Abstract
Purpose
The purpose of this study was to assess patterns and trends of tobacco use among high school students to better understand which products are used individually or concurrently.
Methods
Data from the National Youth Tobacco Survey from 2000 through 2012 were used to assess patterns and trends of current tobacco use (cigarettes, cigars, smokeless tobacco, and other tobacco products) among U.S. high school students. We assessed use of products individually and concurrently.
Results
During 2000–2012, overall linear declines were observed in current use of any tobacco product from 33.6% to 20.4% (p < .05), current use of only 1 tobacco product, from 18.8% to 10.5% (p < .05), and current poly tobacco use, from 14.7% to 9.9% (p < .05), among high school students. Overall current use of only cigarettes had both a linear decline, from 14.0% to 4.7%, as well as a quadratic trend.
Conclusions
During 2000–2012, the most significant overall decline observed was for students who reported smoking only cigarettes. The results suggest that more data on the use of multiple tobacco products, not just cigarettes, is needed to guide tobacco prevention and control policies and programs.
Keywords: Current tobacco use, High school students, United States
Tobacco use continues to be the single leading preventable cause of death and disease in the United States [1], and most tobacco use begins before the age of 18 [2]. Cigarette smoking remains prevalent among youth, with approximately one of five high school students reporting current smoking in 2011 [3]. Although declines in youth smoking rates were observed over the past two decades, more recently, the decline in current cigarette smoking is occurring at a slower rate than was observed during 1997–2003 [4]. The rates observed for use of other tobacco products (e.g., cigars, smokeless tobacco) have not changed during this period [5].
A conclusion from the 2010 Surgeon General’s Report supports previous findings that nicotine is the key compound that produces the addictive effects of tobacco products [6], and all tobacco products contain nicotine [7]. The concurrent use of multiple tobacco products is a public health concern, especially during adolescence when young people may experiment with various tobacco products [2], which may increase their risk of nicotine dependence. Research has suggested that use of multiple tobacco products concurrently may lead to greater addiction among users of these products [2]. Furthermore, among high school students, use of tobacco in the past 30 days is associated with the use of alcohol and other illegal substances [8], and the relationship is even stronger when students report using two or more tobacco products [9]. These findings indicate a need to monitor the use of all types of tobacco products, both individual and concurrently, because young people who use multiple tobacco products are potentially increasing their exposure to nicotine and their risk of dependence on nicotine [10].
Given that the rate of decline has slowed in recent years for current use of cigarettes but not for other tobacco products (e.g., cigars, smokeless tobacco) among young people [2], researchers need to understand better the use of multiple products over time among youth. At present, limited information exists on the current use of specific tobacco products that high school students use individually or concurrently. The purpose of this study is to assess the prevalence of the current use of cigarettes, cigars, smokeless tobacco, pipe tobacco, bidis, and kreteks alone or in combination with one another and to identify any changes over time.
Methods
Data source and study population
We used data from the National Youth Tobacco Survey (NYTS) from 2000 through 2012. The NYTS is a school-based, cross-sectional survey that collects information on key tobacco indicators, such as behaviors and attitudes, from middle school (grades 6–8) and high school (grades 9–12) students and provides national estimates on these indicators. A more comprehensive description of the NYTS and its methodology can be found at http://www.cdc.gov/tobacco/data_statistics/surveys/nyts/index.htm.
Our study focused on patterns and trends in tobacco use among high school students for six specific products: cigarettes, cigars, smokeless tobacco, pipe tobacco, bidis, and kreteks. We limited our analysis to high school students who responded to all questions about their use of these products in the past 30 days; those with missing responses were excluded. Initial sample sizes ranged from 19,350 (highest) students in 2000 to 9,720 (lowest) in 2011 (Table 1). For our study, sample sizes ranged from 18,219 (highest) students in 2000 to 9,198 (lowest) in 2011.
Table 1.
Current tobacco use among U.S. high school students, overall, National Youth Tobacco Survey, 2000–2012
| Characteristics | Survey year
|
|||||||
|---|---|---|---|---|---|---|---|---|
| 2000 % (95% CI) | 2002 % (95% CI) | 2004 % (95% CI) | 2006 % (95% CI) | 2009 % (95% CI) | 2011 % (95% CI) | 2012 % (95% CI) | Trends | |
| Overall | ||||||||
| Sample size | 18,219 out of 19,350 | 12,430 out of 13,460 | 12,318 out of 13,738 | 12,880 out of 14,489 | 11,446 out of 12,346 | 9,198 out of 9,720 | 12,129 out of 12,899 | |
| Any current tobacco use | 33.6 (31.6–35.6) | 27.2 (25.5–29.0) | 26.5 (24.2–29.0) | 24.3 (22.4–26.3) | 21.7 (18.8–24.9) | 22.2 (20.0–24.5) | 20.4 (18.6–22.2) | a |
| Current use of only 1 tobacco product | 18.8 (17.6–20.1) | 16.6 (15.4–17.9) | 15.5 (14.0–17.0) | 13.5 (12.5–14.7) | 12.4 (11.2–13.6) | 12.3 (11.2–13.4) | 10.5 (9.5–11.6) | a |
| Current use of only cigarettes | 14.0 (12.9–15.1) | 12.3 (11.2–13.6) | 11.3 (10.0–12.7) | 9.3 (8.4–10.4) | 8.1 (7.2–9.1) | 6.3 (5.4–7.2) | 4.7 (4.1–5.4) | b |
| Current use of only smokeless tobacco | 1.4 (1.1–1.7) | 1.4 (1.0–1.9) | 1.3 (1.0–1.8) | 1.5 (1.1–2.0) | 1.6 (1.1–2.4) | 2.2 (1.6–2.9) | 1.6 (1.2–2.2) | |
| Current use of only cigars | 3.0 (2.6–3.4) | 2.5 (2.1–2.9) | 2.7 (2.3–3.1) | 2.4 (2.0–2.9) | 2.2 (1.8–2.8) | 3.2 (2.7–3.9) | 3.7 (3.1–4.3) | |
| Current use of only 1 other tobaccoc product | .4 (.3–.6) | .4 (.3–.6) | .2 (.1–.3) | .3 (.2–.5) | .4 (.3–.7) | .6 (.4–.9) | .5 (.4–.6) | |
| Current poly tobacco use | 14.7 (13.7–15.8) | 10.6 (9.7–11.6) | 11.1 (9.8–12.5) | 10.8 (9.8–11.8) | 9.3 (7.4–11.7) | 9.9 (8.5–11.6) | 9.9 (8.8–11.1) | a |
| Current use of only 2 tobacco products | 9.0 (8.4–9.7) | 6.5 (5.9–7.1) | 6.8 (5.9–7.8) | 6.3 (5.7–7.0) | 5.4 (4.3–6.9) | 6.0 (5.1–7.1) | 6.0 (5.3–6.8) | a |
| Current use of cigarettes and 1 tobacco product | 7.9 (7.3–8.6) | 5.6 (5.0–6.2) | 6.0 (5.2–6.9) | 5.5 (4.9–6.2) | 4.6 (3.7–5.8) | 5.1 (4.2–6.1) | 4.7 (4.0–5.4) | a |
| Current use of only cigarettes and smokeless tobacco | 1.2 (1.0–1.5) | 1.2 (.8–1.6) | .9 (.6–1.3) | 1.0 (.7–1.4) | 1.3 (.9–1.9) | 1.5 (1.0–2.1) | 1.0 (.8–1.3) | a |
| Current use of only cigarettes and cigars | 4.9 (4.4–5.5) | 3.4 (3.0–3.9) | 4.6 (4.0–5.3) | 3.5 (3.1–4.0) | 2.9 (2.4–3.6) | 3.2 (2.6–3.8) | 3.1 (2.6–3.7) | a |
| Current use of only cigarettes and only 1 other tobacco product | 1.8 (1.6–2.0) | 1.0 (.8–1.3) | .5 (.3–.8) | 1.0 (.7–1.3) | .4 (.3–.7) | .4 (.3–.6) | .6 (.4–.7) | |
| No current use of cigarettes but only 2 tobacco products | 1.1 (.9–1.3) | .9 (.7–1.2) | .8 (.6–1.1) | .8 (.6–1.0) | .8 (.5–1.3) | .9 (.7–1.2) | 1.3 (1.1–1.6) | |
| Current use of at least 3 tobacco products | 5.7 (5.2–6.3) | 4.1 (3.6–4.7) | 4.3 (3.7–5.0) | 4.4 (3.9–5.0) | 3.9 (3.0–5.0) | 3.9 (3.2–4.8) | 3.9 (3.2–4.7) | |
| Current use of cigarettes and at least 2 tobacco products | 5.5 (5.0–6.0) | 4.0 (3.5–4.6) | 4.0 (3.5–4.7) | 4.2 (3.7–4.8) | 3.7 (2.9–4.7) | 3.8 (3.2–4.7) | 3.6 (3.0–4.4) | |
| Current use of only cigarettes, cigars, and smokeless tobacco | 1.3 (1.0–1.6) | 1.2 (.9–1.6) | .9 (.7–1.2) | 1.1 (.9–1.4) | 1.1 (.7–1.7) | 1.2 (.8–1.7) | 1.0 (.7–1.3) | |
| Current use of only cigarettes, smokeless tobacco, and at least 1 other tobacco product | .3 (.2–.4) | .1 (0.0–.2)d | .1 (.1–.2)d | .1 (.1–.3) | .2 (.1–.4) | .2 (.1–.3)d | .2 (.1–.3) | |
| Current use of only cigarettes, cigars, and at least 1 other tobacco product | 2.4 (2.1–2.8) | 1.5 (1.3–1.8) | 1.7 (1.4–2.0) | 1.5 (1.2–1.9) | 1.2 (.9–1.5) | 1.2 (.9–1.6) | 1.2 (1.0–1.5) | a |
| Current use of only cigarettes and at least 2 other tobacco products | .3 (.2–.4) | .1 (.1–.2) | .1 (.1–.2) | .2 (.1–.4) | .1 (0.0–.2)d | .1 (0.0–.2)d | .1 (0.0–.1)d | |
| Current use of cigarettes, smokeless tobacco, cigars, and at least 1 other tobacco product | 1.2 (1.0–1.4) | 1.1 (.8–1.4) | 1.2 (.9–1.6) | 1.2 (1.0–1.5) | 1.1 (.8–1.5) | 1.2 (.9–1.6) | 1.2 (.9–1.5) | |
| No current use of cigarettes but at least 3 tobacco products | .3 (.2–.4) | .1 (.1–.2) | .2 (.2–.4) | .2 (.1–.3) | .2 (.1–.3) | .1 (.1–.2)d | .2 (.1–.4) | |
CI = confidence interval.
Linear trend.
Linear and quadratic trend.
Other tobacco is defined as use of pipe, bidis, or kreteks on at least 1 day of the past 30 days.
Data statistically unstable (denominator <50 and/or relative standard error >30%).
Measures
The following questions were used to assess current tobacco use: (1) “During the past 30 days, on how many days did you smoke cigarettes?” (2) “During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars?” (3) “During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip?” (4) “During the past 30 days, on how many days did you smoke tobacco in a pipe?” (5) “During the past 30 days, on how many days did you smoke bidis?” and (6) “During the past 30 days, on how many days did you smoke kreteks?” Note that in 2012 the bidis and kreteks questions changed to “In the past 30 days, which of the following products have you used on at least one day?” and students could select different products of which “bidis (small brown cigarettes wrapped in a leaf)” and “clove cigarettes (kreteks)” were possible selections. We defined “any current tobacco ” as using one or use more of these six products on at least 1 day in the past 30 days; respondents who did not use any products on at least 1 day of the past 30 days were categorized as “no current tobacco use” (Figure 1). Because of small sample sizes, we collapsed use of pipe tobacco, bidis, and kreteks in the past 30 days into the category “other tobacco product.”
