National Youth Tobacco Survey Research Articles

Self-reported exposure to tobacco warning labels among U.S. middle and high school students.

Warning labels on tobacco products are a means to communicate information about the negative health effects of tobacco use to current and potential users. Most tobacco use begins in early adolescence, making it particularly important to understand the degree to which warning labels reach adolescents. To examine the extent to which youth report (1) seeing the current warnings on cigarettes and smokeless tobacco (SLT) products in the U.S. and (2) that seeing warnings makes them think about the health risks associated with tobacco use. Exposure to warning labels on cigarettes and SLT, as well as the degree to which adolescents report thinking about health risks in response to warnings, was examined among U.S. middle and high school students using data from the 2012 National Youth Tobacco Survey (NYTS) and analyzed in 2013. Current data suggest that less than half of adolescents who saw a cigarette pack (46.9%) or SLT product (40.3%) reported seeing the warning label "most of the time" or "always." Among adolescents who reported seeing a warning, less than one third reported that cigarette (30.4%) or SLT (25.2%) warning labels made them think about health risks "a lot." These rates were even lower among current tobacco users (<14%). Current warning labels for cigarettes and SLT could be improved by implementing warnings that incorporate features that make them salient and more likely to evoke thoughts about health risks.

Perceptions of the Relative Harm of Cigarettes and E-cigarettes Among U.S. Youth

Despite progress in reducing youth smoking, adolescents remain highly susceptible to tobacco use. Of concern is whether youth perceive electronic cigarettes (e-cigarettes) as a preferable alternative to conventional cigarettes. To describe cigarette harm perception patterns among youth based on the frequency and intensity of cigarette smoking, and examine the relative harm perceptions of conventional versus e-cigarettes, using data from a large, nationally representative sample of U.S. youth. Data from the 2012 National Youth Tobacco Survey (N=24,658) were analyzed in 2013 to identify patterns of cigarette harm perceptions. Multinomial logistic regression was conducted to identify associations between demographic and tobacco use characteristics and cigarette harm perception patterns. Logistic regression was conducted to examine the relationship between cigarette harm perceptions and the perception of e-cigarettes as less harmful than cigarettes for current, ever, and never cigarette smokers. The majority of youth (64.2%) perceived the harmfulness of cigarettes as dose-dependent. Approximately one in three students perceived e-cigarettes as less harmful than conventional cigarettes. Regardless of cigarette smoking status, ever users of e-cigarettes and those with "dose-dependent" cigarette harm perceptions consistently were more likely to perceive e-cigarettes as less harmful than conventional cigarettes. Many youth perceive tobacco use on a continuum of harm. Youth who perceive gradations in harm-both by frequency and intensity of cigarette use and by type of product-may be particularly susceptible to e-cigarette use.

Awareness and use of non-conventional tobacco products among U.S. students, 2012.

Increasing diversity of the tobacco product landscape, including electronic cigarettes (e-cigarettes), hookah, snus, and dissolvable tobacco products (dissolvables), raises concerns about the public health impact of these non-conventional tobacco products among youth. This study assessed awareness, ever use, and current use of non-conventional tobacco products among U.S. students in 2012, overall and by demographic and tobacco use characteristics. Data from the 2012 National Youth Tobacco Survey, a nationally representative survey of U.S. middle and high school students, were analyzed in 2013. Prevalence of awareness, ever use, and current use of e-cigarettes, hookah, snus, and dissolvables were calculated overall and by sex, school level, race/ethnicity, and conventional tobacco product use, including cigarettes, cigars, or smokeless tobacco (chewing tobacco, snuff, or dip). Overall, 50.3% of students were aware of e-cigarettes; prevalence of ever and current use of e-cigarettes was 6.8% and 2.1%, respectively. Awareness of hookah was 41.2% among all students, and that of ever and current use were 8.9% and 3.6%, respectively. Overall awareness; ever; and current use of snus (32%, 5.3%, 1.7%, respectively) and dissolvables (19.3%, 2.0%, 0.7%, respectively) were generally lower than those of e-cigarettes or hookah. Conventional tobacco product users were more likely to be aware of and to use non-conventional tobacco products. Many U.S. students are aware of and use non-conventional tobacco products. Evidence-based interventions should be implemented to prevent and reduce all tobacco use among youth.

