Although teen cigarette smoking has been on the decline overall since 1999, the drop in the number of high school smokers has slowed in recent years, survey data from the CDC found.
The data showed a steady rate of cigarette use in high schoolers from 1991 (70.1%) to 1999 (70.4%), followed by a steep decline in 2003 (58.4%) and a more gradual decline in 2009 (46.3%).
A report in the latest Morbidity and Mortality Weekly Report showed a range of biannual data taken from 1991 to 2009 on teen cigarette use. The data was obtained from surveys of high school students in grades nine to 12. Among other questions, students were asked if they had ever tried smoking, if they currently used cigarettes, and if cigarette use was frequent.
Students who had ever smoked a cigarette -- even if they had taken just one or two puffs -- showed the most stark change over time.
Current cigarette users, those who had smoked at least once in the 30 days prior to the survey, rose from 27.5% in 1991 to a high of 36.4% in 1997. Current use did not reach numbers lower than baseline until 2003, when the rate dropped to 21.9%, and then declined to 19.5% in 2009.
Frequent use was counted as having smoked 20 or more cigarettes in the 30 days prior to the survey.
Some 12.7% of students reported smoking frequently in 1991, and this number rose steadily to its peak in 1999 at 16.8%. Similar to current use statistics, this rate did not fall below baseline until 2003, when only 9.7% reported frequent use. The most recent survey data showed that 7.3% of students smoked often in 2009.
In all three measures, the decline in use was less dramatic than the point of dropoff in use from baseline. For example, although students who had ever smoked a cigarette fell from 70.4% in 1999 to 63.9% in 2001, the number of students smoking only decreased by roughly 4% at each subsequent measure from 2003 to 2009.
The survey also measured current cigarette use by age, race, and sex.
Current use was most common overall in female students, and common specifically in white female students, black students, and students in grades nine and 10.
The CDC reported that these numbers fell short of expectations outlined in the Healthy People 2010 national health objective, which set a 16% or lower benchmark for high school student cigarette use.
The pool of data included a minimum of 10,904 to a maximum of 16,410 surveyed students -- an 83% to 90% response rate -- from 110 to 159 schools -- a 70% to 81% response rate -- over the 18-year period of analysis.
The study was limited by two factors, the CDC said. The survey only included high school-age students enrolled in high school, of which approximately 4% of teens ages 16 to 17 are not, according to 2007 data. Additionally, the self-report nature of the survey could not account for under- or overreporting of cigarette use.
The report was compiled by the CDC's Office on Smoking and Health, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion with an Editorial Note from the editors of MMWR, a publication of the CDC.
Zalman S. Agus, MD Emeritus Professor
University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Morbidity and Mortality Weekly ReportSource Reference: CDC "Cigarette use among high school students -- United States, 1991–2009" MMWR 2010; 59(26): 797-801.