Tag Archives: tobacco products

New York University study: 18% of higher income kids smoke Hookah

7 Jul

Douglas Quenqua reported in the New York Times article, Putting A Crimp In the Hookah about hookah.

Kevin Shapiro, a 20-year-old math and physics major at the University of Pennsylvania, first tried a hookah at a campus party. He liked the exotic water pipe so much that he chipped in to buy one for his fraternity house, where he says it makes a useful social lubricant at parties.
Like many other students who are embracing hookahs on campuses nationwide, Mr. Shapiro believes that hookah smoke is less dangerous than cigarette smoke because it “is filtered through water, so you get fewer solid particles….”
Many young adults are misled by the sweet, aromatic and fruity quality of hookah smoke, which causes them to believe it is less harmful than hot, acrid cigarette smoke. In fact, because a typical hookah session can last up to an hour, with smokers typically taking long, deep breaths, the smoke inhaled can equal 100 cigarettes or more, according to a 2005 study by the World Health Organization.
That study also found that the water in hookahs filters out less than 5 percent of the nicotine. Moreover, hookah smoke contains tar, heavy metals and other cancer-causing chemicals. An additional hazard: the tobacco in hookahs is heated with charcoal, leading to dangerously high levels of carbon monoxide, even for people who spend time in hookah bars without actually smoking, according to a recent University of Florida study. No surprise, then, that several studies have linked hookah use to many of the same diseases associated with cigarette smoking, like lung, oral and bladder cancer, as well as clogged arteries, heart disease and adverse effects during pregnancy. And because hookahs are meant to be smoked communally — hoses attached to the pipe are passed from one smoker to the next — they have been linked with the spread of tuberculosis, herpes and other infections…
http://www.nytimes.com/2011/05/31/health/31hookah.html?emc=eta1&_r=0

Kids mistakenly think hookah is safe.

Anthony Rivas reported in the Medical Daily article, 1 In 5 High School Seniors Smoke Hookah;

Educating Them About Its Harms Is Crucial:
There’s no questioning the stigma cigarette smoking has developed over the past couple of decades. The health risks associated with smoking has led to large declines in the amount of smokers in the U.S. since the 1970s, dropping from around 40 percent to about 18 percent of adults. But as always, as one popular vice fades away, another one gains steam — or in this case, smoke. Now, a new study from New York University has determined how popular hookah smoking has become among high school seniors.
Traditionally from the Middle East, hookah involves smoking flavored tobacco from a large water pipe. It’s become increasingly popular in North America and other parts of the world, in part, because it’s believed to be less harmful to the body — the tobacco is considered to be milder. However, that’s not entirely the case because hookah smokers tend to take more puffs in one session, resulting in similar, if not worse effects than smoking.
The NYU researchers’ study involved data from the Monitoring the Future nationwide study, which follows teens’ behaviors, values, and attitudes. Of the almost 15,000 kids aged 18 involved in the study, 5,540 were questioned about their hookah use between 2010 and 2012. They discovered that 18 percent, or almost one in five high school seniors, had smoked hookah within the 12 months prior to being surveyed.
Interestingly, they also found that “students of higher socioeconomic status appear to be more likely to use hookah,” said Dr. Joseph Palamar, assistant professor of population health at NYU Langone Medical Center, in a press release. “Surprisingly, students with more educated parents or higher personal income are at high risk for use. We also found that hookah use is more common in cities, especially big cities. So hookah use is much different from cigarette use, which is more common in non-urban areas….” http://www.medicaldaily.com/1-5-high-school-seniors-smoke-hookah-educating-them-about-its-harms-crucial-291584

Citation:

Hookah Use Among US High School Seniors
1. Joseph J. Palamar, PhD, MPHa,
2. Sherry Zhou, BAb,
3. Scott Sherman, MD, MPHa, and
4. Michael Weitzman, MDb
+ Author Affiliations
1. Departments of aPopulation Health, and
2. bPediatrics and Environmental Medicine, New York University Langone Medical Center, New York, New York
Abstract
OBJECTIVES: Prevalence of hookah use is increasing significantly among adolescents. This study aimed to delineate demographic and socioeconomic correlates of hookah use among high school seniors in the United States. We hypothesized that more impoverished adolescents and those who smoked cigarettes would be more likely to use hookahs.
METHODS: Data were examined for 5540 high school seniors in Monitoring the Future (years 2010–2012), an annual nationally representative survey of high school students in the United States. Using data weights provided by Monitoring the Future, we used multivariable binary logistic regression to delineate correlates of hookah use in the last 12 months.
RESULTS: Eighteen percent of students reported hookah use in the past year. Compared with white students, black students were at lower odds for use (adjusted odds ratio [AOR] = 0.27, P < .0001). High parent education increased the odds for use (AOR = 1.58, P $50/week (AOR = 1.26, P < .05) or $11 to $50 per week from other sources (AOR = 1.35, P < .01) also increased odds for use. Males and urban students were also at higher odds for use, as were users of alcohol, marijuana, and other illicit substances. Former cigarette smokers were at higher risk, and current smokers were at highest risk for use.
CONCLUSIONS: Adolescents of higher socioeconomic status appear to be at particularly high risk for hookah use in the United States. Prevention efforts must target this group as prevalence continues to increase. http://pediatrics.aappublications.org/content/early/2014/07/01/peds.2014-0538.full.pdf+html

