Tobacco Use Among Middle and High School Students — United States, 1999

Morbidity and Mortality Weekly Report, Jan 28, 2000

The prevalence of cigarette smoking nationwide among high school students increased during the 1990s [1]; more than 80% of current adult tobacco users started smoking cigarettes before age 18 years [2]. To determine the prevalence of cigarette, smokeless tobacco (i.e., chewing tobacco and snuff), cigar, pipe, bidi, and kretek use among middle school and high school students nationwide, the American Legacy Foundation, in collaboration with the CDC Foundation, conducted the National Youth Tobacco Survey (NYTS) during the fall of 1999. This report summarizes data from the NYTS on current use of tobacco products, which indicate that 12.8% of middle school students and 34.8% of high school students use any type of tobacco; that the low prevalence of current cigarette smoking observed among black high school students throughout the 1990s is not found among middle school students [1]; and that the percentages of high school students who currently use bidis and kreteks (two new forms of tobacco in the United States) are almost as high as the proportion who use smokeless tobacco.

The school-based 1999 NYTS employed a three-stage cluster sample designed to produce a nationally representative sample of students in grades 6-12. The first-stage sampling frame contained 1306 primary sampling units (PSUs), each comprising a large county or a group of smaller adjacent counties. From the 1306 PSUs, 66 were selected from 16 strata formed on the basis of the degree of urbanization and the relative percentage of black and Hispanic students in the PSU. PSUs were selected with probability proportional to weighted school enrollment. At the second sampling stage, 145 schools from the 66 PSUs were selected with probability proportional to weighted school enrollment. To ensure separate analysis of black and Hispanic students, schools with substantial numbers of black and Hispanic students were sampled at higher rates than all other schools through a weighted measure of size. The third stage of sampling consisted of randomly selecting approximately five intact classes of a required subject (e.g., Engl ish or social studies) across grades 6-12 from each participating school. All students in the selected classes were eligible to participate. A weighting factor was applied to each student record to adjust for nonresponse and for the varying probabilities of selection, including those resulting from the oversampling of black and Hispanic students. Numbers of students in racial/ethnic groups other than black, white, and Hispanic were too small for meaningful analysis. The weights were scaled so that the weighted count of students equaled the total sample size and the weighted proportions of students in each grade matched national population proportions. For the 1999 NYTS, 15,058 students in 131 schools completed questionnaires. The school response rate was 90%, and the student response rate was 93%, resulting in an overall response rate of 84%.

For the NYTS, students completed an anonymous, self-administered questionnaire that included questions about tobacco use, exposure to environmental tobacco smoke, minors' ability to purchase or otherwise obtain tobacco products, knowledge and attitudes about tobacco, and familiarity with pro- and anti-tobacco media messages. SUDAAN was used to compute 95% confidence intervals, which were used to determine differences between subgroups at the p[less than]0.05 level. Differences between prevalence estimates were considered statistically significant if the 95% confidence intervals did not overlap. Current use of bidis, cigarettes, cigars, kreteks, pipes, and smokeless tobacco was defined as use on one or more of the 30 days preceding the survey. Any current tobacco use was defined as using any of these products on one or more of the 30 days preceding the survey.

Middle School Students

Among middle school (grades 6-8) students, the overall prevalence of any current tobacco use was 12.8% (Table 1). Cigarettes (9.2%) were the most prevalent type of tobacco used, followed by cigars (6.1%). Cigarette smoking rates were similar among boys and girls and among racial/ethnic groups. Boys were significantly more likely than girls to use smokeless tobacco (4.2% and 1.3%, respectively), smoke cigars (7.8% and 4.4%, respectively), and smoke tobacco in a pipe (3.5% and 1.4%, respectively). Black students were significantly more likely than white students to smoke cigars (8.8% and 4.9%, respectively).

High School Students

Among high school (grades 9-12) students, the overall prevalence of any current tobacco use was 34.8%. Cigarettes (28.4%) were the most prevalent type of tobacco used, followed by cigars (15.3%). Boys were significantly more likely than girls to use smokeless tobacco (11.6% and 1.5%, respectively), smoke cigars (20.3% and 10.2%, respectively), smoke tobacco in a pipe (4.2% and 1.4%, respectively), and smoke bidis (6.1% and 3.8%, respectively). White and Hispanic students were significantly more likely than black students to smoke cigarettes (32.8%, 25.8%, and 15.8%, respectively). White students were significantly more likely than black and Hispanic students to use smokeless tobacco (8.7%, 2.4%, and 3.6%, respectively).