November 15, 2012

State Estimates of Adolescent Cigarette Use and Perceptions of Risk from Smoking: 2009 and 2010

Cigarette smoking causes more than 400,000 deaths every year and imposes substantial health and financial costs on our Nation and States.¹ Preventing adolescents from starting to smoke may be the most effective way to reduce the health and economic burden of tobacco-related disease in the future. In recent years, significant progress has been made in reducing adolescent smoking,² but there is still much work left to be done.

States have been at the center of efforts to reduce adolescent smoking through cigarette taxation, enactment of laws that restrict smoking in public places, enforcement of laws that prohibit the sale and distribution of tobacco products to adolescents, and funding of smoking prevention and cessation programs. As longitudinal research has shown, adolescents' attitudes about the risks associated with cigarette smoking are often closely related to their use, with an inverse association between use and risk perceptions (i.e., the prevalence of use is lower among those who perceive high risk of harm from cigarette use).³ This corresponds to States with high prevalence of adolescent cigarette use typically having a low prevalence of adolescent perception that there is a great health risk from smoking. Therefore, many State and national prevention programs focus on teaching youths about the harm that smoking may do to their health and social life. State-level information about cigarette use and attitudes about smoking can provide States with vital data to monitor changes over time and to inform enforcement, educational, and prevention efforts.

This issue of The NSDUH Report uses data from the combined 2009 and 2010 (hereafter "2009-2010") National Surveys on Drug Use and Health (NSDUHs) to present State (including the District of Columbia) estimates of past month cigarette use and perceptions of great risk from smoking one or more packs of cigarettes per day among persons aged 12 to 17.^4,5 These estimates are rank ordered from highest to lowest and divided into quintiles (fifths).⁶ Additionally, the combined 2009-2010 data are compared with combined 2002 and 2003 (hereafter "2002-2003") data to examine changes in these measures over time.

The 2009-2010 data indicate that about 1 in 11 (8.7 percent) adolescents smoked cigarettes in the past month. Rates of adolescent past month cigarette use ranged from 5.9 percent in Utah to 13.5 percent in Wyoming (Figure 1).

Figure 1. Past Month Cigarette Use among Persons Aged 12 to 17, by State: 2009-2010

Of the 10 States with the highest rates of past month cigarette use among adolescents, 4 were in the Midwest (Iowa, Kansas, Missouri, and Ohio), 3 were in the South (Kentucky, Oklahoma, and West Virginia), 2 were in the West (Montana and Wyoming), and 1 was in the Northeast (New Hampshire).⁷ Of the States with the lowest rates of past month cigarette use among adolescents, 5 were in the West (California, Hawaii, Nevada, Utah, and Washington), 3 were in the Northeast (Massachusetts, New Jersey, and New York), and 3 were in the South (District of Columbia, Florida, and Maryland).

The 2009-2010 data indicate that, nationwide, about two in three adolescents (65.4 percent) perceived great risk from smoking one or more packs of cigarettes per day. Among adolescents, perception of great risk from smoking one or more packs of cigarettes per day among this group ranged from 58.7 percent in Oklahoma to 72.6 percent in Utah (Figure 2).

Figure 2. Perceptions of Great Risk from Smoking One or More Packs of Cigarettes Per Day among Persons Aged 12 to 17, by State: 2009-2010

Of the 10 States with the highest rates of adolescent's perception of great risk from smoking one or more packs a day, 5 were in the Northeast (Connecticut, Maine, Massachusetts, New Jersey, and New York), 3 were in the West (Hawaii, Utah, and Wyoming), and 2 were in the Midwest (Minnesota and Wisconsin). Of the States with the lowest rates of perception of great risk from smoking one or more packs of cigarettes per day, 6 were in the South (Alabama, Mississippi, Oklahoma, South Carolina, Tennessee, and West Virginia) and 4 were in the Midwest (Iowa, Kansas, Missouri, and Nebraska).

When 2002-2003 data are compared with 2009-2010, the Nation as a whole experienced a statistically significant reduction in the rate of past month cigarette use among adolescents (from 12.6 to 8.7 percent). On an individual State level, 41 States experienced a statistically significant decrease in the rate of adolescent past month cigarette use, and 10 experienced no change.

Comparisons of the 2002-2003 data to the 2009-2010 data indicate that there was an increase at the national level in the adolescent rate of perception of great risk from smoking one or more packs of cigarettes per day (from 63.7 to 65.4 percent). On an individual State level, 5 States experienced a statistically significant increase in the adolescent rate of perception of great risk from smoking, and 46 experienced no change.

Taken together, 5 States had a statistically significant decrease in past month adolescent cigarette use and an increase in the adolescent rate of perception of great risk from smoking (Figure 3; Table 1); these States are Florida, Louisiana, New Hampshire, New York, and North Carolina.⁸ For 36 States, there was a statistically significant decrease in the rate of adolescent past month cigarette use but no change in the adolescent rate of perception of great risk from smoking. For 10 States, there was no statistically significant change for either measure.

Figure 3. States with Significant Change in Past Month Cigarette Use and Perceptions of Great Risk from Smoking One or More Packs of Cigarettes Per Day among Persons Aged 12 to 17: 2002-2003 to 2009-2010

The prevalence of cigarette use initiation in childhood or adolescence has prompted the Surgeon General to declare tobacco use to be a "pediatric epidemic," affirming the importance of tobacco use prevention and control measures that target youths.⁹ Reducing smoking among adolescents will improve the Nation's health in both the short term and the long term. Findings in this report suggest that efforts to reduce smoking and to change attitudes about smoking among adolescents have resulted in considerable progress, although this progress was not uniform across all States. Highlighting the prevalence of adolescent cigarette use and attitudes toward use in each State, as well as monitoring changes, may help Federal, State, and local policymakers continue to plan for and allocate resources to combat adolescent smoking, including efforts to reduce the availability of tobacco products to young people, raise awareness about smoking and its consequences, and improve prevention efforts.

This page was last updated on October 11, 2010.