Trends in Adolescent Tobacco Use

More than 700,000 middle school students and three million high school students have smoked. [1] Although tobacco use by adolescents has declined substantially in the last forty years, nearly one in 10 high school seniors were daily smokers in 2013. [2] Substantial racial/ethnic and regional differences in smoking rates exist. Among 10th and 12th graders, white teens are more likely to smoke than are their black or Hispanic peers. [3] Smoking rates are typically higher in rural areas, and in the Southern and Midwestern regions of the country. [4]

Figure 1: 30 Day Prevalence of Daily Use of Cigarettes, by Grade, 1975-2013

Line graph showing 12th Graders in 1975 at 29%, in 1997 at 25%, and 2010 at 11% and showing 10th Graders in 1991 at 13%, in 1997 at 18%, and 2010 at 7%

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Table 1: Percent of students who report smoking cigarettes Daily, by grade, 1975-2010
Year collected10th Grade12th Grade
1975  
1976 28.8
1977 28.8
1978 27.5
1979 25.4
1980 21.3
1981 20.3
1982 21.1
1983 21.2
1984 18.7
1985 19.5
1986 18.7
1987 18.7
1988 18.1
1989 18.9
1990 19.1
199112.618.5
199212.317.2
199314.219.0
199414.619.4
199516.321.6
199618.322.2
199718.024.6
199815.822.4
199915.923.1
200014.020.6
200112.219.0
200210.116.9
20038.915.8
20048.315.6
20057.513.6
20067.612.2
20077.212.3
20085.911.4
20096.311.2
20106.610.7

Tobacco products used by adolescents include cigarettes (both store-bought and hand-rolled), cigars, pipes, hookahs, smokeless tobacco, and newer oral products such as pouches, lozenges, strips, and sticks. All of these products deliver tobacco’s toxic effects.

  • Cigarettes: More than 80% of adult smokers begin smoking before 18 years of age and 19.5 percent of high school seniors reported smoking in the last month. Learn more.
  • Smokeless tobacco: Use of smokeless tobacco among adolescents is less common than cigarette smoking. Learn more.
  • Hookahs: Hookahs are no safer than other forms of tobacco smoking and may deliver even higher levels of toxic substances. Learn more.
  • Flavored little cigars and flavored cigarettes: Of middle and high schoolers who smoke, more than 40 percent smoke flavored little cigars or flavored cigarettes.[5]
  • E-cigarettes: During 2011–2012, middle and high school students who had ever used an e-cigarette increased from 3.3% to 6.8%.[6]

Cigarette use

Almost one out of every two high school students reports ever having taken even one puff of a cigarette. [7] However, in 2013 almost one in 11 (9 percent) 12th graders were regular, daily smokers—a number that has declined dramatically from its recent peak of 25 percent in 1997, but more slowly since 2002 (see Figure 1). [8] Cigarette smoking by adolescents (measured as use in the past month) in grades 8, 10, and 12 combined has declined by more than half since its most recent peak in the late 1990s. In 2013, about one in ten adolescents (10 percent) reported smoking cigarettes in the past month, compared with more than one in four (28 percent) in 1996-97 (see Figure 2).[8],

Figure 2: Percent of adolescents who report smoking cigarettes in the past month, 1996-1997 and 2013

Bar graph showing 28% in 1996-1997 and 12% in 2011

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Table 2: Percent of adolescents who report smoking cigarettes in the past month, 1996-1997 and 2012
Year collectedPercentage
1996-9728%
201211%

Although we may not know all of the factors playing a role in this decline, the 1990s were years when funds from tobacco companies (the result of a legal settlement between the tobacco companies and the federal government) supported a number of local, state, and national anti-tobacco campaigns. [7] In addition, during this time, new restrictions on tobacco advertising were instituted, smoke-free laws and policies were widely implemented, and additional taxes were placed on cigarettes, which inhibited demand. [9] However, after 2002, most states did not allocate funds to maintain the proven anti-tobacco efforts shown to deter youth tobacco use. [10]

Smokeless tobacco

Use of smokeless tobacco products (snuff, chewing tobacco) among adolescents is less common than cigarette smoking. However, adolescents increased their use of smokeless tobacco between 2008 and 2010. Rates remained fairly steady from 2010 to 2013. [2] Although 8.1 percent of 12th graders used smokeless tobacco in the past 30 days (in 2011), this is not as high as during the mid-1990s (peaking at 12 percent in 1995). This rate is still higher than levels seen during most of the 2000s (see Figure 3). [2] For smokeless tobacco use, the highest rates of initiation are in the seventh through 11th grades. Although approximately equal proportions of male and female adolescents smoke cigarettes, users of smokeless tobacco products are nearly all males. [2]

