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Youth cigarette use tumbles over three decades


Study finds dramatic declines across boys and girls, racial and ethnic groups.

© Ochsner Journal

This graph, published in Ochsner Journal with the study “Trends in Cigarette Smoking Among United States Adolescents,” shows the steep drop in occasional cigarette use by American high school students from 1991 to 2021.
© Ochsner Journal

Cigarette use plummeted among American high school students over the last three decades, potentially good news for overall health, according to a new study.

However, researchers caution some residual clinical and public health challenges will require targeted interventions.

“Trends in Cigarette Smoking Among United States Adolescents,” published in Ochsner Journal, analyzed data from the 1991 to 2021 Youth Risk Behavior Survey assembled by the U.S. Centers for Disease Control & Prevention. Every two years, the survey collects data from youths in grades nine to 12 in the 50 states and the District of Columbia.

Students were asked if they ever tried cigarette smoking, or were occasional, frequent, or daily users. Results about cigarette smoking were stark: Use dropped “significantly” for girls and boys, with “steep declines” across all racial and ethnic groups, and a “significant decline” across all high school grades.

“The substantial decrease in cigarette use among U.S. adolescents spanning three decades is an encouraging public health achievement,” senior author Panagiota “Yiota” Kitsantas, PhD, said in a news release. Kitsantas is professor and chair of the Department of Population Health and Social Medicine in Florida Atlantic University’s Schmidt College of Medicine. “This decrease underscores the importance of continued vigilance, research, and intervention to further reduce tobacco use and its associated harms.”

By the numbers

  • Overall, ever use, defined as taking just one or two puffs, dropped from 70.1% in 1991 to 17.8% in 2021, an almost four-fold decline, the study said.
  • Occasional use, defined as smoking on at least one day in the last 30 days before the survey, dropped from 27.5% in 1991 to 3.8% in 2021, more than a seven-fold drop.
  • Frequent use, or smoking on 20 or more days during the last 30 before the survey, declined from 12.7% in 1991 to 0.7% in 2021, more than an 18-fold drop.
  • Daily use, defined as smoking on all 30 days before the survey, dropped from 9.8% in 1991 to 0.6% in 2021, greater than a 16% decline.

Additional declines

Among student grades, 12th-graders consistently had the largest number of occasional smokers. “This finding suggests that while smoking has decreased across all age groups, older adolescents might still be more prone to experimenting with cigarettes than their younger counterparts,” the news release said.

The researchers noted the cuts in cigarette use were most pronounced among Black and Asian adolescents. Among White and Hispanic/Latino youths had higher rates of use, but still showed declines from 1991 to 2021.

Study and interventions

Even with declining rates, cigarette smoking causes about one in five deaths in the United States each year. It remains the leading single avoidable cause of premature death, the study said.

The findings are reassuring but suggest public health challenges in the future, coauthor Charles H. Hennekens, MD, DrPH, said in the news release. Hennekens is First Sir Richard Doll Professor of Medicine and senior academic adviser in the Florida Atlantic University Schmidt College of Medicine.

“Quitting smoking significantly reduces risks of cardiovascular disease beginning within a matter of months and reaching the nonsmoker status within a few years, even among older adults,” he said. “However, for lung and other cancers, reductions do not even begin to emerge for years after quitting, and even after 10 years, remain midway between the continuing smoker and lifelong nonsmoker. Thus, for reducing cardiovascular disease risks it’s never too late to quit, but to reduce risks of cancer, it’s never too early.”

Youths using e-cigarettes

The study focused on cigarette use and said the trends “stand in stark contrast to the rise in the popularity of e-cigarettes among adolescents.”

As of November last year, the U.S. Food and Drug Administration’s (FDA) 2023 Findings on Youth Tobacco Use noted any tobacco use dipped from 16.5% in 2022 to 12.6% in 2023 for high school students, driven by a drop in high school e-cigarette use. Cigarette and cigar use reached all-time lows for that group.

But any tobacco use bumped up year-on-year for middle school students, from 4.5% to 6.6%, according to the FDA figures.

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