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Epidemiology of Youth Tobacco Use

Epidemiology of Youth Tobacco Use . Gary A. Giovino, PhD, MS Department of Health Behavior University at Buffalo, SUNY School of Public Health and Health Professions. 2009 Virginia Forum on Youth Tobacco Use April 14, 2009. Overview. Conceptual Models Health Consequences

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Epidemiology of Youth Tobacco Use

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  1. Epidemiology of Youth Tobacco Use Gary A. Giovino, PhD, MS Department of Health Behavior University at Buffalo, SUNY School of Public Health and Health Professions 2009 Virginia Forum on Youth Tobacco Use April 14, 2009

  2. Overview • Conceptual Models • Health Consequences • Trends in Prevalence of: • Cigarette Smoking • Smokeless Tobacco • Cigars • Tobacco Use • State data

  3. Youth Tobacco Use • Approximate 90% of adult smokers in the US smoked their first cigarette before age 18 years. • Each day in the United States approximately 4,000 12-17 year old youths try their first cigarette and another 1,140 become daily cigarette smokers

  4. Preventing Tobacco Use Among Young People: A Report of the Surgeon General • Health Consequences: • Cigarette smoking during childhood and adolescence produces significant health problems among young people, including cough and phlegm production, an increased number and severity of respiratory illnesses, decreased physical fitness, an unfavorable lipid profile, and potential retardation of lung growth and the level of maximum lung function. • Among addictive behaviors, cigarette smoking is the one most likely to become established during adolescence. People who begin to smoke at an early age are more likely to develop severe levels of nicotine addiction than those who start at a later age. Source: USDHHS, 1994.

  5. Preventing Tobacco Use Among Young People: A Report of the Surgeon General • Health Consequences: • Tobacco use is associated with alcohol and illicit drug use and is generally the first drug used by young people who enter a sequence of drug use that can include tobacco, alcohol, marijuana, and harder • Smokeless tobacco use by adolescents is associated with early indicators of periodontal degeneration and with lesions in the oral soft tissue. Adolescent smokeless tobacco users are more likely than nonusers to become cigarette smokers. Source: USDHHS, 1994.

  6. Smoking and Tobacco Smoke Pollution Damage Every Part of the Body Tobacco Smoke Pollution Smoking Source: WHO, Report on the Global Tobacco Epidemic, 2008. The MPWOER Package; page 11.

  7. Patterns of Use

  8. Epidemiologic Model of Tobacco Control and Nicotine Addiction Tobacco Products Agent Environment Familial, Social, Cultural, Political, Economic, Historical, Media Host Vector Smoker/Chewer Tobacco Product Manufacturers; Other Users Incidental Host Involuntary Smoker Source: Orleans & Slade, 1993; Giovino 2002

  9. Conceptual Model of Factors Influencing Trends in Adolescent Smoking – United States, 1975-2001 Data Source: Institute for Social Research, University of Michigan, Monitoring the Future Surveys

  10. Current Use Among Middle and High School Students by Type of Tobacco Product – National Youth Tobacco Survey, 2004 28.0 22.3 12.8 11.7 8.1 6.0 5.2 2.6 2.9 2.6 3.1 2.3 2.3 1.5 Note: Used tobacco on ³ 1 of the 30 days preceding the survey Source: American Legacy Foundation, National Youth Tobacco Survey

  11. Trends in Cigarette Use among 12th Grade Students -- United States, 1975-2008 Lifetime Use 44.7% in 2008 30-day Use Daily Use 20.4% in 2008 11.4% in 2008 ½ pack+/day 5.4% in 2008 Source: Institute for Social Research, University of Michigan, Monitoring the Future Survey

  12. Trends in cigarette smoking among adults and high school seniors -- United States, 1974-2007 *Adult data are from the National Health Interview Surveys., ages > 18 year olds. Before 1992, current smokers were defined as persons who reported having smoked >100 cigarettes and who currently smoked. Since 1992, current smokers were defined as persons who reported having smoked >100 cigarettes during their lifetime and who reported now smoking every day or some days. High School Senior data are on daily smoking. Source: University of Michigan, Institute for Social Research, Monitoring the Future

  13. Trends in Cigarette Smoking Anytime in the Past 30 days by Grade in School – United States, 1975-2008 12th Grade 20.4% in 2008 10th Grade 8th Grade 12.3% in 2008 6.8% in 2008 Source: Institute for Social Research, University of Michigan, Monitoring the Future Surveys

  14. Trends in Prevalence of Past Month Cigarette Smoking Among High School Seniors by Gender – United States, 1975-2008 Female Male Source: Institute for Social Research, University of Michigan, Monitoring the Future Surveys

  15. Trends in Prevalence of Past Month Cigarette Smoking Among High School Seniors by College Plans – United States, 1976-2008 None or < 4 years Complete 4 years Source: Institute for Social Research, University of Michigan, Monitoring the Future Surveys

