Arizona Department of Health Services

Arizona Youth Tobacco Survey
2013 Report
Bureau of Tobacco and Chronic Disease
Arizona
Department of
H

I

Prepared by:
Bureau of Tobacco and Chronic Disease, Arizona Department of Health
Services
Additional Contributors
Centers for Disease Control, Office of Smoking and Health
(core survey questions and dataset preparation)
ORC Macro
(sampling design, survey administration and data collection)
Arizona Department of Education
(survey coordination)

Thanks and Appreciation Are Extended to
The students who participated in the survey
And
The teachers and principals who facilitated their participation

II

Contents
DEFINITION OF TERMS ................................................................................................................................ VII
EXECUTIVE SUMMARY .................................................................................................................................. 1
INTRODUCTION ............................................................................................................................................. 2
1.1. Design and Purpose of the Survey ..................................................................................................... 2
1.2. The Instrument .................................................................................................................................. 2
1.3. Sampling............................................................................................................................................. 2
1.4. School and Student Response Rates .................................................................................................. 2
1.5. Weighting and Analysis ...................................................................................................................... 3
1.6. Population Estimates for Arizona Residents Age 10 – 19 in 2012 and Survey Population ................ 3
1.7. Student Sample (Unweighted Counts)............................................................................................... 4
1.8. Utility of the Survey ........................................................................................................................... 4
RESULTS AND TRENDS .................................................................................................................................. 5
2. PREVENTION ............................................................................................................................................. 5
2.1. Prevalence of Tobacco Use among Arizona Middle School Students................................................ 5
2.2. Access to Cigarettes and Other Tobacco Products .......................................................................... 18
2.3. Influence of the Media..................................................................................................................... 21
3. CESSATION .............................................................................................................................................. 23
3.1. Desire to Quit and Quit Attempts .................................................................................................... 23
3.2. Planning to Quit Within the Next Year............................................................................................. 25
3.3. Methods of Quit Attempts ............................................................................................................... 25
4. SECONDHAND SMOKE ............................................................................................................................ 26
4.1. Exposure in Rooms and Cars ............................................................................................................ 26
4.2. Comparing Exposure Rates from 2003 to 2013 ............................................................................... 28
4.3. Rules about Smoking in the Home ................................................................................................... 30
4.4. Students Bothered by Other People’s Cigarette Smoke .................................................................. 32
5. DISCUSSION OF FINDINGS....................................................................................................................... 32
5.1. Prevention: Tobacco Use, Access to Tobacco Products and the Influence ..................................... 32
of the Media............................................................................................................................................ 32
5.2. Access to Cigarettes and Other Tobacco Products .......................................................................... 33
5.3. Influence of the Media..................................................................................................................... 34
5.4. Cessation .......................................................................................................................................... 34
III

5.5. Secondhand Smoke .......................................................................................................................... 34
5.6. Survey limitations............................................................................................................................. 35

IV

Figures
Figure 1 Students' Self-reported Ever Use of Tobacco Products, YTS 2013 ................................................. 5
Figure 2 Students' Self-reported Current Use of Tobacco Products during the Past 30 Days, YTS 2013 ..... 6
Figure 3 Students' Self-reported Ever and Current Use of Tobacco, YTS 2003, 2013 .................................. 7
Figure 4 Students' Self-reported Ever Use of Tobacco Products, YTS 2003, 2013 ....................................... 8
Figure 5 Students' Self-reported Current Use of Tobacco, YTS 2003, 2013 ................................................. 9
Figure 6 Students' Self-reported Frequent Use of Tobacco, YTS 2003, 2013 ............................................... 9
Figure 7 Students' Self-reported Tobacco Use by Grade, YTS 2013 ........................................................... 10
Figure 8 Comparing Arizona Middle School Students' Self-reported Current Tobacco Use with National
Rates ........................................................................................................................................................... 11
Figure 9 Students' Self-reported Ever, Current, and Frequent Tobacco Use by Gender, YTS 2013 ........... 11
Figure 10 Students' Self-reported Current Use of Tobacco Products by Gender, YTS 2013 ...................... 12
Figure 11 Students' Self-reported Ever, Current and Frequent Tobacco Use by Gender, YTS 2003, 2013 13
Figure 12 Students' Self-reported Ever Use of Tobacco by Race/Ethnicity, YTS 2013................................ 14
Figure 13 Students' Self-reported Current Use of Tobacco by Race/Ethnicity, YTS 2013 .......................... 14
Figure 14 Students' Self-reported Frequent Use of Tobacco by Race/Ethnicity, YTS 2013 ........................ 15
Figure 15 Students' Self-reported Current Use of Tobacco by Race/Ethnicity, YTS 2003, 2013 ................ 15
Figure 16 Students' Self-reported Ever, Current and Frequent Smoking, YTS 2003, 2013......................... 16
Figure 17 Students' Self-reported Current Cigarette Use by Grade, YTS 2003, 2013 ................................. 17
Figure 18 How Current Smokers under 18 Reported Getting Cigarettes, YTS 2013................................... 18
Figure 19 How Current Tobacco Users under 18 Got Tobacco Products Other Than Cigarettes during the
Past 30 Days, YTS 2013 ............................................................................................................................... 19
Figure 20 Where Current Smokers under 18 Who Bought Cigarettes During the Past 30 Days Reported
Buying Them, YTS 2013 ............................................................................................................................... 20
Figure 21 Where Current Smokers under 18 Who Bought Cigarettes During the Past 30 Days Reported
Buying Them, YTS 2003, 2013 ..................................................................................................................... 20
Figure 22 Sale Refusals to Current Smokers under 18 Who Bought Cigarettes from a Store During the
Past 30 Days, YTS 2003, 2013 ..................................................................................................................... 21
Figure 23 Students Who Reported Seeing Actors Use Tobacco Some Times, Most of the Time, or Always
on TV or in the Movies, YTS 2013 ............................................................................................................... 22
Figure 24 Percent of Students Who Reported They Would Use or Wear Something that has a Tobacco
Company Name or Picture on it, YTS 2013 ................................................................................................. 23
Figure 25 Percent of Current Smokers Who Reported Wanting to Stop Smoking and Who Tried to Quit
Smoking During the Past 12 Months, YTS 2003, 2013 ................................................................................ 24
Figure 26 Students' Self-reported Quit Attempts During the Past 12 Months, YTS 2013 .......................... 24
Figure 27 Percent of Current Smokers Who Are Planning to Quit Within the Next Year, YTS 2013 .......... 25
Figure 28 Ways Current Smokers Attempted to Quit within the Last 12 Months, YTS 2013 ..................... 26
Figure 29 Exposure to Secondhand Smoke in Homes and Cars, YTS 2013 ................................................. 27
Figure 30 Exposure to Secondhand Smoke in Homes and Cars, Comparing Students Living with a Smoker
and Those Who Do Not, YTS 2013 .............................................................................................................. 28
Figure 31 Exposure to Secondhand Smoke in Homes and Cars, YTS 2003, 2013 ....................................... 29
V