Here is the press release from New York University:

Jul 6 at 10:26 PM
PUBLIC RELEASE DATE:
7-Jul-2014
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Contact: Lorinda Klein
lorindaann.klein@nyumc.org
212-404-3533
NYU Langone Medical Center / New York University School of Medicine
NYU researchers find 18 percent of high school seniors smoke hookah
Higher socioeconomic status associated with higher rates of hookah use
New York, NY – July 7, 2014 – While cigarette use is declining precipitously among youth, evidence indicates that American adolescents are turning to ethnically-linked alternative tobacco products, such as hookahs, cigars, and various smokeless tobacco products, according to a recent report from the Centers for Disease Control and Prevention (CDC).
Now a new study by researchers affiliated with New York University’s Center for Drug Use and HIV Research (CDUHR), in the August 2014 edition of Pediatrics identifies how prevalent Hookah use is and which teens are most likely to be using it.
The study, “Hookah Use Among U.S. High School Seniors,” published online July 7, used data from Monitoring the Future (MTF), a nation-wide ongoing annual study of the behaviors, attitudes, and values of American secondary school students. The MTF survey is administered in approximately 130 public and private schools throughout 48 states in the US. Roughly 15,000 high school seniors are assessed annually. This study examined data from the 5,540 students (modal age = 18) who were asked about Hookah use from 2010-2012. The researchers found the annual prevalence (use in the last 12 months) of hookah use was nearly 1 in 5 high school seniors.
“What we find most interesting is that students of higher socioeconomic status appear to be more likely to use hookah,” said Joseph J. Palamar, PhD, MPH, a CDUHR affiliated researcher and an assistant professor of Population Health at NYU Langone Medical Center (NYULMC). “Surprisingly, students with more educated parents or higher personal income are at high risk for use. We also found that hookah use is more common in cities, especially big cities. So hookah use is much different from cigarette use, which is more common in non-urban areas.”
Hookah, an ancient form of smoking, in which charcoal-heated tobacco or non-tobacco based shisha smoke is passed through water before inhalation, is rapidly gaining popularity among adolescents in the US. The researchers found those students who smoked cigarettes, and those who had ever used alcohol, marijuana or other illicit substances were more likely to use hookah.
“Tobacco use and exposure to secondhand smoke are the leading preventable causes of morbidity and mortality in the US,” said a study co-author Michael Weitzman, MD, a professor of Pediatrics and of Environmental Medicine at the NYULMC. “Cigarette use has decreased by 33% in the past decade in the US, while the use of alternative tobacco products such as hookahs has increased an alarming 123%. This is especially worrisome given the public misperception that hookahs are a safe alternative to cigarettes whereas evidence suggests that they are even more damaging to health than are cigarettes.”
While the US is experiencing an alarming increase in hookah use among adolescents, Dr. Palamar does point out that “Use tends to be much different from traditional cigarette smoking. Right now it appears that a lot of hookah use is more ritualistic, used occasionally–for example, in hookah bars, and not everyone inhales.”
“However, times are beginning to change,” notes Dr. Palamar. “Now something called hookah pens, which are similar to e-cigarettes, are gaining popularity. While not all hookah pens contain nicotine, this new delivery method might normalize hookah use in everyday settings and bring use to a whole new level.”
Researchers note that social stigma toward cigarette use appears to have played a large part in the recent decrease in rates of use, but they caution that it is doubtful these new hookah pens are frowned upon as much as cigarettes. Hookah pens also come in trendy designs and colors, which may be appealing to both adolescents and adults.
“These nifty little devices are likely to attract curious consumers, possibly even non-cigarette smokers,” said Dr. Palamar. “And unlike cigarettes, hookah comes in a variety of flavors and is less likely to leave users smelling like cigarette smoke after use. This may allow some users to better conceal their use from their parents or peers.”
Researchers conclude increased normalization might lead to increases in use, and possibly adverse consequences associated with repeated use. “This portends a potential epidemic of a lethal habit growing among upper and middle class adolescents,” said Dr. Weitzman. They stress that it is crucial for educators and public health officials to fill in the gaps in public understanding about the harm of hookah smoking.
###
Researcher Affiliations: Joseph J. Palamar, PhD–NYULMC, Department of Population Health; NYU CDUHR; Sherry Zhou, MD, MSc 2015, NYULMC, Departments of Pediatrics and Environmental Medicine; Scott Sherman, MD, MPH, NYULMC, Department of Population Health; Michael Weitzman, MD, NYULMC, Departments of Pediatrics and Environmental Medicine.
Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Acknowledgements: This project was not funded. The National Institute on Drug Abuse, Inter-university Consortium for Political and Social Research, and Monitoring the Future principal investigators, had no role in analysis, interpretation of results, or in the decision to submit the manuscript for publication. Monitoring the Future data were collected through a research grant (R01 DA-01411) from the National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the principal investigators, NIH or NIDA
About CDUHR
CDUHR, funded by the National Institute on Drug Abuse, is the first center for the socio-behavioral study of substance use and HIV in the United States. The Center is dedicated to increasing the understanding of the substance use-HIV/AIDS epidemic, particularly among individuals in high-risk contexts. The Center’s theme is “Discovery to Implementation & Back: Research Translation for the HIV/Substance Use Epidemic.” The Center facilitates the development of timely new research efforts, enhances implementation of funded projects and disseminates information to researchers, service providers and policy makers.
About NYU Langone Medical Center
NYU Langone Medical Center, a world-class, patient-centered, integrated academic medical center, is one of the nation’s premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals—Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, the Medical Center’s dedicated inpatient orthopaedic hospital; and Hassenfeld Children’s Hospital, a comprehensive pediatric hospital supporting a full array of children’s health services across the Medical Center—plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The Medical Center’s tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education, and research. For more information, go to http://www.NYULMC.org, and interact with us on Facebook, Twitter, and YouTube.
About New York University College of Nursing
NYU College of Nursing is a global leader in nursing education, research, and practice. It offers a Bachelor of Science in Nursing, a Master of Science and Post-Master’s Certificate Programs, a Doctor of Philosophy in Research Theory and Development, and a Doctor of Nursing Practice degree. For more information, visit https://nursing.nyu.edu/
Contact: Lorinda Klein, NYULMC | 212.404.3533 |917.693.4846 LorindaAnn.Klein@nyumc.org
Christopher James, CDUHR | 212.998.6876 | christopher.james@nyu.edu

