Cigarette smoking declines slowly among high school students: CDC survey

The following is a statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids:

The latest survey of high school smoking rates, released today by the U.S. Centers for Disease Control and Prevention (CDC), shows that the nation continues to make gradual progress in reducing youth smoking, but declines have slowed significantly since 2003 and nearly one in five high school students still smoke.

This survey is consistent with others that have found a slowing and even stalling of smoking declines among both youth and adults.  These results send a powerful message to elected officials at all levels: We know how to win the fight against tobacco – the nation's number one cause of preventable death – but our ultimate success depends on resisting complacency and more aggressively implementing proven strategies.  These include well-funded tobacco prevention and cessation programs, higher tobacco taxes, smoke-free air laws, and effective regulation of tobacco products and marketing.

The good news in the CDC's 2009 Youth Risk Behavior Survey is that the high school smoking rate (the percentage who smoked in the past month) declined to 19.5 percent in 2009.   This is the first time it has fallen below 20 percent and the lowest rate since this survey was started in 1991.  Altogether, high school smoking has declined by 46 percent since peaking at 36.4 percent in 1997.  This is a remarkable public health success story.  In addition, the percentage of high school students who have ever tried cigarettes has fallen under 50 percent for the first time (to 46.3 percent in 2009 from a high of 71.3 percent in 1995).

The bad news is that high school smoking declined by just 11 percent between 2003 and 2009 (from 21.9 to 19.5 percent), compared to a 40 percent decline between 1997 and 2003 (from 36.4 to 21.9 percent).

It is important to note that this survey was conducted primarily in January-March 2009, before the federal cigarette tax was increased by 61 cents a pack on April 1, 20009, and before the June 22, 2009, enactment of the new federal law granting the U.S. Food and Drug Administration authority over tobacco products.  Tobacco companies have reported large declines in cigarette sales since the cigarette tax increase, and the FDA last month implemented new restrictions on tobacco marketing and sales to children.  Future surveys will indicate the impact of these measures on smoking rates.

While today's CDC report focused on cigarette smoking, the same survey also found a troubling increase in smokeless tobacco use in recent years.  Between 2003 and 2009, there was a 33 percent increase in smokeless tobacco use among high school students (from 6.7 to 8.9 percent reporting smokeless tobacco use in the past month).  Among high school boys, there was a 36 percent increase (from 11 to 15 percent).  This increase, which has also been found in other surveys, coincides with a large increase in smokeless tobacco marketing and the introduction of numerous new smokeless tobacco products, several shaped, flavored and packaged like candy.  These findings underscore the need to enact measures that discourage all tobacco use, not just cigarette smoking.

Why have smoking declines slowed in recent years? The CDC and other experts have cited several factors, including continued heavy spending on tobacco marketing, deep discounting by the tobacco companies that have kept cigarette prices flat despite tax increases, and cuts to tobacco prevention and cessation programs.

It's really very simple. When tobacco prices and funding for tobacco prevention and cessation programs go up, smoking rates go down.  When prices stay flat and prevention programs are cut, smoking rates go up.  Between 1997 and 2003, the average retail price of a pack of cigarettes (adjusted for inflation) increased by 66 percent, while high school smoking declined by 40 percent.  Between 2003 and 2008, the average retail price of cigarettes stayed flat despite state tobacco tax increases, while high school smoking declined by just 11 percent (in 2009, cigarette prices rose by 23 percent in large part because of federal and state tax increases, but these increases occurred largely after this CDC survey was conducted).  In addition, states have repeatedly cut funding for tobacco prevention and cessation programs in recent years.

The challenge for elected leaders today is to finally fight tobacco use with the political will and resources that match the scope of the problem.  All levels of government must do more:

• At the federal level, the FDA must effectively exercise its new authority to regulate the manufacturing, marketing and sale of tobacco products. In addition, the Obama Administration and Congress must implement a national tobacco prevention and cessation campaign.  The Prevention and Public Health Fund created as part of the health care reform law provides one opportunity to do so.
• The states must use more of the billions of dollars they collect from the 1998 tobacco settlement and tobacco taxes to fund tobacco prevention and cessation programs.  In addition, they must continue to increase tobacco taxes, as six states have done this year, and enact comprehensive smoke-free laws that apply to all workplaces and public places.

Tobacco use kills more than 400,000 Americans and costs $96 billion in health care bills each year.  We know how to win the fight against this killer.  What's needed is the political will to do so.