Tobacco Use Among Middle and High School Students—Florida, 1998 and 1999

Morbidity and Mortality Weekly Report, April 2, 1999

Tobacco use is the single leading preventable cause of death in the United States [1], and an estimated $2 billion is spent annually in Florida to treat disease caused by smoking [2]. Florida appropriated $23 million in fiscal year 1997 and $70 million in fiscal year 1998 to fund the Florida Pilot Program on Tobacco Control to prevent and reduce tobacco use among Florida youth. To determine the prevalence of cigarette, cigar, and smokeless tobacco (i.e., chewing tobacco and snuff) use among Florida middle and high school students in public schools, the Florida Department of Health conducted the Florida Youth Tobacco Survey (FYTS) in February 1998 and February 1999. The purpose of these surveys was to establish baseline parameters and monitor the progress of the pilot program, which began in April 1998. This report summarizes advance data from the surveys, which indicate that, from 1998 to 1999, the percentage of Florida public middle and high school students who smoked cigarettes decreased significantly and that the percentage of middle school students who smoked cigars and used smokeless tobacco products decreased significantly.

The 1998 FYTS used a two-stage cluster sample design within each of seven geographic regions (i.e., selecting schools within a region and classrooms within schools) for public middle schools (grades 6-8) and for public high schools (grades (9-12) to obtain a representative sample of 11,865 middle and 10,675 high school students. The 1999 survey was conducted in 242 of the 255 schools that participated in the 1998 survey sample, among a representative sample of 11,724 middle and 9254 high school students. The middle school response rates for 1998 and 1999 were 97% and 93%, respectively; the student response rates were 82% and 88%, respectively; and the overall response rates were 80% and 82%, respectively. For the high school surveys, school response rates for 1998 and 1999 were 95% and 89%, respectively; the student response rates were 76% and 79%, respectively; and the overall response rates were 72% and 70%, respectively. Data were weighted to provide estimates that can be generalized to all public school students in grades 6-12 in the seven regions and in the state. Survey data were analyzed and point estimates were generated using SAS software, and variance estimates and 95% confidence intervals were calculated using SUDAAN.

Students completed a self-administered questionnaire that included questions about tobacco use (cigarette, cigar, and smokeless tobacco), exposure to environmental tobacco smoke, minors' ability to purchase or otherwise obtain tobacco products, knowledge and attitudes about tobacco, familiarity with pro- and anti-tobacco media messages, and tobacco-use curriculum in schools. Current tobacco use prevalence data are presented in this report; data on other findings and survey methodology are available from the Florida Department of Health [3]. Current cigarette, cigar, and smokeless tobacco users were students who reported product use on [greater than or equal to]1 of the 30 days preceding the survey.

From 1998 to 1999, the prevalence of current cigarette use among middle school students declined from 18.5% to 15.0% (p[less than]0.01) (Table 1); among high school students, use declined from 27.4% to 25.2% (p=0.02) (Table 2). Among middle school students, declines in current cigarette use were significant for both males and females; among high school students, the decline was statistically significant among females. Among both middle and high school students, the declines were most pronounced among non-Hispanic white students: from 22.0% to 16.1% (p[less than]0.O1) among middle school students and from 34.8% to 31.3% (p=0.02) among high school students. The change in prevalence of current cigarette use among non-Hispanic black or Hispanic students at the middle or high school level was not statistically significant. Prevalence of current cigarette use in these groups was lower than that among non-Hispanic whites in both 1998 and 1999.

Current cigar use declined significantly only among middle school students, from 14.1% in 1998 to 11.9% in 1999 (p[less than]0.01). This overall decline was almost entirely accounted for by the decline among males, from 17.6% to 14.2%. Among racial/ethnic groups at the middle school level, the decline in current use of cigars was statistically significant only among non-Hispanic white students.

Current smokeless tobacco use declined among middle school students from 6.9% in 1998 to 4.9% in 1999. The decline occurred among male and female middle school students and among non-Hispanic white and Hispanic middle school students. Students at every grade in middle school were significantly less likely to use smokeless tobacco in 1999 than in 1998. Current use of smokeless tobacco products remained unchanged among high school students from 1998 to 1999.

Reported by: U Bauer, PhD, T Johnson, J Pallentino, JD, R Hopkins, MD, State Epidemiologist. W McDaniel, RG Brooks, MD, Secretary, Florida Dept of Health. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.