As with a many issues adolescents face, it is important for parents and guardians to know what is going on in their children’s lives. You should know who your children’s friends are and how these friends feel about smoking, drugs, and issues like sex. You should also know how the parents of your children’s friends feel about these issues. Do they smoke, for example, or are they permissive in allowing their children to use alcohol and/or other drugs. Are these values in accord with your values?

Resources:

1. A History of Tobacco http://archive.tobacco.org/History/Tobacco_History.html

2. American Lung Association’s Smoking and Teens Fact Sheet Women and Tobacco Use
African Americans and Tobacco Use
American Indians/Alaska Natives and Tobacco Use
Hispanics and Tobacco Use
Asian Americans/Pacific Islanders and Tobacco Use
Military and Tobacco Use
Children/Teens and Tobacco Use
Older Adults and Tobacco Use http://www.lung.org/stop-smoking/about-smoking/facts-figures/specific-populations.html

3. Center for Young Women’s Health A Guide for Teens
http://www.youngwomenshealth.org/smokeinfo.html

4. Kroger Resources Teens and Smoking
http://kroger.staywellsolutionsonline.com/Wellness/Smoking/Teens/

5. Teens Health’s Smoking
http://kidshealth.org/teen/drug_alcohol/tobacco/smoking.html

6. Quit Smoking Support.com http://www.quitsmokingsupport.com/teens.htm

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Hookah a growing menace for teen health

17 Nov

Peeps, the kids are thinking up new things to get into faster than moi can post. Newest fad hitting many high schools and colleges is hookah. Douglas Quenqua reported in the New York Times article, Putting A Crimp In the Hookah about hookah.

Kevin Shapiro, a 20-year-old math and physics major at the University of Pennsylvania, first tried a hookah at a campus party. He liked the exotic water pipe so much that he chipped in to buy one for his fraternity house, where he says it makes a useful social lubricant at parties.
Like many other students who are embracing hookahs on campuses nationwide, Mr. Shapiro believes that hookah smoke is less dangerous than cigarette smoke because it “is filtered through water, so you get fewer solid particles.”
“Considering I don’t do it that often, once a month if that, I’m not really concerned with the health effects,” he added.
But in fact, hookahs are far from safe. And now, legislators, college administrators and health advocates are taking action against what many of them call the newest front in the ever-shifting war on tobacco. In California, Connecticut and Oregon, state lawmakers have introduced bills that would ban or limit hookah bars, and similar steps have been taken in cities in California and New York. Boston and Maine have already ended exemptions in their indoor-smoking laws that had allowed hookah bars to thrive….
Many young adults are misled by the sweet, aromatic and fruity quality of hookah smoke, which causes them to believe it is less harmful than hot, acrid cigarette smoke. In fact, because a typical hookah session can last up to an hour, with smokers typically taking long, deep breaths, the smoke inhaled can equal 100 cigarettes or more, according to a 2005 study by the World Health Organization.
That study also found that the water in hookahs filters out less than 5 percent of the nicotine. Moreover, hookah smoke contains tar, heavy metals and other cancer-causing chemicals. An additional hazard: the tobacco in hookahs is heated with charcoal, leading to dangerously high levels of carbon monoxide, even for people who spend time in hookah bars without actually smoking, according to a recent University of Florida study. No surprise, then, that several studies have linked hookah use to many of the same diseases associated with cigarette smoking, like lung, oral and bladder cancer, as well as clogged arteries, heart disease and adverse effects during pregnancy. And because hookahs are meant to be smoked communally — hoses attached to the pipe are passed from one smoker to the next — they have been linked with the spread of tuberculosis, herpes and other infections.
“Teens and young adults are initiating tobacco use through these hookahs with the mistaken perception that the products are somehow safer or less harmful than cigarettes,” said Paul G. Billings, a vice president of the American Lung Association. “Clearly that’s not the case.”
Mr. Billings calls the emerging anti-hookah legislation a “top priority” for the lung association. http://www.nytimes.com/2011/05/31/health/31hookah.html?emc=eta1&_r=0

