1997 Massachusetts Youth Risk Behavior Survey Results
Tobacco Use Among Massachusetts High School Students
Tobacco use is the leading preventable cause of death, and tobacco use among young people poses especially serious risks. Adolescent tobacco use not only threatens health, but it is also associated with drinking and illicit drug use and with poor school performance.1 Every year in the United States over one million adolescents begin smoking. 2 Four out of every five current adult smokers tried their first cigarette before age 18, and half of these became regular smokers by age 18. 3 Unfortunately, both nationally and in Massachusetts, there were increases in adolescent smoking from 1990 to 1995. 4, 5 Recently, two national surveys 6,7 have shown continued additional increases since 1995 in recent cigarette smoking among American high school students.
In 1993, Massachusetts voters approved an excise tax on tobacco products, with funds from the tax going toward the Tobacco Control Program (Department of Public Health) and the Health Protection Fund (Department of Elementary and Secondary Education), which supports Comprehensive Health Education in Massachusetts Schools. Massachusetts middle and high schools significantly increased attention to tobacco prevention education and other health education topics over the past few years.8 Additionally, the Massachusetts Education Reform Law of 1993 made it illegal for students, school staff, and visitors to smoke on school property at any time.
Every two years, the Massachusetts Department of Elementary and Secondary Education conducts the Massachusetts Youth Risk Behavior Survey (MYRBS) to examine the recent rates of adolescent health risk behaviors, including rates of tobacco use. The 1997 MYRBS, administered in randomly chosen public high schools in the Commonwealth in Spring 1997, included questions that asked students to report their history and recent use of cigarettes and smokeless tobacco both on and off school property. The MYRBS also asked about students' attempts to quit smoking and about their customary method of obtaining cigarettes. Results reported here can be generalized to provide an accurate estimate of tobacco use among of Massachusetts high school students as a whole.
Summary Of Results
Since 1995, cigarette smoking among Massachusetts high school students has leveled off and even declined slightly. Decreases from 1995 to 1997 in lifetime smoking (any experimentation with smoking during ones life) and recent smoking (past 30 days) are most notable among 9th grade students. Smokeless tobacco use among adolescents continues to decline significantly.
Male and female students have fundamentally similar smoking patterns. Most measures of tobacco use -- recent smoking, daily smoking, and smokeless tobacco use -- continue to be much higher among White students than among Black, Hispanic, or Asian students.
It has become harder for high school students to buy cigarettes. Among recent smokers, significantly fewer young people in 1997 than in 1995 usually got their cigarettes by buying them in stores, and those that did were significantly more likely to be asked for proof of age. Most high school students who do smoke have made one or more attempts to stop, although most of these attempts appear not to have been successful.
Method: The standard youth risk behavior survey instrument was developed by the U.S. Centers for Disease Control and Prevention (CDC) to monitor adolescent risk behaviors associated with the major causes of morbidity and mortality. Since 1990, Massachusetts Department of Elementary and Secondary Education has administered the MYRBS in randomly chosen public high schools across the Commonwealth. Since 1993, the survey has included students from Boston schools as well as from other districts and has had high enough school and student response rates to be considered representative of the state as a whole. In March through June 1997, the 1997 MYRBS was administered by Department of Elementary and Secondary Education staff in 58 Massachusetts public high schools and was completed by 3,982 students in grades 9 through 12. School and classroom selection were random. Student participation was anonymous and voluntary; less than one percent of students in selected classes decided not to participate.
Survey results were weighted to ensure that the results would accurately reflect the actual population of Massachusetts public high school students. Initial frequency analyses were conducted by the CDC, and subsequent statistical analyses were conducted by the Massachusetts Department of Elementary and Secondary Education, using a specialized weighting procedure to account for the multistage sampling design. 9
Key Findings From The 1997 MYRBS
- Over two-thirds of Massachusetts high school students (69%) have tried smoking cigarettes, at least one or two puffs (lifetime smoking). One quarter of all students (24%) smoked a whole cigarette for the first time before they were 13.
During the 30 days prior to the survey:
- Over one-third of students (34%) smoked cigarettes at least once (recent smoking)
- One in seven students (15%) smoked cigarettes every day (daily smoking)
- Nearly one in five students (19%) smoked cigarettes on school property
- Six percent of students used smokeless tobacco (chewing tobacco or snuff) at least once, and half of those (3%) did so on school property.
- Lifetime cigarette use, age of first smoking, recent smoking, daily smoking, and smoking on school property have remained level since 1995. Recent smokeless tobacco use on and off school property has declined steadily since 1993.
- White students report recent smoking, daily smoking, and smokeless tobacco use at substantially higher rates than Black, Hispanic, or Asian students.
- Most recent smokers (51%) and daily smokers (77%) report having tried to quit smoking at least once. Of all students who describe themselves as ever having been regular smokers, only one in seven (16%) has successfully quit smoking.
