Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In a cross-sectional study using national survey data from 2011 to 2018, there was a significant negative trend in smoking frequency and amount (cigarettes per day) among adolescent cigarette users.

2. While the age at first cigarette use increased slightly, the frequency of e-cigarette use also increased among adolescent cigarette users.

Evidence Rating Level: 3 (Average)

Study Rundown:

Tobacco use is the leading cause of preventable death in the United States prompting the creation of interventions aimed at reducing youth smoking. While previous studies have examined the prevalence of smoking among the pediatric population, few studies have analyzed adolescent cigarette users and their behaviors. In this cross-sectional study, researchers used survey data from the 2011-2018 National Youth Tobacco Survey to conduct linear and logistic regressions to examine trends in smoking behaviors among adolescent cigarette users. During the study period, there was a significant decrease in the percentage of current smokers smoking ≥10 days, ≥20 days, and all 30 days in the past 30 day period when surveyed. Light smoking (≤1-5 cigarettes per day) among current cigarette users rose significantly. The age of first cigarette use increased in the overall sample, though it decreased among males. For e-cigarette use, there was a significant increase in the percentage of current smokers using e-cigarettes ≥10 days, ≥20 days, and all 30 days in the past 30 day period.

These findings are limited by a reliance on self-reported survey data administered in a school setting. Nonetheless, the study is strengthened by its large, nationally representative sample. For physicians, these findings highlight novel insights into the behavior of adolescent cigarette users, as well as important trends that suggest that further interventions to address e-cigarette use among adolescent smokers may be necessary.

In-Depth [cross-sectional study]:

Researchers used 2011-2018 survey data from the National Youth Tobacco Survey encompassing a randomly selected, nationally representative sample of 11 123 middle school and high school students. Logistic regression models and national estimates were used to examine trends in smoking frequency, smoking intensity, and e-cigarette use among adolescents.

Between 2011 and 2018, the smoking frequency decreased significantly. The percentage of current smokers smoking ≥10 days decreased from 50.0% to 38.3%, ≥20 days from 37.2% to 26.3%, and all 30 days from 26.6% to 18.2%. Light smoking (≤1-5 cigarettes per day) among current cigarette users rose significantly from 76.6% to 82.7%, whereas heavy smoking (≥11 cigarettes per day) saw a non-statistically significant decrease. Overall, smoking prevalence decreased among male, female, high school, and non-Hispanic white students. The mean age of first cigarette use increased significantly from 12.56 years to 12.86 years over the study period, though it decreased significantly among male students from 12.90 to 12.57 years. The percentage of current smokers using e-cigarettes ≥10 days, ≥20 days, and all 30 days in the past 30 days increased by 20.1, 18.2, and 12.7 percentage points, respectively.

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