Figure 32 Exposure to Secondhand Smoke in Homes and Cars among Students Living with a Smoker, YTS
2003, 2013 .................................................................................................................................................. 29
Figure 33 Exposure to Secondhand Smoke in Homes and Cars among Students Not Living with a Smoker,
YTS 2003, 2013 ............................................................................................................................................ 30
Figure 34 Rules about Smoking in the Home, YTS 2013 ............................................................................. 31
Figure 35 Rules about Smoking in the Home, Comparing Students Who Live with a Smoker and Those
Who Do Not, YTS 2013 ................................................................................................................................ 32

Tables
Table 1 2013 YTS Student and School Response Rate .................................................................................. 3
Table 2 Population Estimates for Arizona Residents Age 10-19 (2012) and Survey Population .................. 3
Table 3 Student Sample by Age .................................................................................................................... 4
Table 4 Student Sample by Grade................................................................................................................. 4
Table 5 Student Sample by Gender .............................................................................................................. 4
Table 6 Students' Self-reported Current Smoking by Gender, YTS 2003, 2013 .......................................... 17
Table 7 Students' Self-reported Current Smoking by Race/Ethnicity, YTS 2003, 2013 .............................. 17

VI

DEFINITION OF TERMS
Ever smokers or ever tobacco users. Ever users of cigarettes, smokeless tobacco, cigars or
cigarillos, pipe, bidis or kreteks are defined as students who have ever smoked (even one or two
puffs), taken one dip of smokeless tobacco, or tried any other tobacco product in their lifetime.
Current smokers or current tobacco users. Current users of cigarettes, smokeless tobacco,
cigars or cigarillos, pipe, bidis or kreteks are defined as students who reported product use on at
least one of the 30 days prior to the survey.
Frequent smokers or frequent tobacco users. Frequent users of cigarettes, smokeless
tobacco, cigars or cigarillos, pipe, bidis or kreteks are defined as students who reported product
use on at least 20 of the 30 days prior to the survey.

VII

EXECUTIVE SUMMARY
Youth who smoke or use other forms of tobacco are exposing themselves to products known to
have serious health consequences. Because many adult smokers (and users of other tobacco
products) report that they started smoking (or using) before the age of 18, it is important to
monitor youth smoking and tobacco use trends. The long-term health implications of using
tobacco products are not of concern to many youth who take up tobacco, even if they are aware
of them. Monitoring use trends and understanding the attitudes, beliefs, and behaviors of youth
regarding tobacco helps prevention educators, health practitioners, and other concerned adults
design and implement effective prevention programs, counter-marketing strategies, and quit
programs for youth.
This report presents data from the 2013 Arizona Youth Tobacco Survey on tobacco use
prevalence rates (including smoking and other forms of tobacco), access to tobacco products, the
influence of the media, information on desires and attempts to quit smoking, and exposure to
secondhand smoke. It was designed and implemented in coordination with the Centers for
Disease Control, Office of Smoking and Health. The survey administration was coordinated with
the Arizona Department of Education.
Long-term trends of student smoking show important declines – of over 30 percent – over the
past ten years. It is highly likely that youth prevention programs have contributed to the decline.
However, current tobacco use rates have become stable since 2003, and sustained efforts are
needed for the decline to continue. Many students in Arizona (about one-third) continue to be
exposed to secondhand smoke regularly in homes and cars where family members smoke. Rules
that prohibit smoking in the home are far less frequent in households with smokers than
households without smokers. The more that is discovered about the impact of secondhand smoke
on youth, the more health practitioners and other public officials call for strategies to protect
children from exposure in homes and cars where they spend much of their time.
With the help of its partners, the Arizona Department of Health Services will continue to
monitor youth tobacco use to inform and shape the direction of tobacco prevention control in the
state.

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INTRODUCTION
1.1. Design and Purpose of the Survey
The 2013 Arizona Youth Tobacco Survey (YTS) was completed in the spring of 2013 and a
biannual school-based survey first implemented in the spring of 2000. The survey is designed to
help monitor trends in tobacco use among public school students in grades 6 through 8 and to
compare changes in rates over time. The survey also collects data on topics including: tobacco
use; tobacco-related knowledge, attitudes and beliefs; access to tobacco products; exposure to
environmental tobacco smoke; initiation and cessation; influence of family, friends and the
media; and social, school and community interventions.
This report provides information on prevalence rates, access to tobacco, influence of the media,
quitting smoking, and exposure to secondhand smoke.
The 2013 Arizona YTS was centrally coordinated by the Bureau of Tobacco and Chronic
Disease, under the Arizona Department of Health Services, in collaboration with the
Arizona Department of Education and the Centers for Disease Control, Office on Smoking and
Health (CDC).
1.2. The Instrument
The Arizona Youth Tobacco Survey uses a core set of questions developed by the Centers for
Disease Control and Prevention, Office on Smoking and Health (CDC) to assist states with their
tobacco control efforts. The Arizona YTS was administered simultaneously with the Arizona
Youth Risk Behavior Survey in the spring of 2013 as part of a collaborative effort between the
Arizona Department of Education (ADE) and the Arizona Department of Health Services
(ADHS). The Arizona YTS contains 81 multiple-choice questions, including approximately 65
core questions from the CDC’s Youth Tobacco Survey. The questions cover prevalence, sources
of tobacco products, attitudes and beliefs, environmental tobacco smoke, and media exposure
modeled after the standard CDC recommended core YTS questionnaire. Results from the
Arizona YTS can therefore be compared with results from other states and the National Youth
Tobacco Survey conducted by the CDC.
1.3. Sampling
The sampling methods for the 2013 Arizona YTS were devised by the CDC and a subcontractor,
ORC Macro. The sampling involved a two-stage cluster sampling design to obtain a
representative sample of students at the state (but not county) level in grades 6-8. In the first
sampling stage, district and charter schools were selected randomly within grade range. In the
second sampling stage, classes were selected randomly from each middle school with equal
probability sampling and all the students within a selected class are surveyed.
1.4. School and Student Response Rates
Classes from 18 district middle schools, and 14 charter middle schools were selected for the
sample. All students in selected classes were eligible to participate. The student and school
response rates, presented below, are regarded as very good.
2

Public Middle
Charter Middle
Total

2013 YTS School and Student Response Rates
Student
School
Selected Participated Percent Selected Participated Percent
1364
1209
88.6
20
18
90.0
523
412
78.8
20
14
70.0
1887
1621
85.9
40
32
80.0

Table 1 2013 YTS Student and School Response Rate

1.5. Weighting and Analysis
A weighting system was devised based on the probability of selecting the school and selecting
the classroom, a non-response adjustment factor for school size, a class adjustment factor
calculated by school, a student-level non-response adjustment calculated by class, and a poststratification adjustment factor calculated by gender, grade and race. The weighting system was
designed to allow statewide inferences to be made concerning tobacco use risk behaviors for all
public school students in grades 6-8.
The analyses presented in this report were calculated using SAS version 9.3 using the
sampling weights. In compliance with the survey methodology, all findings reported in this
document are based on weighted data.
1.6. Population Estimates for Arizona Residents Age 10 – 19 in 2012 and