- Of students who smoked any cigarettes in the month prior to the survey, those who usually obtained their cigarettes by buying them in a store dropped from 48% in 1995 to 33% in 1997. Among students who tried to buy cigarettes in a store, those asked for proof of age rose significantly from 1995 to 1997.
Results: Lifetime Cigarette Smoking
- Lifetime smoking is defined as ever having tried to smoke cigarettes, even one or two puffs. Over two thirds of Massachusetts high school students (69%) report some history of cigarette smoking in their lives.
- Students in the 9th grade in 1997 had notably lower rates of lifetime smoking (62%) than did their 1995 counterparts (69%). Older grade levels maintained 1995 rates.
- Overall, lifetime cigarette smoking, which had risen significantly from 1993 to 1995, has decreased slightly since then, from 72% (1995) to 69% (1997).
- Female adolescents had slightly higher rates of lifetime smoking than males (70% vs. 68%). This represents a reversal of 1995 female and male results (70% vs. 73%); male rates have decreased somewhat in the past two years.
- Black adolescents and those who described their ethnicity as Other had somewhat higher rates of lifetime cigarette smoking than did students of other ethnic/racial groups. Ethnic group changes in lifetime smoking since 1995 were small.
Results: Recent Cigarette Smoking
- Over one third (34%) of Massachusetts high school students smoked cigarettes at least once in the 30 days prior to the survey (recent cigarette use, sometimes also termed current use). Almost one in five (19%) smoked frequently (on at least 20 of the past 30 days).
- On average, students who smoked consumed approximately 3 to 4 cigarettes per day.
- Recent cigarette smoking, which had risen significantly from 1993 to 1995, has decreased slightly since then, from 36% (1995) to 34% (1997).
- Recent smoking decreased most notably among 9th grade students, from 32% (1995) to 28% (1997). Students in other grades had smoking rates similar to those reported for 1995.
- Recent smoking stayed level for female students from 1995 to 1997 (36% for both years), but dropped slightly for males (35% to 33%).
- The prevalence of recent cigarette smoking was significantly higher among White students and those listing Other ethnicity than among Black, Hispanic, or Asian adolescents.
- From 1995 to 1997, there were no significant changes over time in recent smoking for any of the racial/ethnic groups.
- Nearly one fifth of all students (19%) reported smoking on school property during the month prior to the survey; this figure has not changed substantially since 1993.
- In 1995, rates of recent smoking among Massachusetts students were slightly above those reported by the national YRBS (35.7% vs. 34.8%). Due to slight increases nationally and slight decreases in Massachusetts, the 1997 rates of recent smoking among Massachusetts adolescents dropped below national rates (34.4% vs. 36.4%).
- The percentage of students who reported smoking cigarettes every day in the month prior to the survey (daily smoking) rose from 1993 to 1995, but has remained level since then at 15%.
- Daily smoking rose with grade level, from 10% (9th grade students) to 19% (12th grade).
- Daily smoking, like recent smoking, was higher among White and Other students than among Black, Hispanic, or Asian students.
- Male and female students were equally likely to report smoking cigarettes every day.
- Among students who smoked every day, the proportion of those who smoked more than half a pack a day (11 or more cigarettes) has dropped slightly, from 46% (1995) to 42% (1997).
Results: Cigarette Smoking before Age 13.
- Rates of smoking before age 13 have remained virtually unchanged since 1993.
- Almost one quarter of all Massachusetts students (24%) reported smoking their first whole cigarette before age 13.
- Male students were somewhat more likely than female students to have smoked their first cigarette before age 13 (26% vs. 22%), though this difference was not statistically significant.
- White students were somewhat more likely to have smoked cigarettes before age 13 (25%) than were Black (22%), Hispanic (21%) or Asian students (14%).
- Of all students who had ever smoked a whole cigarette, those who first did so before age 13 were significantly more likely than their peers who started later to be recent smokers (68% vs. 58%), daily smokers (37% vs.18%), and smokeless tobacco users (12% vs. 7%).
Results: Smokeless Tobacco Use
- The 1997 rates of adolescent smokeless tobacco are significantly lower than they were in 1993. The sharpest decline has occurred since 1995.
- Smokeless tobacco (chewing tobacco or snuff) was used by 6% of students in the month before the survey. Half of this group (3%) had used smokeless tobacco on school property.
- Rates of smokeless tobacco use were relatively flat across grade levels; students at each grade were within one percent of the 6% average rate.
- Male students were almost ten times more likely than females to report recent smokeless tobacco use (10.3% vs. 1.4%) and smokeless tobacco use on school property (4.9% vs. 0.4%).
- Among male students, the drop in smokeless tobacco use has been substantial and significant, from 17% (1993) to 15% (1995) to the current 1997 male rate of 10%.
