missouri youth and tobacco, 2007-2017

Missouri Youth and Tobacco, 2007-2017

Results from the Youth Tobacco Survey and Youth Risk Behavior Survey

Missouri Department of Health and Senior Services

Randall W. Williams, MD, FACOG, Director

Missouri Youth and Tobacco 2007-2017

ACKNOWLEDGEMENTS

Special thanks to the middle school students who participated in the 2017 Missouri Youth

Tobacco Survey and the high school students who participated in 2017 Missouri Youth Risk

Behavior Survey. Also, appreciation is extended to the administrators, teachers and staff of the

randomly selected schools for their assistance. This valuable information would not be available

without their cooperation.

Survey administration, data analysis and report preparation by:

Office of Epidemiology:

Noaman Kayani, PhD, Research Analyst

Kyle Waller, PhD, Research Analyst

Katie Long, MBA, Youth Risk Behavior Survey Administrator

Phone: (573) 526-6660

Email: [email protected]

Bureau of Community Health and Wellness:

Valerie Howard, MSW, Comprehensive Tobacco Control Manager

Leslie Murphy, Youth Tobacco Survey Administrator

Phone: (573) 522-2865

E-mail: [email protected]

The 2017 Missouri Youth Risk Behavior Survey was supported by cooperative agreement

number 5U87PS004191-04 between the U.S. Centers for Disease Control and Prevention (CDC)

Division of Adolescent and School Health and the Missouri Department of Elementary and

Secondary Education.

The 2017 Missouri Youth Tobacco Survey was supported by cooperative agreement number

NU58DP006006-02-00 between the CDC, Office on Smoking and Health, and the Missouri

Department of Health and Senior Services, Comprehensive Tobacco Control Program.

Suggested Citation: Missouri Youth and Tobacco, 2007-2017: A decade of progress in

prevention. Jefferson City, MO: Missouri Department of Health and Senior Services.

November 2017.


TABLE OF CONTENTS

Introduction…………………………………… …………………………………. 4

2017 Key Findings ………………….………………………………….……..…... 4

Survey Results:

Tobacco Use…………………….…………………………………………5

Electronic Vapor Products………….……………………………………..8

Quit Attempts and Assistance ..…….……………………………………10

Youth Access to Cigarettes……...……………………………………….11

Influences to Use Tobacco…...…………………………………………..11

Dangers of Tobacco Use Education…….…………………..………...…13

Secondhand Smoke Exposure…................................................................14

Secondhand Policies and Beliefs…….……………………………….…..16

Secondhand Smoke in the Workplace……………………………………18

Survey Methodology and Response Rates….…………………………………….19

Strategies for Reducing Tobacco Use among Missouri Youth…….…..…………20

References………..………………………………………………………….……22


Introduction

Tobacco use continues to be a leading cause of death and disability in Missouri and the United

States. From 2005-2015, an estimated 107,926 smoking attributable deaths occurred in Missouri.1

Preventing young people from becoming addicted to tobacco is a priority health objective for

Missouri and the nation. Nearly 9 out of 10 cigarette smokers first tried smoking before age 18.2

The Missouri Department of Health and Senior Services, in collaboration with the Missouri

Department of Elementary and Secondary Education (DESE) and the U.S. Centers for Disease

Control and Prevention (CDC) conducts biennial (every odd year) surveys of public middle and high

school students to track progress in efforts to reduce youth tobacco use and exposure to secondhand

smoke. Information about the methodology for the Youth Tobacco Survey (YTS) and Youth Risk

Behavior Survey (YRBS) may be found on page 19.

This report summarizes key findings from the 2017 YTS and YRBS and includes results from

previous years that demonstrate change over time. To view reports of YTS findings from previous

years, go to http://health.mo.gov/data/yts/data.php. YRBS data may be found on the CDC website at

https://www.cdc.gov/healthyyouth/data/yrbs/index.htm.

2017 Key Findings

The percentage of middle and high school students that ever tried smoking cigarettes continued

to decline.

