ANN ARBOR—American young people are turning away from cigarette smoking at a pace that should bring cheer to parents, educators, and health professionals alike.

Teen use of cigarettes has been dropping steadily and substantially since the peak rates in 1996 and 1997. Between 2001 and 2002, the proportion of teens saying that they had ever smoked cigarettes fell by 4 or 5 percentage points in each grade surveyed (8, 10, and 12)—more than in any recent year.

“I cannot overemphasize how important these developments are to the health and longevity of this generation of young people,” said Lloyd Johnston, principal investigator of the study and lead author of the forthcoming report with fellow social psychologists Patrick O’Malley and Jerald Bachman. “Smoking remains the leading preventable cause of premature death and disease in this country. Therefore, significant reductions in smoking translate into a great many lives lengthened and an even larger number of serious illnesses prevented—including heart disease, stroke, cancer and emphysema.”

The Monitoring the Future study is funded by the National Institute on Drug Abuse under research grants made to the University of Michigan Institute for Social Research (ISR). It began in 1975 and has tracked the smoking habits of high school seniors in the country each year since then. Grades 8 and 10 were added in 1991 and have been surveyed annually along with the 12th-graders for the past 12 years. The 2002 survey results are based on about 44,000 students in nearly 400 randomly selected public and private secondary schools from across the continental United States.

Following the recent peak in 1996, smoking rates for 8th-graders have dropped by half. Current smoking (any use in the past 30 days) fell from 21percent to 10.7 percent; current daily smoking fell from 10.4 percent to 5.1 percent; and current half-pack-a-day smoking fell from 4.3 percent to 2.1 percent. Among 10th-graders, rates have dropped by nearly half, and among 12th-graders by about a quarter to a third. (See Table 1.) Although proportional declines have been smaller in the upper grades, the investigators expect that picture to improve during the next few years, simply as a result of the current 8th-graders becoming older.

“There are a number of potential explanations for these important declines in teen smoking,” Johnston said. “These include increasing prices, less tobacco advertising that reaches young people, more anti-smoking ads, and a lot more negative publicity about the tobacco industry.” Some of these changes originated with the tobacco settlement between the state attorneys general and the industry. Certain forms of advertising, such as billboard advertising and the Joe Camel ads, were withdrawn as one of the conditions of the settlement. The American Legacy Foundation was created with funds from the settlement, and one of its activities was to launch a major anti-smoking campaign aimed at youth.

Tobacco companies have raised their cigarette prices to help pay for the settlement; moreover, a number of states have raised cigarette taxes, which also translates into higher prices. “There is good evidence from a number of studies, including this one, that higher prices help to deter youth smoking, so we think that price has been one important factor,” Johnston said. (One such study of price effects, funded by the Robert Wood Johnson Foundation, used data from the Monitoring the Future study.) “But in addition, there have been some important changes in how young people view smoking.” One important change has been a substantial increase, beginning in 1996, in the proportion of young people who perceive regular smoking as dangerous. That upturn in perceived risk was followed a year later (beginning in 1997) by an upturn in disapproval of smoking as well as by the beginning of the downturn in actual teen smoking.

The proportion of 8th-graders saying that a person runs a “great risk” of harming himself physically or in other ways by being a pack-a-day smoker increased steadily from 50 percent in 1995 to 59 percent in 2000, before stabilizing. The proportion of them disapproving pack-a-day smoking rose from 77 percent to 85 percent between 1996 and 2002, while over the same interval the proportion saying that they smoked at least once in the prior 30 days (current smoking) fell from 21 percent to 11 percent. (Similar trends can be seen for 10th- and 12th-graders in Tables 1 and 4 or Figure 1.) In 2000 there was a particularly large increase at all three grade levels in the perceived risk of smoking. “That corresponds to when the American Legacy Foundation’s ‘truth’ campaign against smoking was launched,” Johnston said, “so we think it quite possible that this campaign played a role in changing that belief among teens. We also saw a sharp increase in youth exposure to anti-smoking ads that year, which helps to confirm that hypothesis. But clearly things were headed in the right direction even before that campaign got started, so it can account for only part of the downturn.” Young people in middle and high school have clearly become less accepting of cigarette smoking, and that trend continued in 2002. (See Table 4.) The younger students are the least accepting of smoking, with 85 percent of the 8th-graders in 2002 saying they disapprove of someone smoking at a pack-a-day level, compared with 81 percent of the 10th-graders and 74 percent of the 12th-graders.

But the 8th-graders are the least aware of the dangers of cigarette use. Only 58 percent of them, even in 2002, think there is great risk associated with pack-a-day smoking, compared with 74 percent of the 12th-graders, for example. The Monitoring the Future study tracks a number of other specific attitudes about smoking and smokers, and the investigators report that a number of these attitudes have become more negative in recent years. For example, students in all three grade levels are becoming less accepting of being around smokers. Currently about half of them express that view.

The proportion of 8th-graders who agree with the statement “I strongly dislike being near people who are smoking” increased from 46 percent in 1996 to 54 percent this year. (Among 10th-graders the increase was from 42 percent in 1997 to 49 percent in 2002; and among 12th-graders from 38 percent to 47 percent over the same interval.) These changes all are statistically significant. An increasing proportion of young people are also coming to see smoking as reflecting poor judgment on the part of their peers who smoke. Some 64 percent of the 8th-graders now agree with the statement “I think that becoming a smoker reflects poor judgment,” as do about 60 percent of the 10th- and 12th-graders.

But perhaps of most importance to teens is how their peers feel about dating someone who smokes. The proportions saying that they prefer to date non-smokers rose to 81 percent of 8th-graders by 2002 (up from 71 percent in 1996), 76 percent of 10th-graders (up from 68 percent in 1997), and 72 percent of 12th-graders (up from 64 percent in 1997). This aversion to dating smokers is about equally strong among males and females.

“It now appears that taking up smoking makes a youngster less attractive to the great majority of the opposite sex,” Johnston concluded, “just the opposite of what cigarette advertising has been promising all these years. I think this is something that teens need to know, because it may be the most compelling argument for why they should abstain from smoking or, for that matter, quit if they have already started.”

Efforts to reduce youth access to cigarettes, begun by the FDA some years ago and continued by a number of states and localities, appear to have had some success. The proportion of 8th-graders saying it would be “fairly easy” or “very easy” to get cigarettes if they wanted them has fallen from 77 percent in 1996 to 64 percent in 2002, while the comparable proportion for 10th-graders fell from 91 percent to 83 percent over the same interval. Both grades showed a significant decline in perceived availability in 2002, specifically.

“It is worth noting that the great majority of youngsters this age still think they can get cigarettes, if they want them,” Johnston said. “Despite the progress, we still have a fair way to go.” Monitoring the Future has been funded under a series of competing, investigator-initiated research grants from the National Institute on Drug Abuse. Surveys of nationally representative samples of American high school seniors were begun in 1975, making the class of 2002 the 28th such class surveyed. Surveys of 8th- and 10th-graders were added to the design in 1991, making the 2002 nationally representative samples the 12th such classes surveyed. The sample sizes in 2002 are 15,500 8th-graders, 14,700 10th-graders, and 13,500 12th-graders, for a total of 43,700 students. They are located in 394 private and public secondary schools across the coterminous United States, selected with probability proportionate to size, to yield nationally representative samples of students in each of the three grade levels.

The findings summarized here will be published in the forthcoming volume: Johnston, L.D., O’Malley, P.M., & Bachman, J.G. (2003). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2002. (NIH Publication No. [yet to be assigned].) Bethesda MD: National Institute on Drug Abuse.

www.monitoringthefuture.org