Survey Population
Table 2 below provides estimates of the Arizona population between the ages of ten and
nineteen in 2013. The YTS primarily includes students between the ages of eleven and eighteen,
but a small number of students below age eleven and above age eighteen are included. The table
also provides the number of student respondents by race/ethnic group with and without the
weighting scheme. Two racial/ethnic groups had a very low number of respondents. Because
these groups are so small, responses to questions presented by race/ethnicity are not reliable and
therefore are not
included in this report.
White,
nonHispanic
Number
427,139
% of Total
46.3%
Population
Number of
965
Unweighted
Survey
Population

Hispanic/
Latino

African
American/
Black

Asian or
Pacific
Islander

44,404
4.8%

American
Indian or
Alaskan
Native
54,588
5.9%

372,610
40.4%
619

167

214

94

Not
Identified

23,467
2.6%

Total

922,208
100%
261

1,621

Table 2 Population Estimates for Arizona Residents Age 10-19 (2012) and Survey Population

Source: http://www.azdhs.gov/plan/menu/info/pop/pop12/pd12.htm on July 15, 2013.

3

1.7. Student Sample (Unweighted Counts)
The tables below present the number and percent of students by age, grade and gender. Unless
otherwise specified, the findings and graphs in this report refer to the entire sample. If not, the
unweighted count of the sub-sample for each particular graph is specified.
Age
11 years old or younger
12 years old
13 years old
14 years old
15 years old
16 years old or older

Number
172
505
615
295
23
6

Percent
9.9%
29.5%
36.3%
22.3%
1.5%
0.4%

Number
539
628
427

Percent
32.7%
33.6%
33.7%

Number
831
782

Percent
48.8%
51.2%

Table 3 Student Sample by Age

Grade
6th
7th
8th
Table 4 Student Sample by Grade

Gender
Female
Male
Table 5 Student Sample by Gender

1.8. Utility of the Survey
The survey provides timely and reliable data on the prevalence of tobacco use among Arizona’s
school-based youth and permits the formulation of trends over time. In addition, the survey:
1) increases our knowledge and understanding of youth’s attitudes and behaviors regarding
tobacco use;
2) provides data relevant for enhancing the design, implementation, and evaluation of
comprehensive tobacco prevention and control programs directed at Arizona youth;
3) combines with data from other sources to help develop strategies to target youth who are
at higher risk of tobacco use;
4) allows for comparison of Arizona students’ tobacco use rates with those of students from
other states and nationwide; and,
5) allows for the identification of issues in need of further research and study.

4

RESULTS AND TRENDS
2. PREVENTION
Prevention efforts include educational programs to steer young people away from using tobacco,
controlling and monitoring where and how students obtain tobacco, and social marketing
campaigns to influence young people’s choices about taking up tobacco. The first three sections
of the report provide findings that are related to these three areas: tobacco prevalence rates,
access to tobacco products and the influence of the media.
2.1. Prevalence of Tobacco Use among Arizona Middle School Students
This section of the report presents prevalence rates for students who reported using any type of
tobacco product, not just cigarettes, since all forms of tobacco are covered in the survey and all
pose health risks. Some students used more than one type of tobacco product.
Ever, Current and Frequent Tobacco Use, YTS 2013
About one-fifth of middle school students (22%) reported ever trying some form of tobacco in
their lifetime (Figure 1). Current use, defined as the use of any form of tobacco during the past
30 days, including just a puff of a cigarette or dip of chew, was reported by seven percent of
middle school students (Figure 2). Cigarettes were the most commonly used form of tobacco by
both ever and current users in middle school. Current cigarette use was reported by three percent
of middle school students. Current use of cigars and cigarillos was also reported at three percent
for middle school students. The rates for additional tobacco products are reported in Figures 1
and 2, below.
Students' Self-reported Ever Use of Tobacco Products, YTS 2013
25%
22
20%
14

15%

10

10%

8

7
3

5%

0%
Any Tobacco

Cigarettes

Cigars/Cigarillos

Smokeless
Tobacco

Bidis/Kreteks

Pipe/Hookah

Figure 1 Students' Self-reported Ever Use of Tobacco Products, YTS 2013

5

Students' Self-reported Current Use of Tobacco Products during the Past 30
Days, YTS 2013
8%
7%

7

6%
5%

4

4%

3

3%

3

3
2

2%
1%
0%
Any Tobacco

Cigarettes

Cigars/Cigarillos

Smokeless
Tobacco

Bidis/Kreteks

Pipe/Hookah

Figure 2 Students' Self-reported Current Use of Tobacco Products during the Past 30 Days, YTS 2013

Frequent tobacco use, defined as use on 20 or more of the past 30 days, was reported by one
percent of middle school students. About 37 percent of these students reported living with a
smoker.
Trends in Ever, Current and Frequent Tobacco Use, YTS 2000, 2003 and 2005
Trends in ever and current tobacco use are presented for middle school students in Figures 3 to 6,
looking at data from 2003 and 2013. Prevalence rates for specific tobacco products are reported
only for the types of tobacco surveyed consistently across both surveys.
Trends in Ever Use
Middle school students’ ever use of any tobacco product declined from 42 percent in 2003 to 22
percent in 2013, a decrease of almost 50 percent during the ten year period. The decrease in ever
use applied to all forms of tobacco that the surveys collected data on across those years:
cigarettes, cigars/cigarillos, smokeless, and bidis/kreteks (Figure 3).

6

Students' Self-reported Ever and Current Use of Tobacco,
YTS 2003, 2013
45%

42

40%
35%
30%
2003
25%

22

2013

20%
15

15%
10%

7

5%
0%
Ever Use

Current Use

Figure 3 Students' Self-reported Ever and Current Use of Tobacco, YTS 2003, 2013

When broken down by product, ever use for all tobacco products has decreased in the last ten
years (Figure 4). Cigarettes, cigars/cigarillos, and bidis or kreteks have all decreased by more
than 50 percent since 2003. The only reported type of tobacco that did not show a significant
decrease was smokeless tobacco, which decreased by only one percent. While smokeless
tobacco use is still less than cigarette use and cigar use, the lack of a significant decrease in
prevalence is something that needs to be addressed. Ever use of pipe tobacco was asked during
the 2013 survey, with seven percent of youth having ever tried it. However, ever use of pipe
tobacco was not asked in prior years; therefore it is not presented in the figure.

7

Students' Self-reported Ever Use of Tobacco Products,
YTS 2003, 2013
35%

33

30%
25%

15%

2003

20

20%

2013
14
10

9

10%

8

8
3

5%
0%
Cigarettes

Smokeless Tobacco

Cigars

Bidis or Kreteks

Figure 4 Students' Self-reported Ever Use of Tobacco Products, YTS 2003, 2013

Trends in Current Use
Trends in current use (past 30 days) declined significantly for several tobacco products –
cigarettes, cigars/cigarillos, bidis, and pipe tobacco – from 2003 to 2013. Current use remained
stable for smokeless tobacco product use in 2003 (2%) and 2013 (2%, Figure 5). This shows a
clearly defined need for research and additional interventions aimed at this particular tobacco
product.