Symptoms of tobacco dependence among middle and high school tobacco users: results from the 2012 National Youth Tobacco Survey.

A growing body of evidence suggests that tobacco dependence symptoms can occur soon after smoking onset and with low levels of use. However, limited data are available nationally and among non-cigarette tobacco users. To examine the prevalence and determinants of tobacco dependence symptoms among adolescent tobacco users in the 2012 National Youth Tobacco Survey, a nationally representative, school-based survey of U.S. middle and high school students. Multivariate logistic regression was used to identify independent predictors of dependence symptoms among current users (i.e., past 30-day use) of cigarettes, cigars, or smokeless tobacco. Analyses were conducted in 2013 using SAS-callable SUDAAN, version 11 to account for the complex survey design. Prevalence of tobacco dependence symptoms ranged from 20.8% (95% CI=18.6, 23.1) of current tobacco users reporting wanting to use tobacco within 30 minutes of waking to 41.9% (95% CI=39.3, 44.5) reporting recent strong cravings. Reporting of dependence symptoms was most consistently associated with polytobacco use, higher frequency of use, earlier initiation age, and female gender. A 2-4-fold increase in the odds of symptom reporting was found in adolescents using tobacco products on as few as 3-5 days compared to those who only used it for 1-2 of the past 30 days. A substantial proportion of U.S. adolescent tobacco users, including those with low levels of use, report symptoms of tobacco dependence. These findings demonstrate the need for full implementation of evidence-based strategies to prevent both experimentation and progression to regular tobacco use among youth.

Youth curiosity about cigarettes, smokeless tobacco, and cigars: prevalence and associations with advertising.

Curiosity about cigarettes is a reliable predictor of susceptibility to smoking and established use among youth. Related research has been limited to cigarettes, and lacks national-level estimates. Factors associated with curiosity about tobacco products, such as advertising, have been postulated but rarely tested. To describe the prevalence of curiosity about cigarettes, smokeless tobacco, and cigars among youth and explore the association between curiosity and self-reported tobacco advertising exposure. Data from the 2012 National Youth Tobacco Survey, a nationally representative survey of 24,658 students, were used. In 2013, estimates weighted to the national youth school population were calculated for curiosity about cigarettes, smokeless tobacco, and cigars among never users of any tobacco product. Associations between tobacco advertising and curiosity were explored using multivariable regressions. Curiosity about cigarettes (28.8%); cigars (19.5%); and smokeless tobacco (9.7%) was found, and many youth were curious about more than one product. Exposure to point-of-sale advertising (e.g., OR=1.35, 95% CI=1.19, 1.54 for cigarette curiosity); tobacco company communications (e.g., OR=1.70, 95% CI=1.38, 2.09 for cigarette curiosity); and tobacco products, as well as viewing tobacco use in TV/movies (e.g., OR=1.37, 95% CI=1.20, 1.58 for cigarette curiosity) were associated with curiosity about each examined tobacco product. Despite decreasing use of tobacco products, youth remain curious about them. Curiosity is associated with various forms of tobacco advertising. These findings suggest the importance of measuring curiosity as an early warning signal for potential future tobacco use and evaluating continued efforts to limit exposure to tobacco marketing among youth.

Exposure to tobacco coupons among U.S. middle and high school students.

