Teens Smoking Less Butt . . .

Only about 22% of high school students smoked cigarettes in 2003 as compared to 36% in 1997, according to a new Morbidity and Mortality Weekly Report released this week by the CDC. Not only do these numbers appear to be moving in the right direction but, if fewer students begin smoking in high school, it is hoped that this downward trend will eventually translate into fewer lifetime cigarette smokers.

Comment: Although the results of this report are encouraging, the numbers mean that at least 1 in 5 high school students is still smoking -- in spite of the increased cost and the greater difficulty for minors to purchase cigarettes. Stopping cigarette smoking remains a challenge for our society as a whole. Just as fewer teen smokers should translate into fewer smoking adults, fewer adults smoking now should correspond to fewer teens taking up the unhealthy habit. When it comes to smoking, adults are key role models for kids. If kids see Gwyneth Paltrow smoking, that sets a bad example.

Barbara K. Hecht, Ph.D.
Frederick Hecht, M.D.
Medical Editors, MedicineNet.com

Cigarette Use Among High School Students --- United States, 1991--2003

Cigarette use is the leading preventable cause of death in the United States (1). One of the national health objectives for 2010 is to reduce the prevalence of current cigarette use among high school students to <16% (objective no. 27-2b) (1). To examine changes in cigarette use among high school students in the United States during 1991--2003, CDC analyzed data from the national Youth Risk Behavior Survey (YRBS). This report summarizes the results of that analysis, which indicated that although 1) the prevalence of lifetime cigarette use was stable among high school students during the 1990s and 2) the prevalence of both current and current frequent cigarette use increased into the late 1990s, all three behaviors had declined significantly by 2003. Prevention efforts must be sustained to ensure this pattern continues and the 2010 objective is achieved.

The national YRBS, a component of CDC's Youth Risk Behavior Surveillance System, used independent three-stage cluster samples for the 1991--2003 surveys to obtain cross-sectional data representative of public and private school students in grades 9--12 in all 50 states and the District of Columbia. During 1991--2003, sample sizes ranged from 10,904 to 16,296, school response rates ranged from 70% to 81%, student response rates ranged from 83% to 90%, and overall response rates ranged from 60% to 70%. For each cross-sectional national survey, students completed an anonymous, self-administered questionnaire that included identically worded questions about cigarette use.

For this analysis, temporal changes for three behaviors were assessed: 1) lifetime cigarette use (i.e., ever tried cigarette smoking, even one or two puffs), 2) current cigarette use (i.e., smoked cigarettes on >1 of the 30 days preceding the survey), and 3) current frequent cigarette use (i.e., smoked cigarettes on >20 of the 30 days preceding the survey). For current cigarette use, temporal changes and subgroup differences in 2003 were analyzed by sex, race/ethnicity, and grade. Data are presented only for non-Hispanic black, non-Hispanic white, and Hispanic students because the numbers of students from other racial/ethnic groups were too small for meaningful analysis.

Data were weighted to provide national estimates, and SUDAAN was used for all data analyses. Temporal changes were analyzed by using logistic regression analyses that assessed linear and quadratic time effects simultaneously and controlled for sex, race/ethnicity, and grade. Quadratic trends indicated significant but nonlinear trends in the data over time. When a significant quadratic trend accompanied a significant linear trend, the data demonstrated a nonlinear variation (e.g., leveling off or change in direction) in addition to an overall increase or decrease over time. T-tests were used to examine differences in current cigarette use in 2003 by sex, race/ethnicity, and grade. All results are statistically significant (p<0.05) unless otherwise noted.

Significant linear and quadratic trends were detected for lifetime and current cigarette use. The prevalence of lifetime cigarette use, although stable during the 1990s, declined significantly, from 70.4% in 1999 to 58.4% in 2003 (Table 1). The prevalence of current cigarette use increased from 27.5% in 1991 to 36.4% in 1997 and then declined significantly to 21.9% in 2003. A significant quadratic trend was detected for current frequent cigarette use; the prevalence increased from 12.7% in 1991 to 16.7% in 1997 and 16.8% in 1999, then declined significantly to 9.7% in 2003.