Figure 1.
Flowchart for categories used to define current tobacco use among U.S. high school students, National Youth Tobacco Survey, 2000–2012.
Any current tobacco use was then examined as two mutually exclusive categories: “current use of only 1 tobacco product” and “current poly tobacco use” (Figure 1). Current use of only 1 tobacco product was then examined as four mutually exclusive categories: “current use of only cigarettes,” “current use of only smokeless tobacco,” “current use of only cigars,” and “current use of only 1 other tobacco product” (Figure 1).
Current use of 2 or more tobacco products was categorized as “current poly tobacco use” (Figure 1). Current poly tobacco use was then examined as two mutually exclusive categories: “current use of only 2 tobacco products” and “current use of at least 3 tobacco products” (Figure 1).
Current use of only 2 tobacco products was examined as two mutually exclusive categories: “current use of cigarettes and 1 tobacco product” and “no current use of cigarettes but only 2 tobacco products” (Figure 1). Current use of cigarettes and 1 tobacco product was then examined as three mutually exclusive categories: “current use of only cigarettes and smokeless tobacco,” “current use of only cigarettes and cigars,” and “current use of only cigarettes and only 1 other tobacco product” (Figure 1).
Current use of at least 3 tobacco products was examined as two mutually exclusive categories: “current use of cigarettes and at least 2 tobacco products” and “no current use of cigarettes but at least 3 tobacco products” (Figure 1). Current use of cigarettes and at least 2 tobacco products was then examined as five mutually exclusive categories: “current use of only cigarettes, cigars, and smokeless tobacco;” “current use of only cigarettes, smokeless tobacco, and at least 1 other tobacco product;” “current use of only cigarettes, cigars, and at least 1 other tobacco product;” “current use of only cigarettes and at least 2 other tobacco products;” and “current use of cigarettes, smokeless tobacco, cigars, and at least 1 other tobacco product” (Figure 1).
Analysis
All analyses took into account this study’s multistage probability design. Data were adjusted for nonresponse and weighted to provide nationally representative prevalence estimates of current tobacco use (and each of its stratifications) overall and for selected demographic characteristics. Results where the denominator was less than 50 or the relative standard error was higher than 30% were marked as statistically unstable. We used orthogonal polynomials to perform multinomial logistic regression analyses to simultaneously assess for linear and quadratic trends during 2000–2012.
Our models used the following outcomes: Outcome 1 had two possible outcomes: “no current tobacco use” and “any current tobacco use.” Outcome 2 had three possible outcomes: “no current tobacco use,” “current use of only 1 tobacco product,” and “current poly tobacco use.” Outcome 3 had four possible outcomes: “no current tobacco use,” “current use of only 1 tobacco product,” “current use of only 2 tobacco products,” and “current use of at least 3 tobacco products.” Outcome 4 had six possible outcomes: “no current tobacco use,” “current use of only 1 tobacco product,” “current use of cigarettes and 1 tobacco product,” “no current cigarette use but only 2 tobacco products,” “current use of cigarettes and at least 2 tobacco products,” and “no current use of cigarettes but at least 3 tobacco products.” Outcome 5 had fifteen possible outcomes: “no current tobacco use,” “current use of only cigarettes,” “current use of only smokeless tobacco,” “current use of only cigars,” “current use of only 1 other tobacco product,” “current use of only cigarettes and smokeless tobacco,” “current use of only cigarettes and cigars,” “current use of only cigarettes and only 1 other tobacco product,” “no current cigarette use but only 2 tobacco products,” “current use of only cigarettes, cigars, and smokeless tobacco,” “current use of only cigarettes, smokeless tobacco, and at least 1 other tobacco product,” “current use of only cigarettes, cigars, and at least 1 other tobacco product,” “current use of only cigarettes and at least 2 other tobacco products,” “current use of cigarettes, smokeless tobacco, cigars, and at least 1 other tobacco product,” and “no current use of cigarettes but at least 3 tobacco products.”
Multinomial logistic regression analysis was used to compare all outcomes for Outcomes 1–5 with “no current tobacco use.” Our overall model controlled for sex, race/ethnicity, and grade. The models stratified by sex controlled for race/ethnicity and grade, whereas those stratified by race/ethnicity controlled for sex and grade, and those stratified by grade controlled for sex and race/ethnicity. Linear and quadratic trends were considered to be present if p < .05. We used SAS-Callable SUDAAN 11.0 (RTI International, Research Triangle Park, NC) to calculate all results.
Results
Overall
During 2000–2012, significant linear downward trends were observed for current tobacco use (33.6% to 20.4%), current use of only 1 tobacco product (18.8%to10.5%), current poly tobacco use (14.7%to 9.9%), current use of only 2 tobacco products (9.0% to 6.0%), current use of cigarettes and 1 tobacco product (7.9% to 4.7%), current use of only cigarettes and smokeless tobacco (1.2% to 1.0%), current use of only cigarettes and cigars (4.9% to 3.1%), and current use of only cigarettes, cigars, and at least 1 other tobacco product (2.4% to 1.2%); a significant linear and quadratic (nonlinear) trend was observed for current use of only cigarettes (14.0% to 4.7%) among U.S. high school students. No significant trends were observed for any other categories (Table 1). In 2012, 8.3% of high school students currently used cigarettes and at least 1 tobacco product.
Sex
Among males, during 2000–2012, significant linear downward trends were observed for current tobacco use (37.5% to 25.3%), current use of only 1 tobacco product (16.8% to 11.5%), current use of only cigarettes (9.4% to 3.8%), current use of only 2 tobacco products (11.8% to 7.7%), current use of cigarettes and 1 tobacco product (9.9% to 5.5%), current use of only cigarettes and cigars (6.5% to 3.5%), and current use of only cigarettes, cigars, and at least 1 other tobacco product (3.1% to 1.6%) (Table 2, which can be found in the online edition of this article). Among females, significant linear downward trends were only observed for current tobacco use (29.6% to 15.4%), current use of only 1 tobacco product (20.8% to 9.5%), current use of only cigarettes (18.6% to 5.7%), and current use of only cigarettes and only 1 other tobacco product (2.2% to .7%). In 2012, 11.3% of high school males currently used cigarettes and at least 1 tobacco product, and among females it was 5.3%.
Table 2.
Current tobacco use among U.S. high school students, by sex, National Youth Tobacco Survey, 2000–2012
| Characteristics | Survey year
|
|||||||
|---|---|---|---|---|---|---|---|---|
| 2000 % (95% CI) | 2002 % (95% CI) | 2004 % (95% CI) | 2006 % (95% CI) | 2009 % (95% CI) | 2011 % (95% CI) | 2012 % (95% CI) | Trends | |
| Male | ||||||||
| Sample size | 9,219 out of 9,973 | 6,095 out of 6,718 | 5,858 out of 6,694 | 6,155 out of 7,027 | 5,494 out of 6,049 | 4,489 out of 4,832 | 5,958 out of 6,458 | |
| Any current tobacco use | 37.5 (35.2–39.8) | 31.2 (28.8–33.6) | 29.3 (24.2–29.0) | 28.2 (26.0–30.5) | 26.8 (22.6–31.4) | 27.0 (24.2–30.1) | 25.3 (23.1–27.6) | a |
| Current use of only 1 tobacco product | 16.8 (15.8–17.9) | 15.6 (14.1–17.2) | 13.9 (12.5–15.4) | 13.4 (12.2–14.8) | 13.4 (11.9–15.1) | 13.2 (11.8–14.7) | 11.5 (10.2–12.9) | a |
| Current use of only cigarettes | 9.4 (8.6–10.3) | 9.3 (8.1–10.7) | 7.2 (6.2–8.3) | 7.0 (6.1–8.0) | 7.4 (6.6–8.2) | 4.7 (3.9–5.6) | 3.8 (3.2–4.4) | a |
| Current use of only smokeless tobacco | 2.5 (2.0–3.1) | 2.5 (1.8–3.6) | 2.6 (1.9–3.5) | 2.9 (2.1–4.0) | 3.0 (2.0–4.5) | 3.9 (2.9–5.3) | 3.1 (2.3–4.3) | |
| Current use of only cigars | 4.5 (3.9–5.1) | 3.4 (2.8–4.1) | 3.9 (3.4–4.5) | 3.3 (2.7–4.0) | 3.5 (2.7–4.5) | 4.2 (3.3–5.3) | 4.2 (3.5–5.0) | |