Tobacco marketing contributes to increased tobacco use susceptibility and sustained use. There are limited data on youth exposure to tobacco coupons, a type of pro-tobacco promotion. To explore channels through which youth report exposure to coupons and characteristics associated with this exposure. This may help inform efforts aimed at decreasing youth exposure to advertising and promotion. Data from the 2012 National Youth Tobacco Survey were analyzed in 2013 to estimate the self-reported prevalence of U.S. middle and high school student exposure to coupons through various channels. Associations among exposure to coupons and demographics, tobacco use, living with a tobacco user, and receptivity to tobacco marketing were examined using multivariate logistic regression models. Approximately 13% of students reported exposure to tobacco coupons in the past 30 days through mail, digital communications, or tobacco packages. Prevalence was greatest among current tobacco users (34.0%) and those receptive to tobacco marketing (23.4%) compared to non-tobacco users (9.3%) and those not receptive to tobacco marketing (8.2%), respectively. Coupon exposure varied by sex, grade, and race/ethnicity. In adjusted models, current tobacco use (AOR=3.4, 95% CI=3.0, 3.9); living with a tobacco user (AOR=2.1, 95% CI=1.9, 2.4); and receptivity to tobacco marketing (AOR=2.3, 95% CI=2.0, 2.7) were independently associated with coupon exposure. Findings from this study indicate that despite restrictions on marketing to youth, youth are still being exposed to tobacco promotions such as coupons. Efforts to limit youth exposure may be valuable in reducing curiosity, susceptibility, and initiation.

Adolescent Electronic and Conventional Cigarette Use

Research Article| July 01 2014 Adolescent Electronic and Conventional Cigarette Use AAP Grand Rounds (2014) 32 (1): 4. https://doi.org/10.1542/gr.32-1-4 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Adolescent Electronic and Conventional Cigarette Use. AAP Grand Rounds July 2014; 32 (1): 4. https://doi.org/10.1542/gr.32-1-4 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cigarette smoking, electronic cigarettes, smoking cessation, cigarettes Source: Dutra LM, Glantz SA. Electronic cigarettes and conventional cigarette use among US adolescents [published online ahead of print March 6, 2014]. JAMA Pediatrics; doi: https://doi.org/10.1001/jamapediatrics.2013.5488 Investigators from the University of California, San Francisco conducted a study to examine the relationship between electronic cigarette (e-cigarette) use and both conventional cigarette use and smoking cessation among US adolescents. The researchers used data from the 2011 and 2012 National Youth Tobacco Survey, a nationally representative, cross-sectional sample of US middle and high school students (grades 6–12) for the study. The self-administered questionnaire included indicators of tobacco use, intention to quit, and smoking cessation. Conventional cigarette users were defined as experimenters (ever tried ≥1 puff), ever smokers (≥100 cigarettes smoked), or current smokers (≥100 cigarettes smoked in last 30 days). Conventional cigarette abstinence was measured at 30 days, 6 months, and 1 year. Participants who responded that they had used “electronic cigarettes or e-cigarettes, such as Ruyan or NJOY” were defined as ever e-cigarette users (ever tried) or current users (used on ≥1 day in the past 30 days). Multivariable logistic regression was used to evaluate the relationship between e-cigarette use and tobacco cigarette use and cessation. The investigators analyzed data from 17,353 respondents in 2011 and 22,539 in 2012. Among cigarette experimenters, ever e-cigarette use was associated with higher odds of being classified as an “ever smoker” (OR = 6.31; 95% CI, 5.39–7.39) and current cigarette smoking (OR = 5.96; 95% CI, 5.67–6.27). Current e-cigarette use was also associated with higher odds of ever having smoked cigarettes (OR = 7.42; 95% CI, 5.63–9.79) and current cigarette smoking (OR = 7.88; 95% CI, 6.01–10.32). For 2011 study participants, current cigarette smokers who had ever used e-cigarettes were more likely to intend to quit smoking within the next year (OR = 1.53; 95% CI, 1.03–2.28). Among cigarette experimenters and ever cigarette smokers, ever e-cigarette use and current e-cigarette use was associated with lower odds of abstinence from cigarettes at 30 days, 6 months, and 1 year. The investigators conclude that e-cigarettes do not discourage use, and may be encouraging use, of conventional cigarettes among US adolescents. They suggest that their results contradict claims that e-cigarettes are effective as smoking cessation aids. Dr Wong has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Adult and youth e-cigarette use has been rapidly rising. In another analysis of the NYTS data, e-cigarette use among youth in grades 6 to 12 doubled, from 3.3% in 2011 to 6.8% in 2012.1 With these increasing rates, the public debate on the impact of e-cigarettes and other electronic nicotine delivery systems on public health has intensified. Other nicotine delivery systems include emerging e-cigarette-like devices marketed under different names, such as “e-hookahs” or “vape pipes,” which may result in considerable underestimates of youth e-cigarette use.2 While e-cigarettes contain fewer toxins and lower levels of these toxins compared to conventional cigarettes, they... You do not currently have access to this content.