Kids mistakenly think hookah is safe.

Richard D. Hurt, M.D. of the Mayo Clinic has posted the article Hookah Smoking: Is it Safer Than Cigarettes? at the Mayo Clinic site:

Specially made tobacco is heated, and the smoke passes through water and is then drawn through a rubber hose to a mouthpiece. The tobacco is no less toxic in a hookah pipe, and the water in the hookah does not filter out the toxic ingredients in the tobacco smoke. Hookah smokers may actually inhale more tobacco smoke than cigarette smokers do because of the large volume of smoke they inhale in one smoking session, which can last as long as 60 minutes.
While research about hookah smoking is still emerging, evidence shows that it poses many dangers:
• Hookah smoke contains high levels of toxic compounds, including tar, carbon monoxide, heavy metals and cancer-causing chemicals (carcinogens). In fact, hookah smokers are exposed to more carbon monoxide and smoke than are cigarette smokers.
• As with cigarette smoking, hookah smoking is linked to lung and oral cancers, heart disease and other serious illnesses.
• Hookah smoking delivers about the same amount of nicotine as cigarette smoking does, possibly leading to tobacco dependence.
• Hookah smoke poses dangers associated with secondhand smoke.
• Hookah smoking by pregnant women can result in low birth weight babies.
• Hookah pipes used in hookah bars and cafes may not be cleaned properly, risking the spread of infectious diseases. http://www.mayoclinic.com/health/hookah/AN01265

Karen Kaplan reported in in the L.A. Times about Hookah growing allure among teens

In Cigars, e-cigarettes and hookahs increasingly popular among youth, Kaplan reported:

Electronic cigarettes, hookahs and dissolvable tobacco were all more popular in 2012 than in 2011, according to data CDC researchers published this week in the Morbidity and Mortality Weekly Report. Cigar smoking has also become more prevalent among high school students.
Overall, 6.7% of middle schoolers and 23.3% of high schoolers were using tobacco in 2012. In 2011, the corresponding figures were 7.5% and 24.3%.
Those figures are based on surveys of roughly 25,000 students in grades 6 through 12 who participated in the National Youth Tobacco Survey. Students were considered current tobacco users if they had smoked a cigarette, cigar, pipe, hookah, electronic cigarette, bidis (thin, hand-rolled cigarettes) or kreteks (clove cigarettes) or used smokeless tobacco, dissolvable tobacco, or snus (a powdered tobacco) at least once in the last 30 days.
Here’s what the researchers found:
Cigarettes were the most popular form of tobacco or nicotine among middle school students, with 3.5% of kids in grades 6 through 8 saying they had smoked a cigarette in the previous 30 days. That was followed by cigars (2.8% used them), pipes (1.8%), smokeless tobacco (1.7%), hookahs (1.3%), electronic cigarettes (1.1%), snus (0.8%), bidis (0.6%), kreteks (0.5%) and dissolvable tobacco (0.5%).
Cigarettes were also the most popular item among high schoolers, with 14% of students in grades 9 through 12 reporting they had smoked one within the last 30 days. Cigars came in a close second, with 12.6% of students saying they smoked them recently. In addition, 6.4% of high schoolers used smokeless tobacco, 5.4% used hookahs, 4.5% used pipes, 2.8% used electronic cigarettes, 2.5% used snus, 1% used kreteks, 0.9% used bidis and 0.8% used dissolvable tobacco.
Though overall tobacco use was down, the authors of the report flagged the rising popularity of products other than cigarettes that are not regulated by the Food and Drug Administration. In the case of cigars, they noted that some of the items in that category were “similar to cigarettes in terms of appearance, but depending on their weight, can be taxed at lower rates and legally sold with certain flavors that are banned from cigarettes.” The lower prices and option of flavors probably make them especially appealing to teens, they wrote….
http://www.latimes.com/science/sciencenow/la-sci-sn-smoking-tobacco-teens-cdc-20131115,0,6663897.story#axzz2ksth5AXn

Here is the press release from the Centers for Disease Control:

Tobacco Product Use Among Middle and High School Students — United States, 2011 and 2012
Weekly
November 15, 2013 / 62(45);893-897
Nearly 90% of adult smokers in the United States began smoking by age 18 years (1). To assess current tobacco product use among youths, CDC analyzed data from the 2012 National Youth Tobacco Survey (NYTS). This report describes the results of that analysis, which found that, in 2012, the prevalence of current tobacco product use among middle and high school students was 6.7% and 23.3%, respectively. After cigarettes, cigars were the second most commonly used tobacco product, with prevalence of use at 2.8% and 12.6%, respectively. From 2011 to 2012, electronic cigarette use increased significantly among middle school (0.6% to 1.1%) and high school (1.5% to 2.8%) students, and hookah use increased among high school students (4.1% to 5.4%). During the same period, significant decreases occurred in bidi* and kretek† use among middle and high school students, and in dissolvable tobacco use among high school students. A substantial proportion of youth tobacco use occurs with products other than cigarettes, so monitoring and prevention of youth tobacco use needs to incorporate other products, including new and emerging products. Implementing evidence-based interventions can prevent and reduce tobacco use among youths as part of comprehensive tobacco control programs. In addition, implementation of the 2009 Family Smoking Prevention and Tobacco Control Act, which granted the Food and Drug Administration (FDA) the authority to regulate the manufacture, distribution, and marketing of tobacco products (1–3), also is critical to addressing this health risk behavior.
NYTS is a school-based, self-administered, pencil-and-paper questionnaire administered to U.S. middle school (grades 6–8) and high school (grades 9–12) students to collect information on key tobacco control outcome indicators used to monitor the impact of comprehensive tobacco control policies and programs (4) and FDA’s newly granted regulatory authority. NYTS was conducted in 2000, 2002, 2004, 2006, 2009, 2011, and 2012. The 2012 NYTS used a three-stage cluster sampling procedure to generate a cross-sectional, nationally representative sample of students in grades 6–12. This report includes 2011 and 2012 NYTS data to provide an updated definition of current tobacco use, which now also includes hookahs, snus, dissolvable tobacco, and electronic cigarettes, to take into account nonconventional products that are new to the market or are increasing in popularity; data for these four products were first collected in 2011. The previous definition for current tobacco use did not include all of these products, thus yielding slightly lower estimates of current tobacco use. For example, in 2011, the previous definition for overall current tobacco use resulted in estimates of 7.1% for middle school and 23.2% for high school students (5), whereas the new definition resulted in 2011 estimates of 7.5% for middle school and 24.3% for high school students (Table).
Of the 284 schools selected for the 2012 NYTS, 228 (80.3%) participated, resulting in a sample of 24,658 (91.7%) among 26,873 eligible students; the overall response rate was 73.6%. The 2011 NYTS had a comparable overall response rate of 72.7% (5). Respondents were asked about their current use of cigarettes, cigars§ (defined as cigars, cigarillos, or little cigars), smokeless tobacco, pipes, bidis, kreteks, hookahs, snus, dissolvable tobacco, and electronic cigarettes. For each product, current use was defined as using on ≥1 day of the past 30 days.
Data were adjusted for nonresponse and weighted to provide national prevalence estimates with 95% confidence intervals for current tobacco use overall and by product, school level, sex, and race/ethnicity. Point estimate differences between 2011 and 2012 were assessed using a two-tailed t-test for significance (p<0.05).
In 2012, 6.7% of middle students reported current use of any tobacco product (Table). The most commonly used forms of tobacco were cigarettes (3.5%), cigars (2.8%), pipes (1.8%), smokeless tobacco (1.7%), hookahs (1.3%), electronic cigarettes (1.1%), snus (0.8%), bidis (0.6%), kreteks (0.5%), and dissolvable tobacco (0.5%). Among high school students, 23.3% reported current use of any tobacco product. The most commonly used forms of tobacco were cigarettes (14.0%), cigars (12.6%), smokeless tobacco (6.4%), hookahs (5.4%), pipes (4.5%), electronic cigarettes (2.8%), snus (2.5%), kreteks (1.0%), bidis (0.9%), and dissolvable tobacco (0.8%).
During 2011–2012, among middle school students, for current electronic cigarette use, significant increases were observed overall (0.6% to 1.1%) and among females (0.4% to 0.8%), males (0.7% to 1.5%), and Hispanics (0.6% to 2.0%) (Table). For hookahs, a significant increase was observed among Hispanics (1.7% to 3.0%).
During 2011–2012, among high school students, for electronic cigarette use, significant increases were observed overall (1.5% to 2.8%) and among females (0.7% to 1.9%), males (2.3% to 3.7%), non-Hispanic whites (1.8% to 3.4%), and Hispanics (1.3% to 2.7%). For hookahs, significant increases were observed overall (4.1% to 5.4%) and among non-Hispanic whites (4.3% to 6.1%). For cigars, a significant increase in use was observed among non-Hispanic blacks (11.7% to 16.7%).
Reported by
René A. Arrazola, MPH, Shanta R. Dube, PhD, Brian A. King, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Corresponding contributor: René A. Arrazola, rarrazola@cdc.gov, 770-488-2414.
Editorial Note
The findings in this report indicate that during 2011–2012 significant increases occurred in current use of nonconventional tobacco products, such as electronic cigarettes and hookahs, among middle and high school students; in addition, an increase in cigar use occurred among non-Hispanic black high school students. During this same period, overall current use of some tobacco products, such as bidis and kreteks, significantly decreased. These findings indicate that more efforts are needed to monitor and prevent the use of both conventional and nonconventional tobacco products among youths.
During 2011–2012, cigar use increased significantly among non-Hispanic black high school students to 16.7%, more than doubling the 2009 estimate (6). Further, cigar use among high school males (16.7%) was approximately double that of high school females (8.4%) and similar to cigarette use among high school males (16.3%). Cigars include traditional premium cigars as well as cigarillos and "little cigars," which are similar to cigarettes in terms of appearance, but depending on their weight, can be taxed at lower rates and legally sold with certain flavors that are banned from cigarettes (7). Youths are known to have higher rates of cigar use than adults, which might be related to the lower price of some cigars (e.g., cigarillos and "little cigars") relative to cigarettes, or the marketing of flavored cigars that might appeal to youths (8). Significant increases also were observed in overall use of current electronic cigarettes (9) and hookahs. Current use of electronic cigarettes doubled among middle and high school females, middle school males, and Hispanic high school students. Among non-Hispanic white high school students, this increase was slightly less than double (1.8% to 3.4%), and among high school males, this increase was slightly more than 60% (2.3 to 3.7). For current hookah use, an increase of more than 75% (1.7% to 3.0%) was observed for Hispanic middle school students; among high school students, an overall increase of more than 30% (4.1% to 5.4%) was observed, but for non-Hispanic whites, this increase was more than 40% (4.3% to 6.1%). The increase in use of electronic cigarettes and hookah tobacco could be attributed to low price, an increase in marketing, availability, and visibility of these products, and the perception that these tobacco products might be "safer" alternatives to cigarettes. Cigars, electronic cigarettes, hookah tobacco, and certain other new types of tobacco products are not currently subject to FDA regulation. FDA has stated it intends to issue a proposed rule that would deem products meeting the statutory definition of a "tobacco product" to be subject to the Federal Food, Drug, and Cosmetic Act.¶