8

Students' Self-reported Current Use of Tobacco,
YTS 2003, 2013

10%
9%

9

8%
7%
6

6%

2003

5

5%

4

4%

3

3%

2013

4

3
2

2

2

2%
1%
0%
Cigarettes Smokeless Tobacco

Cigars

Bidis

Pipe

Figure 5 Students' Self-reported Current Use of Tobacco, YTS 2003, 2013

Trends in Frequent Use
Trends in frequent tobacco use among middle school students have varied by product between
2003 and 2013. Frequent use of cigarettes has decreased by more than one third. Frequent
smokeless tobacco use has decreased by half. Frequent cigar use and frequent pipe use has
remained stable over the last ten years. The only category that has shown an increase in frequent
users is with Bidis.
Students' Self-reported Frequent Use of Tobacco,
YTS 2003, 2013

1.5
1.5%

1.0%
0.8

0.4

2003
2013

0.6
0.5%

0.8 0.8

0.5 0.5

0.5

0.3

0.0%
Cigarettes

Smokeless Tobacco

Cigars

Bidis

Pipe

Figure 6 Students' Self-reported Frequent Use of Tobacco, YTS 2003, 2013

9

Tobacco Use by Grade, YTS 2013
Figure 7 presents tobacco use by grade for ever, current, and frequent use in 2013. The overall
trend shows that tobacco use typically rises at each grade level. This shows that young people
continue to try and use tobacco from grade 6 through grade 8.
Students' Self-reported Tobacco Use by Grade, YTS 2013
30%
27
25%
22

20%

Ever Use
Current Use

17

15%

Frequent Use

10%
6

5

8

5%
1

1.2

1.6

0%
6th Grade

7th Grade

8th Grade

Figure 7 Students' Self-reported Tobacco Use by Grade, YTS 2013

Comparing Tobacco Use by Grade in 2003 and 2013
Ever, current, and frequent tobacco use was lower in all grades in 2013 than in 2003. The rate
decreased by 50 percent in almost every grade and category, with the exception of frequent use
among seventh grade students.
Comparing Arizona Students’ Use Rates (YTS 2013) With National Rates (NYTS
2011)
The most recent national student tobacco survey data available are for the 2011 National Youth
Tobacco Survey conducted by the Centers for Disease Control. The national survey uses the
same core questions as Arizona YTS. Overall, current use rates reported nationally among
students were similar to rates reported in Arizona. In 2011, the national rate for current use of
any tobacco product among middle school students was just over seven percent. The current use
rate for Arizona’s middle school students in 2013 was just under seven percent. Current use rates
for specific tobacco products among Arizona middle school students showed slight variations
from the rates reported nationally (Figure 8).

10

Comparing Arizona Middle School Students' Self-reported Current Tobacco
Use with National Rates
8%
7
7%

National YTS 2011

7

Arizona YTS 2013

6%
5%
4

4

4%

3

3

3

3%

3
2

2

2

2

2%
1%
0%
Any Tobacco

Cigarettes

Cigars/Cigarillos Smokeless Tobacco Bidis/Kreteks

Pipe/Hookah

Figure 8 Comparing Arizona Middle School Students' Self-reported Current Tobacco Use with National Rates

Students Reporting Ever, Current and Frequent Tobacco Use by Gender
In 2013, ever, current, and frequent tobacco use rates were higher for male students in middle
school than for female students. The differences in use rates were more than six percent for ever
use, two percent for current use and almost one percent for frequent use (Figure 9).

30%

Students' Self-reported Ever, Current, and Frequent Tobacco Use by
Gender, YTS 2013
26

25%
20%

19
Female

15%

Male

10%

8
6

5%
1

2

0%
Ever Use

Current Use

Frequent Use

Figure 9 Students' Self-reported Ever, Current, and Frequent Tobacco Use by Gender, YTS 2013

11

Use of Specific Tobacco Products by Gender
Figure 10 presents current use rates by gender for specific tobacco products. The rates are similar
for cigarettes, smokeless tobacco and bidis. The only two products having higher use rates for
males than females is cigar/illos and pipe tobacco (Figure 10).
Students' Self-reported Current Use of Tobacco Products by Gender,
YTS 2013

6%

5
5%
4%
3

3.5

3

3

3%

2

2

Male
Female

2

2

2

2%
1%
0%
Cigarettes

Smokeless
Tobacco

Cigar

Pipe

Bidis

Figure 10 Students' Self-reported Current Use of Tobacco Products by Gender, YTS 2013

Trends in Ever, Current and Frequent Use by Gender
Looking at trends in middle school ever use and current use rates by gender over time, both
males and females reported lower rates in 2013 than in 2003 (Figure 11). However, frequent use
rates in both males and females in middle school remained stable over time.

12

Student's Self-reported Ever, Current and Frequent Tobacco Use by
Gender, YTS 2003, 2013
50%

46

45%
38

40%
35%
30%

26

2003

25%

19

20%

2013

15

14

15%
8

10%

6

5%

2

3
2

1

0%
Male

Female

Ever Use

Male

Female

Current Use

Male

Female

Frequent Use

Figure 11 Students' Self-reported Ever, Current and Frequent Tobacco Use by Gender, YTS 2003, 2013

Tobacco Use Rates by Race/Ethnicity
There are important differences in ever, current and frequent tobacco use rates across
racial/ethnic groups (see Figures 12 to 14 below). Findings for Asians and Hawaiian or Pacific
Islanders are not reported due to low numbers of respondents.
American Indian/Alaskan Native students reported the highest rates for ever tobacco use
(29.8%). The ever tobacco use rate for American Indians in middle school was higher by almost
three percent than the next highest group, Hispanic/Latino (27%). American Indian/Alaskan
Native, African American/Black and Hispanic/Latino students all had similar rates for current
tobacco use (9%, 9%, 9%). Frequent use rates were higher for African American/Black students
by more than three percent than for any other racial/ethnic group (6%).
It is important to recognize, however, that any use of tobacco for traditional or ceremonial
purposes by American Indians was not recorded in the survey and may be contributing to these
rates. In addition, the sample of American Indian students was located mostly in urban areas.
Current tobacco use rates were lowest for Whites (12%) in in all categories. Hispanic/Latino
students had rates similar to White students with frequent tobacco use.