Electronic cigarettes and conventional cigarette use among U.S. adolescents: a cross-sectional study.

To examine e-cigarette use and conventional cigarette smoking. Cross-sectional analyses of survey data from a representative sample of US middle and high school students in 2011 (n = 17 353) and 2012 (n = 22 529) who completed the 2011 and 2012 National Youth Tobacco Survey. Ever and current e-cigarette use. Experimentation with, ever, and current smoking, and smoking abstinence. Among cigarette experimenters (1 puff), ever e-cigarette use was associated with higher odds of ever smoking cigarettes (100 cigarettes; odds ratio [OR] = 6.31; 95% CI, 5.39-7.39) and current cigarette smoking (OR = 5.96; 95% CI, 5.67-6.27). Current e-cigarette use was positively associated with ever smoking cigarettes (OR = 7.42; 95% CI, 5.63-9.79) and current cigarette smoking (OR = 7.88; 95% CI, 6.01-10.32). In 2011, current cigarette smokers who had ever used e-cigarettes were more likely to intend to quit smoking within the next year (OR = 1.53; 95% CI, 1.03-2.28). Among experimenters with conventional cigarettes, ever use of e-cigarettes was associated with lower 30-day (OR = 0.24; 95% CI, 0.21-0.28), 6-month (OR = 0.24; 95% CI, 0.21-0.28), and 1-year (OR = 0.25; 95% CI, 0.21-0.30) abstinence from cigarettes. Current e-cigarette use was also associated with lower 30-day (OR = 0.11; 95% CI, 0.08-0.15), 6-month (OR = 0.11; 95% CI, 0.08-0.15), and 1-year (OR = 0.12; 95% CI, 0.07-0.18) abstinence. Among ever smokers of cigarettes (100 cigarettes), ever e-cigarette use was negatively associated with 30-day (OR = 0.61; 95% CI, 0.42-0.89), 6-month (OR = 0.53; 95% CI, 0.33-0.83), and 1-year (OR = 0.32; 95% CI, 0.18-0.56) abstinence from conventional cigarettes. Current e-cigarette use was also negatively associated with 30-day (OR = 0.35; 95% CI, 0.18-0.69), 6-month (OR = 0.30; 95% CI, 0.13-0.68), and 1-year (OR = 0.34; 95% CI, 0.13-0.87) abstinence. Use of e-cigarettes was associated with higher odds of ever or current cigarette smoking, higher odds of established smoking, higher odds of planning to quit smoking among current smokers, and, among experimenters, lower odds of abstinence from conventional cigarettes. Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among U.S. adolescents.

Assessment of secondhand smoke exposure at school among U.S. Middle and high school students.

To obtain nationally representative estimates of the prevalence of secondhand smoke (SHS) exposure at U.S. schools, we assessed the prevalence and correlates of SHS exposure at school among U.S. middle and high school students using data from the 2011 National Youth Tobacco Survey comprising of 18,866 students spread across all the U.S. states. Overall prevalence of SHS exposure at school was 25.7% (95% CI: [23.6%, 27.8%]). Multivariate logistic regression indicated that having ≥1 smoker friends (adjusted Odds Ratio [aOR] = 2.92; p < .001); being a smoker (aOR = 2.75; p < .001); and being aged 13-16 years, or ≥17 years (vs. 9-12 years) significantly increased the likelihood of SHS exposure. Understanding the health risks of SHS exposure alone did not seem to play a significant role in reducing exposure (aOR = .89; p = .342). These findings show there are significant levels of SHS exposure among students at U.S. middle and high schools, and sustained multipronged efforts are needed to reduce youth SHS exposure.