| Current use of only 1 other tobaccoc product | .4 (.3–.6) | .3 (.2–.6) | .2 (.1–.3)d | .3 (.1–.5)d | 1.1 (.6–1.9) | .4 (.2–.7) | .4 (.3–.6) | |
| Current poly tobacco use | 20.7 (19.1–22.4) | 15.6 (14.0–17.4) | 15.4 (13.6–17.3) | 14.8 (13.3–16.3) | 13.3 (10.5–16.9) | 13.8 (11.9–16) | 13.8 (12.3–15.6) | |
| Current use of only 2 tobacco products | 11.8 (10.7–13.0) | 8.8 (7.9–9.9) | 8.9 (7.8–10.2) | 8.0 (7.0–9.2) | 7.4 (5.7–9.6) | 7.7 (6.5–9.0) | 7.7 (6.7–8.8) | a |
| Current use of cigarettes and 1 tobacco product | 9.9 (8.9–11.0) | 7.3 (6.4–8.3) | 7.5 (6.5–8.7) | 6.7 (5.8–7.8) | 6.0 (4.6–7.6) | 6.1 (5.0–7.3) | 5.5 (4.7–6.5) | a |
| Current use of only cigarettes and smokeless tobacco | 2.1 (1.6–2.6) | 2.1 (1.5–2.9) | 1.5 (1.0–2.2) | 1.8 (1.3–2.4) | 2.2 (1.5–3.2) | 2.6 (1.8–3.7) | 1.6 (1.2–2.1) | |
| Current use of only cigarettes and cigars | 6.5 (5.8–7.3) | 4.3 (3.6–5.0) | 5.7 (5.0–6.5) | 4.2 (3.6–4.8) | 3.6 (2.9–4.4) | 3.2 (2.6–3.9) | 3.5 (2.9–4.2) | a |
| Current use of only cigarettes and only 1 other tobacco product | 1.3 (1.1–1.6) | .9 (.7–1.3) | .3 (.2–.6)d | .8 (.5–1.3) | .4 (.2–.7)d | .3 (.2–.5) | .4 (.3–.6) | |
| No current use of cigarettes but only 2 tobacco products | 1.9 (1.6–2.3) | 1.5 (1.2–2.0) | 1.4 (1.0–2.0) | 1.3 (1.0–1.7) | 1.5 (.9–2.3) | 1.6 (1.2–2.1) | 2.2 (1.7–2.7) | |
| Current use of at least 3 tobacco products | 8.9 (7.9–9.9) | 6.8 (5.8–7.9) | 6.5 (5.5–7.6) | 6.7 (5.8–7.7) | 5.9 (4.5–7.7) | 6.2 (5.1–7.5) | 6.1 (5.1–7.4) | |
| Current use of cigarettes and at least 2 tobacco products | 8.4 (7.5–9.4) | 6.5 (5.6–7.7) | 6.0 (5.1–7.1) | 6.4 (5.5–7.4) | 5.6 (4.3–7.3) | 6.0 (5.0–7.3) | 5.8 (4.8–6.9) | |
| Current use of only cigarettes, cigars, and smokeless tobacco | 2.3 (1.9–2.9) | 2.4 (1.8–3.1) | 1.5 (1.2–2.0) | 2.0 (1.6–2.6) | 2.0 (1.3–3.1) | 2.2 (1.6–3.0) | 1.8 (1.4–2.5) | |
| Current use of only cigarettes, smokeless tobacco, and at least 1 other tobacco product | .5 (.3–.7) | .1 (0.0–.2)d | .2 (.1–.4)d | .2 (.1–.3)d | .3 (.2–.7)d | .3 (.1–.6)d | .2 (.1–.4)d | |
| Current use of only cigarettes, cigars, and at least 1 other tobacco product | 3.1 (2.7–3.7) | 2.2 (1.8–2.7) | 2.0 (1.6–2.5) | 1.8 (1.4–2.2) | 1.5 (1.2–1.9) | 1.6 (1.2–2.2) | 1.6 (1.3–2.1) | a |
| Current use of only cigarettes and at least 2 other tobacco products | .3 (.2–.5) | .1 (0.0–.2)d | .1 (0.0–.2)d | .1 (.1–.3)d | .2 (.1–.4)d | .1 (0.0–.2)d | .1 (0.0–.2)d | |
| Current use of cigarettes, smokeless tobacco, cigars, and at least 1 other tobacco product | 2.1 (1.8–2.6) | 1.8 (1.4–2.5) | 2.2 (1.6–3.1) | 2.3 (1.7–2.9) | 2.0 (1.4–2.7) | 2.4 (1.8–3.2) | 2.0 (1.6–2.6) | |
| No current use of cigarettes but at least 3 tobacco products | .5 (.3–.7) | .2 (.1–.4) | .5 (.3–.7) | .4 (.2–.6) | .3 (.2–.5) | .2 (.1–.4)d | .4 (.2–.7)d | |
| Female | ||||||||
| Sample size | 8,996 out of 9,371 | 6,318 out of 6,719 | 6,395 out of 6,964 | 6,638 out of 7,359 | 5,936 out of 6,273 | 4,651 out of 4,819 | 6,170 out of 6,439 | |
| Any current tobacco use | 29.6 (27.6–31.6) | 23.3 (21.5–25.2) | 24.0 (21.5–26.6) | 20.8 (18.7–23.0) | 16.8 (14.6–19.1) | 17.3 (15.4–19.5) | 15.4 (13.6–17.4) | a |
| Current use of only 1 tobacco product | 20.8 (19.2–22.6) | 17.6 (15.9–19.3) | 16.9 (15.0–18.9) | 13.7 (12.2–15.3) | 11.4 (9.8–13.2) | 11.3 (10.0–12.8) | 9.5 (8.4–10.9) | a |
| Current use of only cigarettes | 18.6 (17.0–20.3) | 15.3 (13.6–17.2) | 15.0 (13.2–17.0) | 11.5 (10.2–13.1) | 9.4 (8.0–10.9) | 7.8 (6.5–9.3) | 5.7 (4.9–6.6) | a |
| Current use of only smokeless tobacco | .3 (.2–.5) | .3 (.2–.5) | .1 (.1–.3)d | .2 (.1–.4)d | .3 (.2–.7)d | .5 (.3–.8) | .1 (.1–.3)d | |
| Current use of only cigars | 1.4 (1.1–1.8) | 1.5 (1.2–1.9) | 1.5 (1.2–2) | 1.6 (1.2–2.1) | 1.3 (.9–1.9) | 2.2 (1.7–3) | 3.2 (2.6–3.9) | |
| Current use of only 1 other tobacco | .5 (.3–.7) | .4 (.3–.7) | .2 (.1–.4) | .4 (.2–.5) | .4 (.2–.7)d | .8 (.5–1.5) | .6 (.4–.8) | |
| Current poly tobacco use | 8.7 (7.9–9.7) | 5.7 (5.0–6.6) | 7.1 (5.9–8.4) | 7.1 (6.1–8.2) | 5.3 (4.3–6.7) | 6.0 (4.9–7.5) | 5.9 (5.0–6.9) | |
| Current use of only 2 tobacco products | 6.2 (5.5–6.9) | 4.2 (3.6–4.9) | 4.9 (4.0–6.0) | 4.7 (4.0–5.6) | 3.4 (2.7–4.4) | 4.4 (3.4–5.5) | 4.3 (3.5–5.1) | |
| Current use of cigarettes and 1 tobacco product | 5.9 (5.3–6.6) | 3.9 (3.3–4.6) | 4.6 (3.8–5.6) | 4.4 (3.7–5.3) | 3.3 (2.5–4.2) | 4.1 (3.2–5.3) | 3.8 (3.1–4.6) | |
| Current use of only cigarettes and smokeless tobacco | .4 (.2–.6) | .2 (.1–.5)d | .3 (.1–.7)d | .4 (.1–.9)d | .2 (.1–.6)d | .3 (.2–.6)d | .4 (.2–.6) | |
| Current use of only cigarettes and cigars | 3.3 (2.8–3.9) | 2.6 (2.1–3.3) | 3.6 (2.9–4.5) | 2.9 (2.4–3.7) | 2.4 (1.9–3.0) | 3.2 (2.5–4.3) | 2.7 (2.1–3.4) | |
| Current use of only cigarettes and only 1 other tobacco product | 2.2 (1.9–2.6) | 1.1 (.8–1.5) | .7 (.4–1.2) | 1.1 (.8–1.7) | .6 (.4–1.0) | .6 (.3–.9) | .7 (.5–1.0) | a |
| No current use of cigarettes but only 2 tobacco products | .3 (.2–.4) | .3 (.2–.5) | .3 (.2–.5) | .3 (.2–.5) | .2 (.1–.3) | .3 (.2–.5) | .5 (.3–.7) | |
| Current use of at least 3 tobacco products | 2.6 (2.1–3.1) | 1.5 (1.2–2.0) | 2.2 (1.7–2.9) | 2.4 (1.9–2.9) | 1.9 (1.4–2.6) | 1.7 (1.2–2.3) | 1.6 (1.2–2.1) | |
| Current use of cigarettes and at least 2 tobacco products | 2.5 (2.1–3.1) | 1.5 (1.1–2.0) | 2.1 (1.6–2.8) | 2.3 (1.9–2.8) | 1.8 (1.3–2.4) | 1.6 (1.2–2.2) | 1.5 (1.2–2.0) | |
| Current use of only cigarettes, cigars, and smokeless tobacco | .2 (.1–.5)d | .2 (.1–.3)d | .3 (.2–.6)d | .2 (.1–.5)d | .2 (.1–.5)d | .3 (.1–.8)d | .1 (.1–.2)d | |
| Current use of only cigarettes, smokeless tobacco, and at least 1 other | .1 (0.0–.2)d | .1 (0.0–.2)d | .1 (0.0–.2)d | .1 (.1–.3)d | .2 (0.0–.7)d | .1 (0.0–.3)d | .1 (.1–.3)d | |
| Current use of only cigarettes, cigars, and at least 1 other tobacco product | 1.7 (1.3–2.1) | .9 (.6–1.2) | 1.3 (1–1.8) | 1.3 (.9–1.9) | 1.0 (.7–1.4) | 1 (.7–1.4) | .9 (.7–1.1) | |
| Current use of only cigarettes and at least 2 other tobacco products | .3 (.2–.5) | .1 (0.0–.2)d | .2 (.1–.4) | .3 (.2–.5) | .1 (0.0–.1)d | .2 (.1–.4)d | 0.0 (0.0–.1)d | |
| Current use of cigarettes, smokeless tobacco, cigars, and at least 1 other tobacco product | .2 (.1–.3) | .3 (.2–.5) | .2 (.1–.4)d | .3 (.2–.4) | .4 (.2–.8)d | .2 (.1–.5)d | .4 (.2–.6) | |
| No current use of cigarettes but at least 3 tobacco products | 0.0 (0.0–.1)d | 0.0 (0.0–.1)d | 0.0 (0.0–.1)d | .1 (0.0–.2)d | .1 (0.0–.3)d | .1 (0.0–.2)d | .1 (0.0–.2)d | |
CI = confidence interval.
Linear trend.
Linear and quadratic trend.
Other Tobacco is defined as use of pipe, bidis, or kreteks on at least 1 day of the past 30 days.
Data statistically unstable (denominator <50 and/or relative standard error >30%).
Race/Ethnicity
During 2000–2012, among non-Hispanic whites, significant linear downward trends were observed for current tobacco use (37.1% to 21.9%), current use of only 1 tobacco product (20.5% to 10.7%), current use of cigarettes and 1 tobacco product (8.8% to 5.1%), current use of only cigarettes and cigars (5.2% to 3.0%), and current use of only cigarettes, cigars, and at least 1 other tobacco product (2.6% to 1.4%); a significant linear and quadratic trend was observed for current use of only cigarettes (16.0% to 5.4%) (Table 3, which can be found in the online edition of this article). Among non-Hispanic blacks, a significant linear downward trend was observed for current use of only cigarettes (8.0% to 2.7%); significant linear and quadratic trends were observed for current tobacco use (25.4% to 19.8%) and current use of only 1 tobacco product (15.8% to 13.2%). Among Hispanics, a significant linear and quadratic trend was observed for current use of only cigarettes (9.8% to 4.1%). Among non-Hispanic others (Asians, American Indians/Alaska Natives, or Native Hawaiian/Other Pacific Islanders), significant linear downward trends were observed for current tobacco use (25.6% to 11.2%), current use of only 1 tobacco product (14.0% to 6.7%), current poly tobacco use (11.5% to 4.5%), and current use of only 2 tobacco products (6.0% to 2.4%). In 2012, 9.3% of high school non-Hispanic whites currently used cigarettes and at least 1 tobacco product. The proportion was 5.7% among non-Hispanic blacks, 8.4% among Hispanics, and 3.9% among non-Hispanic others.
Table 3.
