Trends in Adolescent Tobacco Use

More than 380,000 12-to-13-year-olds and almost four million 14-to-17-year-olds have smoked.[1] Although tobacco use by adolescents has declined substantially in the last 40 years, nearly one in 15 high school seniors was a daily smoker in 2014.[2] Substantial racial/ethnic and regional differences in smoking rates exist. Among high school students, 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, 1976-2014


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Table 1: Percent of students who report smoking cigarettes Daily, by grade, 1976-2014
Year collected8th Grade10th Grade12th Grade
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
1991 7.212.618.5
19927.012.317.2
19938.3 14.219.0
19948.8 14.619.4
19959.3 16.321.6
199610.4 18.322.2
19979.0 18.024.6
19988.8 15.822.4
19998.1 15.923.1
20007.4 14.020.6
20015.5 12.219.0
20025.1 10.116.9
20034.5 8.915.8
20044.4 8.315.6
20054.0 7.513.6
20064.0 7.612.2
20073.0 7.212.3
20083.1 5.911.4
20092.7 6.311.2
20102.9 6.610.7
20112.4 5.510.3
20121.9 5.09.3
20131.8 4.48.5
20141.4 3.26.7
 

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

  • Cigarettes: Nearly 90 percent of adult smokers began smoking before age 18 and 14 percent of high school seniors reported smoking in the last month.[2] 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 than. Learn more.
  • Flavored little cigars and flavored cigarettes: Of middle and high school students who smoke, more than 40 percent smoke flavored little cigars or flavored cigarettes.[5]
  • E-cigarettes: From 2010 to 2014, the percentage of 12th-grade students who had ever used an e-cigarette increased from 4.7 to 17.2 percent.[2] For the first time, more teenagers used e-cigarettes than smoked cigarettes.[2]

Cigarette use

About one out of every three high school seniors reports ever having smoked a cigarette.[2] However, in 2014, almost one in 15 12th graders (seven percent) was a regular, daily smoker—a number that has declined dramatically from its recent peak of 25 percent in 1997  (see Figure 1).[2] Cigarette smoking by adolescents (measured as use in the past month) in grades eight, 10, and 12 combined has declined by more than half since its most recent peak in the late 1990s. In 2014, about one in 12 adolescents (eight percent) reported smoking cigarettes in the past month, compared with more than one in four (28 percent) in 1996-97 (see Figure 2).[2]

Figure 2: Percent of adolescents who report smoking cigarettes in the past month, 1996-1997 and 2014


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Table 2: Percent of adolescents who report smoking cigarettes in the past month, 1996-1997 and 2014
Year collectedPercentage
1996-9728%
20148%

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.[8] 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 (e.g., 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 2014.[2] Although 8.4 percent of 12th graders used smokeless tobacco in the past 30 days (in 2014), this is not as high as during the mid-1990s (peaking at 12 percent in 1995). However, recent rates are 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 7th through 11th grades. Although approximately equal proportions of male and female adolescents smoke cigarettes, users of smokeless tobacco products are nearly all male.[2]

Figure 3: Percent of students who report using smokeless tobacco in the last 30 days, by grade, 1993-2014


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Table 3: Percent of students who report using smokeless tobacco in the last 30 days, by grade, 1993-2014
Year collected8th Grade10th Grade12th Grade
19936.610.410.7
19947.7 10.511.1
19957.19.712.2
19967.1 8.69.8
19975.5 8.99.7
19984.8 7.58.8
19994.5 6.58.4
20004.2 6.17.6
20014.0 6.97.8
20023.3 6.16.5
20034.1 5.36.7
20044.1 4.96.7
20053.3 5.67.6
20063.7 5.76.1
20073.2 6.16.6
20083.5 5.06.5
20093.7 6.58.4
20104.1 7.58.5
20113.5 6.68.3
20122.8 68
20132.8 6.18.4
20143.0 5.38.4

Hookahs

Hookahs (water pipes) are popular among some adolescents and are typically used in groups and sometimes in "hookah cafés." When used in groups, 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]  Older teens have increased their use of hookahs in recent years. Between 2010 and 2014, the percentage of high school seniors who had used a hookah in the last year increased from 17 to 23 percent.[2] Among adolescents and young adults, hookah use is highest among those ages 19-20, and those that live in cities.  It is less common in suburban and rural areas. [12]

E-Cigarettes

Electronic cigarettes, or e-cigarettes, are battery-powered devices designed to deliver nicotine, flavor, and other chemicals. They turn chemicals, including highly addictive nicotine, into an aerosol that is inhaled by the user.[15] E-cigarettes not marketed for therapeutic purposes are currently unregulated by the Food and Drug Administration. Adolescent use of e-cigarettes is becoming increasingly common. The percent of high school seniors who had ever tried an e-cigarette more than doubled in a one-year period between 2011 and 2012 (from 4.7 percent to 10.0 percent) and, in 2014, increased again to 17.2 percent. The number that used an e-cigarette in the past 30 days increased from 1.5 percent to 17.2 percent from 2010 to 2014.[2]

