years. The 2009 survey included a total of 46,097 students in the 8th, 10th and 12th grades in 389 secondary schools.

The research is conducted by a team of research professors at the U-M Institute for Social Research, which in addition to Johnston includes Patrick O'Malley, Jerald Bachman and John Schulenberg. The National Institute on Drug Abuse supports this investigator-initiated study through a series of competitive research grants.

"While great strides have been made in reducing youth smoking in this country, there is still plenty of room for improvement," Johnston said. "Among high school seniors in the Class of 2009, 20 percent have smoked in the most recent month and one in nine (11 percent) is a current daily smoker. Further, our follow-up studies have shown that a number of the lighter smokers in high school will convert to heavy smoking after leaving high school. Given what we know about the consequences of smoking, this is still an unacceptable level of involvement."

To illustrate the progress that has occurred, among 8th-graders (13- and 14-year-olds), the proportion saying that they smoked any cigarettes in the month prior to the survey has dropped by two-thirds (from 21 percent in 1996, the peak year, to 7 percent by 2009). Among 10th- graders, the decline over the same 13-year interval was more than one-half (down from 30 percent to 13 percent); among 12th-graders, whose smoking rate reached a recent peak in 1997, there has been a decline of almost one-half (down from 37 percent in 1997 to 20 percent by 2009). Daily smoking has declined by even larger proportions.

One reason smoking has declined so sharply is that the proportion of students ever trying smoking has fallen dramatically. While 49 percent of 8th-graders in 1996 had tried cigarettes, "only" 20 percent of the 8th-graders in 2009 indicated having ever done so, a 60 percent-decline in smoking initiation over the past 13 years.

"These are very substantial improvements in the situation and they have enormous implications for the health and longevity of this newest generation of young Americans," Johnston said.

But the improvement has been continuing at a much slower rate. Over the past two years , the prevalence of smoking in the 30 days prior to the survey has fallen by just 0.6, 0.9 and 1.5 percentage points among 8th-, 10th- and 12th-graders, respectively.

This reduced rate of improvement, plus the fact that the rises in perceived risk and disapproval of smoking have leveled off, leaves Johnston less optimistic about future gains.

"Future progress, if it occurs, is likely to be due to changes in the external environment—policy changes such as increasing cigarette taxes, further limiting where smoking is permitted, broad-based prevention campaigns, and making quit-smoking programs more available," Johnston said.

The perceived availability of cigarettes to under-age buyers, as measured by the percent of students who say they could buy cigarettes "fairly easily" or "very easily" if they wanted some, has declined substantially since 1996 among 8th- and 10th-graders (12th-graders are not asked the question).

The 8th-graders showed the sharpest decline—from 77 percent in 1996 to 56 percent in 2007—about where it remained in 2009. Perceived availability leveled among 10th-graders in 2009, having fallen from 91 percent in 1996 to 76 percent by 2009. Although availability has decreased, the investigators note that the majority of these students in their early to mid-teens still report that they could easily get cigarettes.

A number of attitudes toward smoking and smokers changed in important ways during 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 have shown little change since then.

One attitude widely held by young people today may be of particular salience to those considering smoking. In 2009, 81 percent of 8th-graders, 80 percent of 10th-graders, and 75 percent of 12th-graders said that they "would prefer to date people who don't smoke."

It is clear that any young person today who becomes a smoker will pay an important social price for that choice by becoming less attractive to the great majority of the opposite sex.

"This fact provides what we believe could be a very strong prevention message," Johnston said.

Smokeless Tobacco

The use of smokeless tobacco (which includes snuff, plug, dipping tobacco, chewing tobacco and more recently "snus") is assessed in all three grades. From the mid-1990s to the early 2000s, there was a substantial decline in use, with monthly prevalence falling by one-third to one-half, but the declines have not continued.

In fact, there have been significant increases occurring over the past three-to-four years in 10th and 12th grades (with still little change in 8th grade). While so far modest in size, these changes suggest an upward trajectory in use. Thirty-day prevalence of smokeless tobacco use in 2009 is 3.7 percent, 6.5 percent and 8.4 percent among 8th-, 10th- and 12th-graders, respectively.

Perceived risk of regular use appears to have played an important role in the decline phase in use, as was true for cigarettes. In all three grades, perceived risk rose fairly steadily from 1995 through 2004 before leveling. In 2009, all three grades showed some decline in perceived risk (significant in 10th grade), consistent with the increase in use.

Kreteks and Bidis

Kreteks are clove-flavored cigarettes from Indonesia, and at the beginning of this decade there was concern that they could become popular among American youth. However, the annual prevalence of kretek use was not very high in the first year of measurement (2001). After that, use declined by roughly half in 8th and 10th grades by 2005, before the question was dropped from the 8th- and 10th-grade questionnaires.

Among 12th-graders, annual prevalence declined steadily from 2001 to 2004, before leveling at around 6-7 percent. In 2009 there was a further drop, bringing annual prevalence for kreteks down to 5.5 percent—reflecting a decline of almost half from the level of use as first measured in 2001. The investigators conclude that kretek use was a short-term fad that simply did not catch on with mainstream youth.

Bidis are small, flavored cigarettes imported from India, and again there was early concern that they might find favor among youth. A question on their use was added in 2000, and again their annual prevalence was fairly low, at 3.9 percent, 6.4 percent and 9.2 percent for 8th-, 10th- and 12th-graders, respectively. The rates of use fell fairly sharply thereafter, with the result that the annual prevalence rates in 2005 were less than 2 percent among 8th- and 10th-graders, at which point the question was dropped for them. Among 12th-graders, a further decline of more than one-half has been observed since 2005. Use was 1.5 percent in 2009—down by 84 percent from the peak level in 2000. Here again, a threat seems to have been contained and is diminishing steadily.

Using new regulatory authority granted under federal legislation, the Food and Drug Administration in September 2009 banned the sale of flavored cigarettes (with the exception of menthol-flavored cigarettes). Thus, the already low-use of kreteks and bidis is likely to decline even further, the investigators say.

"One of the purposes of the Monitoring the Future study is to assess potential new threats to our youth population and fortunately in these two cases the threats never really materialized," Johnston said. "Two of the latest developments to raise concern in this sphere, however, are the of tobacco in the form of small cigars and also by using hookah water pipes. Questions about these behaviors will be included in the 2010 survey."

Monitoring the Future has been funded under a series of competing, investigator-initiated research grants from the National Institute on Drug Abuse, one of the National Institutes of Health. In addition to Johnston, the lead investigators are Patrick O'Malley, Jerald Bachman and John Schulenberg—all research professors at the University of Michigan's Institute for Social Research. Surveys of nationally representative samples of American high school seniors were begun in 1975, making the class of 2009 the 35th such class surveyed. Surveys of 8th- and 10th-graders were added to the design in 1991, making the 2009 nationally representative samples the 19th such classes surveyed. The sample sizes in 2009 are 15,509 8th-graders in 145 schools; 16,320 10th-graders in 119 schools; and 14,268 12th-graders in 125 schools, for a total of 46,097 students in 389 secondary schools. The samples are drawn separately at each grade level to be representative of students in that grade in public and private secondary schools across the coterminous United States. Schools are selected with probability proportionate to their estimated class size.

More information: The findings summarized here will be published in the forthcoming volume: Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2010). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2009 (NIH Publication No. [yet to be assigned]). Bethesda, MD: National Institute on Drug Abuse.

Provided by University of Michigan

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