Current tobacco use among U.S. high school students, by race/ethnicity, National Youth Tobacco Survey, 2000–2012
| Characteristics | Survey year
|
|||||||
|---|---|---|---|---|---|---|---|---|
| 2000 % (95% CI) | 2002 % (95% CI) | 2004 % (95% CI) | 2006 % (95% CI) | 2009 % (95% CI) | 2011 % (95% CI) | 2012 % (95% CI) | Trends | |
| non-Hispanic whites | ||||||||
| Sample size | 10,999 out of 11,512 | 7,050 out of 7,466 | 5,819 out of 6,065 | 6,385 out of 6,851 | 5,945 out of 6,206 | 4,097 out of 4,230 | 6,462 out of 6,802 | |
| Any current tobacco use | 37.1 (34.8–39.4) | 30.1 (28.0–32.2) | 29.9 (26.8–33.2) | 27.3 (25.0–29.8) | 25.3 (22.2–28.7) | 24.8 (21.9–27.9) | 21.9 (19.6–24.2) | a |
| Current use of only 1 tobacco product | 20.5 (19.1–22.0) | 18.1 (16.7–19.6) | 17.5 (15.5–19.7) | 15.0 (13.5–16.5) | 14.2 (12.8–15.7) | 13.3 (11.8–14.8) | 10.7 (9.5–12.0) | a |
| Current use of only cigarettes | 16.0 (14.8–17.4) | 13.8 (12.6–15.2) | 13.0 (11.3–15.0) | 10.5 (9.3–11.8) | 9.1 (8.1–10.2) | 6.8 (5.6–8.2) | 5.4 (4.6–6.3) | b |
| Current use of only smokeless tobacco | 1.8 (1.4–2.2) | 1.8 (1.3–2.5) | 1.7 (1.3–2.3) | 1.9 (1.4–2.6) | 2.3 (1.6–3.2) | 2.9 (2.2–3.9) | 2.2 (1.6–3.1) | |
| Current use of only cigars | 2.5 (2.1–2.9) | 2.1 (1.8–2.6) | 2.6 (2.2–3.1) | 2.3 (1.9–2.9) | 2.5 (2.0–3.2) | 3.1 (2.4–4.0) | 2.8 (2.2–3.5) | |
| Current use of only 1 other tobaccoc product | .3 (.2–.4) | .3 (.2–.5) | .1 (.1–.3)d | .3 (.2–.5) | .2 (.1–.4)d | .4 (.2–.9)d | .3 (.2–.5) | |
| Current poly tobacco use | 16.5 (15.3–17.9) | 12.0 (10.8–13.2) | 12.4 (10.8–14.2) | 12.4 (11.1–13.7) | 11.1 (9.1–13.5) | 11.5 (9.6–13.8) | 11.1 (9.6–12.8) | |
| Current use of only 2 tobacco products | 10.0 (9.1–10.9) | 7.2 (6.4–8.1) | 7.5 (6.5–8.8) | 7.1 (6.3–8.0) | 6.6 (5.4–8.0) | 7.2 (5.9–8.7) | 6.7 (5.7–7.9) | |
| Current use of cigarettes and 1 tobacco product | 8.8 (8.0–9.7) | 6.2 (5.5–7.0) | 6.7 (5.6–7.9) | 6.2 (5.4–7.1) | 5.5 (4.5–6.6) | 6.1 (4.9–7.5) | 5.1 (4.2–6.3) | a |
| Current use of only cigarettes and smokeless tobacco | 1.6 (1.3–2.1) | 1.5 (1.1–2.0) | 1.2 (.8–1.8) | 1.3 (.9–1.9) | 1.7 (1.3–2.4) | 2.1 (1.5–2.9) | 1.4 (1.1–1.8) | |
| Current use of only cigarettes and cigars | 5.2 (4.5–5.9) | 3.6 (3.0–4.2) | 4.9 (4.2–5.8) | 3.8 (3.2–4.5) | 3.2 (2.7–3.8) | 3.5 (2.8–4.5) | 3.0 (2.4–3.8) | a |
| Current use of only cigarettes and only 1 other tobacco product | 2.0 (1.7–2.3) | 1.2 (.9–1.6) | .6 (.3–1.0)d | 1.1 (.7–1.6) | .6 (.3–.9) | .5 (.3–.8) | .7 (.5–1.0) | |
| No current use of cigarettes but only 2 tobacco products | 1.2 (.9–1.4) | 1.0 (.7–1.4) | .9 (.6–1.3) | .9 (.7–1.2) | 1.1 (.7–1.7) | 1.1 (.8–1.5) | 1.6 (1.2–2.1) | |
| Current use of at least 3 tobacco products | 6.6 (5.9–7.3) | 4.8 (4.1–5.5) | 4.9 (4.1–5.7) | 5.2 (4.6–6.0) | 4.5 (3.4–5.9) | 4.4 (3.4–5.6) | 4.4 (3.6–5.5) | |
| Current use of cigarettes and at least 2 tobacco products | 6.3 (5.7–7.0) | 4.7 (4.0–5.4) | 4.6 (3.8–5.5) | 5.0 (4.4–5.7) | 4.2 (3.2–5.5) | 4.2 (3.3–5.5) | 4.2 (3.3–5.2) | |
| Current use of only cigarettes, cigars, and smokeless tobacco | 1.7 (1.4–2.1) | 1.7 (1.3–2.3) | 1.2 (.9–1.5) | 1.4 (1.1–1.9) | 1.4 (1.0–2.2) | 1.6 (1.1–2.4) | 1.3 (.9–1.8) | |
| Current use of only cigarettes, smokeless tobacco, and at least 1 other | .4 (.3–.5) | .1 (.1–.3)d | .1 (.1–.3)d | .2 (.1–.3)d | .2 (.1–.4)d | .2 (.1–.4)d | .2 (.1–.3)d | |
| Current use of only cigarettes, cigars, and at least 1 other tobacco product | 2.6 (2.2–3.1) | 1.7 (1.4–2.0) | 1.8 (1.4–2.3) | 1.7 (1.3–2.2) | 1.4 (1.0–1.8) | 1.1 (.8–1.6) | 1.4 (1.1–1.8) | a |
| Current use of only cigarettes and at least 2 other tobacco products | .4 (.3–.5) | .1 (0.0–.2)d | .2 (.1–.3)d | .3 (.1–.5) | .1 (0.0–.2)d | .1 (.1–.3)d | 0.0 (0.0–.1)d | |
| Current use of cigarettes, smokeless tobacco, cigars, and at least 1 other tobacco product | 1.3 (1.0–1.5) | 1.1 (.8–1.5) | 1.4 (1.0–1.9) | 1.4 (1.1–1.9) | 1.1 (.8–1.6) | 1.2 (.8–1.8) | 1.2 (.9–1.6) | |
| No current use of cigarettes but at least 3 tobacco products | .3 (.2–.4) | .1 (0.0–.3)d | .3 (.2–.4) | .2 (.1–.4) | .3 (.2–.5) | .1 (0.0–.3)d | .3 (.2–.5)d | |
| non-Hispanic blacks | ||||||||
| Sample size | 2,475 out of 2,721 | 2,005 out of 2,185 | 2,315 out of 2,556 | 2,643 out of 2,901 | 1,668 out of 1,850 | 1,512 out of 1,617 | 1,737 out of 1,855 | |
| Any current tobacco use | 25.4 (22.1–29.0) | 20.2 (17.4–23.3) | 15.5 (13.0–18.5) | 13.4 (11.4–15.6) | 10.3 (6.9–15.1) | 16.7 (13.5–20.5) | 19.8 (17.2–22.7) | b |
| Current use of only 1 tobacco product | 15.8 (13.9–17.8) | 13.9 (11.6–16.6) | 9.7 (8.0–11.6) | 8.8 (7.3–10.6) | 6.9 (5.2–9.1) | 11.2 (9.1–13.8) | 13.2 (11.2–15.6) | b |
| Current use of only cigarettes | 8.0 (6.7–9.6) | 7.8 (5.9–10.4) | 5.2 (4.1–6.7) | 4.7 (3.8–5.8) | 3.5 (2.1–5.7) | 4.8 (3.2–7.2) | 2.7 (1.9–3.8) | a |
| Current use of only smokeless tobacco | .5 (.2–1.2)d | .3 (.1–.7)d | .2 (.1–.6)d | .2 (.1–.7)d | .2 (.1–.7)d | .9 (.3–2.4)d | .6 (.3–1.3)d | |
| Current use of only cigars | 6.4 (5.2–7.9) | 5.0 (3.7–6.8) | 4.0 (3.0–5.3) | 3.4 (2.4–4.8) | 2.2 (1.0–4.8)d | 5.1 (3.8–6.7) | 9.6 (7.9–11.6) | |
| Current use of only 1 other tobacco product | .8 (.5–1.3) | .8 (.4–1.5)d | .2 (.1–.6)d | .5 (.3–1.0)d | 1.0 (.3–3.6)d | .4 (.1–1.3)d | .3 (.1–.8)d | |
| Current poly tobacco use | 9.7 (7.9–11.8) | 6.3 (5.1–7.6) | 5.8 (4.5–7.5) | 4.6 (3.4–6.0) | 3.4 (1.6–7.2)d | 5.5 (3.9–7.7) | 6.6 (5.4–8.1) | |
| Current use of only 2 tobacco products | 6.8 (5.4–8.4) | 4.3 (3.4–5.5) | 4.4 (3.3–5.8) | 3.3 (2.5–4.4) | 2.3 (1.1–4.9)d | 3.6 (2.5–5.3) | 5.0 (4.0–6.3) | |
| Current use of cigarettes and 1 tobacco product | 5.7 (4.4–7.4) | 3.5 (2.7–4.7) | 3.8 (2.8–5.1) | 3.0 (2.2–4.1) | 2.0 (.9–4.3)d | 3.3 (2.2–4.9) | 4.3 (3.3–5.8) | |
| Current use of only cigarettes and smokeless tobacco | .2 (.1–.5)d | .1 (0.0–.5)d | .1 (0.0–.4)d | .1 (0.0–.4)d | .3 (0.0–1.4)d | .3 (0.0–1.9)d | .2 (.1–.7)d | |
| Current use of only cigarettes and cigars | 4.5 (3.3–6.1) | 2.6 (1.9–3.6) | 3.6 (2.6–4.9) | 2.3 (1.7–3.1) | 1.6 (.7–3.3)d | 2.8 (2.0–4.0) | 4.0 (2.9–5.5) | |
| Current use of only cigarettes and only 1 other tobacco product | .9 (.6–1.6) | .8 (.3–1.6)d | .2 (.1–.5)d | .6 (.3–1.1)d | .1 (0.0–.5)d | .2 (0.0–.7)d | .1 (0.0–.4)d | |
| No current use of cigarettes but only 2 tobacco products | 1.1 (.7–1.6) | .8 (.5–1.4) | .6 (.3–1.1) | .3 (.2–.6)d | .3 (.1–.9)d | .4 (.1–1.3)d | .7 (.3–1.4)d | |
| Current use of at least 3 tobacco products | 2.9 (2.2–3.9) | 1.9 (1.3–2.9) | 1.4 (.9–2.2) | 1.3 (.8–2.0) | 1.1 (.4–2.9)d | 1.8 (1.1–3.0) | 1.5 (1.0–2.5) | |
| Current use of cigarettes and at least 2 tobacco products | 2.7 (2.0–3.6) | 1.7 (1.1–2.6) | 1.3 (.8–2.1) | 1.2 (.8–1.9) | 1.0 (.4–2.8)d | 1.8 (1.1–3.0) | 1.4 (.8–2.3) | |
| Current use of only cigarettes, cigars, and smokeless tobacco | .2 (.1–.7)d | 0.0 (0.0–.3)d | .1 (0.0–.7)d | .1 (0.0–.4)d | .2 (.1–.6)d | .6 (.2–1.4)d | .1 (0.0–.2)d | |
| Current use of only cigarettes, smokeless tobacco, and at least 1 other | .1 (0.0–.3)d | 0.0 (0.0–.1)d | 0.0 (0.0–.3)d | .1 (0.0–.5)d | .1 (0.0–.3)d | 0.0 (.–.)d | .2 (0.0–1.3)d | |
| Current use of only cigarettes, cigars, and at least 1 other tobacco product | 1.5 (1.0–2.2) | .6 (.4–1.1) | .5 (.3–.9)d | .6 (.4–1.0) | .2 (0.0–.5)d | .6 (.3–1.4)d | .5 (.2–1.1)d | |
| Current use of only cigarettes and at least 2 other tobacco products | .2 (.1–.5)d | .2 (0.0–.7)d | .1 (0.0–.4)d | .1 (0.0–.3)d | 0.0 (0.0–.2)d | 0.0 (.–.)d | .1 (0.0–.6)d | |
| Current use of cigarettes, smokeless tobacco, cigars, and at least 1 other tobacco product | .6 (.3–1.3)d | .8 (.4–1.7)d | .5 (.2–1.3)d | .2 (.1–.6)d | .6 (.1–2.4)d | .6 (.3–1.6)d | .5 (.2–1.1)d | |
