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Cancer Trends Progress Report – 2007 Update

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Age at Smoking Initiation
Youth Smoking
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Youth Smoking
Prevention: Behavioral Factors

Cigarette smoking by high school students rose early and through the mid 1990s, but has fallen more steeply since the end of the 1990s. The most recent data point in 2005 suggests a flattening of this declining trend but future data are needed to see if there is a significant shift. Smokeless tobacco use appears to be falling.

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Youth Tobacco Use and Cancer

For most of the 1990s, about 3,000 youths under 18 became regular cigarette smokers each day. This number has declined recently to just over 2,000 each day. Of these 2,000, nearly 700 will die early due to lung cancer or other tobacco-related diseases.

Other forms of tobacco used by young people include smokeless tobacco (chewing tobacco and snuff, also known as spit tobacco), cigars, and bidis (small, brown, hand-rolled, flavored cigarettes). Each of these also can cause cancer.

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Measure

Percentage of high school students who were current cigarette or smokeless tobacco users: Students (grades 9–12) who reported having used cigarettes or smokeless tobacco in the 30 days before the survey.

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Period – 1991–2005

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Trends

Cigarettes: After a non-significant rise from 1991–1997, current cigarette smoking among youth has fallen, showing a very large and statistically significant trend downward since 1997. In fact, the 2005 estimate is lower than the estimate in 1991 at the beginning of the rise in youth smoking, but not significantly different from the previous data point in 2003.

Smokeless tobacco: Current smokeless tobacco use has been falling over the entire 1991–2005 period.

The source of trend data used in this report does not provide data for use of either "any tobacco" or cigars before 1997.

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Most Recent Estimates

Among high school students in 2005:

  • 23% were current cigarette smokers
  • 8% were current users of smokeless tobacco
  • 14% were current cigar smokers (including little cigars)
  • 28.4% were current users of "any tobacco"

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Healthy People 2010 Targets

Decrease the proportion of high school students who currently:

  • Smoke cigarettes to 16%
  • Use smokeless tobacco to 1%
  • Smoke cigars to 8%
  • Use any tobacco to 21%

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Groups at High Risk for Tobacco Use

In 2005, current cigarette use was higher among White (24.8%) and Hispanic than Black students. Male and female students were equally likely to smoke cigarettes. Overall, cigarette use increases correspondingly with students' grade level, with percentages higher among 12th grade (27.6%) and 11th grade (24.3%) students as compared with 10th grade (21.4%) and 9th grade (19.7%) students. Overall, 9.4% of students had smoked greater than or equal to 20 of the preceding 30 days with more frequent use higher among White than Black and Hispanic students. Among the current smokers, 10.7% of these students smoked more than 10 cigarettes per day on the days that they smoked over the past 30 days, with this rate being higher for male students than female students.

High school males are much more likely than females to use smokeless tobacco (13.6% males, 2.2% females). White students reported higher usage of smokeless tobacco products (10.2%) than Black (1.7%) and Hispanic (5.1%) students.

Current cigar use was higher among male (19.2%) than female (8.7%) students and higher among White (14.9%) and Hispanic (14.6%) students than Black (10.3%) students.

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Key Issues

Some research has shown a close link between tobacco promotional activities and adolescent smoking. Over time, the likelihood of smoking initiation is increased when an adolescent acquires a cigarette promotional item. Results suggest that elimination of cigarette promotional campaigns could reduce adolescent smoking. Substantial increases in tobacco industry expenditures on tobacco advertising and promotion in the United States from $5.7 billion in 1997 to $15.2 billion in 2003 may have impacted the stalled trend downward in 2005 in adolescent current cigarette smoking.

Previous research has suggested a correlation between smoking in movies and youth smoking. During 2002–2004, a significant overall decline in screen time for tobacco was observed among both middle and high school students who reported seeing fewer actors using tobacco on television or in the movies.

In 2004, 11.7% of middle school students (grades 6 to 8) reported using some form of tobacco in the past month. Cigarettes were the most popular choice (8.1%), followed by cigars (5.2%), then by smokeless tobacco (2.9%), pipes (2.5%), bidis (2.3%), and kreteks (clove cigarettes) (1.5%).

Among high school students reporting current cigarette smoking who were under 18 years of age in 2005, 15.2% reported usually getting their own cigarettes by buying them in a store or gas station. Among those reporting trying to buy cigarettes in a store, nearly 50% said they were not asked to show proof of age.

Overall declining trends in cigarette use are encouraging, but prevention efforts (such as increases in cigarette taxes resulting in increased cigarette prices, anti-tobacco media campaigns, restrictions on public smoking, and community mobilization combined with other interventions to decrease minors' access) must be increased and sustained in order to reach the Healthy People 2010 goal. For every 10% increase in cigarette price, there is a 3.7% decrease in youth prevalence.

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Additional Information on Youth Smoking

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National Cancer InstituteDepartment of Health and Human ServicesNational Institutes of HealthUSA.gov