ANN ARBOR—Following a decade of substantial improvement, daily smoking among young people in their early and middle teens has stopped declining, according to the latest Monitoring the Future survey.
The survey, which is now in its 32nd year, measures smoking, drinking and illicit drug use among the nation's secondary school students, surveying about 50,000 8th, 10th, and 12th graders in more than 400 secondary schools every year.
The study had previously been reporting a large and continuing decline in cigarette smoking in these populations since they reached their recent peak smoking rates in the mid-1990s; current daily smoking has fallen by half among 12th graders, and by more than half among those in 8th and 10th grades.
However, this year no further decline in daily smoking was observed at 8th or 10th grade. Further declines did occur at 12th grade; daily smoking fell a bit further from 13.6 percent in 2005 to 12.2 percent in 2006 (a not quite statistically significant drop). Their half-pack-a-day smoking fell from 6.9 percent to 5.9 percent (which was significant).
Although the proportion reporting daily smoking in the past month has stabilized in the lower grades this year, all grades showed at least a small continuing decline in the proportions of students reporting any past month smoking. Rates for 8th graders were down from 9.3 percent in 2005 to 8.7 percent in 2006, for 10th graders from 14.9 percent to 14.5 percent, and for 12th graders from 23.2 percent to 21.6 percent. No one of these changes was large enough to be statistically significant, but the three in combination were.
The investigators note that even occasional smoking in senior year is important, because many of the light to moderate smokers transition into regular smoking in the years after high school. Like daily smoking, the statistics for monthly smoking are down by large proportions from the mid-1990s, when they reached a peak.
Monthly prevalence (the percent smoking at all in the past 30 days) is down by about 60 percent, 50 percent and 40 percent in grades 8, 10, and 12, respectively. The 12th grade is currently showing the greatest declines, note the investigators, as the class cohorts of 8th and 10th graders who have previously shown large declines in their use move into 12th grade.
"Many fewer of today's students have ever even tried smoking than was true a decade ago, when recent peak levels in lifetime prevalence were attained," said the University of Michigan's Lloyd Johnston, the principal investigator of the study. While 49 percent of the 8th graders in 1996 had tried cigarettes, " only 25 percent of the 8th graders in 2006 indicated having done so.
Lifetime prevalence of ever smoking a cigarette is down by about half among 8th graders, 40 percent among 10th graders, and by about 30 percent among 12th graders since the recent peak year of 1996, or 1997 in the case of 12th graders.
"We expect the decline among 12th graders to continue as the younger, less tobacco-experienced class cohorts move into 12th grade," Johnston said.
In addition to Johnston, the authors of the forthcoming report include Patrick O'Malley, Jerald Bachman, and John Schulenberg all research professors at the U-M Institute for Social Research and all social or developmental psychologists.
The investigators believe that some of the forces contributing to the substantial declines in smoking over the past decade have diminished, which likely explains the leveling in teen smoking that is now taking place.
The public debate that led up to the tobacco settlement between the major tobacco companies and the state attorneys general centered attention on the hazards of smoking and some of the questionable practices of the industry, all of which likely led to less favorable attitudes toward smoking.
In addition, there were several relevant changes as a direct result of the settlement: the tobacco companies raised cigarette prices considerably to permit the industry to cover the costs of the settlement, the Joe Camel campaign and all billboard advertising were both terminated, and the American Legacy Foundation was created with settlement monies and launched a successful national anti-tobacco advertising campaign. Moreover, many states mounted their own ad campaigns and initiated other activities aimed at curbing smoking, in part with settlement monies.
Now, however, there is no heated public debate about the behavior of the industry: state anti-tobacco initiatives, including anti-smoking ad campaigns, have shrunk as settlement monies have been diverted by many states to other activities; the national ad campaign has diminished considerably as a result of time limitations in the settlement's funding of the American Legacy Foundation; and there are fewer states raising tobacco taxes and thus raising the price of cigarettes. The investigators believe that the substantial, and concurrent, diminution of these various forces helps to explain why youth smoking is no longer declining.
Attitudes and beliefs about smoking
"For some years we were seeing an increase in the proportions of young people who thought smoking was dangerous" what we have labeled as 'perceived risk but over the past two years perceived risk of cigarette use has held level among 10th graders and begun to drop among 8th graders," Johnston said. " Generally we have found perceived risk to be an important indicator of changes in future use of a drug, so this is not a favorable development. The good news is that disapproval of cigarette smoking is still rising and is at very high levels among teens."