The findings in this report are subject to at least six limitations. First, data were only collected from youths who attended either public or private schools and might not be generalizable to all middle and high school-aged youths. Second, data were self-reported; thus, the findings are subject to recall and response bias. Third, current tobacco use was defined by including students who responded to questions about at least one of the 10 tobacco products but might have had missing responses to any of the other tobacco products that were assessed; missing responses were considered as nonuse, which might have resulted in conservative estimates. Fourth, in 2012, the question wording for bidis and kreteks was modified, and cigar brand examples were added to the heading and ever cigar use question of the survey; therefore, any observed changes in prevalence estimates across years might be attributed in part to these wording modifications. Fifth, the NYTS overall response rate of 73.6% in 2012 and 72.7% in 2011 might have resulted in nonresponse bias, even after adjustment for nonresponse. Finally, estimates might differ from those derived from other youth surveillance systems, in part because of differences in survey methodology, survey type and topic, and age and setting of the target population. However, overall relative trends are similar across the various youth surveys (1).
Effective, population-based interventions for preventing tobacco use among youths are outlined in the Surgeon General's report (1) and the World Health Organization's MPOWER package (10). Interventions include increasing the price of all tobacco products, implementing 100% comprehensive smoke-free laws and policies in workplaces and public places, warning about the dangers of all tobacco use with tobacco use prevention media campaigns, increasing access to help quitting, and enforcing restrictions on all tobacco product advertising, promotion, and sponsorship. Interventions are best implemented as part of comprehensive tobacco control programs, which are effective in decreasing tobacco use in the United States (2). Full implementation of comprehensive tobacco control programs at CDC-recommended funding levels, in coordination with FDA regulations of tobacco products, would be expected to result in further reductions in tobacco use and changes in social norms regarding the acceptability of tobacco use among U.S. youths (1,2,10).
References
1. US Department of Health and Human Services. Preventing tobacco use among youth and young adults. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2012/index.htm.
2. CDC. Best practices for comprehensive tobacco control programs—2007. Atlanta, GA: US Department of Health and Human Services, CDC; 2007. Available at http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm.
3. CDC. CDC Grand Rounds: current opportunities in tobacco control. MMWR 2010;59:487–92.
4. CDC. Key outcome indicators for evaluating comprehensive tobacco control programs. Atlanta, GA: US Department of Health and Human Services, CDC; 2005. Available at http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/key_outcome/pdfs/frontmaterial.pdf .
5. CDC. Current tobacco use among middle and high school students—United States, 2011. MMWR 2012;61:581–5.
6. CDC. Tobacco use among middle and high school students—United States, 2000–2009. MMWR 2010;59:1063–8.
7. United States Government Accountability Office. Tobacco taxes: large disparities in rates for smoking products trigger significant market shifts to avoid higher taxes (GAO-12-475). Washington, DC: United States Government Accountability Office; 2012. Available athttp://www.gao.gov/products/gao-12-475 .
8. King B, Tynan M, Dube S, Arrazola R. Flavored-little-cigar and flavored-cigarette use among U.S. middle and high school students. J Adolesc Health 2013 [Epub ahead of print].
9. CDC. Notes from the field: electronic cigarette use among middle and high school students—United States, 2011–2012. MMWR 2013;62:729–30.
10. World Health Organization. WHO report on the global tobacco epidemic, 2008—the MPOWER package. Geneva, Switzerland: World Health Organization; 2008. Available at http://www.who.int/tobacco/mpower/mpower_report_full_2008.pdf .
* The question to assess past 30 day use of bidis changed between 2011 and 2012. In 2011, the bidis question was "In the past 30 days, on how many days did you smoke bidis?" Students selected among "0 days," "1 or 2 days," "3 to 9 days," "10 to 19 days," "20 to 29 days," or "all 30 days." In 2012, the bidis question was "In the past 30 days, which of the following products have you used on at least one day?" Students could select different products, of which "bidis (small brown cigarettes wrapped in a leaf)" was a possible selection. This change might have affected the results for bidis.
† The question to assess past 30 day use of kreteks changed between 2011 and 2012. In 2011, the kreteks question was "In the past 30 days, on how many days did you smoke kreteks?" Students selected among "0 days," "1 or 2 days," "3 to 9 days," "10 to 19 days," "20 to 29 days," or "all 30 days." In 2012, the bidis question was "In the past 30 days, which of the following products have you used on at least one day?" Students could select different products, of which "clove cigarettes (kreteks)" was a possible selection. This change might have affected the results for kreteks.
§ The heading for the cigar section of the questionnaire changed between 2011 and 2012. In 2011, the heading was "Cigars." In 2012, the heading was "Cigars, cigarillos, or little cigars, such as Black and Milds, Swisher Sweets, Dutch Masters, White Owl, or Phillies Blunts," and the question on ever use of cigars also included brand names. This change might have affected the results for cigars.
¶ FDA has expressed its intent to assert jurisdiction over all tobacco products. Additional information available at http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201304&RIN=0910-AG38 .
What is already known on this topic?
Nearly 90% of adult smokers began smoking by age 18 years.
What is added by this report?
Although decreases in the use of certain tobacco products (bidis and kreteks) have been observed, current cigar use has increased among non-Hispanic black high school students (11.7% to 16.7%), and the use of nonconventional products, such as electronic cigarettes, have increased among middle school (0.6% to 1.1%) and high school (1.5% to 2.8%) students.
What are the implications for public health practice?
Current use of cigars and nonconventional tobacco products need to be monitored at local, state, and national levels. This is especially true for nonconventional tobacco products and specific population subgroups. To reduce tobacco use among youths, national and state tobacco control programs can continue to implement evidence-based strategies, including those that will work in coordination with the Food and Drug Administration to regulate the manufacture, distribution, and marketing of tobacco products. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6245a2.htm?s_cid=mm6245a2_w