  16. Trends in Prevalence of Past Month Cigarette Smoking Among High School Seniors by Region – United States, 1975-2008 Northeast Midwest South West Source: Institute for Social Research, University of Michigan, Monitoring the Future Surveys

  17. Trends in Prevalence of Past Month Cigarette Smoking Among High School Seniors by Population Density – United States, 1975-2008 Non-MSA Other MSA Large MSA Source: Institute for Social Research, University of Michigan, Monitoring the Future Surveys

  18. Trends in Prevalence of Past Month Cigarette Smoking Among High School Seniors by Race – United States, 1977-2008 White Hispanic Black Source: Institute for Social Research, University of Michigan, Monitoring the Future Surveys; for racial subgroups, data for the current year and the previous year are combined

  19. Trends in cigarette smoking* among African American and white adults aged 20-24 years - United States, 1978-1995, aggregate data *Before 1992, current smokers were defined as persons who reported having smoked >100 cigarettes and who currently smoked. Since 1992, current smokers were defined as persons who reported having smoked >100 cigarettes during their lifetime and who reported now smoking every day or some days. Source: USDHHS, 1998 – Tobacco Use among US Racial/Ethnic Minority Groups; NHIS data from 1978-1995

  20. Trends in cigarette smoking* among African American and white adults aged 25-29 years - United States, 1978-1995, aggregate data *Before 1992, current smokers were defined as persons who reported having smoked >100 cigarettes and who currently smoked. Since 1992, current smokers were defined as persons who reported having smoked >100 cigarettes during their lifetime and who reported now smoking every day or some days. Source: USDHHS, 1998 – Tobacco Use among US Racial/Ethnic Minority Groups; NHIS data from 1978-1995

  21. Trends in cigarette smoking* among African American and white adults aged 30-34 years - United States, 1978-1995, aggregate data *Before 1992, current smokers were defined as persons who reported having smoked >100 cigarettes and who currently smoked. Since 1992, current smokers were defined as persons who reported having smoked >100 cigarettes during their lifetime and who reported now smoking every day or some days. Source: USDHHS, 1998 – Tobacco Use among US Racial/Ethnic Minority Groups; NHIS data from 1978-1995

  22. Percentage of High School Students Who Reported Lifetime Cigarette Use,* by Sex** and Race/Ethnicity, 2007 * Ever tried cigarette smoking, even one or two puffs. ** M > F National Youth Risk Behavior Survey, 2007

  23. Percentage of High School Students Who Reported Lifetime Cigarette Use,* 1991 – 2007 * Ever tried cigarette smoking, even one or two puffs. 1 No change 1991-1999, decreased 1999-2007, p < .05 National Youth Risk Behavior Surveys, 1991 – 2007

  24. Percentage of High School Students Who Reported Current Cigarette Use,* by Sex** and Race/Ethnicity,*** 2007 *Smoked cigarettes on at least 1 day during the 30 days before the survey. **M > F ***W > H > B National Youth Risk Behavior Survey, 2007

  25. Percentage of High School Students Who Reported Current Cigarette Use,* 1991 – 2007 * Smoked cigarettes on at least 1 day during the 30 days before the survey. 1 Increased 1991-1997, decreased 1997-2007, p < .05 National Youth Risk Behavior Surveys, 1991 – 2007

  26. Range and Median Percentage of High School Students Who Reported Current Cigarette Use,* Across 39 States and 22 Cities, 2007 * Smoked cigarettes on at least 1 day during the 30 days before the survey. State and Local Youth Risk Behavior Surveys, 2007

  27. Percentage of High School Students Who Reported Current Frequent Cigarette Use,* 1991 – 2007 * Smoked cigarettes on 20 or more days during the 30 days before the survey. 1 Increased 1991-1999, decreased 1999-2007, p < .05 National Youth Risk Behavior Surveys, 1991 – 2007

  28. Percentage of High School Students Who Currently Smoked More Than 10 Cigarettes/Day,* by Sex** and Race/Ethnicity,*** 2007 * On the days they smoked during the 30 days before the survey, among the 20.0% of students nationwide who had smoked cigarettes on at least 1 day during the 30 days before the survey. ** M > F *** W > B, H National Youth Risk Behavior Survey, 2007

  29. Percentage of High School Students Who Tried to Quit Smoking Cigarettes,* by Sex** and Race/Ethnicity,*** 2007 * During the 12 months before the survey, among the 20.0% of students nationwide who had smoked cigarettes on at least 1 day during the 30 days before the survey. ** F > M *** B > W, H National Youth Risk Behavior Survey, 2007

  30. Percentage of High School Students Who Tried to Quit Smoking Cigarettes,* 2001 – 2007 * During the 12 months before the survey, among students who had smoked cigarettes on at least 1 day during the 30 days before the survey. 1 Decreased 2001-2007, p < .05 National Youth Risk Behavior Surveys, 2001 – 2007

