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2 Patterns of Tobacco Use by Adolescents and Young Adults
Pages 31-62

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From page 31...
... . When discussing the rates of tobacco use, "tobacco use" is defined to include use of cigarettes, smokeless tobacco, cigars, and electronic nicotine delivery systems (ENDS)
From page 32...
... Table 2-1 provides current cigarette smoking rates from the 2013 YRBSS by gender, race/ethnicity, and grade. Data from the 2013 YRBSS show that slightly fewer than one in five high school seniors (19 percent)
From page 33...
... . While black and Hispanic males smoke more than females, prevalence rates of current smoking are the same for males and females among whites.
From page 34...
... The sharp increase from 16.1 percent at age 17 to 25.1 percent at age 18 is presumably due at least in part to the fact that the minimum legal age for purchase of tobacco products is 18. Although MTF is a school-based sample, the study includes a longitudinal component, allowing for estimates for smoking rates for young adults who are high school graduates.
From page 35...
... For Hispanic students, the relationship was nonlinear, with smoking rates relatively high among Hispanic students with parents of higher education levels compared to white and black students, and relatively low among Hispanic students with the least educated parents compared to whites and blacks. It is possible, however, that these findings TABLE 2-3  Percentage of 10th Graders Who Smoked Cigarettes in the Past 30 Days, by Parental Education, MTF, 1997 and 2013 Parental Education 1997 2013 1.0–2.0 (low)
From page 36...
... . As a further illustration, Table 2-4 provides smoking rates for two groups: those who expect to complete a 4-year college program versus those who do not.
From page 37...
... FIGURE 2-2 Cigarette use in the past month among adolescents ages 12 to 17, by state. Average annual percentages, NSDUH, 2010 and 2011.
From page 38...
... 38 TABLE 2-6  Percentage Using Cigarettes in the Past Month, Ages 12–17, by State, NSDUH, 2002–2003 and 2010–2011 State 2002–2003 2010–2011 Change State 2002–2003 2010–2011 Change Alabama 13.69 8.84 −4.85 Montana 16.1 11.73 −4.37 Alaska 13.25 7.84 −5.41 Nebraska 16.36 8.87 −7.49 Arizona 12.84 8.76 −4.08 Nevada 12.73 6.95 −5.78 Arkansas 16.05 9.35 −6.7 New Hampshire 14.03 10.7 −3.33 California 7.48 6.25 −1.23 New Jersey 11.83 8.35 −3.48 Colorado 13.74 8.64 −5.1 New Mexico 12.34 9.08 −3.26 Connecticut 13.45 8.02 −5.43 New York 11.81 6.83 −4.98 Delaware 14.07 8.16 −5.91 North Carolina 14.78 8.86 −5.92 District of 7.1 5.99 −1.11 North Dakota 17.53 9.64 −7.89 Columbia Florida 12.26 6.91 −5.35 Ohio 14.52 9.62 −4.9 Georgia 12.83 9.41 −3.42 Oklahoma 14.96 10.21 −4.75 Hawaii 8.78 6.68 −2.1 Oregon 11.29 7.45 −3.84 Idaho 12.48 8.57 −3.91 Pennsylvania 14.73 9.58 −5.15
From page 39...
... Illinois 13 7.28 −5.72 Rhode Island 13.72 8.39 −5.33 Indiana 14.39 8.06 −6.33 South Carolina 12.21 9.7 −2.51 Iowa 14.27 10.8 −3.47 South Dakota 19.79 10.18 −9.61 Kansas 13.95 9.62 −4.33 Tennessee 14.33 9.18 −5.15 Kentucky 17.62 11.66 −5.96 Texas 11.65 7.11 −4.54 Louisiana 15.01 9.14 −5.87 Utah 6.57 5.13 −1.44 Maine 12.16 8.87 −3.29 Vermont 14.84 10.48 −4.36 Maryland 11.08 5.9 −5.18 Virginia 14.17 6.99 −7.18 Massachusetts 11.69 8.16 −3.53 Washington 10.84 8.56 −2.28 Michigan 13.59 8.4 −5.19 West Virginia 17.34 11.8 −5.54 Minnesota 15.67 8.7 –6.97 Wisconsin 15.32 8.1 –7.22 Mississippi 12.83 9.37 –3.46 Wyoming 12.78 11.26 –1.52 Missouri 17.88 11.6 –6.28         SOURCE: SAMHSA, 2012c.