Current cigarette smoking among middle and high schools students continued to decline with

the prevalence for both reduced by almost one-half since 2007.

Daily cigarette smoking among high school students continued to decline.

The percentage of males who used smokeless tobacco on one or more of the past 30 days

significantly declined from 17.0 percent in 2015 to 8.1 percent in 2017.

The percentage of middle school students who ever used any form of tobacco declined from

34.6 percent in 2007 to 15.1 percent in 2017.

The percentage of high school students who ever used any form of tobacco increased

significantly from 2013-2015 due to use of electronic vapor products.

Forty percent of high school students and 14 percent of middle school students had ever tried a

vapor product.

There was a significant decrease in the percentage of high school students who currently used

an electronic vapor product on one or more of the past 30 days from 22.0 percent in 2015 to

10.9 percent in 2017.

About one-half of middle (49.6%) and high (47.8%) school current smokers tried to quit in the

past year.

Almost one-half of middle (44.6%) and high (50.6%) school students were exposed to

secondhand smoke in a public indoor or outdoor place.

More than 80 percent of middle school current smokers live with someone that smokes tobacco

products.

About one-third of middle (30.8%) and high (36.6%) school students rode in or drove family

vehicles in which smoking was allowed, yet the vast majority thought smoking should never be

allowed in vehicles.

http://health.mo.gov/data/yts/data.php


Tobacco Use

The percentage of middle and high school students who had ever tried smoking cigarettes

declined significantly from 2007 to 2017 (Figure 1).

Current cigarette smoking among middle and high school students declined significantly from

2007 to 2017 (Figure 2).

26.4 22.118.3 14.6 11.5 10.3

51.145.7 43.0

39.234.5

28.6

0

20

40

60

80

100

2007 2009 2011 2013 2015 2017

Missouri Youth and Tobacco, 2007-2017Percentage of middle and high school students who ever smoked cigarettes

MiddleSchool

High School

Figure 1

21.3 19.4 18.1 14.911.0

9.26.9 5.7 5.4 4.0 2.43.50

20

40

60

80

100

2007 2009 2011 2013 2015 2017

Missouri Youth and Tobacco, 2007-2017Percentage of middle and high school students who smoked cigarettes on one

or more of the past 30 days (Current Smoking)

High School

Middle School

Figure 2


In 2017, there was a higher percentage of 12th grade students who had ever tried smoking

cigarettes (33.2%) than 6th grade students (6.0%). Current cigarette smoking among 6th grade

students was 2.4 percent while the percentage of 12th grade students was 15.4 percent (Figure 3).

The percentage of high school students who smoked cigarettes daily declined significantly from

6.9 percent in 2007 to 2.0 percent in 2017 (Figure 4).

6.010.7 14.2

22.527.7

32.4 33.2

2.4 3.2 5.1 4.07.7 10.3

15.4

0

20

40

60

80

100

6th 7th 8th 9th 10th 11th 12th

Missouri Youth and Tobacco, 2017Percentage of middle and high school students, by grade

Ever tried smoking cigarettes Currently smoke

Ever triedsmoking

Currentlysmoke

6.9 6.6 6.0 3.9 3.1 2.0

0

20

40

60

80

100

2007 2009 2011 2013 2015 2017

Missouri Youth and Tobacco, 2007-2017: High SchoolPercentage of students who smoked cigarettes daily

Figure 3

Figure 4


The percentage of males who used smokeless tobacco on one or more of the past 30 days

significantly increased from 2007 to 2013 before significantly declining from 17.0 percent in

2015 to 8.1 percent in 2017 (Figure 5).

The percentage of middle school students who had ever used any form of tobacco declined

significantly from 2007 to 2017 (Figure 6). Among high school students, who ever used any

form of tobacco also declined significantly from 2007 to 2013, but increased significantly in

2015 due to the increase in trying electronic vapor products (see page 8).