13

Students' Self-reported Ever Use of Tobacco by Race/Ethnicity, YTS
2013
35%
30%

29.8
25.5

26.9

25%
18.0

20%
15%
10%
5%
0%
American Indian /
Alaskan Native

White

African American /
Black

Hispanic / Latino

Figure 12 Students' Self-reported Ever Use of Tobacco by Race/Ethnicity, YTS 2013

Students' Self-Reported Current Use of Tobacco by Race/Ethnicity,
YTS 2013
10%
9%

9.1

9.3

8.9

African American /
Black

Hispanic / Latino

8%
7%
6%

4.8

5%
4%
3%
2%
1%
0%
American Indian /
Alaskan Native

White

Figure 13 Students' Self-reported Current Use of Tobacco by Race/Ethnicity, YTS 2013

14

Students' Self-reported Frequent Use of Tobacco by Race/Ethnicity,
YTS 2013
6%

5.5

5%
4%
3%
2%

2.1

1.7
1.6

1%
0%
American Indian /
Alaskan Native

White

African American /
Black

Hispanic / Latino

Figure 14 Students' Self-reported Frequent Use of Tobacco by Race/Ethnicity, YTS 2013

Trends in Tobacco Use Rates by Race/Ethnicity, YTS 2003 and 2013
Figure 15 presents trends in current tobacco use rates for middle school students between 2003
and 2013. Overall, current tobacco use rates among middle school students decreased a little over
two percent for American Indian/Alaskan Native, White and African American/Black students.
Current tobacco use rates remained stable for Hispanics (9%).

14%
12%
10%

Students' Self-reported Current Use of Tobacco by Race/Ethnicity,
YTS 2003, 2013
11.9

11.5

9.3

9.1

8%

8.9

8.9
2003

7.1

6%

2013

4.8

4%
2%
0%
American Indian /
Alaskan Native

White

African American /
Black

Hispanic / Latino

Figure 15 Students' Self-reported Current Use of Tobacco by Race/Ethnicity, YTS 2003, 2013

15

Trends in Cigarette Smoking Prevalence Rates
This section of the report provides information on cigarette smoking only (no other tobacco
products).
Figure 16 presents ever, current and frequent smoking rates for middle students for 2003 and
2013. Ever, current and frequent smoking rates have decreased by more than 50 percent since
2003.
Students' Self-reported Ever, Current and Frequent Smoking, YTS
2003, 2013
35%

32.7

30%
25%
2003

20%
15%

2013

14.2
8.9

10%

3.2

5%

1.5

0.4

0%
Ever Use

Current Use

Frequent Use

Figure 16 Students' Self-reported Ever, Current and Frequent Smoking, YTS 2003, 2013

Figure 17 presents current smoking rates by grade. Current smoking rates more than double from
sixth grade to eighth grade. All grades have shown significant decrease from 2003 rates, with all
grades decreasing by more than half.

16

Students' Self-reported Current Cigarette Use by Grade,
YTS 2003, 2013
14%
13.1
12%
10%

2003

9.2
8%

2013

6%
4%

4.7

4.5
2.7

2%
1.7
0%
6th Grade

7th Grade

8th Grade

Figure 17 Students' Self-reported Current Cigarette Use by Grade, YTS 2003, 2013

Table 6 presents current cigarette smoking rates by gender. Current smoking rates are very
similar for males and females and follow the same trend in 2013 as in 2003.
2003
Male Current Smokers
Female Current Smokers

2013

9.0%
8.8%

3.2%
3.0%

Table 6 Students' Self-reported Current Smoking by Gender, YTS 2003, 2013

Table 7 presents current cigarette smoking rates by race/ethnicity. In 2003, African
American/Black students had the highest current smoking rates (12%) and showed the most
dramatic decrease in 2013 (1%). American Indian/Alaskan Natives were the second lowest in
2003 (7.4%) and decreased by two percent in 2013 (5%); however this is currently the highest
rate of all ethnicities.
2003
American Indian / Alaskan Native
White
African American / Black
Hispanic / Latino

7.4%
7.1%
11.9%
8.9%

2013
5.3%
3.0%
1.0%
4.1%

Table 7 Students' Self-reported Current Smoking by Race/Ethnicity, YTS 2003, 2013

17

2.2. Access to Cigarettes and Other Tobacco Products
How and Where Students Reported Getting Tobacco
Youth access to tobacco products has been a major focus of concern in tobacco control efforts
across the country. Federal and state laws in Arizona make it illegal for merchants to sell
tobacco to youth under the age of 18. Nonetheless, students in Arizona are able to get tobacco
from multiple sources, both social and commercial.
Figure 18 presents data on ways that current cigarette smokers under 18 reported getting their
cigarettes. The majority of current smokers who reported getting their cigarettes in a specific
way reported social sources as the most common, such as borrowing or bumming them (16%).
Having someone else buy them was the next most common way of obtaining cigarettes (13%).
However, the largest single source for obtaining cigarettes for middle school smokers was “some
other way”, that is, a way not included in the answer options. Surveillance surveys like the YTS
have not been successful at identifying all the sources youth have for obtaining cigarettes. This
indicates a need to conduct qualitative research, such as interviews and focus groups with youth
to help identify alternative sources.
How Current Smokers under 18 Reported Getting Cigarettes,
YTS 2013
23.5

25%
20%
16.3
15%
10%

12.9

11.2
8.1

7.0

5%
0%
I bought them I had someone I borrowed or Someone gave I took them
I got them
myself
else buy them bummed them them to me from a store or some other
for me
without my another person
way
asking
Figure 18 How Current Smokers under 18 Reported Getting Cigarettes, YTS 2013

Figure 19 presents data on how current users of tobacco products other than cigarettes acquired
them. Respondents were able to choose more than one answer, as they could have gotten their
tobacco from more than one source in the past 30 days.
Current tobacco users were more likely to purchase tobacco products other than cigarettes than
any other specified way (27%). Social sources such as borrowing or bumming tobacco from
someone (24%), and someone giving tobacco to the student (23%) were the next most likely

18

ways of obtaining tobacco. The majority of respondents stated they obtained their tobacco from
some other way (29%).
How Current Tobacco Users under 18 Got Tobacco Products Other
Than Cigarettes during the Past 30 Days, YTS 2013
35%
30%
25%
20%

28.7

27.3

24.1
20.5

22.7
18.6

15%
10%
5%
0%
I bought them I had someone I borrowed or Someone gave I took them
I got them
myself
else buy them bummed them them to me from a store or some other
for me
without my another person
way
asking
Figure 19 How Current Tobacco Users under 18 Got Tobacco Products Other Than Cigarettes during the Past 30 Days, YTS
2013

Where Current Smokers Buy Cigarettes
Figure 20 presents data about where current cigarette smokers in middle school buy cigarettes,
including social and commercial sources. These data present responses only for current smokers
who reported that they bought cigarettes during the past 30 days. The majority of students under
18 who identified a specific location bought cigarettes in a store, such as a gas station,
convenience store, grocery store or drug store (19%, 7%, 8%, 14%). However, the majority of
students reported buying cigarettes some other way (39%). Very few current smokers reported
buying from a vending machine, on the internet, or through the mail (3%, 3%, 4%).

19

Where Current Smokers under 18 Who Bought Cigarettes During the
Past 30 Days Reported Buying Them, YTS 2013
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%

38.7

19.7

14.0
8.6

8.2
3.1

3.1

4.2

Figure 20 Where Current Smokers under 18 Who Bought Cigarettes During the Past 30 Days Reported Buying Them, YTS 2013

Figure 21 compares data from 2003 to 2013 on stores where current smokers reported buying
cigarettes. Few differences exist other than grocery store and drugstore purchases more than
doubling over time. The “other” places category remains high and unexplained.
Where Current Smokers under 18 Who Bought Cigarettes During the
Past 30 Days Reported Buying Them, YTS 2003, 2013
60%

52.2

50%

38.7

40%
30%
20%
10%
0%

21.3

19.7
10.3 8.6

8.2
3.1

14.0
6.7

4.5
3.1

3.1
1.9

2003
2013

Figure 21 Where Current Smokers under 18 Who Bought Cigarettes During the Past 30 Days Reported Buying Them, YTS
2003, 2013

20

Vendors Requesting Proof of Age
To get a sense of the extent of merchant compliance with statutes forbidding the sale of tobacco
to underage youth, the students were questioned on whether someone in a store refused to sell
them cigarettes during the past 30 days because of their age. More than two thirds of students
(67.4%) attempted to buy cigarettes in a store during the past 30 days reported that
no one refused to sell them cigarettes because of their age.
Comparing data from 2003 to 2013, among the students who bought or attempted to buy
cigarettes in a store, student reports of sales refusals were 57 percent in 2003 and decreased to 33
percent in 2013 (Figure 22).
Sale Refusals to Current Smokers under 18 Who Bought Cigarettes
from a Store During the Past 30 Days, YTS 2003, 2013
70%
60%

57.2

50%
40%

32.6

30%

2003
2013

20%
10%
0%
Student was not refused sale due to age
Figure 22 Sale Refusals to Current Smokers under 18 Who Bought Cigarettes from a Store During the Past 30 Days, YTS 2003,
2013

2.3. Influence of the Media
The American Legacy Foundation, the Campaign for Tobacco Free Kids, and other organizations
have devoted considerable energy and resources to gain a better understanding of the impact of
the media, especially tobacco companies’ advertising campaigns, on young people taking up
tobacco and on their smoking behaviors. The questions related to media on the YTS do not
provide comparable scope or depth of information on this subject, but they do give us an
indication of the relationship between students viewing smoking in the media, using articles with
tobacco branding, hearing messages in the media on the dangers of tobacco use and their
smoking behaviors.
In addition to being the target of direct marketing on the part of tobacco companies, youth are
exposed to adult smoking in the mass media, especially on television and in the movies. Viewing
admired television, sports, and movie stars using tobacco is believed to present an influential role
model promoting tobacco use to youth. In this survey, students were asked how often they saw
21

actors and athletes using tobacco on television and/or in the movies when they watched them.
The majority reported seeing actors use tobacco some or most of the time.
However, how much influence seeing actors use tobacco has on students’ tobacco use is not
clear. In the YTS, current tobacco users reported slightly lower levels (58%) of seeing actors use
tobacco on TV and in the movies than students who hadn’t used tobacco in the past month (64%,
Figure 23). Frequent tobacco users reported seeing actors using tobacco more often than any
other group (88%).
Students Who Reported Seeing Actors Use Tobacco Some Times,
Most of the Time, or Always on TV or in the Movies, YTS 2013
100%

87.9

90%
80%
70%
60%

64.2
58.3

50%
40%
30%
20%
10%
0%
Current Tobacco Users

Frequent Tobacco Users

Students who had not used
tobacco in past month

Figure 23 Students Who Reported Seeing Actors Use Tobacco Some Times, Most of the Time, or Always on TV or in the
Movies, YTS 2013

Tobacco companies target youth with advertising paraphernalia such as lighters, t-shirts, hats
and sunglasses. Less than ten percent of never smokers reported they would definitely or
probably use or wear something with a tobacco company name or picture on it (7.2%). In
contrast, this was true for almost 40 percent of ever smokers (38.9%, Figure 24). Counter
marketing campaigns might be helpful in reducing this appeal.

22

Percent of Students Who Reported They Would Use or Wear
Something that has a Tobacco Company Name or Picture on it,
YTS 2013
90%

76.8

80%
70%
60%
50%

41.8

40%
30%
20%
10%

Has not tried smoking

22.1

16.8
1.9

Has tried smoking

5.3

12.5 12.0

0%
Very Likely

Somewhat Likely

Somewhat
Unlikely

Very Unlikely

Figure 24 Percent of Students Who Reported They Would Use or Wear Something that has a Tobacco Company Name or
Picture on it, YTS 2013

3. CESSATION
This section of the report presents data on current smokers’ responses to questions about
quitting. The number of respondents is included in each graph since current smokers are a subset
of the total sample.
3.1. Desire to Quit and Quit Attempts
In 2013, almost 40 percent of the current smokers reported that they want to quit smoking
cigarettes (38.3%, Figure 25). This has decreased more than ten percent from 2003. Just over
half the current smokers reported they had tried to quit smoking during the past twelve months,
which shows a slight increase from 2003 (56%, Figure 25).
In attempting to quit, more students reported trying one time in the past 12 months than any other number
of quit attempts (24%, Figure 26). The next highest percentage of students tried to quit ten or more times
during the past month (14%).

23

Percent of Current Smokers Who Reported Wanting to Stop
Smoking and Who Tried to Quit Smoking During the Past 12
Months, YTS 2003, 2013
60%
51.9

50.3

55.5

50%
38.3

40%

2003

30%

2013
20%
10%
0%
Want to Quit

Tried to Quit

Figure 25 Percent of Current Smokers Who Reported Wanting to Stop Smoking and Who Tried to Quit Smoking During the
Past 12 Months, YTS 2003, 2013

Students' Self-reported Quit Attempts During the Past 12 Months,
YTS 2013
25%

23.6

20%
14.2

15%

10%

8.0

7.6

5%
2.1
0%
1 time

2 times

3-5 times

6-9 times

10 or more times

Figure 26 Students' Self-reported Quit Attempts During the Past 12 Months, YTS 2013

24

3.2. Planning to Quit Within the Next Year
The majority of current youth smokers either do not identify themselves as smokers or do not plan to give
up smoking within the next year (Figure 27). Of the students who plan on quitting within the next year,
the majority identify the next sixth months as when they want to quit (12.3%).

Percent of Current Smokers Who Are Planning to Quit Within the
Next Year, YTS 2013
35%
30%

32.5

28.2

25%
20%
12.3

15%
10%

7.7
6.6

7.2

5%
0%
I do not smoke Within 7 days Within 30 days

Within 6
months

Within 1 year I do not plan to
give up
smoking in the
next year

Figure 27 Percent of Current Smokers Who Are Planning to Quit Within the Next Year, YTS 2013

3.3. Methods of Quit Attempts
Figure 28 shows the majority of current smokers did not try to quit within the past year (19%).
Of those that did attempt to quit for good, trying to quit on their own, or “cold turkey”, was the
method that was used most often (13%). Less than ten percent had utilized a program either
within their school or within their community (8%). Almost five percent reported they had
called a telephone help line or quit line, and none of the students reported visiting an internet quit
site.

