REFERENCE: Elder, J. P., Atkins, C., de Moor, C., Edwards, C. C., Golbeck, A., Hovell, M. F., Molgaard, C. A., Nader, P. R., Sallis, J. F., Shulkin, J. J., Sleet, D. A., Wildey, M. B., Young, R. L., Wendt, G. (1989). Prevention of tobacco use among adolescents in public schools in San Diego County, U.S.A. Soz Preventive Medicine, 34, 24-29..

Data from the most recent U.S.A. national survey on the pattern of drug use among American adolescents indicate that cigarette use among high school students is declining. Between 1977 and 1986 the prevalence of daily smoking decreased from 29.0% to 18.4%. Currently 30% of high school seniors report having smoked cigarettes in the past month and 67.6% report having tried cigarettes at least once in their lifetimes. Thirty-day prevalence estimates vary by a number of demographic and social factors including gender, region of the U.S. and population density. National monthly use rates of males were found to be 27.9% versus 30.6% for females. Monthly use rates are highest in the Northeastern portion of the U.S. (35.2%) and lowest in the South (26.1%). Rural regions have a slightly higher rate of use (31.0%) than suburban (28.0%) and urban (30.8%) areas.

Just as cigarette smoking among adolescents has been decreasing, the use of chewing tobacco and snuff (both referred to as smokeless tobacco) has been increasing. Currently some 20 to 30 million Americans use some form of smokeless tobacco. A recent study by Schaefer, et al. showed that 12% of high school students regularly used smokeless tobacco; a study conducted in Massachusetts found 12% of high school boys to be users, while a Nebraska study showed only 7% of students in grades 7-12 to be regular users. Other prevalence estimates vary from 10.4% to as high as 31.0% for students of approximately the same age.

Smokeless tobacco use among high school students has been shown to be a predominantly male phenomena. In a recent study among high school students in Arkansas, fully 36.7% of males versus only 2.2% of females were shown to be current users of smokeless tobacco. Though rates of smokeless tobacco use are typically highest in the Southeastern and rural regions of the United States, substantial use rates are found outside these areas as well, with one recent study of Colorado high school students showing 10% of urban and 13% of rural subjects to be users.

Data from students at younger age levels show that weekly use among males in fourth grade varies from 2.8% to as high as 9.4%. The percentages among females at this grade level are substantially lower, ranging from 0.0% to 2.0%.

Generally, ethnic minorities are at reduced risk for assuming the practice of smokeless tobacco use, with the possible exception of American Indians. Hispanics have also been shown in some locations to be at increased risk for smokeless tobacco use. Blacks and Asians, however, are shown in most areas to be at substantially lower risk of use.

Just as progress has been made in recent efforts for preventing cigarette smoking, the tobacco industry in the United States and other Western countries has rapidly maneuvered to increase the marketing of smokeless tobacco. Their efforts have been successful, as it now appears that American youth are switching from cigarette smoking to smokeless tobacco use. Project S.H.O.U.T. is one of several new studies in the United States designed to counteract this trend by using successful psychosocial intervention techniques adapted from previous smoking prevention programs in the United States, Canada, Germany and elsewhere.


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