Teens and Tobacco Use: Why Declines in Youth Have Stalled

Tobacco use in dropped sharply between 1997 and 2003, but since then the rate of decline has slowed. Between 2009 and 2011, it nearly ground to a halt. Why?

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Smoking rates in teens have dropped considerably over the last decade, but the rate of decline has ground to a halt in recent years, according to the latest data from the Centers for Disease Control and Prevention (CDC).

In a study released Thursday, CDC researchers report that from 2000 to 2011, middle schoolers’ use of any tobacco, including chew tobacco, declined from 14.9% to 7.1%; use of any smokable tobacco, including cigars, pipes and bidis, fell from 14% to 6.3%; and cigarette smoking dropped from 10.7% to 4.3%. High school students registered similar declines, though overall rates of tobacco use in that age group remained high: from 200o to 2011, any tobacco use went from 34.4% to 23.2%; smokable tobacco use dropped from 33.1% to 21.0%; and cigarette smoking went from 27.9% to 15.8%. The data come from the 2011 National Youth Tobacco Survey (NYTS).

But while teen tobacco use plummeted in the U.S. between 1997 to 2003, that decline started losing momentum in the early 2000s as states cut funding for tobacco-control programs. Indeed, from 2009 to 2011, there was no significant decline in tobacco use among middle school students. And at least 1 in 5 high school kids are still using some form of tobacco.

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“We had a very strong emphasis on funding for state programs between 1997 and 2003. What’s happened in the last five years is a disturbing decline in state investments in comprehensive tobacco controlling programs,” says Dr. Tim McAfee, director of CDC’s Office on Smoking and Health. “The funding rate nationwide is 30% to 40% less than what it was four years ago. In some states, these programs have virtually collapsed.”

In 2011, nearly 30% of high school boys and 18% of high school girls used tobacco, while more than 8% of middle school boys and nearly 6% of middle school girls did. “A large majority of people initiate their use of tobacco and smoking in adolescence. We are very concerned that more needs to be done in all levels of our society to rapidly diminish the rate of use in youth and young adults,” says McAfee.

Ninety percent of smokers pick up the habit before they’re 18, and smoking continues to be the leading cause of preventable death and disability in the U.S., with nearly 443,000 deaths each year attributable to smoking or exposure to secondhand smoke.

A disturbing trend emerged when the data were parsed by ethnicity: between 2009 and 2011, cigar use among black high school students jumped from 7.1% to 11.7%. “If there’s one statistic that’s truly alarming, it’s this,” says McAfee. “In many ways middle school and high school use of cigarettes has been a success story in the African American community. But their level of cigar use brings them up to the level of cigarette use among other students.”

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Indeed, spikes in cigar use are occurring among smokers overall. Last week, a separate CDC study reported a 123% increase in the consumption of smokable tobacco products like cigars and pipes over the last decade — even while cigarette consumption declined — because because these products aren’t taxed like cigarettes and are therefore cheaper. As adult cigarette smokers switch to cigars to save money, the trend is reflected among youth too.

The findings underscore the need to meet the 2012 Surgeon General’s Report recommendations of making tobacco less affordable, increasing aggressive mass media campaigns and tobacco control programs, and encouraging tougher regulation of tobacco marketing, sales and distribution to youth.

The overall declines in tobacco use are certainly encouraging, said  Dr. Thomas Frieden, director of the CDC, in a statement, “but although 4 out of 5 teens don’t smoke, far too many kids start to smoke each day.”

(MORE: Should Movies With Smoking Be Rated R?)

“The good news is we know things we can do that work,” says McAfee. “We succeeded in having much more dramatic rates of decline in the late 90s and early 2000s. We have new capacity with FDA regulatory authority of tobacco that we’ve never had before. If we work together around this, we can turn it around in a relatively short period of time.”

The study was published in the CDC’s Morbidity and Mortality Weekly Report.

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"We also are encouraged by the latest government data that show illegal retail tobacco sales to minors are at an all-time low."

Mr. Garcia's point would also suggest the validity of my point.

I am not a smoking advocate however I am concerned about youth and addiction. I was a smoker and I know why people start. I also know why many cannot stop. I would not encourage smoking nor healthier alternatives to smoking such as e cigs to anyone who does not currently smoke.

I have been smoke free for 2 months now by using e cigs and PVs. While Health Canada has "banned" these products (with nicotine) in Canada, I really don't care. I have no confidence in their irrational scare tactics. I was able to quit smoking immediately and effectively with no discomfort using this method and my health has improved greatly. I will continue my efforts advocate e cigs as an alternative for smokers while educating our youth in the process.the difference is, I base my decisions and direction on facts, not erroneous and misleading perceptions designed to scare and not educate and inform.

Jon Krueger
Jon Krueger

The largest, longest-running, best funded, best designed tobacco campaign for teens is run by the tobacco industry. It teaches teens that cigarettes are GREAT and will help them show their independence, be part of the in crowd, and, for teen girls, keep them thin. This program has not had its funding cut. If you're looking for why kids are still smoking, and you don't look at this program, you're no journalist.

"If our company is to strive and prosper, over the long term we must

get our share of the youth market.... Thus we need new brands designed

to be particularly attractive to the young smoker"  R.J. Reynolds

"The base of our business is the high school student"  Lorillard

"Marlboro's phenomenal growth rate in the past has been attributable in large part to our high market penetration among young smokers . . .15 to 19 years old . . . my own data, which includes younger teenagers, shows even higher Marlboro market penetration among 15-17-year-olds"  Philip Morris

Do some journalism, guys.


 Smoking in Adolescence can even lead to hearing loss, I'm pretty sure a few of our members were damaged in this way.


There is more tobacco-generated revenue available to states and the federal government today than ever before to fund proven efforts to prevent underage tobacco use. However, The Centers for Disease Control has said that many states have not devoted adequate funding toward underage tobacco prevention and cessation programs and we think they should. Philip Morris USA, alone, has made tobacco settlement agreement payments of more than $59 billion to the states since 1997.

Philip Morris USA, U.S. Smokeless Tobacco and John Middleton Co. agree that kids should not use tobacco products, and we share the common goal of keeping tobacco products out of the hands of kids. Tremendous progress has been made in reducing overall underage tobacco use, which is at its lowest level in a generation according to a recent CDC survey (http://www.cdc.gov/mmwr/pdf/ss.... We also are encouraged by the latest government data that show illegal retail tobacco sales to minors are at an all-time low.


While significant progress has been made in reducing underage tobacco use over time, we agree that more work needs to be done. We believe states should to devote more of the already available tobacco settlement funds to prevent and further reduce underage tobacco use.

Ken Garcia

Media Affairs

Altria Client Services on behalf of Philip Morris USA, U.S. Smokeless Tobacco Co. and John Middleton Co.

Jon Krueger
Jon Krueger

That's what "Altria" (tobacco giant Philip Morris) says in public: "oh gosh, we don't want kids to smoke!"

In private, Philip Morris says something different:

"Marlboro's phenomenal growth rate in the past has been attributable

in large part to our high market penetration among young smokers

. . . 15 to 19 years old . . . my own data, which includes

younger teenagers, shows even higher Marlboro market penetration

among 15-17-year-olds"

"The smoking patterns of teen-agers are particularly important to

Philip Morris"

"today's teen-ager is tomorrow's

potential regular customer. . . . Because of our high

share of the market among the youngest smokers, Philip

Morris will suffer more than the other companies from the

decline in the number of teenage smokers."

All quotes from tobacco industry memos. What the tobacco industry says

in private, when it thinks no one is listening, tells a very different story

than what Big Tobacco says in public.