25

Ways Current Smokers Attempted to Quit within the Last 12 Months,
YTS 2013
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%

18.6
13.2

5.6

2.5

4.6
3.1

1.6

2.4
0.9

0

0.7

Figure 28 Ways Current Smokers Attempted to Quit within the Last 12 Months, YTS 2013

4. SECONDHAND SMOKE
Secondhand smoke contains cancer causing chemicals and contributes to numerous diseases in
both adults and children. The impact of secondhand smoke on young people’s health is
heightened due to their ongoing physiological development. Young people are particularly
vulnerable to exposure to secondhand smoke at home and in cars.
4.1. Exposure in Rooms and Cars
Students were asked on how many of the past seven days they had been in the house or the same
car with someone who was smoking cigarettes. Students reported 20 percent exposure to
cigarette smoke at least once in their house during the past week, and 19 percent also reported
exposure at least once in a car (Figure 29).
Repeated exposure in the home (three or more times in the past week) was reported by 15
percent of students. Repeated exposure in a car was reported by 10 percent of students.

26

Exposure to Secondhand Smoke in Homes and Cars, YTS 2013
25%
20.7
20%

19.4
14.8

15%

10.3
10%

5%

0%
Exposure in the home, Exposure in a car, one Repeated exposure in Repeated exposure in a
one or more days
or more days
the home
car
Figure 29 Exposure to Secondhand Smoke in Homes and Cars, YTS 2013

Figure 30 compares exposure to secondhand smoke between students who live with a smoker
and those who do not. Differences in exposure rates between the two groups are high. One or
more exposures in the home during the past seven days was reported by 47 percent of students
living with a smoker compared to four percent of the students that do not live with a smoker.
One or more exposure in a car during the past seven days was reported by 40 percent of those
living with a smoker compared to eight percent of those who do not.
The difference in repeated exposures (three or more times) in the home and cars is particularly
pronounced. Repeated exposure in the home was reported by 37 percent of those who live with a
smoker compared to two percent of those who do not. Repeated exposures in a car were reported
by 24 percent of those living with a smoker and three percent of those who do not.

27

Exposure to Secondhand Smoke in Homes and Cars, Comparing
Students Living with a Smoker and Those Who Do Not, YTS 2013
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%

47.0
40.3

37.4

24.3

Lives with a
smoker
Does not live
with a smoker

7.7
4.3

Exposed at least
once in home in
past 7 days

2.0

2.7

Exposed at least Exposed at least Exposed at least
three times in once in car in past three times in car
home in past 7
7 days
in past 7 days
days

Figure 30 Exposure to Secondhand Smoke in Homes and Cars, Comparing Students Living with a Smoker and Those Who Do
Not, YTS 2013

4.2. Comparing Exposure Rates from 2003 to 2013
Reports of exposure rates among middle school students in 2013 decreased in all categories from
2003. Reports of exposure at least once in a room were 49 percent in 2003 and decreased to 21
percent in 2013. Repeated exposures in the home decreased by almost half, from 28 percent in
2003 to 15 percent in 2013. Reports of single exposure in a car were lower by 16 percent (35% to
19%) and repeated exposures in a car were lower by 11 percent (21% to 10%).

28

Exposure to Secondhand Smoke in Homes and Cars, YTS 2003, 2013
60%
50%

49.2

40%

35.2
29.2

30%
20.7
20%

2003

21.0

19.4
14.8

2013
10.3

10%
0%
Exposure in the
home, one or more
days

Exposure in a car,
one or more days

Repeated exposure Repeated exposure
in the home
in a car

Figure 31 Exposure to Secondhand Smoke in Homes and Cars, YTS 2003, 2013

When comparing exposure rates of students living with a smoker from 2003 to 2013, both rates
for a single exposure in a room and single exposure in a car decreased by more than 20 percent.
Repeated exposures in a room decreased by 15 percent and repeated exposures in a car decreased
by almost 20 percent (Figure 32).
Exposure to Secondhand Smoke in Homes and Cars among Students
Living with a Smoker, YTS 2003, 2013
80%

70.8

70%

63.1

60%
50%
40%
30%

47.0

52.7
37.4

40.3

43.4
2003
24.3

2013

20%
10%
0%
Exposed at least once Exposed at least Exposed at least once Exposed at least
in home in past 7 three times in home in car in past 7 days three times in car in
days
in past 7 days
past 7 days
Figure 32 Exposure to Secondhand Smoke in Homes and Cars among Students Living with a Smoker, YTS 2003, 2013

29

From 2003 to 2013, exposure rates of students not living with a smoker decreased more for
exposures in a room (by 28 percent for single exposure and 10 percent for repeated exposures)
than in a car (by eight percent for single exposure and two percent for repeated exposures, Figure
33).
Figure 33. Exposure to Secondhand Smoke in Homes and Cars among Students Not Living with a
Smoker, Comparing YTS 2003 and 2013

Exposure to Secondhand Smoke in Homes and Cars among Students
Not Living with a Smoker, YTS 2003, 2013
35%

32.7

30%
25%
20%
15.2
15%

2013

10%
5%

2003

12.4
7.7

4.3
2.0

5.1
2.7

0%
Exposed at least once Exposed at least Exposed at least once Exposed at least
in home in past 7 three times in home in car in past 7 days three times in car in
days
in past 7 days
past 7 days
Figure 33 Exposure to Secondhand Smoke in Homes and Cars among Students Not Living with a Smoker, YTS 2003, 2013

4.3. Rules about Smoking in the Home
Eight out of ten students (81%) reported that smoking is not allowed anywhere inside their home.
Less than ten percent of students (8%) reported that smoking is allowed in some places or at
some times in their home. Five percent of middle school students reported that smoking is
allowed anywhere in their home (Figure 34).

30

Rules about Smoking in the Home, YTS 2013
90%

81.3

80%
70%
60%
50%
40%
30%
20%
10%

7.9
4.5

0%
Always Allowed

Sometimes Allowed or in Some
Places

Smoking is Never Allowed

Figure 34 Rules about Smoking in the Home, YTS 2013

Rules about smoking in the home vary considerably with or without the presence of a smoker in
the home. Seventy-two percent of students who do not live with a smoker reported that smoking
is not allowed anywhere in the home. Only 30 percent of students who live with a smoker
reported that smoking is not allowed anywhere in the home (Figure 35). This is extremely
important because it demonstrates that there is an opportunity to educate parents who smoke at
home about the risks of secondhand smoke to their children. Parents who smoke at home could
be targeted with media campaigns to implement smoking bans in their homes. Smoking bans
may provide an extra incentive for their children not to take up smoking or at least not to smoke
inside the home.