How to Prevent Your Teen from Smoking

Science Daily reported about a Swedish Study which showed that parents are influential in their child’s decision whether to smoke.

Teenagers are more positive today towards their parents’ attempts to discourage them from smoking, regardless of whether or not they smoked, than in the past. The most effective actions parents could take include dissuading their children from smoking, not smoking themselves and not allowing their children to smoke at home. Younger children were more positive about these approaches than older children. Levels of smoking amongst participants were stable at 8% in 1987 and 1994, but halved in 2003. The decrease in the proportion of teenagers smoking is thought to result from a number of factors, including changes in legislation and the decreasing social acceptability of smoking.
Use of snus, a type of moist snuff, remained relatively constant. Fewer teenagers thought their parents would be concerned about snus use, probably reflecting a general perception that snus is less of a health hazard than smoking. Unsurprisingly, older children were more likely to smoke or use snus than younger children.
The authors of the study concluded that the prevalence of smoking in adolescents in Sweden has fallen and an increasing number of teenagers have never smoked. “The fact that adolescents respond positively to parental attitudes to smoking is encouraging,” says Nilsson. “Parents should be encouraged to intervene with respect to their children’s tobacco use.” http://www.sciencedaily.com/releases/2009/03/090303193956.htm

Another study reported by Reuters came to a similar conclusion that parents influence the decision whether to smoke

