Youth smoking down despite weak programs

While states are coming under fire for not spending as much tobacco settlement money on smoking cessation programs for youth as they should, the American Legacy Foundation’s 2002 National Youth Tobacco Survey indicates that the prevalence of current smoking among high-school students declined about 18%, from 28% in 2000 to 22.9% in 2002. But the survey found no significant decrease in prevalence of smoking among middle-school youth in the same period.

The Washington, DC-based American Legacy Foundation was created as a result of the tobacco settlement agreement in 1998, and develops programs that address the health effects of tobacco use through grants, technical assistance and training, youth activism, strategic partnerships, counter-marketing and grass-roots marketing campaigns, public relations, and outreach to populations disproportionately affected by tobacco use.

Poll results were included in the Nov. 14, 2003, Morbidity and Mortality Weekly Report, published by the Centers for Disease Control and Prevention (CDC). The National Youth Tobacco Survey is the only comprehensive national survey that measures use of cigarettes, cigars, smokeless tobacco, pipes, bidis (leaf wrapped, flavored cigarettes from India), and kreteks (clove cigarettes) among middle school and high school students in the United States.

Researchers found that each day in the United States, some 4,400 youths ages 12 to 17 try their first cigarette, and an estimated one-third are expected to die from a smoking-related disease.

In 2002, 13.3% of middle-school students reported current use of any tobacco product, with cigarettes the most commonly used product. There were no significant differences in usages by sex. Cigars were the second most commonly used product, followed by smokeless tobacco, pipes, bidis, and kreteks. Males were more likely than females to use all tobacco products except for cigarettes. There were no significant differences found for any type of tobacco use when the data were cut by race or ethnicity.

Among high-school students, 28.4% report current use of any tobacco product, with no difference by sex, although white students were more likely to use cigarettes than blacks, Hispanics, or Asian students. Cigars were the second most common tobacco product, followed by smokeless tobacco, pipes, kreteks, and bidis. Males were more likely than females to use all tobacco products except for cigarettes. Asian students were less likely to use cigars, and white students were more likely to use smokeless tobacco than students in other racial or ethnic groups.

The researchers said the lack of progress in reducing smoking among middle-school students suggests that health officials should improve implementation of proven anti-smoking strategies and develop new strategies to promote continued declines in youth smoking. They also noted that the declines in cigarette smoking and overall tobacco use among high-school students reflect downward national trends since 1997, and the declining use of cigars, bidis, and kreteks, and the unchanged use of smokeless tobacco and pipes among high-school students suggested that students are not substituting other tobacco products for cigarettes, and efforts to reduce cigarette smoking might be reducing use of all tobacco products.

"Why middle-school and high-school students appear to be responding differently to the current anti-smoking environment is not clear," the report said. "Factors expected to discourage youth from smoking include increases in cigarette prices; implementation of smoke-free laws and policies; restrictions on tobacco advertising; and governmental anti-tobacco campaigns. However, spending on tobacco industry marketing doubled during 1997-2001, and tobacco industry-sponsored media campaigns have been determined to reduce the impact of public health campaigns."

According to the researchers, the survey data suggest that further refinements in evidence-based strategies will be needed to cut tobacco use among middle-school students. Efforts that might be successful could focus on devising more targeted and effective media campaigns; reducing depictions of tobacco use in entertainment media; starting campaigns to discourage family and friends from providing cigarettes to youth; promoting smoke-free homes; starting comprehensive school-based programs and policies in conjunction with supportive community activities; and reducing the number of adult smokers so that youths see more non-smoking role models.

Meanwhile, a report presented to Congress by a number of anti-smoking groups charged that states are spending less on smoking prevention programs than the amount recommended by the CDC. According to the report, only Arkansas, Delaware, Maine, and Mississippi spend the levels recommended by the CDC to fund tobacco prevention programs. And five states and the District of Columbia reportedly have not dedicated any tobacco settlement money to prevention programs.

One reason for the decrease in prevention spending, analysts suggested, is state budget problems, since 16 states have used tobacco settlement money to secure bonds that lawmakers used to reduce state budget deficits.

At a Nov. 12, 2003, hearing sponsored by the U.S. Senate Committee on Commerce, Science, and Transportation at which the report was released, committee chairman John McCain (R-AZ) suggested that an ounce of prevention might be worth more than a pound of cure. "From both a long-term economic perspective and a moral perspective, I would like to understand why states are, to a large degree, ignoring the problem of youth smoking," the senator said. "The surgeon general testified in 2000 before this committee that smoking prevention programs work, and that proper funding of these programs could cut smoking rates in half by 2010. I believe the tobacco settlement revenues may be our best chance to dramatically reduce smoking rates, especially among our children."

Presenting the report on prevention activities, Campaign for Tobacco-Free Kids president Matthew Myers said the failure of states to do as they had promised "will have tragic consequences for the health of our nation’s children and the amount taxpayers are forced to pay in the future to cover the costs of tobacco-related Medicaid expenditures. . . . Every state that has implemented a well-funded tobacco prevention program in accordance with the guidelines issued by the CDC has experienced a significant reduction in tobacco use. These programs work."

Mr. Myers reported that states have a clear source of revenue to address the problem because, despite their recent budget shortfalls, states are actually collecting more tobacco-generated revenue than ever before from the tobacco settlement and tobacco taxes. That is because 32 states and the District of Columbia have increased tobacco taxes since Jan. 1, 2002. Altogether, he said, states in 2003 will collect $19.5 billion in tobacco-generated revenue, and it would take just 8.2% or $1.6 billion for every state to fund prevention programs at the minimum level recommended by the CDC. "That leaves plenty of tobacco revenue to balance budgets and meet other needs," he said. "But the states are barely spending a third of what the CDC recommends."

National Governors Association executive director Ray Scheppach said that the "most important issue facing states today is the dismal fiscal situation. States are enduring the worst fiscal stress since World War II, and although the national economy is beginning to recover, state revenue growth has not responded, and historically has lagged federal recoveries by upward of 18 months.

American Legacy Foundation president Cheryl Healton issued four challenges to the Senate committee:

1. The nation must reinforce and renew its commitment, and the commitment in individual states, to youth tobacco prevention.

2. Attention must be given to the 47 million Americans who are smokers and especially the large percentage of them who want to quit.

3. Encouragement is needed for new and expanded public-private partnerships between business, unions, communities, states, and the federal government that will help expand the life-saving benefits of prevention programs and smoke-free workplaces.

4. Congress should continue its oversight responsibilities, tracking the progress of the tobacco settlement and encouraging the federal government to find appropriate avenues to become a more direct partner in tobacco prevention programs on the national level.

(To find out more about the survey, contact the American Legacy Foundation. Web: