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November 15, 2012

State Estimates of Adolescent Cigarette Use and Perceptions of Risk from Smoking: 2009 and 2010

In Brief
  • Based on combined 2009 and 2010 data, the rate of past month cigarette use among adolescents aged 12 to 17 was 8.7 percent nationally, and State rates ranged from 5.9 percent in Utah to 13.5 percent in Wyoming
  • Rates of adolescent perceptions of great risk from smoking one or more packs of cigarettes per day ranged from 58.7 percent in Oklahoma to 72.6 percent in Utah
  • Compared with combined 2002 and 2003 data, the 2009 and 2010 data show that 41 States experienced a statistically significant decrease in the rate of adolescent past month cigarette use, and there were no States with a statistically significant increase in adolescent smoking

Cigarette smoking causes more than 400,000 deaths every year and imposes substantial health and financial costs on our Nation and States.1 Preventing adolescents from starting to smoke may be the most effective way to reduce the health and economic burden of tobacco-related disease in the future. In recent years, significant progress has been made in reducing adolescent smoking,2 but there is still much work left to be done.

States have been at the center of efforts to reduce adolescent smoking through cigarette taxation, enactment of laws that restrict smoking in public places, enforcement of laws that prohibit the sale and distribution of tobacco products to adolescents, and funding of smoking prevention and cessation programs. As longitudinal research has shown, adolescents' attitudes about the risks associated with cigarette smoking are often closely related to their use, with an inverse association between use and risk perceptions (i.e., the prevalence of use is lower among those who perceive high risk of harm from cigarette use).3 This corresponds to States with high prevalence of adolescent cigarette use typically having a low prevalence of adolescent perception that there is a great health risk from smoking. Therefore, many State and national prevention programs focus on teaching youths about the harm that smoking may do to their health and social life. State-level information about cigarette use and attitudes about smoking can provide States with vital data to monitor changes over time and to inform enforcement, educational, and prevention efforts.

This issue of The NSDUH Report uses data from the combined 2009 and 2010 (hereafter "2009-2010") National Surveys on Drug Use and Health (NSDUHs) to present State (including the District of Columbia) estimates of past month cigarette use and perceptions of great risk from smoking one or more packs of cigarettes per day among persons aged 12 to 17.4,5 These estimates are rank ordered from highest to lowest and divided into quintiles (fifths).6 Additionally, the combined 2009-2010 data are compared with combined 2002 and 2003 (hereafter "2002-2003") data to examine changes in these measures over time.


State Estimates of Adolescent Past Month Cigarette Use

The 2009-2010 data indicate that about 1 in 11 (8.7 percent) adolescents smoked cigarettes in the past month. Rates of adolescent past month cigarette use ranged from 5.9 percent in Utah to 13.5 percent in Wyoming (Figure 1).

Figure 1. Past Month Cigarette Use among Persons Aged 12 to 17, by State: 2009-2010
This is a map comparing past month cigarette use among persons aged 12 to 17, by state: 2009-2010. Accessible table located below this figure.

Figure 1 Table. Past Month Cigarette Use among Persons Aged 12 to 17, by State: 2009-2010
State Percentage of Youths
Wyoming 13.47%
Montana 13.47%
West Virginia 11.85%
Ohio 11.22%
Kentucky 11.01%
New Hampshire 10.66%
Kansas 10.64%
Arkansas 10.30%
South Dakota 10.29%
Pennsylvania 10.28%
North Dakota 10.27%
Mississippi 10.22%
New Mexico 10.17%
Arizona 9.92%
Oregon 9.53%
Michigan 9.49%
Maine 9.47%
Wisconsin 9.43%
Indiana 9.41%
Vermont 9.34%
Delaware 9.31%
Georgia 9.25%
Tennessee 9.25%
Nebraska 9.13%
South Carolina 9.02%
Alabama 9.01%
Minnesota 8.89%
Idaho 8.85%
Colorado 8.77%
Connecticut 8.76%
Louisiana 8.69%
Illinois 8.67%
Virginia 8.60%
Rhode Island 8.46%
North Carolina 8.22%
Alaska 8.20%
Texas 8.00%
Florida 7.95%
Washington 7.95%
Massachusetts 7.88%
New York 7.79%
New Jersey 7.66%
Maryland 7.43%
Nevada 7.39%
Hawaii 7.16%
California 6.83%
District of Columbia 6.53%
Utah 5.86%
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2009 and 2010 (revised March 2012).

Of the 10 States with the highest rates of past month cigarette use among adolescents, 4 were in the Midwest (Iowa, Kansas, Missouri, and Ohio), 3 were in the South (Kentucky, Oklahoma, and West Virginia), 2 were in the West (Montana and Wyoming), and 1 was in the Northeast (New Hampshire).7 Of the States with the lowest rates of past month cigarette use among adolescents, 5 were in the West (California, Hawaii, Nevada, Utah, and Washington), 3 were in the Northeast (Massachusetts, New Jersey, and New York), and 3 were in the South (District of Columbia, Florida, and Maryland).



State Estimates of the Adolescent Perception of Great Risk from Cigarette Use

The 2009-2010 data indicate that, nationwide, about two in three adolescents (65.4 percent) perceived great risk from smoking one or more packs of cigarettes per day. Among adolescents, perception of great risk from smoking one or more packs of cigarettes per day among this group ranged from 58.7 percent in Oklahoma to 72.6 percent in Utah (Figure 2).

Figure 2. Perceptions of Great Risk from Smoking One or More Packs of Cigarettes Per Day among Persons Aged 12 to 17, by State: 2009-2010
This is a map comparing perceptions of great risk from smoking one or more packs of cigarettes per day among persons aged 12 to 17, by state: 2009-2010. Accessible table located below this figure.

Figure 2 Table. Perceptions of Great Risk from Smoking One or More Packs of Cigarettes Per Day among Persons Aged 12 to 17, by State: 2009-2010
State Percentage of Youths
Utah 72.63%
New York 71.09%
Massachusetts 70.34%
Connecticut 68.65%
Wisconsin 67.47%
Minnesota 67.41%
Maine 67.35%
New Jersey 67.23%
Hawaii 67.01%
Wyoming 66.90%
Delaware 66.85%
North Carolina 66.79%
Alaska 66.75%
Colorado 66.71%
California 66.60%
Florida 66.55%
Virginia 66.41%
Washington 66.20%
Maryland 65.98%
Nevada 65.85%
North Dakota 65.63%
Vermont 65.59%
Rhode Island 65.34%
District of Columbia 65.22%
Oregon 65.20%
Illinois 65.15%
Louisiana 65.08%
Arizona 65.07%
New Hampshire 64.70%
Indiana 64.61%
Idaho 64.43%
South Dakota 64.35%
Montana 64.27%
Georgia 64.22%
Ohio 64.16%
Michigan 64.08%
Texas 63.54%
New Mexico 63.49%
Pennsylvania 63.44%
Kentucky 63.41%
Arkansas 63.20%
Nebraska 62.38%
South Carolina 62.06%
Missouri 61.97%
Iowa 61.65%
West Virginia 61.44%
Tennessee 61.01%
Mississippi 60.99%
Alabama 60.26%
Kansas 58.79%
Oklahoma 58.74%
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2009 and 2010 (revised March 2012).

Of the 10 States with the highest rates of adolescent's perception of great risk from smoking one or more packs a day, 5 were in the Northeast (Connecticut, Maine, Massachusetts, New Jersey, and New York), 3 were in the West (Hawaii, Utah, and Wyoming), and 2 were in the Midwest (Minnesota and Wisconsin). Of the States with the lowest rates of perception of great risk from smoking one or more packs of cigarettes per day, 6 were in the South (Alabama, Mississippi, Oklahoma, South Carolina, Tennessee, and West Virginia) and 4 were in the Midwest (Iowa, Kansas, Missouri, and Nebraska).



Changes over Time

When 2002-2003 data are compared with 2009-2010, the Nation as a whole experienced a statistically significant reduction in the rate of past month cigarette use among adolescents (from 12.6 to 8.7 percent). On an individual State level, 41 States experienced a statistically significant decrease in the rate of adolescent past month cigarette use, and 10 experienced no change.

Comparisons of the 2002-2003 data to the 2009-2010 data indicate that there was an increase at the national level in the adolescent rate of perception of great risk from smoking one or more packs of cigarettes per day (from 63.7 to 65.4 percent). On an individual State level, 5 States experienced a statistically significant increase in the adolescent rate of perception of great risk from smoking, and 46 experienced no change.

Taken together, 5 States had a statistically significant decrease in past month adolescent cigarette use and an increase in the adolescent rate of perception of great risk from smoking (Figure 3; Table 1); these States are Florida, Louisiana, New Hampshire, New York, and North Carolina.8 For 36 States, there was a statistically significant decrease in the rate of adolescent past month cigarette use but no change in the adolescent rate of perception of great risk from smoking. For 10 States, there was no statistically significant change for either measure.


Figure 3. States with Significant Change in Past Month Cigarette Use and Perceptions of Great Risk from Smoking One or More Packs of Cigarettes Per Day among Persons Aged 12 to 17: 2002-2003 to 2009-2010
This is a map comparing states with significant change in past month cigarette use and perceptions of great risk from smoking one or more packs of cigarettes per day among persons aged 12 to 17: 2002-2003 to 2009-2010. Accessible table located below this figure.

Figure 3 Table. States with Significant Change in Past Month Cigarette Use and Perceptions of Great Risk from Smoking One or More Packs of Cigarettes Per Day among Persons Aged 12 to 17: 2002-2003 to 2009-2010
Significant Decrease
in Use and Increase
in Perception of Great Risk
Significant Decrease
in Use and No Change
in Perception of Great Risk
No Significant Change
in Either Use
or Perception of Great Risk
Florida
Louisiana
New Hampshire
New York
North Carolina
Alabama
Alaska
Arkansas
Colorado
Connecticut
Delaware
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Maryland
Massachusetts
Michigan
Minnesota
Missouri
Montana
Nebraska
Nevada
New Jersey
North Dakota
Ohio
Oklahoma
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Vermont
Virginia
Washington
West Virginia
Wisconsin
Arizona
California
Hawaii
District of Columbia
Maine
Mississippi
New Mexico
Oregon
Utah
Wyoming
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2002, 2003, 2009, and 2010 (revised March 2012).

Table 1. Percentages of Past Month Cigarette Use and Perceptions of Great Risk from Smoking One or More Packs of Cigarettes Per Day among Persons Aged 12 to 17, by State: 2002-2003 and 2009-2010
State Past Month Cigarette Use Perception of Great Risk from Smoking One or
More Packs of Cigarettes per Day
2002-2003 2009-2010 2002-2003 2009-2010
Total United States 12.57%   8.69%** 63.67%    65.41%**
Alabama 13.69%   9.01%** 62.18% 60.26%
Alaska 13.25%   8.20%** 66.56% 66.75%
Arizona 12.84% 9.92%* 64.39% 65.07%
Arkansas 16.05% 10.30%** 61.55% 63.20%
California   7.48% 6.83%  67.07% 66.60%
Colorado 13.74%   8.77%** 63.77% 66.71%
Connecticut 13.45%   8.76%** 64.74% 68.65%
Delaware 14.07%   9.31%** 63.20% 66.85%
District of Columbia   7.10% 6.53%  61.87% 65.22%
Florida 12.26%   7.95%** 63.06%    66.55%**
Georgia 12.83%   9.25%** 64.49% 64.22%
Hawaii   8.78% 7.16%  65.39% 67.01%
Idaho 12.48%   8.85%** 65.57% 64.43%
Illinois 13.00%   8.67%** 64.55% 65.15%
Indiana 14.39%   9.41%** 64.18% 64.61%
Iowa 14.27% 10.83%** 61.99% 61.65%
Kansas 13.95% 10.64%** 60.16% 58.79%
Kentucky 17.62% 11.01%** 58.90%   63.41%*
Louisiana 15.01%   8.69%** 59.33%    65.08%**
Maine 12.16%  9.47%* 64.49% 67.35%
Maryland 11.08%   7.43%** 65.27% 65.98%
Massachusetts 11.69%   7.88%** 67.22% 70.34%
Michigan 13.59%   9.49%** 64.02% 64.08%
Minnesota 15.67%   8.89%** 63.18%   67.41%*
Mississippi 12.83% 10.22%* 59.22% 60.99%
Missouri 17.88% 11.61%** 61.78% 61.97%
Montana 16.10% 12.16%** 64.76% 64.27%
Nebraska 16.36%   9.13%** 63.18% 62.38%
Nevada 12.73%   7.39%** 64.24% 65.85%
New Hampshire 14.03% 10.66%** 59.52%    64.70%**
New Jersey 11.83%   7.66%** 64.03% 67.23%
New Mexico 12.34% 10.17%   61.12% 63.49%
New York 11.81%   7.79%** 64.32%    71.09%**
North Carolina 14.78%   8.22%** 60.76%    66.79%**
North Dakota 17.53% 10.27%** 61.29%   65.63%*
Ohio 14.52% 11.22%** 61.92% 64.16%
Oklahoma 14.96% 10.80%** 60.58% 58.74%
Oregon 11.29% 9.53%  68.14% 65.20%
Pennsylvania 14.73% 10.28%** 62.31% 63.44%
Rhode Island 13.72%   8.46%** 65.01% 65.34%
South Carolina 12.21%   9.02%** 62.27% 62.06%
South Dakota 19.79% 10.29%** 60.68% 64.35%
Tennessee 14.33%   9.25%** 62.38% 61.01%
Texas 11.65%   8.00%** 61.14%   63.54%*
Utah   6.57% 5.86%  71.49% 72.63%
Vermont 14.84%   9.34%** 63.59% 65.59%
Virginia 14.17%   8.60%** 64.05% 66.41%
Washington 10.84%   7.95%** 66.48% 66.20%
West Virginia 17.34% 11.85%** 59.35% 61.44%
Wisconsin 15.32%   9.43%** 63.58%   67.47%*
Wyoming 12.78% 13.47% 64.05% 66.90%
* Difference between estimates for 2002-2003 and 2009-2010 is significant at the .10 level.
** Difference between estimates for 2002-2003 and 2009-2010 is significant at the .05 level.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2002, 2003, 2009, and 2010 (revised March 2012).


Discussion

The prevalence of cigarette use initiation in childhood or adolescence has prompted the Surgeon General to declare tobacco use to be a "pediatric epidemic," affirming the importance of tobacco use prevention and control measures that target youths.9 Reducing smoking among adolescents will improve the Nation's health in both the short term and the long term. Findings in this report suggest that efforts to reduce smoking and to change attitudes about smoking among adolescents have resulted in considerable progress, although this progress was not uniform across all States. Highlighting the prevalence of adolescent cigarette use and attitudes toward use in each State, as well as monitoring changes, may help Federal, State, and local policymakers continue to plan for and allocate resources to combat adolescent smoking, including efforts to reduce the availability of tobacco products to young people, raise awareness about smoking and its consequences, and improve prevention efforts.



End Notes
1 Adhikari, B., Kahende, J., Malarcher, A., Pechacek, T., & Tong, V. (2008). Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000-2004. Morbidity and Mortality Weekly Report, 57(45), 1226-1228. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm
2 Center for Behavioral Health Statistics and Quality. (2011). Results from the 2010 National Survey on Drug Use and Health: Summary of national findings (NSDUH Series H-41, HHS Publication No. SMA 11-4658). Rockville, MD: Substance Abuse and Mental Health Services Administration.
3 Song, A. V., Morrell, H. E., Cornell, J. L., Ramos, M. E., Biehl, M., Kropp, R. Y., & Halpern-Felsher, B. L. (2009). Perceptions of smoking-related risks and benefits as predictors of adolescent smoking initiation. American Journal of Public Health, 99(3), 487-492.
4 The data for this report are based on tables D14 and D15 from the report: Substance Abuse and Mental Health Services Administration. (2012). State estimates of substance use and mental disorders from the 2009-2010 National Surveys on Drug Use and Health (NSDUH Series H-43, HHS Publication No. SMA 12-4703). Rockville, MD: Author. This report provides State-level estimates for a more extensive set of measures of substance use and substance use disorders and is available at http://www.samhsa.gov/data/NSDUH/2k10State/NSDUHsaeTOC2010.htm. In addition to the percentages shown in the report, this Web link also provides estimated numbers.
5 All estimates in this report are based on a small area estimation (SAE) methodology in which State-level NSDUH data are combined with local-area county and census block group/tract-level data from the State. This model-based methodology provides more precise estimates of substance use at the State level than those based solely on the sample, particularly for smaller States. The precision of the SAE estimates, particularly for States with smaller sample sizes, can be improved significantly by combining data across 2 years (i.e., 2002-2003, 2009-2010).
6 Estimates were divided into quintiles for ease of presentation and discussion, but differences between States and quintiles were not tested for statistical significance. In some instances, more than 10 or fewer than 10 States were assigned to each quintile because of ties in the estimated prevalence rates.
7 The West has 13 States: AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, UT, WA, and WY. The South has 16 States plus the District of Columbia: AL, AR, DE, FL, GA, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, and WV. The Northeast has 9 States: CT, MA, ME, NH, NJ, NY, PA, RI, and VT. The Midwest has 12 States: IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, and WI.
8 Tests of significance were conducted separately on the difference in the rates of cigarette use from 2002-2003 to 2009-2010 and the difference in the percentage perceiving great risk for the same two time periods. However, no tests of significance were conducted jointly between the difference in cigarette use and the difference in the perceptions of great risk.
9 U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General. (2012). Preventing tobacco use among youth and young adults: A report of the Surgeon General. Retrieved from http://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/full-report.pdf


Suggested Citation
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (November 15, 2012). The NSDUH Report: State Estimates of Adolescent Cigarette Use and Perceptions of Risk from Smoking: 2009 and 2010. Rockville, MD.

The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The 2009 and 2010 data used in this report are based on information obtained from 44,400 persons aged 12 to 17; the 2002 and 2003 data are based on information obtained from 46,300 persons aged 12 to 17. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.

The NSDUH Report is prepared by the Center for Behavioral Health Statistics and Quality (CBHSQ), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.)

Information on the most recent NSDUH is available in the following publication:

Center for Behavioral Health Statistics and Quality. (2011). Results from the 2010 National Survey on Drug Use and Health: Summary of national findings (NSDUH Series H-41, HHS Publication No. SMA 11-4658). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Also available online: http://www.samhsa.gov/data/.

The NSDUH Report is published periodically by the Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies), Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Center for Behavioral Health Statistics and Quality are available online: http://www.samhsa.gov/data/. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov.

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