The same trend is observed in younger adolescents – use among 8th-grade students also more than doubled (in 2014, nine percent had used one in the past 30 days). Overall, among younger adolescents (those in 8th and 10th grades), more than twice as many reported using e-cigarettes than those who reported using tobacco cigarettes in 2014. This is less true for older adolescents; this discrepancy may be due to the relatively recent emergence of e-cigarettes.[2]

The parallel use of e-cigarettes with conventional cigarettes is also common. In 2014, approximately one out of four eighth and 10th grade students who used an e-cigarette in the past 30 days had also smoked a conventional cigarette; looking at those in 12th grade, that figure rises to more than half.[2]

There is concern that e-cigarettes represent a gateway to the use of traditional cigarettes and other tobacco products. In 2013, one out of five middle school students who had tried an e-cigarette had not yet tried a conventional cigarette.[13] Overall, approximately 263,000 middle- and high-school students used e-cigarettes that year, even though they had never smoked a conventional cigarette. Of these adolescents, just under half (43.9 percent) reported an intent to smoke conventional cigarettes in the next year. This is significantly higher than the number of youth who had never used an e-cigarette; of those, 21.5 percent reported an intent to smoke conventional cigarettes in the next year.[16]

Other Oral Tobacco Products

Newer forms of oral tobacco products 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 currently no reliable data on how many adolescents use these newer products.

Footnotes »

1

Substance Abuse & Mental Health Services Administration Office of Applied Studies. (2013). Results from the 2012 National Survey on Drug Use and Health: Detailed tables. Tables 2.2A-2.4A. Washington, DC: U.S. Department of Health and Human Services. Retrieved October 10, 2014, from http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect2peTabs1to42-2012.htm#Tab2.2A

2

Johnston, L. D., Miech, R. A., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2014). Use of alcohol, cigarettes, and number of illicit drugs declines among U.S. teens. University of Michigan News Service: Ann Arbor, MI. Retrieved January 12, 2015, from http://www.monitoringthefuture.org/data/14data.html#2014data-cigs

3

Centers for Disease Control and Prevention. (2014). Youth risk behavior surveillance-United States, 2013. Morbidity and Mortality Weekly Report, 63(4). Retrieved October 10, 2014, from http://www.cdc.gov/mmwr/pdf/ss/ss6304.pdf

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, October 10, 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 U.S. middle and high school students. Journal of Adolescent Health, 54(1), 40-46.

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. Morbidity and Mortality Weekly Report, 62(35). Retrieved October 10, 2014, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6235a6.htm?s_cid=mm6235a6_w

7

Arrazola, R. A., Neff, L. J., Kennedy, S. M., Holder-Hayes, E., & Jones, C. D. (2014). Tobacco use among middle and high school students – United States, 2013. Morbidity and Mortality Weekly Report, 63(45), 1021-1026.

8

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(3), 692–700.

9

Centers for Disease Control and Prevention. (2003). Tobacco use among middle and high school students—United States, 2002. Morbidity and Mortality Weekly Report, 52(45), 1096-1098. Retrieved October 10, 2014, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5245a2.htm

10

U.S. Department of Health and Human Services. (2012). Preventing tobacco use among youth and young adults: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Retrieved on October 10, 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, nicotine, & e-cigarettes. Retrieved October 10, 2014, from http://teens.drugabuse.gov/facts/facts_nicotine1.php

12

Johnston, L. D., O'Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Miech, R. A., (2014). Monitoring the Future national survey results on drug use, 1975-2013: Volume 2, College students and adults ages 19-55. Ann Arbor: Institute for Social Research, University of Michigan. Available at http://monitoringthefuture.org/pubs/monographs/mtf-vol2_2013.pdf

13

Centers for Disease Control and Prevention. (2013). E-cigarette use more than doubles among U.S. middle and high school students from 2011-2012. Retrieved October 10, 2014, from http://www.cdc.gov/media/releases/2013/p0905-ecigarette-use.html

14

Centers for Disease Control and Prevention. (2012). Youth Risk Behavior Survey fact sheets. Retrieved October 10, 2014, from http://www.cdc.gov/healthyyouth/yrbs/factsheets/

15

U.S. Food and Drug Administration. (2014). Electronic cigarettes (e-Cigarettes). Retrieved October 10, 2014, from http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm172906.htm

16

Centers for Disease Control and Prevention. (2014). More than a quarter-million youth who had never smoked a cigarette used e-cigarettes in 2013. Retrieved January 13, 2015, from http://www.cdc.gov/media/releases/2014/p0825-e-cigarettes.html

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Last updated: April 27, 2015