Teen Smoking Still a Worry

Sometimes it seems that the old maxim, “you can’t believe everything you read,” becomes truer by the day. The Washington Post ran an article a few months ago bearing the headline, “Teens are drinking, smoking, and fighting less …”¹ Stobbe, Mike. “Teens are drinking, smoking, and fighting less, the government says, but screen time is up.” 12 June 2014. The Washington Post. 14 November 2014. http://www.washingtonpost.com/politics/teens-are-drinking-smoking-and-fighting-less-the-government-says-but-screen-time-is-up/2014/06/12/806c9e02-f27c-11e3-914c-1fbd0614e2d4_story.html A few days later, The Centers for Disease Control underlined that news with a reassuring report: “Cigarette smoking among U.S. high school students at lowest level in 22 years.”² http://www.cdc.gov/media/releases/2014/p0612-YRBS.html  With headlines like that, American health officials could pat themselves on the collective back and relax into the belief that the teen smoking problem was well under control.

Now, though, just five months later, the very same CDC office released a report of a different color, stating: “Youth tobacco smoking rates putting millions at risk of premature death.”³ http://www.cdc.gov/media/releases/2014/p1113-youth-tobacco.html The report goes on to declare that almost one quarter of all high school students in the US use tobacco in some form.

Did a new breed of high school students burst onto the scene this fall, cigarettes in hand, just minutes behind their abstaining older siblings? Did some extraordinary commercial persuade masses of teens to suddenly light up? Unfortunately, exactly why the new report pulls up such different numbers and differs so radically in tone from the one preceding is unclear. The fact is that both surveys polled students from across the US and both drew from sizeable samples. The latest data, from the 2013 National Youth Tobacco Survey, included 18,406 students, and the earlier, more optimistic study included over 13,000.⁴ Netburn, Deborah. “1 in 5 high school students uses tobacco, CDC says.” 13 November 2014. Los Angeles Times. 14 November 2014. http://www.latimes.com/science/sciencenow/la-sci-sn-one-in-five-high-school-students-use-tobacco-cdc-20141113-story.html While the latest survey found that about 23 percent of high school students currently smoke, the data from a few months earlier, based on the National Youth Risk Behavior Survey, reported that only 15.7 percent smoked.

The new report found that 12.7 percent of the respondents admitted to smoking cigarettes within the past 30 days, while 11.9 percent had smoked a cigar, and 4.5 percent reported smoking e-cigarettes. Of those, 12.6 percent claimed to currently use two or more tobacco products. Half of the respondents said they had smoked at least once in their lives, and nearly 12 percent had tried e-cigarettes.

Middle school students had far lower rates of smoking, with only 2.9 percent reporting having smoked a cigarette in the past 30 days and 3.1 percent smoking a cigar.

The good news is that the percentage of teens smoking is down slightly from 2011, even using the higher numbers. Back then, the CDC report found that 24.3 percent of teens smoked, a 1.3 percent difference—if that older report can be trusted. The drop has been even more dramatic since 2000, when 28 percent of high school students smoked as did 11 percent of middle schoolers. On the other hand, e-cigarette use among teens has tripled in the few years since 2011.

The rising rates of e-smoking are of concern to public health advocates for several reasons. First, the health effects of e-cigarettes, which turn tobacco smoke into a vapor, are still largely unknown. While experts agree that they’re probably less pernicious health-wise than regular cigarettes, there’s considerable reason for worry. Evidence suggests that any tobacco exposure can negatively affect brain development in young people, and that includes exposure from e-cigarettes. Plus, e-cigarettes still deliver toxic chemicals to the lungs via the vapor, although at reduced levels, incurring an increased risk of cancer and of pulmonary inflammation leading to asthma and related conditions,. Plus, e-cigarette vapor makes the lungs more vulnerable to bacterial infection, and studies show it may actually render bacteria in the lungs antibiotic resistant.⁵ Raloff, Janet. “Health risks of e-cigarettes emerge.” 3 June 2014. Science News. 15 November 2014. http://www.sciencenews.org/article/health-risks-e-cigarettes-emerge

Another concern is that even if e-smoking itself is less toxic than smoking regular cigarettes, it decidedly does not help people avoid regular cigarettes but actually seems to whet the appetite for more traditional forms of smoking. According to a CDC report, “National Youth Tobacco surveys of middle and high school students show that youth who had never smoked conventional cigarettes but who used e-cigarettes were almost twice as likely to have intentions* to smoke conventional cigarettes as those who had never used e-cigarettes. Among non-smoking youth who used e-cigarettes, 43.9 percent said they have intentions* to smoke conventional cigarettes within the next year, compared with 21.5 percent of those who had never used e-cigarettes.”⁶ “More than a quarter-million youth who never smoked used e-cigarettes in 2013.” 15 November 2014. http://www.cdc.gov/media/releases/2014/p0825-e-cigarettes.html

Also, cigar use has not declined among youth. In fact, high school boys smoke cigars at higher rates than they do cigarettes. Cigars aren’t taxed, they are sold individually, laws still don’t prohibit kids from purchasing them, and manufacturers have created sweeter, candy-flavored cigars that young people apparently like.

In any event, exact numbers aside, the fact is that plenty of kids under age 18 still smoke, and about 3200 youths start smoking for the first time every single day. Ninety percent of adults who are smokers started as teens; and 99 percent started by age 26. As a Surgeon General’s Fact Sheet says, “Almost no one starts smoking after age 25.”⁷ http://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/factsheet.html On the other hand, three-quarters of the teens who start smoking will keep doing so once they become adults.⁸ Preidt, Robert. “More Than One-Fifth of High-School Students Smoke.”13 November 2014. WebMd. 14 November 2014. http://www.webmd.com/parenting/news/20141113/more-than-one-fifth-of-high-school-students-smoke-cdc In other words, if we want to rout out smoking among adults, we have to focus on those in their teens.

A CDC Fact Sheet reports that “If smoking persists at the current rate among youth in this country, 5.6 million of today’s Americans younger than 18 years of age are projected to die prematurely from a smoking-related illness. This represents about one in every 13 Americans aged 17 years or younger alive today.”

Patricia Folan, Director of the Center for Tobacco Control at LIJ Health System in New York suggests what might be done. She says, “States with the lowest rates of tobacco use among adolescents and young adults are those that have strong tobacco control policies and programs that include high taxes on cigarettes, tobacco-free environments, point of sale restrictions, bans on tobacco product advertising targeted to youth, and anti-tobacco media campaigns.”

Whether the actual picture is better or worse than the latest study indicates, one thing is clear: we’re certainly not out of the woods with teen smoking.

*EDITOR’S NOTE:

Researchers used established methods to identify youth who are at risk of future cigarette smoking. In this approach, only youth who have a firm intention to not smoke, that is they reported they would “definitely not” smoke in the next year and reported they would “definitely not” smoke if offered a cigarette by a friend are classified as not having smoking intentions. All others were classified as having smoking intentions. Previous research has demonstrated that even youth who believe they probably will not smoke in the next year, are at heightened risk of initiating smoking in the future. For this reason, they are traditionally included by researchers as having smoking intentions and were in this study as well.

In addition to the primary analysis, the authors performed multiple analyses using alternative classifications of smoking intentions among youth. Even when using a more restrictive classification, which only includes those youth with strongest smoking intentions (responses of “definitely” or “probably” will smoke), the results continue to show that never smoking youth who smoked e-cigarettes are nearly two times more likely to have intentions to smoke conventional cigarettes than those who had never used e-cigarettes.