| No current use of cigarettes but at least 3 tobacco products | .2 (.1–.7)d | .2 (.1–.7)d | .1 (0.0–.3)d | .1 (0.0–.3)d | .1 (0.0–.3)d | 0.0 (.–.)d | .2 (.1–.6)d | |
| Hispanics | ||||||||
| Sample size | 3,090 out of 3,317 | 2,302 out of 2,595 | 3,129 out of 3,610 | 2,774 out of 3,471 | 3,073 out of 3,403 | 2,990 out of 3,217 | 2,873 out of 3,098 | |
| Any current tobacco use | 25.5 (22.4–28.9) | 21.3 (18.6–24.3) | 23.6 (21.1–26.3) | 22.9 (20.5–25.5) | 21.3 (19.1–23.6) | 20.5 (17.9–23.3) | 18.5 (15.9–21.3) | |
| Current use of only 1 tobacco product | 13.7 (11.7–16.0) | 12.3 (10.3–14.6) | 13.2 (11.5–15.0) | 12.8 (11.3–14.3) | 12.2 (10.7–13.9) | 11.4 (9.9–13.1) | 8.7 (7.4–10.3) | |
| Current use of only cigarettes | 9.8 (8.0–12.0) | 9.6 (7.8–11.9) | 9.9 (8.5–11.5) | 9.1 (8.0–10.4) | 9.2 (7.4–11.4) | 6.6 (5.7–7.6) | 4.1 (3.2–5.4) | b |
| Current use of only smokeless tobacco | .8 (.5–1.2) | .9 (.5–1.6) | .5 (.2–1.1)d | 1.1 (.6–2.0)d | .5 (.2–1.0)d | 1.1 (.6–2.0)d | .9 (.5–1.6) | |
| Current use of only cigars | 2.2 (1.7–2.9) | 1.3 (.9–2.0) | 2.3 (1.7–3.1) | 2.2 (1.6–2.9) | 1.7 (1.0–2.7) | 2.5 (1.8–3.5) | 2.6 (1.9–3.6) | |
| Current use of only 1 other tobacco product | .9 (.6–1.5) | .4 (.2–.9)d | .4 (.2–.8)d | .4 (.2–.7) | .8 (.4–1.6)d | 1.3 (.8–2.0) | 1.0 (.7–1.5) | |
| Current poly tobacco use | 11.8 (10.3–13.5) | 9.0 (7.5–10.7) | 10.4 (8.9–12.1) | 10.2 (8.7–11.9) | 9.1 (7.4–11.0) | 9.1 (7.7–10.7) | 9.7 (8.1–11.6) | |
| Current use of only 2 tobacco products | 7.6 (6.6–8.8) | 5.5 (4.5–6.7) | 5.9 (4.8–7.2) | 6.0 (4.9–7.3) | 4.8 (3.5–6.5) | 4.6 (3.7–5.8) | 5.6 (4.5–6.9) | |
| Current use of cigarettes and 1 tobacco product | 6.7 (5.7–7.9) | 5.1 (4.2–6.2) | 5.4 (4.3–6.7) | 5.3 (4.3–6.6) | 4.4 (3.2–6.0) | 3.7 (3.0–4.7) | 4.4 (3.4–5.5) | |
| Current use of only cigarettes and smokeless tobacco | .4 (.2–.9)d | .3 (.1–.9)d | .2 (.1–.6)d | .5 (.2–1.0)d | .7 (.3–2.0)d | .5 (.2–1.2)d | .4 (.2–.9)d | |
| Current use of only cigarettes and cigars | 4.8 (3.9–5.8) | 4.1 (3.3–5.1) | 4.4 (3.4–5.6) | 4.0 (3.2–5.1) | 3.5 (2.4–4.9) | 2.9 (2.2–3.8) | 3.5 (2.7–4.4) | |
| Current use of only cigarettes and only 1 other tobacco product | 1.5 (1.2–2.1) | .7 (.4–1.1) | .8 (.6–1.2) | .8 (.4–1.5)d | .2 (.1–.5)d | .4 (.2–.7)d | .5 (.3–.9)d | |
| No current use of cigarettes but only 2 tobacco products | .9 (.6–1.5) | .4 (.2–.8)d | .5 (.3–.9) | .7 (.4–1.2) | .4 (.2–.7)d | .9 (.6–1.3) | 1.2 (.8–1.9) | |
| Current use of at least 3 tobacco products | 4.2 (3.3–5.3) | 3.5 (2.6–4.6) | 4.5 (3.8–5.4) | 4.2 (3.3–5.2) | 4.3 (3.4–5.4) | 4.4 (3.5–5.6) | 4.2 (3.3–5.2) | |
| Current use of cigarettes and at least 2 tobacco products | 3.9 (3–5.1) | 3.2 (2.4–4.3) | 4.2 (3.5–5.0) | 3.8 (3.1–4.8) | 4.2 (3.3–5.3) | 4.2 (3.4–5.3) | 4.0 (3.2–5.1) | |
| Current use of only cigarettes, cigars, and smokeless tobacco | .5 (.2–1.0)d | .2 (.1–.6)d | .3 (.1–.7)d | .3 (.1–.8)d | .5 (.2–1.2)d | .4 (.2–.8)d | .6 (.4–1.1) | |
| Current use of only cigarettes, smokeless tobacco, and at least 1 other tobacco product | .1 (0.0–.6)d | 0.0 (.–.)d | .1 (0.0–.5)d | 0.0 (0.0–.3)d | .5 (.2–1.8)d | .1 (0.0–.3)d | .2 (.1–.4)d | |
| Current use of only cigarettes, cigars, and at least 1 other tobacco product | 2.3 (1.7–3.1) | 2.0 (1.4–2.8) | 2.6 (2.0–3.4) | 1.6 (1.1–2.2) | 1.4 (1.1–2.0) | 2.1 (1.5–2.9) | 1.4 (1.0–2.1) | |
| Current use of only cigarettes and at least 2 other tobacco products | .2 (.1–.4)d | .1 (0.0–.3)d | .2 (.1–.5)d | .3 (.1–.6)d | .1 (0.0–.5)d | .1 (0.0–.2)d | .1 (0.0–.3)d | |
| Current use of cigarettes, smokeless tobacco, cigars, and at least 1 other tobacco product | .8 (.5–1.3) | .9 (.5–1.7)d | 1.0 (.7–1.4) | 1.6 (1.1–2.4) | 1.5 (1.1–2.3) | 1.6 (1.0–2.4) | 1.7 (1.1–2.6) | |
| No current use of cigarettes but at least 3 tobacco products | .3 (.2–.5)d | .2 (.1–.6)d | .3 (.2–.7)d | .3 (.1–.9)d | .1 (.1–.3)d | .2 (.1–.5)d | .1 (0.0–.3)d | |
| non-Hispanic others (Asians, American Indians/Alaska Natives, or Native Hawaiian/Other Pacific Islanders) | ||||||||
| Sample size | 1,438 out of 1,549 | 906 out of 1,015 | 876 out of 934 | 861 out of 1,007 | 629 out of 677 | 474 out of 508 | 858 out of 909 | |
| Any current tobacco use | 25.6 (22.4–29.0) | 22.1 (17.5–27.5) | 15.6 (12.6–19.1) | 14.7 (11.6–18.6) | 13.2 (9.2–18.5) | 12.6 (9.3–16.9) | 11.2 (8.0–15.6) | a |
| Current use of only 1 tobacco product | 14.0 (11.8–16.6) | 13.3 (9.3–18.8) | 8.1 (6.1–10.6) | 9.4 (7.2–12.1) | 7.1 (5.0–9.9) | 6.2 (4.0–9.6) | 6.7 (4.5–10.0) | a |
| Current use of only cigarettes | 12.0 (10.0–14.3) | 10.4 (6.8–15.5) | 6.2 (4.6–8.4) | 7.8 (5.8–10.4) | 5.9 (4.0–8.5) | 2.9 (1.6–5.4)d | 3.8 (2.1–6.8) | |
| Current use of only smokeless tobacco | .6 (.3–1.5)d | .8 (.3–2.1)d | .4 (.1–1.3)d | .5 (.1–1.5)d | .4 (0.0–2.6)d | 1.0 (.3–2.9)d | .6 (.3–1.3)d | |
| Current use of only cigars | .6 (.3–1.1)d | 1.7 (.9–3.1)d | 1.0 (.4–2.7)d | 1.0 (.5–1.9)d | .7 (.3–1.6)d | 1.4 (.5–4.1)d | 1.9 (1.2–3.2) | |
| Current use of only 1 other tobacco product | .8 (.4–1.4)d | .4 (.2–1.1)d | .5 (.1–1.6)d | .2 (0.0–.6)d | .2 (0.0–.7)d | .9 (.2–4.2)d | .4 (.1–1.3)d | |
| Current poly tobacco use | 11.5 (9.3–14.3) | 8.8 (6.4–11.9) | 7.5 (5.6–10.0) | 5.3 (3.7–7.6) | 6.1 (3.8–9.6) | 6.4 (4.2–9.7) | 4.5 (2.9–6.8) | a |
| Current use of only 2 tobacco products | 6.0 (4.5–7.8) | 5.0 (3.1–8.0) | 4.3 (2.9–6.4) | 3.4 (2.1–5.4) | 2.6 (1.5–4.6) | 4.1 (2.3–7.0) | 2.4 (1.5–3.5) | a |
| Current use of cigarettes and 1 tobacco product | 5.4 (4.1–7.0) | 4.8 (2.8–7.8) | 4.2 (2.7–6.3) | 2.5 (1.3–4.6)d | 2.2 (1.2–4.0) | 3.4 (1.9–6.2)d | 1.8 (1.1–3.0) | |
| Current use of only cigarettes and smokeless tobacco | .5 (.2–1.1)d | 1.6 (.6–3.9)d | .4 (.1–2.2)d | .5 (.1–1.7)d | .2 (0.0–.9)d | .8 (.3–2.2)d | .5 (.2–1.1)d | |
| Current use of only cigarettes and cigars | 3.3 (2.3–4.8) | 2.9 (1.8–4.7) | 3.4 (2.2–5.2) | 1.9 (.9–4.1)d | 1.7 (.9–3.5)d | 1.5 (.7–3.1)d | 1.1 (.6–1.9) | |
| Current use of only cigarettes and only 1 other tobacco product | 1.6 (1.0–2.5) | .3 (.1–1.2)d | .3 (.1–1.0)d | .1 (0.0–.5)d | .3 (.1–.9)d | 1.1 (.4–2.9)d | .3 (.1–1.0)d | |
| No current use of cigarettes but only 2 tobacco products | .6 (.2–1.6)d | .3 (.1–.8)d | .2 (0.0–.6)d | .9 (.4–2.1)d | .4 (.1–1.2)d | .7 (.2–1.9)d | .5 (.2–1.3)d | |
| Current use of at least 3 tobacco products | 5.6 (4.1–7.6) | 3.8 (2.1–6.5) | 3.1 (2.2–4.5) | 2.0 (1.0–3.8)d | 3.5 (2.0–6.0) | 2.3 (1.2–4.4)d | 2.1 (1.2–3.7) | |
| Current use of cigarettes and at least 2 tobacco products | 5.5 (4.0–7.5) | 3.8 (2.1–6.5) | 2.9 (2.0–4.3) | 1.8 (.9–3.6)d | 3.5 (2.0–6.0) | 2.3 (1.2–4.4)d | 2.1 (1.2–3.7) | |
| Current use of only cigarettes, cigars, and smokeless tobacco | .2 (.1–.7)d | .3 (.1–1.1)d | .4 (.1–1.5)d | .4 (.1–1.8)d | .5 (.2–1.4)d | .3 (.1–1.2)d | .8 (.2–2.4)d | |
| Current use of only cigarettes, smokeless tobacco, and at least 1 other tobacco product | .2 (.1–.7)d | 0.0 (.–.)d | .2 (0.0–1.1)d | 0.0 (.–.)d | .3 (.1–1.2)d | .6 (.1–3.2)d | .1 (0.0–.4)d | |
| Current use of only cigarettes, cigars, and at least 1 other tobacco product | 2.5 (1.6–3.9) | 1.4 (.7–2.9)d | 1.5 (.8–2.7)d | .8 (.3–2.0)d | 1.4 (.7–2.7)d | .7 (.2–3.1)d | .5 (.2–1.3)d | |
| Current use of only cigarettes and at least 2 other tobacco products | .3 (.1–.8)d | 0.0 (.–.)d | 0.0 (.–.)d | 0.0 (.–.)d | 0.0 (.–.)d | 0.0 (.–.)d | 0.0 (.–.)d | |
| Current use of cigarettes, smokeless tobacco, cigars, and at least 1 other tobacco product | 2.2 (1.3–3.6) | 2.1 (1.1–4.1)d | .9 (.4–1.9)d | .5 (.2–1.5)d | 1.3 (.5–3.3)d | .7 (.2–2.4)d | .8 (.4–1.8)d | |
| No current use of cigarettes but at least 3 tobacco products | .1 (0.0–.9)d | 0.0 (.–.)d | .2 (0.0–1.4)d | .2 (0.0–1.5)d | 0.0 (.–.)d | 0.0 (.–.)d | 0.0 (.–.)d | |
CI = confidence interval.