Quantifying the Effect of Changes in State-Level Adult Smoking Rates on Youth Smoking

Quantify the degree to which changes in state-level adult smoking prevalence subsequently influence youth smoking prevalence. Analysis of data from the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) collected from 1995 to 2006 and the National Youth Tobacco Survey (NYTS) collected from 1999 to 2006. Adults 25 years or older who completed the TUS-CPS and youth in middle and high school who completed the NYTS. Current smoking among middle and high school students as a function of the change in state-level adult smoking, controlling for individual-level sociodemographic characteristics and state-level tobacco control policy variables. Among middle school students, declines in state-level adult smoking rates are associated with lower odds of current smoking (P < .05), and each doubling of the decline in adult smoking rates is associated with a 6.0% decrease in youth smoking. Among high school students, declines in state-level adult smoking rates are not associated with current smoking. Higher cigarette prices were associated with lower odds of smoking among middle and high school students. Greater population coverage by smoke-free air laws and greater funding for tobacco control programs were associated with lower odds of current smoking among high school students but not middle school students. Compliance with youth access laws was not associated with middle or high school smoking. By quantifying the effect of changes in state-level adult smoking rates on youth smoking, this study enhances the precision with which the tobacco control community can assess the return on investment for adult-focused tobacco control programs.

Fatal Intravenous Injection of Electronic Nicotine Delivery System Refilling Solution

The popularity of electronic cigarettes or electronic nicotine delivery systems (ENDS) is increasing. Data from the 2012 National Youth Tobacco Survey demonstrates a nearly 50 % increase in ENDS usage over the last year among middle and high school students [1]. Similar increases in usage have been seen in adults [2]. ENDS are devices which vaporize a nicotine-containing solution so it can be inhaled [3]. In many cases, these devices can be refilled with nicotine-containing solutions called “eLiquid” [3, 4]. Some of these solutions contain potentially fatal amounts of nicotine [5]. Users of ENDS have reported negative symptoms involving multiple organ systems [6]. Serious morbidity or mortality related to these devices has not yet been reported. We report a fatality associated with the intentional injection of eLiquid.

Trends in age verification among U.S. adolescents attempting to buy cigarettes at retail stores, 2000–2009

ObjectiveThis study assessed trends in age verification prior to cigarette sales to U.S. middle and high school students, and refusal to sell cigarettes to students aged <18years during 2000–2009. MethodData were obtained from the 2000–2009 National Youth Tobacco Survey. Trends during 2000–2009 were assessed using binary logistic regression (p<0.05). ResultThe proportion of all students, who reported being asked to show proof of age prior to a cigarette purchase in the past 30days did not change significantly between 2000 (46.9%) and 2009 (44.9%) (p=0.529 for linear trend). No significant trend in the proportion of students aged <18years who were refused a sale when attempting to buy cigarettes was observed between 2000 (39.8%) and 2009 (36.7%) (p=0.283 for linear trend). Refusal of a cigarette sale was significantly higher among under-aged boys compared to girls (adjusted odds ratio=1.48; 95% confidence interval: 1.28–1.70). ConclusionAbout half of U.S. middle and high school students who reported making a cigarette purchase were not asked for proof of age, and about three of five under-aged buyers successfully made a cigarette purchase in 2009. Intensified implementation and enforcement of policies requiring age verification among youths is warranted to reduce access and use of tobacco products.

Gender differences in the prevalence and determinants of tobacco use among school-aged adolescents (11-17 years) in Sudan and South Sudan.

IntroductionTobacco use is one of the leading and preventable causes of global morbidities and premature mortalities. The study explores gender differences in the prevalence and determinants of tobacco use among school-aged adolescents (11-17years) in Sudan and South Sudan.MethodsThe study utilized the national Global Youth Tobacco Survey (GYTS) data collected in 2005 for Sudan (4,277 unweighted; 131,631 weighted). Univariate and bivariate analyses were conducted to examine the associations between the dependent (tobacco use status) and independent variables. Logistic regression analyses were performed to identify the key factors which influence tobacco consumption among adolescents in the 2 Sudans for ever cigarette users, current cigarette users, and users of noncigarette tobacco products.ResultsThere were significant gender differences in the prevalence of ever cigarette users (21.8%; male=13.1%, female=6.5%, p<0.05) and current cigarette users (6.9%; male=4.9%, female = 1.3%, p<0.05) but not among users of noncigarette tobacco products (14.7%; male=6.8%, female=6.1%). Adolescent tobacco use was significantly associated with availability of monthly income or allowance, exposure to tobacco industry promotions, and tobacco-use behavior of familial relations. Knowledge about the harmful effects of secondhand smoke was related with decreased likelihood of tobacco use.ConclusionSchool programs that focus on health messages alone may not work for the adolescent population. Legislations that ban all types of tobacco advertisements, promotions, and sponsorships among adolescents are needed in the 2 countries.

Secondhand Smoke Exposure in Cars and Rooms: Trend Comparisons Among Subpopulations of Nonsmoking U.S. Middle and High School Students

Young people in the United States are exposed to secondhand smoke (SHS) primarily in 2 settings: homes and cars. Recently, researchers reported that the prevalence of U.S students exposed to SHS in cars decreased from 2000 to 2009; however, comparisons of trends across school levels, gender, and racial/ethnic groups were not assessed. Moreover, no studies have examined trends of exposure to SHS in rooms. We used data from the 2000, 2002, 2004, 2006, and 2009 waves of the National Youth Tobacco Survey, a nationally representative cross-sectional survey of U.S. middle and high school students. For SHS in cars and rooms, we identified exposure trends among nonsmokers from 2000 to 2009 and compared trends across subpopulations with binary logistic regression. We identified significant downward linear trends in SHS in cars and rooms for nearly all measured subpopulations of nonsmoking students from 2000 to 2009. SHS exposure in cars and rooms declined at a significantly greater rate for males than for females. SHS exposure in cars declined at a significantly greater rate for non-Hispanic (NH) Blacks than for NH Whites. SHS exposure in rooms declined at a significantly greater rate for NH Whites than for Hispanics and Native Hawaiians/Pacific Islanders. Although prevalence of exposure to SHS in cars and rooms among nonsmoking U.S. middle and high school students has declined from 2000 to 2009, the rates of decline were not equal across genders and racial/ethnic groups. Identification of these differing rates of exposure can help the public health community advocate for interventions focused on reducing adolescent SHS exposure.

Disparities and Trends in Indoor Exposure to Secondhand Smoke among U.S. Adolescents: 2000-2009