From page 40...
... Use of other tobacco products similarly varies by metropolitan status, with greater use in more rural communities and less use in more urban areas. Adolescents and young adults residing in rural communities are more likely to use tobacco and, particularly, smokeless tobacco or chew because of the cultural norms set within their communities (Melnick et al., 2001; Peek et al., in preparation)
From page 41...
... The lowest rates are found in the western United States, in large metropolitan areas, among African Americans, adolescents who plan to go to college, and adolescents whose parents' education includes graduate school or a professional degree. INITIATION The Surgeon General's 2012 report stated that one of the most important and widely cited findings from the 1964 Surgeon General's report on smoking and health was that cigarette smoking almost always begins
From page 42...
... However, the NHIS survey used a different definition of age of initiation, which is often used in surveys of adults, and does not treat a person as having initiated smoking until that person has smoked at least 100 cigarettes. In the models reported in Chapter 8, NHIS data are used as the basis for estimating the effects that changing the minimum legal age has on initiation.
From page 43...
... TABLE 2-8  Cumulative Percentage of Recalled Ages at Which Respondents First Used a Cigarette and Began Smoking Daily, by Smoking Status Among 30- to 34-Year-Olds, NSDUH, 2012 Persons Who Had Ever Tried All Persons  a Cigarette Persons Who Ever Smoked Daily First Tried a Began Smoking First Tried a Age Cigarette Daily First Tried a Cigarette  Cigarette Began Smoking Daily ≤10 3.8 0.4 5.4  7.0 1.1 11 5.9 1.1 8.5  11.4 2.7 12 11.9 2.3 17.0  21.4 5.8 13 17.4 3.9 25.0  30.6 9.8 14 25.2 6.1 36.2  45.6 15.4 15 34.6 9.8 49.7  62.3 24.8 16 43.5 15.9 62.4  75.0 40.1 17 48.9 21.3 70.2  81.9 53.9 18 56.7 27.3 81.5  89.8 69.0 19 60.0 30.5 86.1  94.1 77.0 20 63.0 33.6 90.5  95.9 84.9 21 64.9 35.1 93.3  97.1 88.5 22 66.1 36.0 94.9  98.0 90.7 23 66.8 36.4 95.9  98.5 92.0 24 67.1 37.1 96.4  98.5 93.6 continued 43
From page 44...
... TABLE 2-8 Continued 44 Persons Who Had Ever Tried All Persons  a Cigarette Persons Who Ever Smoked Daily First Tried a Began Smoking First Tried a Age Cigarette Daily First Tried a Cigarette  Cigarette Began Smoking Daily 25 68.0 38.4 97.7  99.2 96.8 26 68.4 38.6 98.2  99.4 97.5 27 68.8 38.8 98.9  99.5 98.0 28 69.0 38.9 99.1  99.7 98.1 29 69.2 39.2 99.3  99.9 98.9 30 69.5 39.5 99.8  100.0 99.8 31 69.5 39.5 99.8  100.0 99.8 32 69.6 39.5 100.0  100.0 99.8 33 69.6 39.6 100.0  100.0 99.9 34 69.6 39.6 100.0  100.0 100.0 Never smoked 100 100 NA  NA NA SOURCE: Committee analysis of data from HHS et al., 2014.
From page 45...
... PATTERNS OF TOBACCO USE BY ADOLESCENTS AND YOUNG ADULTS 45 FIGURE 2-3  Age distribution of cigarette initiation reported by 26- to 34-year-olds, broken down by those who did versus those who did not progress to using 100-plus cigarettes in their lifetimes (62 percent progressed; 38 percent did not) , NSDUH, 2002 through 2012.