Linear trend.
Linear and quadratic trend.
Other Tobacco is defined as use of pipe, bidis, or kreteks on at least 1 day of the past 30 days.
Data statistically unstable (denominator <50 and/or relative standard error >30%).
Grade
During 2000–2012, among 9th graders, significant linear downward trends were observed for current tobacco use (26.5% to 14.2%), current use of only 1 tobacco product (15.0% to 7.1%), current use of only cigarettes (10.9% to 3.1%), current poly tobacco use (11.5% to 7.1%), current use of only 2 tobacco products (6.7% to 4.4%), and current use of cigarettes and 1 tobacco product (5.9% to 3.2%); a significant linear and quadratic trend was observed for current use of only cigarettes and cigars (3.8% to 2.3%) (Table 4, which can be found in the online edition of this article). Among 10th graders, significant linear downward trends were observed for current tobacco use (33.6% to 18.8%), current use of only 1 tobacco product (18.3% to 9.7%), current use of only cigarettes (13.6% to 4.8%), current use of only 2 tobacco products (9.1% to 5.1%), and current use of cigarettes and 1 tobacco product (7.9% to 4.2%). Among 11th graders, significant linear downward trends were observed for current tobacco use (35.8% to 21.8%), current use of only 1 tobacco product (19.8% to 11.3%), and current use of only cigarettes, cigars, and 1 other tobacco product (2.5% to 1.2%); a significant linear and quadratic trend was observed for current use of only cigarettes (14.6% to 5.1%). Among 12th graders, significant linear downward trends were observed for current tobacco use (41.0% to 28.0%), current use of only cigarettes (18.3% to 6.1%), current use of cigarettes and 1 tobacco product (9.7% to 6.7%), current use of only cigarettes and cigars (5.9% to 4.3%), and current use of at least 3 tobacco products (5.9% to 4.8%); a significant linear and quadratic trend was observed for current use of only 1 tobacco product (23.9% to 14.6%). In 2012, 11.3% of 12th graders currently used cigarettes and at least 1 tobacco product. The proportion was 8.9% among 11th graders, 7.8% among 10th graders, and 5.8% among 9th graders.
Table 4.
Current tobacco use among U.S. high school students, by grade, National Youth Tobacco Survey, 2000–2012
| Characteristics | Survey year
|
|||||||
|---|---|---|---|---|---|---|---|---|
| 2000 % (95% CI) | 2002 % (95% CI) | 2004 % (95% CI) | 2006 % (95% CI) | 2009 % (95% CI) | 2011 % (95% CI) | 2012 % (95% CI) | Trends | |
| 9th grade | ||||||||
| Sample size | 5,288 out of 5,615 | 3,651 out of 3,978 | 3,880 out of 4,359 | 3,713 out of 4,170 | 2,859 out of 3,118 | 2,369 out of 2,513 | 3,074 out of 3,262 | |
| Any current tobacco use | 26.5 (24.2–28.9) | 20.2 (17.7–22.9) | 18.5 (15.6–21.7) | 18.6 (16.8–20.6) | 13.9 (10.6–18.1) | 16.0 (13.0–19.5) | 14.2 (12.3–16.4) | a |
| Current use of only 1 tobacco product | 15.0 (13.6–16.5) | 12.1 (10.3–14.2) | 10.4 (8.8–12.4) | 10.7 (9.4–12.2) | 8.5 (6.5–11.0) | 9.3 (7.6–11.4) | 7.1 (6.0–8.4) | a |
| Current use of only cigarettes | 10.9 (9.6–12.3) | 8.2 (7.0–9.6) | 8.3 (6.9–9.9) | 7.1 (6.0–8.3) | 5.6 (4.0–7.8) | 5.0 (3.9–6.4) | 3.1 (2.4–4.0) | a |
| Current use of only smokeless tobacco | 1.4 (1.0–1.8) | 1.8 (1.1–3.1) | .8 (.5–1.3) | 1.6 (1.0–2.6) | 1.3 (.7–2.3)d | 2.0 (1.3–3.1) | 1.4 (.9–2.1) | |
| Current use of only cigars | 2.3 (1.8–2.8) | 1.8 (1.3–2.5) | 1.2 (.9–1.6) | 1.6 (1.2–2.1) | 1.0 (.5–1.7)d | 1.6 (1.0–2.3) | 2.2 (1.6–3.0) | |
| Current use of only 1 other tobaccoc product | .4 (.3–.7) | .3 (.1–.5)d | .2 (.1–.4)d | .4 (.2–.8)d | .7 (.2–2.3)d | .7 (.4–1.2) | .4 (.2–.7) | |
| Current poly tobacco use | 11.5 (10.2–13) | 8.0 (7.0–9.2) | 8.0 (6.4–10.0) | 7.9 (6.8–9.3) | 5.4 (3.7–7.9) | 6.7 (5.0–8.9) | 7.1 (5.8–8.7) | a |
| Current use of only 2 tobacco products | 6.7 (5.8–7.7) | 4.9 (4.1–5.9) | 4.3 (3.4–5.4) | 4.3 (3.5–5.2) | 2.6 (1.7–4.1) | 3.5 (2.5–4.9) | 4.4 (3.5–5.7) | a |
| Current use of cigarettes and 1 tobacco product | 5.9 (5.0–7.0) | 4.3 (3.7–5.2) | 3.7 (2.9–4.8) | 3.4 (2.7–4.3) | 2.3 (1.5–3.6) | 2.6 (2.0–3.5) | 3.2 (2.4–4.3) | a |
| Current use of only cigarettes and smokeless tobacco | .7 (.5–1.1) | 1.0 (.5–1.8)d | .6 (.3–1.2)d | .5 (.3–.9) | .8 (.4–1.7)d | .4 (.2–.8)d | .6 (.3–1.1) | |
| Current use of only cigarettes and cigars | 3.8 (3.1–4.6) | 2.8 (2.3–3.5) | 2.6 (2.0–3.4) | 2.4 (1.9–3.1) | 1.1 (.7–1.8) | 1.8 (1.3–2.5) | 2.3 (1.7–3.2) | b |
| Current use of only cigarettes and only 1 other tobacco product | 1.4 (1–1.9) | .6 (.3–1.0)d | .5 (.3–.8) | .5 (.3–.8) | .4 (.1–1.0)d | .4 (.2–.9)d | .3 (.2–.6)d | |
| No current use of cigarettes but only 2 tobacco products | .8 (.5–1.1) | .6 (.3–1.2)d | .6 (.3–.9) | .9 (.6–1.3) | .3 (.1–.7)d | .9 (.5–1.8)d | 1.2 (.8–2) | |
| Current use of at least 3 tobacco products | 4.8 (4.1–5.7) | 3.1 (2.5–3.8) | 3.8 (2.8–5.0) | 3.7 (2.9–4.6) | 2.8 (1.9–4.2) | 3.1 (2.3–4.3) | 2.7 (2.0–3.5) | |
| Current use of cigarettes and at least 2 tobacco products | 4.6 (3.9–5.4) | 2.8 (2.3–3.5) | 3.6 (2.7–4.8) | 3.5 (2.8–4.5) | 2.7 (1.8–4.1) | 3.0 (2.2–4.2) | 2.6 (1.9–3.5) | |
| Current use of only cigarettes, cigars, and smokeless tobacco | .7 (.5–1.0) | .6 (.3–1.0) | .5 (.3–.9) | .9 (.5–1.5) | .6 (.3–1.4)d | .7 (.4–1.4)d | .3 (.1–.7)d | |
| Current use of only cigarettes, smokeless tobacco, and at least 1 other | .3 (.2–.5) | .1 (0.0–.3)d | .2 (.1–.5)d | .1 (0.0–.3)d | .4 (.2–1.2)d | .1 (0.0–.2)d | .1 (0.0–.4)d | |
| Current use of only cigarettes, cigars, and at least 1 other tobacco product | 2.3 (1.8–2.9) | 1.4 (1.0–2.0) | 1.5 (1.1–2.2) | 1.1 (.7–1.8) | 1.0 (.6–1.6) | 1.3 (.8–2.1) | 1.1 (.7–1.7) | |
| Current use of only cigarettes and at least 2 other tobacco products | .2 (.1–.4)d | .1 (0.0–.2)d | .2 (.1–.5)d | .2 (.1–.5)d | .1 (0.0–.4)d | .1 (0.0–.6)d | .1 (0.0–.3)d | |
| Current use of cigarettes, smokeless tobacco, cigars, and at least 1 other tobacco product | 1.1 (.8–1.4) | .7 (.4–1.1) | 1.1 (.7–1.8) | 1.2 (.8–1.9) | .6 (.3–1.1)d | .8 (.4–1.5)d | 1.0 (.6–1.5) | |
| No current use of cigarettes but at least 3 tobacco products | .3 (.1–.5)d | .3 (.1–.5)d | .2 (.1–.4)d | .1 (.1–.3)d | .1 (.1–.3)d | .1 (0.0–.3)d | .1 (0.0–.2)d | |
| 10th grade | ||||||||
| Sample size | 4,695 out of 4,965 | 3,282 out of 3,517 | 3,214 out of 3,615 | 3,662 out of 4,078 | 2,828 out of 3,040 | 2,198 out of 2,327 | 2,924 out of 3,113 | |
| Any current tobacco use | 33.6 (30.6–36.8) | 25.4 (23.1–27.9) | 25.2 (22.2–28.3) | 24.3 (21.4–27.5) | 20.3 (17.2–23.7) | 19.9 (17.3–22.8) | 18.8 (16.3–21.6) | a |
| Current use of only 1 tobacco product | 18.3 (16.4–20.3) | 15.6 (13.8–17.6) | 14.0 (12.1–16.1) | 12.8 (11.1–14.8) | 11.6 (9.6–14.0) | 11.3 (9.8–13.0) | 9.7 (8.2–11.5) | a |
| Current use of only cigarettes | 13.6 (12.0–15.4) | 11.4 (9.7–13.4) | 9.8 (8.1–12.0) | 8.6 (7.3–10.3) | 6.9 (5.8–8.2) | 5.9 (4.6–7.5) | 4.8 (3.9–5.9) | a |
| Current use of only smokeless tobacco | 1.4 (1.0–2.0) | 1.6 (1.1–2.3) | 1.4 (.9–2.2) | 1.7 (1.1–2.4) | 2.2 (1.2–3.9)d | 2.0 (1.3–3.1) | 1.8 (1.1–2.8) | |
| Current use of only cigars | 2.8 (2.3–3.4) | 2.1 (1.6–2.8) | 2.6 (1.8–3.6) | 2.2 (1.6–2.9) | 2.1 (1.2–3.6) | 3.2 (2.4–4.3) | 2.8 (2.1–3.8) | |
| Current use of only 1 other tobacco product | .5 (.3–.8) | .5 (.2–.9)d | .2 (.1–.4)d | .3 (.2–.7)d | .4 (.1–1.2)d | .3 (.2–.6)d | .3 (.2–.6)d | |
| Current poly tobacco use | 15.3 (13.7–17.2) | 9.8 (8.7–11.1) | 11.1 (9.5–13.0) | 11.5 (9.8–13.5) | 8.6 (6.8–10.9) | 8.5 (6.9–10.5) | 9.1 (7.3–11.2) | |
| Current use of only 2 tobacco products | 9.1 (8.0–10.4) | 6.0 (5.2–7.0) | 7.1 (5.8–8.6) | 6.3 (5.1–7.8) | 4.7 (3.6–5.9) | 5.0 (4.0–6.2) | 5.1 (4.0–6.4) | a |
| Current use of cigarettes and 1 tobacco product | 7.9 (6.8–9.1) | 5.0 (4.2–6.0) | 6.1 (5.0–7.3) | 5.7 (4.5–7.1) | 3.8 (3.0–4.9) | 4.4 (3.4–5.7) | 4.2 (3.3–5.3) | a |
| Current use of only cigarettes and smokeless tobacco | 1.2 (.8–1.6) | 1.0 (.6–1.7) | .7 (.3–2.0)d | .8 (.5–1.4) | .9 (.5–1.5) | 1.6 (1.0–2.8) | .8 (.4–1.3) | |
| Current use of only cigarettes and cigars | 5.3 (4.3–6.5) | 2.7 (2.1–3.6) | 4.9 (3.9–6.1) | 3.8 (3.0–4.9) | 2.6 (2.0–3.3) | 2.5 (1.8–3.4) | 2.9 (2.1–3.9) | |
| Current use of only cigarettes and only 1 other tobacco product | 1.4 (1.1–1.8) | 1.3 (.8–1.9) | .5 (.2–.8)d | 1.1 (.7–1.5) | .4 (.2–1.1)d | .3 (.1–.6)d | .5 (.3–.9)d | |
| No current use of cigarettes but only 2 tobacco products | 1.3 (.9–1.7) | 1.0 (.7–1.6) | 1.0 (.6–1.7) | .6 (.4–1.1) | .8 (.5–1.5) | .6 (.4–1.0) | .9 (.6–1.4) | |