IntroductionSecondhand smoke (SHS) exposure causes disease and death among nonsmokers. With a plethora of smoke-free legislation implemented and a steady decrease in cigarette consumption noted over the past decade in the U.S., this study assessed trends in indoor SHS exposure among U.S. adolescents in grades 6–12 during 2000–2009.MethodsData were obtained from the 2000–2009 National Youth Tobacco Survey – a national survey of U.S. middle and high school students. SHS exposure within an indoor area within the past seven days was self-reported. Trends in indoor SHS exposure during 2000–2009 were assessed overall and by socio-demographic characteristics, using the Wald's test in a binary logistic regression. Within-group comparisons were performed using chi-squared statistics (p<0.05).ResultsThe proportion of U.S. middle and high school students who were exposed to indoor SHS declined from 65.5% in 2000 to 40.5% in 2009 (p<0.05 for linear trend). Significant declines were also observed across all population subgroups. Between 2000 and 2009, prevalence of indoor SHS exposure declined significantly among both middle (58.5% to 34.3%) and high school (71.5% to 45.4%) students. Prevalence of indoor SHS exposure was significantly higher among girls (44.0% in 2009) compared to boys (37.2% in 2009) during each survey year. Similarly, prevalence of indoor SHS exposure during 2000–2009 was highest among non-Hispanic whites (44.2% in 2009) and lowest among non-Hispanic Asians (30.2% in 2009). During each survey year, prevalence was highest among the oldest age group (≥18 years) and lowest among the youngest (9–11 years). Also, prevalence was significantly higher among current cigarette smokers (83.8% in 2009) compared to nonsmokers (34.0% in 2009).ConclusionSignificant declines in indoor SHS exposure among U.S. middle and high school students occurred during 2000–2009. While the results are encouraging, additional efforts are needed to further reduce youth indoor SHS exposure.

The Effect of Exposure to Pro-Tobacco Advertising on Experimentation With Emerging Tobacco Products Among U.S. Adolescents

This study assessed the influence of exposure to pro-tobacco advertisements on experimentation with emerging tobacco products among U.S. adolescents aged ≥9 years, in Grades 6 to 12. Data were obtained from the 2011 National Youth Tobacco Survey. Multivariate logistic regression was used to measure the association between experimentation with snus and e-cigarettes and exposure to pro-tobacco advertisements from three sources: over the Internet, in newspapers/magazines, and at retail stores. After controlling for sociodemographic characteristics and current use of other tobacco products, the odds of experimenting with snus were 1.36 (95% confidence interval [CI] = 0.88-3.16), 2.03 (95% CI = 1.30-3.17), and 3.24 (95% CI = 2.07-5.07), among students exposed to one, two, or all three types of pro-tobacco advertisements, respectively, compared with those exposed to none. Similar results were obtained for e-cigarettes. Stronger restrictions on tobacco advertisements, in concert with increased tobacco taxes and warning about the dangers of tobacco, use may help reduce youth tobacco use.

Trends in exposure to pro-tobacco advertisements over the Internet, in newspapers/magazines, and at retail stores among U.S. middle and high school students, 2000–2012

BackgroundMost tobacco use begins during youth. Thus, this study assessed the prevalence, trends, and correlates of pro-tobacco advertising among United States students in grades 6–12 during 2000–2012. MethodsData from the 2000–2012 National Youth Tobacco Survey were analyzed to assess self-reported exposure to pro-tobacco advertisements through three media: over the Internet, in newspapers/magazines, and at retail stores. Trends during 2000–2012 were assessed in a binary logistic regression model (P<0.05). ResultsAmong all middle and high school students, the overall prevalence of exposure to Internet pro-tobacco advertisements increased from 22.3% to 43.0% during 2000–2012 (P<0.001 for linear trend). During the same period, declines were observed in the overall prevalence of exposure to pro-tobacco advertisements in newspapers/magazines (65.0% to 36.9%) and at retail stores (87.8% to 76.2%) (P<0.001 for all linear trends). ConclusionExposure to pro-tobacco advertisements over the Internet increased significantly during 2000–2012 among United States middle and high school students, while a decline in exposure to advertisements in newspapers or magazines, and at retail stores occurred during the same period. However, over two-thirds of students still reported retail store exposure to pro-tobacco advertisements in 2012. Enhanced and sustained efforts would be beneficial to reduce even more exposure to all forms of pro-tobacco advertisements among youths.

