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Overall tobacco use prevalent among middle, high school students
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Despite significant progress in decreasing tobacco use among adolescents, overall tobacco use remains high, as 1 in 5 high school students and 1 in 20 high school students currently use tobacco, according to an MMWR report.
René A. Arrazola, MPH, of the CDC, and colleagues assessed data from the 2013 National Youth Tobacco Survey to determine the prevalence of tobacco use among US middle and high school students. Surveyed students were asked if they ever (at least once) or currently (at least once in the past 30 days) use cigarettes, cigars, hookahs, smokeless tobacco, electronic cigarettes, pipes, snus, bidis, kreteks and dissolvable tobacco.
Data was derived from self-administered, pencil and paper questionnaires completed by 18,406 students in grades 6 through 12. There was an overall response rate of 67.8%.
Nearly 23% of high school students, in grades 9 through 12, reported current use of a tobacco product. Approximately 12.6% of high school students reported currently using two or more tobacco products.
Cigarettes and cigars were the most commonly used products among high school students, 12.7% and 11.9% reported using them. Approximately 5.7% of high school students used smokeless tobacco; 5.2% used hookahs; 4.5% used e-cigarettes; 4.1% used pipes; 1.8% used snus; and less than 1% used kreteks, bidis or dissolvable tobacco.
Cigarettes were the most commonly used tobacco product among non-Hispanic white or Hispanic high school students, whereas cigars were the most commonly used among all other ethnicities.
Current tobacco use was less common among middle school students, who researchers defined as children in grades 6 through 8. Approximately 6.5% of middle school students currently used tobacco products and 2.9% currently used two or more products. Cigars and cigarettes were the most commonly used, accounting for 3.1% and 2.9% of current tobacco use among middle school students. Pipes were used by 1.9% of middle school students; smokeless tobacco was used by 1.4%; 1.1% used e cigarettes and hookahs; and 0.4% used bidis, kreteks and snus.
Forty six percent of high school students reported ever using any single tobacco product and 31.4% reported ever using two or more tobacco products. Among middle school students, these rates were 17.7% and 9.4%, respectively.
“Considering how trends in tobacco product use and tobacco marketing changes, rigorous surveillance of all available forms of tobacco use by youths, particularly emerging products such as e-cigarettes, is essential,” Arrazola and colleagues wrote. “Rigorous surveillance of the use of all types of tobacco will inform enhanced prevention efforts that could protect the estimated 5.6 million youths in the United States currently projected to die prematurely from a smoking-related disease.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Susan C. Walley, MD
The major highlights from this report are 1) nearly 1 in 4 high students are current tobacco users, 2) the rapid increase in e-cigarette use, and 3) the high percentage of e-cigarette use with other tobacco products. E-cigarettes are battery operated devices that deliver an aerosolized solution containing nicotine, flavoring and carrier solvents such as propylene glycol, to the user. While traditional e-cigarettes resemble conventional cigarettes, newer generations vary in design and are known as e-hookah, vape-pens, and hookah sticks. These devices have been marketed by e-cigarette companies as healthy and safe despite lack of scientific evidence.
While the majority of tobacco use remains combustible tobacco products (cigarettes and cigars), the rapid increase in market penetration, awareness and use of e-cigarettes threatens prior successes in decreasing tobacco use in the United States. If the increase in e-cigarette use continues, a growing number of youth will be exposed to nicotine, potentially leading to addiction and dual use with combustible tobacco products.
There is no current federal regulation on the marketing, advertising, product design, or sale of e-cigarettes or e-liquid, the solution in e-cigarettes. In April 2014, the FDA proposed deeming regulations for tobacco products which would grant them authority to regulate e-cigarettes in the same manner as cigarettes. When asking youth about tobacco use, it is important to specifically ask about e-cigarettes and counsel youth that all tobacco products can be addictive and harmful to health.
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Arrazola RA. MMWR. 2014; 63(45):1021 1026.
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