| Current use of at least 3 tobacco products | 6.2 (5.2–7.4) | 3.8 (3.1–4.7) | 4.1 (3.3–4.9) | 5.2 (4.3–6.3) | 4.0 (2.8–5.6) | 3.5 (2.4–5.1) | 4.0 (2.9–5.3) | |
| Current use of cigarettes and at least 2 tobacco products | 6.0 (5.0–7.2) | 3.8 (3.0–4.7) | 3.8 (3.1–4.7) | 5.0 (4.1–6.0) | 3.6 (2.5–5.2) | 3.5 (2.4–5.1) | 3.6 (2.6–4.8) | |
| Current use of only cigarettes, cigars, and smokeless tobacco | 1.3 (.8–1.9) | 1.1 (.7–1.8) | 1.2 (.8–1.7) | 1.3 (.9–1.9) | .9 (.4–1.8)d | 1.1 (.6–2) | .8 (.5–1.3) | |
| Current use of only cigarettes, smokeless tobacco, and at least 1 other tobacco product | .3 (.1–.5)d | 0.0 (.–.)d | .1 (0.0–.3)d | .2 (.1–.6)d | .1 (0.0–.3)d | .2 (0.0–.7)d | .1 (0.0–.3)d | |
| Current use of only cigarettes, cigars, and at least 1 other tobacco product | 2.7 (2.2–3.4) | 1.5 (1.1–2.1) | 1.6 (1.1–2.2) | 1.4 (1.0–1.9) | .9 (.6–1.5) | 1.1 (.6–2.0) | 1.3 (.9–1.9) | |
| Current use of only cigarettes and at least 2 other tobacco products | .4 (.2–.6) | .2 (.1–.4)d | .1 (0.0–.3)d | .2 (.1–.5)d | .2 (0.0–.5)d | .1 (0.0–.2)d | 0.0 (0.0–.2)d | |
| Current use of cigarettes, smokeless tobacco, cigars, and at least 1 other tobacco product | 1.4 (1.0–1.9) | .9 (.6–1.4) | .9 (.6–1.2) | 1.8 (1.3–2.5) | 1.6 (1.0–2.5) | 1.1 (.5–2.1)d | 1.3 (.8–2.1) | |
| No current use of cigarettes but at least 3 tobacco products | .2 (.1–.4)d | 0.0 (0.0–.3)d | .2 (.1–.4)d | .2 (.1–.5)d | .3 (.2–.7)d | 0.0 (.–.)d | .4 (.2–.8)d | |
| 11th grade | ||||||||
| Sample size | 4,677 out of 4,949 | 2,973 out of 3,248 | 2,811 out of 3,097 | 3,032 out of 3,410 | 2,835 out of 3,045 | 2,277 out of 2,393 | 3,140 out of 3,344 | |
| Any current tobacco use | 35.8 (33.5–38.3) | 28.4 (25.4–31.7) | 27.7 (24.8–30.7) | 26.6 (23.9–29.5) | 25.6 (21.9–29.7) | 23.6 (20.5–27.0) | 21.8 (19.4–24.4) | a |
| Current use of only 1 tobacco product | 19.8 (18.1–21.6) | 17.7 (15.7–19.9) | 16.6 (14.6–18.7) | 15.8 (13.6–18.3) | 14.4 (12.6–16.5) | 12.5 (10.8–14.4) | 11.3 (9.7–13.1) | a |
| Current use of only cigarettes | 14.6 (13.1–16.3) | 13.2 (11.2–15.6) | 12.2 (10.3–14.4) | 10.8 (8.8–13.3) | 9.5 (8.2–11.1) | 6.7 (5.4–8.2) | 5.1 (4.2–6.1) | b |
| Current use of only smokeless tobacco | 1.5 (1.0–2.0) | 1.2 (.7–1.8) | 1.2 (.7–1.9) | 1.7 (1.1–2.7) | 1.7 (1.1–2.7) | 2.2 (1.4–3.3) | 1.8 (1.0–3.1) | |
| Current use of only cigars | 3.3 (2.7–4) | 2.7 (2.0–3.7) | 3.0 (2.3–3.9) | 3.1 (2.4–4.0) | 2.8 (1.8–4.1) | 3.2 (2.4–4.1) | 3.9 (3.1–4.9) | |
| Current use of only 1 other tobacco product | .4 (.2–.7) | .7 (.4–1.2) | .2 (.1–.5)d | .2 (.1–.5)d | .4 (.2–1.0)d | .5 (.2–1.0)d | .5 (.3–.9) | |
| Current poly tobacco use | 16.1 (14.4–17.8) | 10.7 (9.2–12.4) | 11.1 (9.3–13.2) | 10.8 (9.0–12.7) | 11.2 (9.0–13.9) | 11.1 (8.8–13.8) | 10.5 (8.8–12.4) | |
| Current use of only 2 tobacco products | 9.9 (8.7–11.2) | 6.4 (5.2–7.7) | 6.9 (5.7–8.3) | 6.4 (5.3–7.8) | 6.7 (5.3–8.5) | 6.7 (5.0–8.9) | 6.2 (5.2–7.4) | |
| Current use of cigarettes and 1 tobacco product | 8.9 (7.8–10.1) | 5.1 (4.2–6.3) | 6.2 (5–7.7) | 5.7 (4.7–6.9) | 5.9 (4.6–7.5) | 5.6 (4.2–7.6) | 4.9 (4.0–6.0) | |
| Current use of only cigarettes and smokeless tobacco | 1.6 (1.1–2.3) | 1.1 (.7–1.6) | .6 (.3–1.2)d | 1.2 (.7–1.9) | 1.7 (1.1–2.5) | 1.9 (1.2–3.0) | 1.2 (.8–1.8) | |
| Current use of only cigarettes and cigars | 5.2 (4.3–6.1) | 3.1 (2.3–4.1) | 4.9 (3.8–6.1) | 3.5 (2.7–4.6) | 3.8 (3.0–4.8) | 3.5 (2.6–4.7) | 3.0 (2.4–3.8) | |
| Current use of only cigarettes and only 1 other tobacco product | 2.1 (1.7–2.6) | 1.0 (.6–1.6) | .7 (.3–1.5)d | 1.0 (.6–1.7) | .5 (.3–1.0)d | .3 (.1–.6)d | .7 (.4–1.1) | |
| No current use of cigarettes but only 2 tobacco products | 1.0 (.7–1.4) | 1.2 (.8–1.8) | .7 (.4–1.2) | .7 (.4–1.2) | .8 (.4–1.4) | 1.1 (.6–1.8) | 1.3 (.9–1.9) | |
| Current use of at least 3 tobacco products | 6.2 (5.2–7.3) | 4.3 (3.4–5.5) | 4.2 (3.2–5.5) | 4.3 (3.4–5.4) | 4.5 (3.3–6.1) | 4.4 (3.4–5.5) | 4.3 (3.2–5.6) | |
| Current use of cigarettes and at least 2 tobacco products | 5.9 (5.0–7.0) | 4.2 (3.3–5.4) | 3.9 (3.0–5.2) | 4.1 (3.2–5.2) | 4.2 (3.1–5.7) | 4.2 (3.3–5.3) | 4.0 (3.0–5.3) | |
| Current use of only cigarettes, cigars, and smokeless tobacco | 1.6 (1.2–2.3) | 1.5 (.9–2.5) | 1.1 (.7–1.8) | .9 (.6–1.3) | 1.8 (1.1–2.9) | 1.7 (1.1–2.5) | 1.5 (1.0–2.4) | |
| Current use of only cigarettes, smokeless tobacco, and at least 1 other | .3 (.2–.5) | .1 (0.0–.5)d | .2 (0.0–.6)d | .2 (.1–.5)d | .1 (.1–.3)d | .2 (0.0–.6)d | .2 (.1–.8)d | |
| Current use of only cigarettes, cigars, and at least 1 other tobacco product | 2.5 (1.9–3.2) | 1.5 (1.0–2.1) | 1.7 (1.0–2.7) | 2 (1.4–2.7) | 1.1 (.8–1.5) | .9 (.6–1.3) | 1.2 (.8–1.8) | a |
| Current use of only cigarettes and at least 2 other tobacco products | .4 (.2–.6) | .1 (0.0–.4)d | .2 (.1–.4)d | .2 (0.0–.8)d | 0.0 (0.0–.2)d | .1 (0.0–.6)d | .1 (0.0–.4)d | |
| Current use of cigarettes, smokeless tobacco, cigars, and at least 1 other tobacco product | 1.1 (.8–1.6) | 1 (.5–1.9)d | .8 (.5–1.4) | .9 (.5–1.4) | 1.2 (.7–2.0) | 1.4 (.9–2.2) | 1 (.7–1.5) | |
| No current use of cigarettes but at least 3 tobacco products | .3 (.2–.5)d | .1 (0.0–.3)d | .3 (.1–.7)d | .2 (.1–.5)d | .3 (.1–.6)d | .2 (.1–.5)d | .2 (.1–.5)d | |
| 12th grade | ||||||||
| Sample size | 3,559 out of 3,821 | 2,524 out of 2,717 | 2,413 out of 2,667 | 2,473 out of 2,831 | 2,924 out of 3,143 | 2,354 out of 2,487 | 2,991 out of 3,180 | |
| Any current tobacco use | 41.0 (37.6–44.5) | 38.0 (34.7–41.5) | 38.2 (34.6–41.8) | 29.6 (26.1–33.4) | 28.8 (24.3–33.8) | 30.9 (27.9–34.1) | 28.0 (24.9–31.2) | a |
| Current use of only 1 tobacco product | 23.9 (21.4–26.5) | 22.8 (20.4–25.5) | 23.0 (20.4–25.8) | 15.8 (13.8–18.2) | 15.9 (14.0–18.0) | 16.6 (14.3–19.2) | 14.6 (12.7–16.6) | b |
| Current use of only cigarettes | 18.3 (16.0–20.8) | 18.3 (15.8–21.1) | 16.2 (14.1–18.5) | 11.7 (9.9–13.9) | 11.0 (9.8–12.4) | 7.8 (6.3–9.6) | 6.1 (5.1–7.4) | a |
| Current use of only smokeless tobacco | 1.4 (.9–2.0) | .9 (.5–1.6)d | 2.0 (1.3–3.2) | .8 (.5–1.4) | 1.3 (.8–2.1) | 2.5 (1.7–3.8) | 1.7 (1.2–2.3) | |
| Current use of only cigars | 3.8 (3.1–4.7) | 3.5 (2.6–4.6) | 4.5 (3.7–5.5) | 3.1 (2.3–4.1) | 3.4 (2.4–4.7) | 5.3 (4.0–7.2) | 6.1 (5.0–7.5) | |
| Current use of only 1 other tobacco product | .4 (.2–.7) | .2 (.1–.6)d | .2 (.1–.5)d | .2 (.1–.4)d | .2 (.1–.4)d | .9 (.4–2.3)d | .6 (.4–1.0) | |
| Current poly tobacco use | 17.1 (15.4–19.0) | 15.2 (13.0–17.8) | 15.2 (13.0–17.7) | 13.7 (11.6–16.2) | 12.9 (9.5–17.3) | 14.3 (12.4–16.4) | 13.4 (11.4–15.6) | |
| Current use of only 2 tobacco products | 11.2 (10.0–12.5) | 9.4 (8.0–10.9) | 9.8 (8.3–11.6) | 9.0 (7.3–11.0) | 8.5 (5.9–12.0) | 9.4 (7.7–11.4) | 8.6 (7.1–10.4) | |
| Current use of cigarettes and 1 tobacco product | 9.7 (8.7–10.9) | 8.6 (7.2–10.1) | 8.7 (7.3–10.4) | 8.1 (6.4–10.1) | 6.9 (4.9–9.6) | 8.2 (6.6–10.1) | 6.7 (5.4–8.2) | a |
| Current use of only cigarettes and smokeless tobacco | 1.5 (1.1–2.1) | 1.6 (1.0–2.6) | 1.6 (1.0–2.6) | 1.7 (.9–3.2)d | 1.9 (1.1–3.4) | 2.1 (1.2–3.5) | 1.6 (1.1–2.3) | |
| Current use of only cigarettes and cigars | 5.9 (5.1–6.8) | 5.6 (4.7–6.6) | 6.7 (5.4–8.2) | 4.8 (4.0–5.7) | 4.6 (3.4–6.1) | 5.4 (4.1–7.1) | 4.3 (3.4–5.4) | a |
| Current use of only cigarettes and only 1 other tobacco product | 2.3 (1.8–3.0) | 1.4 (.9–2.2) | .4 (.2–1.0)d | 1.6 (.9–2.8) | .4 (.2–.8)d | .7 (.3–1.6)d | .8 (.5–1.3) | |
| No current use of cigarettes but only 2 tobacco products | 1.5 (1.0–2.0) | .8 (.4–1.4) | 1.1 (.7–1.7) | .9 (.6–1.6) | 1.5 (.8–2.9)d | 1.2 (.7–1.9) | 1.9 (1.3–2.7) | |
| Current use of at least 3 tobacco products | 5.9 (5.0–7.0) | 5.9 (4.4–7.7) | 5.4 (4.2–6.8) | 4.7 (3.7–6.0) | 4.5 (3.3–6.0) | 4.9 (4.0–6.0) | 4.8 (3.8–6.0) | a |
| Current use of cigarettes and at least 2 tobacco products | 5.6 (4.7–6.7) | 5.7 (4.3–7.6) | 5.0 (3.9–6.4) | 4.4 (3.4–5.7) | 4.4 (3.3–5.8) | 4.8 (3.9–5.9) | 4.6 (3.6–5.8) | |
| Current use of only cigarettes, cigars, and smokeless tobacco | 1.8 (1.3–2.5) | 2.0 (1.3–3.0) | .9 (.6–1.5) | 1.5 (.9–2.3) | 1.0 (.6–1.8) | 1.3 (.8–2.2) | 1.4 (.9–1.9) | |
| Current use of only cigarettes, smokeless tobacco, and at least 1 other tobacco product | .3 (.1–.7)d | .1 (0.0–.4)d | 0.0 (0.0–.1)d | 0.0 (0.0–.2)d | .2 (.1–.6)d | .3 (.1–.7)d | .2 (.1–.6)d | |
| Current use of only cigarettes, cigars, and at least 1 other tobacco product | 2.1 (1.6–2.8) | 1.8 (1.2–2.5) | 1.9 (1.3–2.7) | 1.8 (1.2–2.7) | 1.9 (1.4–2.5) | 1.6 (1.0–2.5) | 1.4 (1.0–2.0) | |
| Current use of only cigarettes and at least 2 other tobacco products | .3 (.2–.6) | 0.0 (0.0–.2)d | .1 (0.0–.3)d | .2 (.1–.6)d | .1 (0.0–.3)d | .1 (0.0–.3)d | 0.0 (0.0–.2)d | |