  31. Percentage of High School Students Who Usually Obtained Their Own Cigarettes by Buying Them in a Store or Gas Station,* by Sex** and Race/Ethnicity, 2007 * During the 30 days before the survey, among the 16.1% of students who were aged < 18 years and had smoked cigarettes on at least 1 day during the 30 days before the survey. ** M > F National Youth Risk Behavior Survey, 2007

  32. Percentage of High School Students Who Usually Obtained Their Own Cigarettes by Buying Them in a Store or Gas Station,* 2001 – 2007 * During the 30 days before the survey, among students who were aged < 18 years and had smoked cigarettes on at least 1 day during the 30 days before the survey. 1 Decreased 2001-2007, p < .05 National Youth Risk Behavior Surveys, 2001 – 2007

  33. Brands by Age Source: O’Connor, Tobacco Control, 2005, citing NSDUH data

  34. Trends in Smokeless Tobacco Use Anytime in the Past 30 days by Grade in School – United States, 1991-2008 10th Grade 12th Grade 6.5% in 2008 5.0% in 2008 8th Grade 3.5% in 2008 Source: Institute for Social Research, University of Michigan, Monitoring the Future Surveys

  35. Trends in Smokeless Tobacco Use Anytime in the Past 30 Days Among High School Seniors by Sex – United States, 1992-2008 Males 11.8% in 2008 Females 1.0% in 2008 Source: Institute for Social Research, University of Michigan, Monitoring the Future Surveys

  36. Trends in Smokeless Tobacco Use Anytime in the Past 30 Days Among High School Seniors by Population Density – United States, 1992-2008 Non-MSA 11.8% in 2008 Other MSA 6.2% in 2008 Large MSA 2.6% in 2008 Source: Institute for Social Research, University of Michigan, Monitoring the Future Surveys

  37. Percentage of High School Students Who Currently Used Smokeless Tobacco,* by Sex** and Race/Ethnicity,*** 2007 * Used chewing tobacco, snuff, or dip on at least 1 day during the 30 days before the survey. ** M > F *** W > H > B National Youth Risk Behavior Survey, 2007

  38. Range and Median Percentage of High School Students Who Currently Used Smokeless Tobacco,* Across 35 States and 20 Cities, 2007 * Used chewing tobacco, snuff, or dip on at least 1 day during the 30 days before the survey. State and Local Youth Risk Behavior Surveys, 2007

  39. Percentage of High School Students Who Currently Smoked Cigars,* by Sex** and Race/Ethnicity,*** 2007 * Smoked cigars, cigarillos, or little cigars on at least 1 day during the 30 days before the survey. ** M > F *** W > H > B National Youth Risk Behavior Survey, 2007

  40. Percentage of High School Students Who Currently Smoked Cigars,* 1997 – 2007 * Smoked cigars, cigarillos, or little cigars on at least 1 day during the 30 days before the survey. 1 Decreased 1997-2005, no change 2005-2007, p < .05 National Youth Risk Behavior Surveys, 1997 – 2007

  41. Range and Median Percentage of High School Students Who Currently Smoked Cigars,* Across30 States and 20 Cities, 2007 * Smoked cigars, cigarillos, or little cigars on at least 1 day during the 30 days before the survey. State and Local Youth Risk Behavior Surveys, 2007

  42. Percentage of High School Students Who Currently Used Tobacco,* by Sex** and Race/Ethnicity,*** 2007 * Smoked cigarettes; smoked cigars, cigarillos, or little cigars; or used chewing tobacco, snuff, or dip on at least 1 day during the 30 days before the survey. ** M > F *** W > B, H National Youth Risk Behavior Survey, 2007

  43. Percentage of High School Students Who Currently Used Tobacco,* 1997 – 2007 * Smoked cigarettes; smoked cigars, cigarillos, or little cigars; or used chewing tobacco, snuff, or dip on at least 1 day during the 30 days before the survey. 1 Decreased 1997-2007, p < .05 National Youth Risk Behavior Surveys, 1997 – 2007

  44. Range and Median Percentage of High School Students Who Currently Used Tobacco,* Across 30 States and 20 Cities, 2007 * Smoked cigarettes; smoked cigars, cigarillos, or little cigars; or used chewing tobacco, snuff, or dip on at least 1 day during the 30 days before the survey. State and Local Youth Risk Behavior Surveys, 2007

  45. Fig 4.3 Age in Years Past Month Cigarette Use among Persons Aged 12 or Older, by Age: 2006 NSDUH Percent Using in Past Month

  46. Trends in cigarette smoking* by age - United States, 1965-2007 *Before 1992, current smokers were defined as persons who reported having smoked >100 cigarettes and who currently smoked. Since 1992, current smokers were defined as persons who reported having smoked >100 cigarettes during their lifetime and who reported now smoking every day or some days. Source: various National Health Interview Surveys from 1965 - 2007, National Center for Health Statistics

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