From page 46...
... SMOKING INTENSITY The most commonly used metric of smoking intensity is the number of cigarettes smoked per smoking day. Table 2-9 provides the average number of cigarettes smoked per smoking day for those who smoked cigarettes in the past 30 days, by age, based on 2012 NSDUH data.
From page 47...
... The survey question was, "On the days you smoked cigarettes during the past 30 days, how many cigarettes did you smoke per day, on average? " SOURCE: Committee analysis of data from HHS et al., 2014.
From page 48...
... The situation regarding tobacco products other than traditional cigarettes is currently highly volatile, with new products being introduced and existing products being modified. NYTS asks questions about a range of non-cigarette tobacco products, including cigars, smokeless tobacco, tobacco smoked with a hookah, pipes, electronic cigarettes, snus, kreteks, bidis, and dissolvable tobacco.
From page 49...
... According to the 2011 YRBSS, 12.8 percent of adolescent males and 2.2 percent of adolescent females in the United States reported current use of smokeless tobacco (Eaton et al., 2012)
From page 50...
... national study, Monitoring the Future reported that more high school students used e-cigarettes than traditional cigarettes or any other tobacco product. The difference in the use of e-cigarettes versus traditional cigarettes was greater among younger students: 9 percent of 8th grade students reported using an e-cigarette in the past 30 days, as compared with 4 percent for traditional cigarettes; 16 percent of 10th grade students reported using an e-cigarette, as compared with 7 percent for traditional cigarettes; and 17 percent of 12th grade students reported using an e-cigarette, as compared with 15 percent for traditional cigarettes (Wadley and Bronson, 2014)
From page 51...
... The male/ female ratios were particularly high for smokeless tobacco and the newer smokeless snus. The Surgeon General's 2012 report noted that as of 2010, about 1 in 10 high school senior males was a current smokeless tobacco user and about 1 in 5 high school senior males was a current cigar smoker (HHS, 2012)
From page 52...
... The Surgeon General's report of 2012 data concluded that concurrent use of multiple tobacco products (poly-tobacco use; usually using cigarettes and another tobacco product) was prevalent among adolescents.
From page 53...
... In addition, to date there has been no systematic data collected concerning how patterns of tobacco product use may vary by product or by combinations of products, including product switching. The changing landscape of available tobacco products may well affect overall patterns of use.
From page 54...
... also show clear gradients indicating that the earlier the age of starting cigarette smoking, the greater the nicotine dependence; in both studies the strong association between a younger age of initiation and greater nicotine dependence was clearly evident across ages of initiation ranging from adolescence to 25 years of age and older. These findings suggest that there is no apparent threshold beyond which this association does not apply.
From page 55...
... . Age of Initiation and Continued Smoking The evidence reviewed above that a younger age of initiation is associated with greater nicotine dependence and greater smoking intensity supports the suggestion that an earlier age of initiation would be associated with an increased likelihood of remaining a smoker throughout the life span, and the empirical data on this association supports that assumption.
From page 56...
... . A recent Cochrane meta-analysis of tobacco cessation interventions for regular smokers younger than 20 reported mixed findings for interventions, with the more complex counseling approaches showing some promise, but few trials showing pharmacotherapy to be effective in helping adolescent smokers quit (Stanton and Grimshaw, 2013)
From page 57...
... . In sum, adolescents, even those who are light and intermittent adolescent smokers, have difficulty stopping their tobacco use, especially once dependence symptoms have emerged, even if the symptoms have not yet reached the level of fully developed nicotine dependence.
From page 58...
... 2014. Patterns of current use of tobacco products among U.S.
From page 59...
... 2000. Predic tors of cigarette smoking and smoking cessation among adults with asthma.
From page 60...
... 2002. Methodological issues in measuring treatment outcome in adolescent smoking cessation studies.
From page 61...
... . Understanding smokeless tobacco initiation and use among rural youth: An unexplored population.
From page 62...
... 2006. Cigarette smoking from adolescence to young adulthood: Women's developmental trajectories and associates outcomes.


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