| Current use of cigarettes, smokeless tobacco, cigars, and at least 1 other tobacco product | 1.1 (.8–1.6) | 1.8 (1.1–2.9) | 2.1 (1.3–3.3) | .9 (.6–1.4) | 1.2 (.7–2.0) | 1.5 (1–2.4) | 1.6 (1.1–2.2) | |
| No current use of cigarettes but at least 3 tobacco products | .3 (.1–.5)d | .1 (0.0–.7)d | .4 (.2–.8)d | .3 (.1–.8)d | .1 (0.0–.3)d | .1 (0.0–.3)d | .3 (.1–.6)d | |
CI = confidence interval.
Linear trend.
Linear and quadratic trend.
Other Tobacco is defined as use of pipe, bidis, or kreteks on at least 1 day of the past 30 days.
Data statistically unstable (denominator < 50 and/or relative standard error > 30%).
Discussion
We estimate that, in 2012, approximately one of five high school students in the United States were currently using some form of tobacco, and nearly half of this group were poly tobacco users. Our findings that the prevalence of poly tobacco use among high school students is relatively high and that over 80% of poly tobacco users in 2012 also smoked cigarettes are consistent with results from previous studies [10,11]. Among specific tobacco products, significant downward trends observed during the study period were for the use of certain cigarette categories.
Few studies have investigated concurrent, or poly, tobacco use in adolescents [11], and none have investigated it at the detailed level of this study. Previous research has found that poly tobacco use is more likely to occur in specific subgroups of young people, especially when stratified by both sex and race/ethnicity [2], which our study did not explore. The results of our study indicate differences in poly tobacco use by sex. This finding is supported by a recent report from the U.S. Surgeon General [2], which presented similar estimates for high school males and females that were based on data from the National Youth Risk Behavior Survey. In that analysis, more than 50% of high school males and approximately 30% of high school females who used tobacco used multiple products concurrently [2].
By examining tobacco use in detail, researchers can get a comprehensive view of use among youth, as well as insight into the use of specific products. For example, our analysis found that in 2012 nearly 50% of all high school students who were current tobacco users were poly tobacco users, and 35.8% of current tobacco users did not smoke cigarettes.
Poly use of tobacco products may contribute to the development of nicotine dependence among adolescents. A 2008 study found that the use of other tobacco products by cigarette smokers is associated with higher levels of nicotine dependence in young adults [12]. Another study found that current established smokers had the highest rate of current use of other tobacco products, suggesting a hastening of nicotine dependence for poly tobacco users who smoke cigarettes [8]. Although a cross-sectional study cannot follow the trajectories of addiction, the longitudinal studies that have looked at this topic have only focused on cigarette use [2], and none have looked at the trajectories of addiction for other types of tobacco use. Furthermore, no studies have looked at the risks and behavioral factors associated with poly tobacco use among youth, and the available studies that attempted to look at factors associated with poly tobacco use have focused only on cigarette users who use other tobacco products [8,10,11,13]. Some of these studies have found that young people who use cigarettes and other tobacco products may be at risk for multiple unhealthy behaviors that compromise their current and future health [8,10].
The results of our study can be used to guide policy, programmatic, and regulatory efforts to prevent and control tobacco use. The decline in current use of any tobacco since the early 2000s appears to be based in large part on declines in current use of only cigarettes, which lends credibility to the evidence that policy and programmatic efforts designed to reduce cigarette use among young people have been effective [2]. However, programs may need to do more to address the use of noncigarette tobacco products and the use of two or more tobacco products concurrently among adolescents. Furthermore, to fill the demand for cigarette flavors banned by the Family Smoking Prevention and Tobacco Control Act [14] in 2009, the tobacco industry expanded marketing and production of flavored cigars that look and are smoked like cigarettes [15]. The industry has also increased production and promotion of roll-your-own tobacco, which is not subject to federal excise taxes and thus is cheaper than cigarettes [16–18]. Consequently, per capita consumption of loose-leaf] tobacco and cigars has increased since 2000 [19]. Recent data also show that advertisement and promotional expenditures for smokeless tobacco products increased by approximately $200 million during 1997–2006 and again by the same amount during 2006–2008 [20].
Further research may help determine whether these factors and the relatively lower price of smokeless tobacco and cigars compared with cigarettes [21] may be contributing to the lack of decline in their use observed in our study. Strategies to prevent the use of any tobacco products by young people need to be developed, tested, and implemented population-wide as a way to further reduce all tobacco use among young people. These strategies should be used in conjunction with current tobacco control strategies that focus mainly on cigarette smoking.
Our findings are subject to at least six limitations. First, the data were collected from students attending either public or private high schools and might not be representative of all youth in the United States, especially those who were not enrolled in school. Second, the analysis only focused on youth who attended high school and did not include students who attended middle school. Third, reporting and recall bias might have been introduced because of the sensitivity of the questions or because some questions asked about past behaviors. Fourth, our analysis did not examine frequency and intensity of the tobacco used or the use of other emerging tobacco products (e.g., electronic cigarettes, hookahs, dissolvable tobacco products). Information about frequency and intensity were not available, except for cigarette use, and information about trends in the use of emerging products are not available because some only recently have been introduced to the market. Fifth, in order to increase sample size, non-Hispanic Asians, American Indian/Alaska natives, and native Hawaiians and other Pacific islanders were collapsed together, making interpretations difficult for these groups individually. Finally, our estimates may differ from those derived from other surveillance systems that collect data on young people. These differences can be explained, in part, by differences in survey methods, modes, and topics and in the age and setting of the study population. However, the trends identified in our study are similar to those identified in other surveys of young people [2].
Our results suggest that the collection and detailed analysis of data on the use of multiple tobacco products and not just cigarettes is needed to guide policies and programs intended to prevent and control tobacco use. All tobacco use surveys should include questions on lifetime and current use of a range of tobacco products, including emerging products, and on frequency and intensity of use. Longitudinal surveys should examine trajectories of initiation, experimentation, and addiction and assess which tobacco products, alone or in any combination, may serve as gateways to the use of other tobacco products, as well as to the use of alcohol and other illegal substances and risk behaviors.
IMPLICATIONS AND CONTRIBUTION.
Recent declines in current tobacco use among U.S. high school students appear to be driven by those who smoke cigarettes. To achieve greater declines, policies and programs focused on cigarettes may consider expanding to all tobacco products. Monitoring of all tobacco use among youth provides information to prevent initiation.
Acknowledgments
Funding Sources
There were no sources of funding, either direct or indirect, for this study.
Footnotes
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Conflicts of Interest: The authors have no conflicts of interest or financial disclosures to report.
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