- White adolescents especially White males -- were substantially more likely than Black, Hispanic, or Asian youth to have used smokeless tobacco. Nearly one in eight White male students (12%) had used chewing tobacco or snuff in 30 days before the survey.
Results: Obtaining Cigarettes
- One third (33%) of students who had smoked cigarettes in the past month usually obtained their cigarettes by buying them in a store (convenience store, supermarket, or gas station). This represents a significant drop from 1995, when 48% of recent smokers reported that they bought their cigarettes in a store.
- Although sale of tobacco products to underage youth is illegal in Massachusetts, 26% of students who had smoked in the past month and who were age 17 or younger reported that they usually got their cigarettes by buying them in a store.
- Students were significantly more likely in 1997 than in 1995 to be asked for proof of age if they tried to buy cigarettes in a store: 61% were asked for proof of age in 1997, compared to only 49% who were asked in 1995.
Results: Smoking Cessation
- Using their own definition of the term, over one quarter of all students (28%) had at some time been regular smokers.
- Three-quarters (75%) of these ever regular smokers had tried to quit smoking at least once and one third (33%) had tried to quit three or more times.
- At the time of the survey, only 16% of adolescents who described themselves as ever having been regular smokers had quit successfully and had not smoked any cigarettes in the past 30 days. Most ever-regular smokers (84%) reported smoking cigarettes recently and half (52%) smoked cigarettes every day.
- Most students who used cigarettes had tried to quit smoking. Among students who reported daily smoking, over three-quarters (77%) had tried to quit at least once. Over one-third (36%) had made three or more (unsuccessful) attempts to quit. One out of eleven daily smokers (9%) had tried to quit smoking ten or more times.
The 1997 MYRBS results concerning tobacco use offer cause for cautious optimism. In contrast to recent national surveys, which report continued increases in adolescent cigarette consumption across the country.6,7 Massachusetts rates are no longer rising. In 1995, Massachusetts adolescents reported recent smoking at slightly higher levels than was true nationally; in 1997, these rates were slightly lower. Unfortunately, however, unacceptably high numbers of Massachusetts youth continue to endanger their health by consuming tobacco products.
Findings presented here call attention to the need for early and repeated tobacco prevention education, beginning well before high school and reinforced at every grade level. Many young people initiate tobacco use before high school, and those who do are more likely than their peers to become regular smokers. It is encouraging that 9th grade students in 1997, whose exposure to school and community anti-smoking messages is likely to have started earliest and been most consistent, reported lower prevalence of lifetime and recent smoking than had been true in 1995.
Regulations concerning adolescent tobacco purchasing and use are also important. The substantial shift downward in the percentage of students who buy their cigarettes in stores is evidence that ordinances outlawing sale of tobacco products to minors are being enforced with increasing rigor, though not perfectly. It is also critical that there be stronger local enforcement of smoke-free school campuses, an area in which little apparent progress has been made in the past few years.
Most students who smoke, especially those who have ever developed a regular smoking habit, have tried to quit at least once. Unfortunately, tobacco is an addictive substance, and most of these attempts have not been successful. School- and/or community-based cessation programs aimed at adolescents would offer these students more support and guidance.
Changing widespread patterns of tobacco use among adolescents is a difficult and complex task, but the data presented here support the view that such changes may gradually be taking place. Research evidence suggests that providing information about the harmful effects of tobacco use is rarely enough, by itself, to curb adolescent smoking. 10 Rather, effective tobacco prevention programs are those that focus on helping students recognize peer and media pressure and on helping them develop the skills to resist such pressure. 10,11 Additionally, because tobacco use is associated with other risk behaviors, tobacco prevention education should be integrated into comprehensive school health programs. The Massachusetts Health Education Framework, Building Resilience through Comprehensive School Health, is a useful starting place to help districts develop school health programs that encourage young people to make healthy choices.