Hazards of New Media: Youth's Exposure to Tobacco Ads/Promotions

A gap in knowledge exists about the youth's exposure to protobacco campaigns via new electronic media outlets. In response, we use national data to delineate the associations between tobacco ads/promotions delivered through new media outlets (i.e., social network sites and text messages) and youth attitudes/beliefs about tobacco and intent to use (among youth who had not yet used tobacco). Data were derived from the 2011 National Youth Tobacco Survey, a nationally representative sample of U.S. youth enrolled in both public and private schools (N = 15,673). Logistic regression models were used to examine associations between demographic characteristics and reported exposure to tobacco ads/promotions via social networking sites and text messages. Logistic regression models were also used to investigate associations between exposure tobacco ads/promotions and attitudes toward tobacco. We found that highly susceptible youth (i.e., minorities, very young youth, and youth who have not yet used tobacco) have observed tobacco ads/promotions on social networking sites and text messages. These youth are more likely to have favorable attitudes toward tobacco, including the intention to use tobacco among those who had not yet used tobacco. Our findings underscore the need for policy strategies to more effectively monitor and regulate tobacco advertising via new media outlets.

E-Cigarette Use by Children Increasing

“One in 10 high school students said they had tried an ecigarette last year, up from one in 20 in 2011.” THE SHARE OFMIDDLE and high school students who have tried electronic cigarettes (e-cigarettes) more than doubled in a year according to a recent federal report. The percentage of students in grades 6 through 12 who had ever used e-cigarettes increased from 3.3 percent in 2011 to 6.8 percent in 2012, according to the Centers for Disease Control and Prevention (CDC) report (Corey et al., 2013). Those who reported currently using the devices increased from 1.1 percent to 2.1 percent. Based on these numbers, the CDC estimates that 1.78 million middle and high school students have tried e-cigarettes. One in 10 high school students said that they had tried an e-cigarette last year, up from one in 20 in 2011. Among high school students, 7 percent who had tried an e-cigarette said that they had never smoked a traditional cigarette. This is a serious concern because the overall impact of ecigarette use on public health remains uncertain. The CDC report noted concerns including the potential negative impact of nicotine on adolescent brain development, as well as the risk for nicotine addiction and initiation of the use of conventional cigarettes or other tobacco products. The new data come from the National Youth Tobacco Survey, which surveyed youths in grades 6 through 12 across the country about their use of cigarettes, both electronic and tobacco-filled. The sharp rise among students mirrors that among adult users, and researchers said that it appears to be driven, at least in part, by aggressive national marketing campaigns, some of which feature famous actors. The producers say the ads are not aimed at adolescents. E-cigarettes are battery-powered devices that provide doses of nicotine and other additives to the user in an aerosol. They do not burn tobacco; instead the battery-powered

Hookah Use Among Adolescents in the United States: Results of a National Survey

U.S. adolescents increasingly use alternative tobacco products (ATPs), including hookah. No study has previously assessed correlates of adolescent hookah use in a nationally representative sample. Cross-sectional, nationally representative data of adolescents from the 2011 National Youth Tobacco Survey (NYTS) were used. Student demographics and their use of, exposure to, and beliefs about tobacco were examined as correlates of hookah use. Of adolescents nationwide, 7.3% reported ever trying hookah and 2.6% reported using hookah within the past month. Increasing age was associated with trying hookah, but not current hookah use. Sex was unassociated with hookah use. Asians were most likely to have tried hookah; Hispanics and those of another race reported greater current hookah use. Hookah use increased with perceived ease of access to and willingness to try tobacco. Students with a hookah user at home were more likely to have tried hookah and to currently use hookah. Current cigarette use was not associated with current hookah use (odds ratio [OR] = 1.3, 95% CI = 0.8-2.1), but was associated with trying hookah (OR = 1.5, 95% CI = 1.1-2.2). Non-cigarette tobacco use was associated with trying hookah (OR = 2.7, 95% CI = 2.1-3.5) and current hookah use (OR = 4.8, 95% CI = 2.7-8.7). A sizeable minority of U.S. adolescents use hookah, particularly those living with hookah users, those who use other ATPs, and those who perceive tobacco as easily accessible. Current cigarette use was not associated with current hookah use. Future studies assessing the dangers of hookah use and interventions to curb this emerging problem appear warranted.