31

Rules About Smoking in the Home, Comparing Students Who Live
with a Smoker and Those Who Do Not, YTS 2013
1

94.2

0.9
0.8

73.4

0.7

Students who live
with a smoker

0.6
0.5

Students who do
not live with a
smoker

0.4
0.3
0.2
0.1

17.6
8.9
1.6

3.4

0
Always Allowed

Sometimes Allowed or
in Some Places in the
Home

Smoking is Never
Allowed

Figure 35 Rules about Smoking in the Home, Comparing Students Who Live with a Smoker and Those Who Do Not, YTS 2013

4.4. Students Bothered by Other People’s Cigarette Smoke
Most students (84%) reported that they were definitely or probably bothered by other people’s
cigarette smoke. Among students not living with a smoker, 91 percent reported they were
bothered by other people’s cigarettes smoke (67% definitely and 24% probably). This was true
for 89 percent of students living with a smoker (61% definitely and 25% probably).
Responses were quite different for students who are current smokers. Of current smokers, 71
percent reported that other people’s cigarette smoke definitely or probably bothered them,
compared to 86 percent of non-smokers.

5. DISCUSSION OF FINDINGS
5.1. Prevention: Tobacco Use, Access to Tobacco Products and the Influence

of the Media
There are mixed results in trends regarding tobacco use rates among middle and high school
students since 2000, the first year of the YTS.
Ever tobacco use (trying any form of tobacco sometime in one’s life) is going down. Ever
tobacco use (or lifetime use rates for all tobacco products combined) has decreased for middle
school students from 46 percent in 2000 to 22 percent in 2013, a decrease of 48 percent. This
suggests that experimentation with tobacco products has decreased in recent years.
Current tobacco use (using any form of tobacco even minimally at least once during the past 30
32

days) has decreased by more than half since 2000 for middle school students. Because current
use included students who used tobacco only once during the past month, it is important to
recognize that all current users were not necessarily regular users.
Frequent tobacco use (using on 20 or more of the past 30 days) has decreased by more than a
third. It is fair to assume that frequent users (less than two percent of middle school students) are
approaching addiction or are already addicted to tobacco.
Current smoking rates have declined among middle students (from 11% in 2000 to 3% in
2013).
A look at prevalence by race/ethnicity across YTS surveys (2000 to 2013) shows that rates have
decreased for all groups except for Hispanic/Latinos, which has remained stable (the numbers
sampled for Asians and Hawaiian/Pacific Islanders are too small to give reliable estimates).
American Indian, Whites, and African American/Blacks in middle school show declines in
current smoking within the last ten years.
Regarding tobacco use by gender for all products, females have lower use rates than males. Ever
and current tobacco use went down for both males and females in middle school, but frequent
use saw little change.
Much progress has been made over the past ten years in curbing tobacco use. One of the most
important trends in the data shows that current tobacco use rates (including smoking) jump
substantially at each grade level. As students get older, more take up tobacco and use it on a
regular basis. This indicates that opportunities continue to exist beyond middle school and into
high school to steer young people away from experimentation to regular use of tobacco. It also
indicates that providing effective interventions to high school students may be a tough challenge.
5.2. Access to Cigarettes and Other Tobacco Products
Students under 18 reported they acquired tobacco products through social sources and social
networks more than through commercial venues. Social sources are friends, acquaintances and
family members. Commercial venues are stores such as gas stations, tobacco shops, convenience
stores, grocery stores and drug stores.
Monetary exchange for tobacco products other than cigarettes was reported by 28 percent of
middle school current tobacco users (27 percent reported buying the tobacco themselves),
however borrowing or bumming tobacco products was also high on the list (24%).
A significant number of students reported getting both cigarettes and other tobacco products
“some other way,” which may include a monetary exchange. These other ways need to be
researched so that targeted interventions can take place.
Although a small proportion of students reported buying cigarettes from commercial sources
(7%), only about one-third of those who bought in a store reported they were asked for proof of
age.

33

Clamping down on tobacco sales to minors in commercial venues is extremely important but will
not curtail youth’s access to tobacco as social sources are more difficult to regulate. Conducting
inspections of retail tobacco vendors that are close to schools and to places where young people
congregate may help. Informing the public about the extent and dangers of social sources of
tobacco for youth is also needed. Consideration might be given to developing communications
that would discourage sales by older to younger persons, or even to friends.
5.3. Influence of the Media
Frequent tobacco users reported seeing actors use tobacco on tv and in the movies more than any
other group (88%). Students who had not used tobacco in the past month reported seeing actors
use tobacco 64% of the time, whereas current tobacco users reported seeing actors use tobacco
58% of the time. How much impact this has on their taking up tobacco is not clear, especially
when compared to the influence of family and friends. Ever smokers showed much more interest
in using or wearing something that has a tobacco company name or logo on it than never
smokers (39% for ever smokers, 7% for never smokers).
5.4. Cessation
Over a third of current smokers reported a desire to quit smoking, and just under half reported
trying to quit sometime during the past twelve months. About one-third reported two or more
quit attempts. The highest percentage of current smokers who attempted to quit within the past
12 months reported trying “cold turkey” (13%). Eight percent reported using a school or
community program. Fewer than 5 percent used a patch or nicotine gum to help them quit.
If students truly want to quit smoking, they need help to quit successfully. An examination of
successful quit programs and approaches to quitting that appeal to youth is in order. In addition,
strategies to get smokers who aren’t interested in quitting (more than half) to consider it would
also be beneficial.
5.5. Secondhand Smoke
In 2013, the frequency of students’ exposure varied substantially with the presence of a smoker
in the home. Almost 30 percent of students reported living with someone who smokes. Students
living with a smoker reported far higher rates of being exposed to secondhand smoke once or
multiple times in the home or a car during the previous week than students not living with a
smoker. Rates were reported at eight to ten times higher, with almost half of students living with
a smoker exposed at least once in the home during the previous week. Students living with a
smoker reported decreases in the number of exposures in the home and in cars during the past
seven days since 2003.
Rules about smoking in the home also varied substantially based on the presence of a smoker in
the home. About three quarters of students living with a smoker reported that smoking was not
allowed anywhere in their home compared to 95 percent of students not living with a smoker.
This means that about 25 percent of students living with a smoker are exposed to secondhand
smoke on a regular basis at home.
Most students reported that they are bothered by other people’s cigarette smoke (84%). Almost
three quarters of students who were current smokers reported so (71%).
34

Information about the harms of secondhand smoke is constantly being updated by researchers
and scientists. The more that is discovered, especially with regard to children, the more health
practitioners and other public officials call for strategies to protect children and youth from
secondhand smoke in homes and cars, where they are most likely to be exposed. There are
important social and health costs to having large numbers of youth exposed to secondhand
smoke. Efforts to get smokers in Arizona to refrain from smoking in the home and in cars would
be a good first step to alleviating those costs.
5.6. Survey limitations
There are important limitations to surveillance methodology and to this survey in particular:
1) The prevalence rates reported are based on self-reported behaviors, are estimates and are
meant to capture general trends. The most important functions of the survey are to detect general
trends and to uncover points of interest for further inquiry and study. 2) The data in this survey
are representative of the public school student population. Private schools, parochial schools,
juvenile detention centers and other special schools are not included in the survey. This
limitation is important because of existing evidence demonstrating that adolescents who are not
in school (and those with high numbers of absences) have higher rates of tobacco use than do
adolescents who are in school. This is known to be true for high school drop-outs in particular.

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