Friday, October 9, 2009

More Good News on Teen Smoking: Rates At or Near Record Lows

Last week I discussed my recently published study of smokeless tobacco use among adult men in the U.S. But what about tobacco use among children? It’s an important question. Earlier this year, when Congress gave the FDA regulatory authority over tobacco products, Chris Dodd (D- CT) told the Senate that the bill was “necessary…to protect our children and the public health from deadly tobacco products.”

Readers already know that smokeless tobacco doesn’t even come close to falling into the “deadly” category. In fact, the health risks (cancer, heart and circulatory disorders and all other tobacco-related illnesses) of long-term smokeless tobacco use are so small that they are barely measurable using modern epidemiologic methods.

Still, American media dwell on references to tobacco use among children, giving the impression that it is an escalating crisis. As Senator Blanche Lincoln (D- AR) put it, the FDA bill “would implement important marketing restrictions on tobacco products and especially on the marketing practices that have been shown to increase tobacco use among our Nation's young people.”

Let’s look at data behind those “increases” in tobacco use.

The title for this post was borrowed from a press release dated December 11, 2008 by Monitoring the Future, an authoritative source for information about tobacco use among children. MTF is a long-term survey-based study of the behaviors, attitudes and values of American high school students. It has been collecting information on smoking and smokeless tobacco use among grade 12 students since 1975. MTF, like other youth surveys, counts any child who has used a tobacco product within the past 30 days as a current user. Prevalence estimates using this definition are not understated; they tend to be higher than those using the adult definition, which counts only people using tobacco “every day or some days.”

Let’s start with 1998, the year of the Master Settlement Agreement, in which seven tobacco companies (including UST, the nation’s largest smokeless manufacturer) agreed to change the way tobacco products were marketed and pay the states an estimated $206 billion. Tobacco manufacturers agreed not to “take any action, directly or indirectly, to target Youth within any Settling State in the advertising, promotion or marketing of Tobacco Products, or take any action the primary purpose of which is to initiate, maintain or increase the incidence of Youth smoking within any Settling State.” We’ll end with 2008, the most recent year for which MTF data is available.

According to MTF, 8.8% of 12th graders were users of smokeless tobacco in the past 30 days (15.6% percent of boys and 1.5% of girls) in 1998. Ten years later, only 6.5% were current users (11.8% of boys and 1.0% of girls), a decline of 26%.

Smoking rates were also declining during this period. In 1998, 35.1% of 12th graders smoked cigarettes (36.3% of boys and 33.3% of girls). By 2008 the prevalence of smoking was 20.4% (21.5% for boys and 19.1% for girls). This means that smoking among high school seniors declined by 42% in the decade after the MSA.

It is informative to compare the 2008 rates of current smoking (20.4%) and smokeless tobacco use (6.5%) with usage rates for two other popular teenage drugs, alcohol and marijuana. A whopping 43% of 12th graders used alcohol, and 28% had been binge drinking; 19.4% of them had used marijuana, almost the same percentage as smoking.

Last year over four out of ten 12th graders reported drinking and two-thirds of drinkers had binged, putting them at immediate and potentially life-threatening risk for alcohol poisoning, motor vehicle and other accidents. In comparison, the cigarette smoking rate was about the same as that for smoking marijuana, and smokeless tobacco use was far lower.

Tobacco use among children is a relatively small problem, and shrinking virtually every year. More importantly, the issue of teen tobacco use is entirely irrelevant to tobacco harm reduction. Society has a genuine interest in stopping tobacco initiation among children. But it is disingenuous for tobacco prohibitionists to label every attempt to provide vastly safer smokeless substitutes to adult inveterate smokers as an attack on children. If prohibitionists have specific evidence that tobacco manufacturers are marketing to children, they should contact the appropriate state attorney general. Many states have an expedited process for policing and enforcing MSA provisions about targeting children. Otherwise, these allegations represent nothing more than hollow and specious diatribes.

Tobacco harm reduction isn’t a children’s issue. The 8 million Americans who will die from a smoking-related illness in the next 20 years are not children. They are adults who are at least 35 years old. Preventing youth access to tobacco is vitally important, but the issue should not be twisted to condemn cigarette-using parents and grandparents to premature death.

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