Certain other attitudes related to smoking have been included in the surveys over the years, and they show that negative attitudes about smoking and smokers grew from 1996 or 1997 through about 2004, before leveling.
Some have continued to increase, though, including " Smoking is a dirty habit" and "I think becoming a smoker reflects poor judgment." The most widely endorsed of these attitudinal statements about smoking is " I prefer to date people who don't smoke." Some 80 percent of all 8th and 10th graders agree with this statement, while 77 percent of 12th graders now endorse it, and the percentage is still rising at 12th grade.
"Wanting to be attractive to the opposite sex should be a major motivation to avoid smoking for nearly all teens today," Johnston said. "Clearly the social stigma attached to smoking has grown, and is now very high, even within their peer group."
Availability of cigarettes
After 1996, the proportions of 8th and 10th graders who said that they could get cigarettes fairly easily began to decline; the decline continues today for the 8th graders pretty much leveled off after 2003 among the 10th graders, though there was some further decline this year. (Twelfth graders are not asked this question.)
In sum, after a very important increase in the rate of smoking among the nation's teens in the early 1990s, there was a turnaround that began after 1996/1997" one that has now more than offset the increases in smoking observed in the early 1990s. However, this more recent period of decline in teen smoking appears to be nearing its end, except insofar as there are cohort effects still emerging at 12th grade. In the lower grades, perceived risk has begun to decline, and the declines in use are now very small" indeed, they have ended for daily smoking.
Like cigarettes, the 30-day prevalence of using smokeless or " spit" tobacco reached a recent peak level in the mid-1990s and then began to decline. All three grade levels have shown about a one half-decline in their 30-day prevalence since those peak levels, but the declines have ended at the lower grades, where use remained level this year. Only the 12th graders are showing further evidence of any decline in their use of smokeless tobacco, no doubt the result of a cohort-effect working its way up the age scale. At present, the prevalence rates for any use in the prior 30 days are 3.7 percent, 5.7 percent, and 6.1 percent in grades 8, 10, and 12. That means that one in every 16 high school seniors is a current user of smokeless tobacco.
"This is a bit deceptive though because boys account for almost all smokeless tobacco use," Johnston said. " Among 12th-grade males, one in nine is a current user."
Kreteks and bidis
In 2000, a single question was introduced into the study about the use of bidis" small flavored cigarettes imported from India" because of rising concern at the time about their growing use. In 2001, a single question was introduced for similar reasons about the use of kreteks" clove-flavored cigarettes imported from Indonesia.
Relatively low prevalence rates were observed for both types of specialty cigarettes in the initial years of measurement, and since then use has declined substantially and fairly steadily in all grades.
By 2006, the annual prevalence of bidis use was down by three quarters among 12th graders, from 9 percent in 2000 to 2 percent in 2006, including a statistically significant drop this year. Annual prevalence of kretek use among 12th graders is down by about 40 percent since 2001, including further decline this year.
Therefore, the investigators conclude that both kreteks and bidis constituted short-term fads that have not caught on with mainstream American youth, making it unlikely that they will become the health menace some had feared. The investigators note, however, that mainstream tobacco companies have themselves introduced flavored cigarettes, which may help to explain the demise in these fringe products.
Monitoring the Future has been funded under a series of competing, investigator-initiated research grants from the National Institute on Drug Abuse, part of the National Institutes of Health. Surveys of nationally representative samples of American high school seniors were begun in 1975, making the class of 2006 the 32nd such class surveyed. Surveys of 8th and 10th graders were added to the design in 1991, making the 2006 nationally representative samples the 16th such classes surveyed. The sample sizes in 2006 are 17,026 eighth graders in 151 schools, 16,620 tenth graders in 123 schools, and 14,814 twelfth graders in 136 schools, for a total of 48,460 students in 410 secondary schools. The samples are drawn separately at each grade level to be representative of students in that grade in public and private secondary schools across the coterminous United States. Schools are selected with probability proportionate to their estimated class size.
The findings summarized here will be published in the forthcoming volume: Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2007). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2006. (NIH Publication No. [yet to be assigned].) Bethesda MD: National Institute on Drug Abuse.