Tobacco Use Among Massachusetts High School Students, 1993 to 1997
Massachusetts Department of Elementary and Secondary Education
|Total||9th Grade||10th Grade ||11th Grade||12th Grade |
|Any cigarette smoking, lifetime||67.8||71.5||69.1||64.4||68.9||62.3||62.3||71.0||72.0||72.8||72.0||69.3||73.0||74.8||73.8 |
|Males, Lifetime||68.8||73.3||68.1||66.6||72.7||61.9||66.1||73.7||67.8||71.3||71.6||71.3||72.4||74.8||72.2 |
|Females, Lifetime||66.8||69.7||70.1||62.3||65.1||62.6||58.2||68.4||76.3||74.2||72.3||67.3||73.7||74.9||75.4 |
|Recent Cigarette Smoking||30.2||35.7||34.4||28.9||32.3||27.8||25.2||34.8||35.8||31.0||37.7||35.5||35.9||39.1||40.2|
|Males, Recent Smoking||31.1||35.2||33.0||28.8||32.4||26.9||26.0||34.2||32.7||32.3||36.6||34.9||37.8||38.5||39.9|
|Females, Recent Smoking||29.2||36.2||35.8||29.1||32.2||28.8||24.3||35.3||39.0||29.6||38.8||36.1||34.0||39.6||40.7|
|Daily Cigarette Smoking||11.9||14.6||14.5||8.1||11.8||10.4||9.9||14.7||14.2||14.1||14.6||15.8||15.9||18.0||18.5|
|Males, Daily Cigarette Smoking||12.3||15.1||14.6||7.1||13.9||11.2||10.8||16.9||12.4||14.5||12.9||16.4||16.8||16.7||19.9|
|Females, Daily Cigarette Smoking||11.5||14.2||14.3||9.0||9.8||9.5||8.9||12.4||1.2||13.3||16.2||15.2||15.0||19.4||17.3|
|Recent Smokeless Tobacco Use||9.4||8.4||6.0||10.3||8.8||5.7||8.1||8.1||6.8||10.1 ||8.1||5.6||8.8||8.1||5.3|
|Males, Smokeless Tobacco||17.0||15.1||10.3||18.5||15.9||9.6||14.5||15.0||11.3||18.8||14.8||10.0||15.9||14.6||9.5|
|Females, Smokeless Tobacco||1.5||1.5||1.4||1.8||1.5||1.4||1.5||1.0||1.7||1.0||1.5||1.2||1.5||1.5||1.4 |
References and Notes
- Johnston, LD, O'Malley, PM, and Bachman, JG (1987). National trends in drug use and related factors among American high school students and young adults, 1997-1986, DHHS Pub. No (ADM) 87-1535. Rockville, MD: National Institute on Drug Abuse.
- US Department of Health and Human Services (DHHS). (1990) Prevention '89/90: Federal programs and progress. Washington DC: US Government Printing Office.
- Public Health Service (1994). Preventing tobacco use among young people: A report of the Surgeon General. Washington, DC: US Department of Health and Human Services.
- Centers for Disease Control and Prevention (1996) Tobacco use and sources of cigarettes among high school students United States, 1995. Morbidity and Mortality Weekly Report, Vol. 45, No. 20, May 24, 1996.
- Massachusetts Department of Elementary and Secondary Education (1996). 1995 Massachusetts Youth Risk Behavior Survey Results.
- Johnston, LD, Bachman, JG, and OMalley, PM (1997) Monitoring the Future Study, 1997. Ann Arbor, MI: Institute for Survey Research, University of Michigan.
This most recent report of the Monitoring the Future Study showed that recent (past 30 days) smoking rose among 10th grade students from 28% (1995) to 30% (1997). 12th grade students recent smoking rates rose from 34% (1995) to 37% (1997).
- Centers for Disease Control and Prevention. (1998) Tobacco use among high school students United States, 1997. Morbidity and Mortality Weekly Review, April 3, 1998. This most recent report of the Youth Risk Behavior Survey administered to a national sample showed an increase in recent (past 30 days) smoking from 34.8% of high school students in 1995 to 36.4% in 1997.
- Massachusetts Department of Elementary and Secondary Education (1997). The 1996 Massachusetts School Health Education Profile
- The design-effect weights used in making statistical comparisons between groups or between years were calculated by (1) normalizing weights provided by the CDC for each case, and (2) dividing these normalized weights by four, yielding an average weight per case of .25. This procedure was done to correct for the tendency of SPSS or SAS to overestimate the significance of differences with data collected through a multi-stage sampling design. Design-effect weights provide a more stringent but more accurate test of significance than has been used in past analyses of the YRBS.
- Reid, DK, McNeill, AD, and Glynn, TJ (1995). Reducing the prevalence of smoking in youth in Western countries: An international review. Tobacco Control, 4, 266-277.
- Centers for Disease Control and Prevention (1994). Guidelines for school health programs to prevent tobacco use and addiction. Morbidity and Mortality Weekly Review, 43 (No. RR-2).
- Race/ethnicity was determined by student self-report. In the total sample, there were 2958 students who categorized themselves as White-not Hispanic; 247 Black-not Hispanic; 310 Hispanic; 219 Asian; and 216 who answered Other to the question about race/ethnicity. This last category also includes a very small number (26) of students who identified themselves as American Indian or Alaskan Native.
Results on tobacco use presented here will be included as part of the1997 Massachusetts Youth Risk Behavior Survey Results Report, which focuses on behaviors associated with major causes of morbidity and mortality among youth and adults. The full report will also include findings related to adolescent alcohol and illegal drug use, sexual behavior that might lead to sexually transmitted disease (including HIV/AIDS) or unintended pregnancy, behaviors leading to intentional and unintentional injury (such as fighting, drunk driving, or suicidal behavior), poor dietary behavior, and lack of physical activity.