Trends in cigarette smoking among high school students--United States, 1991-2001.

Abstract

CIGARETTE SMOKING AMONG ADOLEScents is one of the 10 Leading Health Indicators that reflect the major health concerns in the United States. To examine changes in cigarette smoking among U.S. high school students during 1991-2001, CDC analyzed data from the national Youth Risk Behavior Survey (YRBS). This report summarizes the results of the analysis, which found that although cigarette smoking rates increased during most of the 1990s, they have declined significantly since 1997. If this pattern continues, the United States could achieve the national health objective for 2010 of reducing current smoking rates among high school students to 16% (objective no. 27-2b). YRBS, a component of CDC’s Youth Risk Behavior Surveillance System, measures the prevalence of health risk behaviors among high school students through representative biennial national, state, and local surveys. The 1991, 1993, 1995, 1997, 1999, and 2001 national surveys used independent three-stage cluster samples to obtain cross-sectional data representative of students in grades 9-12 in all 50 states and the District of Columbia. During 1991-2001, sample sizes ranged from 10,904 to 16,296, school response rates ranged from 70% to 79%, student response rates ranged from 83% to 90%, and overall response rates ranged from 60% to 70%. For each cross-sectional survey, students completed an anonymous, selfadministered questionnaire that included identically worded questions about cigarette smoking. For this report, three behaviors were assessed: lifetime smoking (defined as having ever smoked cigarettes, even one or two puffs), current smoking (defined as smoking on 1 of the 30 days preceding the survey), and current frequent smoking (defined as smoking on 20 of the 30 days preceding the survey). Data are presented only for nonHispanic black, non-Hispanic white, and Hispanic students because the numbers of students from other racial/ ethnic populations were too small for meaningful analysis. Current smoking was analyzed among sex, racial/ ethnic, and grade subgroups. Data were weighted to provide national estimates, and SUDAAN was used for all data analysis. Temporal changes were analyzed using logistic regression analyses that assessed linear and quadratic time effects simultaneously and that controlled for sex, race/ ethnicity, and grade. Quadratic trends indicated a significant but nonlinear trend in the data over time. When a significant quadratic trend accompanied a significant linear trend, the data demonstrated some nonlinear variation (e.g., leveling off or change in direction) in addition to a linear trend. Significant linear and quadratic trends were detected for lifetime, current, and current frequent smoking. The prevalence of lifetime smoking, although stable through the 1990s, declined significantly from 70.4% in 1999 to 63.9% in 2001. The prevalence of current smoking increased from 27.5% in 1991 to 36.4% in 1997 and then declined significantly to 28.5% in 2001. Current frequent smoking increased from 12.7% in 1991 to 16.7% in 1997 and 16.8% in 1999 and then declined significantly to 13.8% in 2001. Among female students, a significant quadratic trend was detected, indicating that the prevalence of current smoking peaked during 1997-1999 and then declined significantly by 2001. Similarly, among white female, black male, Hispanic, Hispanic female, Hispanic male, and 9thand 11th-grade students, current smoking prevalence peaked by 1999 and then declined significantly by 2001. A positive linear trend was detected among black female students, indicating that the prevalence of current smoking among this subgroup increased significantly throughout the decade. Among male students, significant linear and quadratic trends were detected, indicating that the prevalence of current smoking increased significantly during 1991-1997 and then declined significantly by 2001. A similar pattern was detected among white, white male, black, and 10thand 12thgrade students; however, among 12thgrade students, the increase lasted until 1999. During 2001, white and Hispanic students were significantly more likely than black students to report current smoking. Current smoking was significantly more likely to be reported by white and Hispanic female students than by black female students, by white and Hispanic male students than by black male students, and by 12thgrade students than by 9thand 10thgrade students.