Friends and parents have a strong influence over whether teenagers move from experimenting with cigarettes to becoming full-fledged smokers — but so do parents, a new study finds.
The study, which followed 270 teenagers who had become occasional smokers before high school, found that 58 percent made it a daily habit by 12th grade.
But the likelihood of that happening depended partly on friends and parents, according to a study published in the journal Pediatrics.
“We found that parents play an important role in preventing teens’ smoking escalation from experimental to daily smoking,” Dr. Min Jung Kim, of the University of Washington in Seattle, said.
When friends or parents smoked, teens were more likely to become daily smokers. On the other hand, they were less likely to become habitual smokers when their parents had a “positive family management” style — monitoring their comings and goings, doling out reasonable punishments for rule-breaking and rewarding good behavior.
Teens whose parents kept tabs on them and were non-smokers themselves had a 31 percent chance of becoming daily smokers. The odds were 71 percent among teenagers with parents who smoked and were more lax in managing their kids’ behavior. http://www.reuters.com/article/2009/08/26/us-smoking-teens-idUSTRE57P43R20090826

The Mayo Clinic has some excellent tips on preventing your teen from smoking These 10 tips can help.

1. Understand the attraction.
Sometimes teen smoking is a form of rebellion or a way to fit in with a particular group of friends. Some teens light up in an attempt to lose weight or to feel better about themselves. Others smoke to feel cool or independent. ..
2. Say no to teen smoking.
You may feel as if your teen doesn’t hear a word you say, but say it anyway. Tell your teen that smoking isn’t allowed. Your disapproval may have more impact than you think. Teens whose parents set the firmest smoking restrictions tend to smoke less than do teens whose parents don’t set smoking limits. The same goes for teens who feel close to their parents.
3. Set a good example.
Teen smoking is more common among teens whose parents smoke. If you don’t smoke, keep it up. If you do smoke, quit — now. ..
4. Appeal to your teen’s vanity.
Smoking isn’t glamorous. Remind your teen that smoking is a dirty, smelly habit. ..
5. Do the math.
Smoking is expensive. Help your teen calculate the weekly, monthly or yearly cost of a pack-a-day smoking habit. You might compare the cost of smoking with that of electronic gadgets, clothes or other teen essentials.
6. Expect peer pressure.
Friends who smoke can be convincing, but you can give your teen the tools he or she needs to refuse cigarettes. Rehearse how to handle tough social situations. It might be as simple as, “No thanks, I don’t smoke.” The more your teen practices this basic refusal, the more likely he or she will say no at the moment of truth.
7. Take addiction seriously.
Most teens believe they can quit smoking anytime they want. But teens become just as addicted to nicotine as do adults, often quickly and at relatively low doses of nicotine. And once you’re hooked, it’s tough to quit.
8. Predict the future.
Teens tend to assume that bad things only happen to other people. But the long-term consequences of smoking — such as cancer, heart attack and stroke — may be all too real when your teen becomes an adult. Use loved ones, friends or neighbors who’ve been ill as real-life examples.
9. Think beyond cigarettes.
Smokeless tobacco, clove cigarettes (kreteks) and candy-flavored cigarettes (bidis) are sometimes mistaken as less harmful or addictive than are traditional cigarettes. Hookah smoking — smoking tobacco through a water pipe — is another alternative sometimes touted as safe. Don’t let your teen be fooled. Like traditional cigarettes, these products are addictive and can cause cancer and other health problems. Many deliver higher concentrations of nicotine, carbon monoxide and tar than do traditional cigarettes.
10. Get involved.
Take an active stance against teen smoking. Participate in local and school-sponsored anti-smoking campaigns. Support bans on smoking in public places.
If your teen has already started smoking, avoid threats and ultimatums. Instead, be supportive. Find out why your teen is smoking — and then discuss ways to help your teen stop smoking, such as hanging out with friends who don’t smoke or getting involved in new activities. Stopping teen smoking in its tracks is the best thing your teen can do for a lifetime of good health. http://www.mayoclinic.com/health/teen-smoking/HQ00139

As with a many issues adolescents face, it is important for parents and guardians to know what is going on in their children’s lives. You should know who your children’s friends are and how these friends feel about smoking, drugs, and issues like sex. You should also know how the parents of your children’s friends feel about these issues. Do they smoke, for example, or are they permissive in allowing their children to use alcohol and/or other drugs. Are these values in accord with your values?

Resources

1. A History of Tobacco http://archive.tobacco.org/History/Tobacco_History.html

2. American Lung Association’s Smoking and Teens Fact Sheet Women and Tobacco Use
African Americans and Tobacco Use
American Indians/Alaska Natives and Tobacco Use
Hispanics and Tobacco Use
Asian Americans/Pacific Islanders and Tobacco Use
Military and Tobacco Use
Children/Teens and Tobacco Use

Older Adults and Tobacco Use
http://www.lung.org/stop-smoking/about-smoking/facts-figures/specific-populations.html

3. Center for Young Women’s Health A Guide for Teens http://www.youngwomenshealth.org/smokeinfo.html

4. Kroger Resources Teens and Smoking http://kroger.staywellsolutionsonline.com/Wellness/Smoking/Teens/

5. Teens Health’s Smoking http://kidshealth.org/teen/drug_alcohol/tobacco/smoking.html

6. Quit Smoking Support.com
http://www.quitsmokingsupport.com/teens.htm

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