Figure 3: Percent of students who report using smokeless tobacco in the last 30 days, by grade, 1993-2013

Line graph showing in 1993 11% of 12th Graders and 10% of 10th Graders, and in 2011 8% of 12th Graders and 7% of 10th Graders

See the data »

Table 3: Percent of students who report using smokeless tobacco in the last 30 days, by grade, 1993-2011
Year collected10th Grade12th Grade
199310.410.7
199410.511.1
19959.712.2
19968.69.8
19978.99.7
19987.58.8
19996.58.4
20006.17.6
20016.97.8
20026.16.5
20035.36.7
20044.96.7
20055.67.6
20065.76.1
20076.16.6
20085.06.5
20096.58.4
20107.58.5
20116.68.3
201268

Hookahs

Hookahs (water pipes) are popular among some adolescents; typically used in groups, and sometimes in “hookah cafés,” the hookah mouthpiece is passed around from person to person. Hookahs are no less addictive than other forms of tobacco smoking, and at least as toxic as cigarette smoking. [11] There are currently no national estimates of hookah smoking among adolescents.

Other Oral Tobacco Products

Newer forms of oral tobacco products including pouches, lozenges, strips, and sticks are also cause for concern. Most of these are designed to dissolve in the user’s mouth, and are offered in candy-like flavors; however, they all contain potent toxins that can lead to cancer and other serious diseases. Unfortunately, there are no reliable data yet on how many adolescents use these newer products.


Footnotes>>

[1]Substance Abuse & Mental Health Services Administration Office of Applied Studies. (2010). Results from the 2009 National Survey on Drug Use and Health: Detailed tables. Tables 2.2A-2.5A. Washington, DC: U.S. Department of Health and Human Services. Retrieved March 21, 2014, from http://www.oas.samhsa.gov/NSDUH/2k9NSDUH/tabs/Sect2peTabs1to10.pdf
[2] Johnston, L. D., O'Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2014). Monitoring the Future national survey results on drug use: 1975-2013: Overview of key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan. Retrieved March 21, 2014, from http://www.monitoringthefuture.org//pubs/monographs/mtf-overview2013.pdf
[3]Centers for Disease Control and Prevention. (2012). Youth Risk Behavior Surveillance-United States, 2011. Morbidity and Mortality Weekly Report, 61(4). Retrieved March 21,  2014, from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6104a1.htm
[4]Substance Abuse and Mental Health Services Administration. (2013). Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. Retrieved, March 21, 2014, from http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/Index.aspx
[5]King, B. A., Tynan, M. A., Dube, S. R., & Arrazola, R. (2013). Flavored-little-cigar and flavored-cigarette use among US middle and high school students. Journal of Adolescent Health.
[6]Centers for Disease Control and Prevention (2013). Notes from the field: electronic cigarette use among middle and high school students-United States, 2011-2012. MMWR. Morbidity and mortality weekly report62(35), 729.
[7]Jones, W.J., &  Silvestri, G.A. (2010). The Master Settlement Agreement and its impact on tobacco use 10 years later: lessons for physicians about health policy making. Chest.137, 692–700.
[8]Johnston, L. D., O'Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2014). Monitoring the Future national survey results on drug use: 1975-2013: Overview of key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan. Retrieved March 21, 2014, from http://www.monitoringthefuture.org//pubs/monographs/mtf-overview2013.pdf
[9]Centers for Disease Control and Prevention. (2003). Tobacco use among middle and high school students—United States, 2002. MMWR, 52(45), 1096-1098. Retrieved March 21, 2014, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5245a2.htm
[10]U.S. Department of Health and Human Service. (2012). Preventing tobacco use among youth and young adults: A report of the Surgeon General. Rockville, MD. Retrieved March 21, 2014, from http://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/full-report.pdf
[11]National Institute on Drug Abuse. (2011). Facts on drugs: Tobacco addiction.  NIDA for Teens. Retrieved March 21, 2014, from http://teens.drugabuse.gov/facts/facts_nicotine1.php
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Last updated: April 19, 2014