Note: From 2005-2011, any form of tobacco included cigarettes, cigars, smokeless, pipe, bidis, and

kreteks. For middle school students, e-cigarettes were added in 2013 and electronic vapor products were

added in 2015. Any form of tobacco used by high school students in 2013 was limited to cigarettes,

cigars, chewing tobacco, and e-cigarettes and in 2015 electronic vapor products were added.

12.916.6 17.8 18.0 17.0

8.1

0

20

40

60

80

100

2007 2009 2011 2013 2015 2017

Missouri Youth and Tobacco, 2007-2017: High SchoolPercentage of males who used smokeless tobacco on one or more of the past

30 days (Current smokeless tobacco use)

34.625.4 22.1 17.8 15.5 15.1

58.951.5 49.1

44.653.0 49.2

0

20

40

60

80

100

2007 2009 2011 2013 2015 2017

Missouri Youth and Tobacco, 2007-2017Percentage of middle and high school students who ever used any form of

tobacco

MiddleSchool

High School

Figure 5

Figure 6


Electronic Vapor Products

In 2017, the prevalence of ever used an electronic cigarette or electronic vapor product was at

14.4 percent among middle school students and 39.9 percent among high school students. This

prevalence significantly increased from 2013 to 2015 among middle and high school students,

but there was no significant change from 2015 to 2017 (Figure 7).

There was a significant decrease from 2015 to 2017 in the percentage of high school students

who currently used an electronic vapor product on one or more of the past 30 days (Figure 8).

8.514.0 14.412.4

40.6 39.9

0

20

40

60

80

100

2013 2015 2017

Percentage of middle and high school students, 2013-2017Ever used an electronic vapor product

Middle School

High School

7.25.4

22.0

10.9

0

20

40

60

80

100

2015 2017

Percentage of middle and high school students, 2015-2017Used an electronic vapor product on one or more of the past 30 days

(Current use)

Middle School

High School

Figure 7

Figure 8


The percentage of 6th grade students who ever tried vapor products was 6.1 percent compared to

50.1 percent of 12th grade students (Figure 9). Fourteen percent of 12th grade students currently

use vapor products.

*Middle school current use data from 2015, question was not asked on the 2017 survey.

Among high school current cigarette smokers, 85.3 percent had ever used a vapor product and

55.9 percent currently used vapor products (Figure 10). Among students who had tried

cigarettes, but did not smoke now, 69.8 percent had ever used a vapor product and 17.5 percent

were current vapor users. Among students who had never tried smoking cigarettes, 24.6 percent

had ever used a vapor product and only 4.4 percent currently used the products. This indicates

that current smokers are more likely than former and non-smokers to ever try or currently use

vapor products.

6.114.4

22.331.8 34.5

47.4 50.1

2.9* 6.3*12.6*

6.511.0

13.7 14.0

0

20

40

60

80

100

6th 7th 8th 9th 10th 11th 12th

Missouri Youth and Tobacco, 2017*Percentage of middle and high school students by grade

Ever used vapor productCurrently use vapor products

Ever used vaporproduct

Currently use vaporproducts

85.3

69.8

24.6

55.9

17.5

4.4

0

20

40

60

80

100

Currently smokecigarettes

Tried cigarettes, do notsmoke now

Never tried cigarettes

Missouri Youth and Tobacco, 2017: High SchoolPercentage of current cigarette smokers and non-smokers

Ever used vapor productsCurrently use vapor products

Ever used vaporproduct

Currently usevapor product

Figure 9

Figure 10


Quit Attempts and Assistance

About one-half of middle and high school current smokers tried to quit each year from 2007-

2017 (Figure 11).

Few high school students who currently smoked or were a tobacco user (2007-2017) had

participated in a program to help them quit (Figure 12). In 2017, only 4.1 percent of high school

students had special groups or classes at school for students who wanted to quit using tobacco.

56.864.6

58.2

70.3

52.6 49.656.8 55.4 52.1 54.4

46.0 47.8

0

20

40

60

80

100

2007 2009 2011 2013 2015 2017

Missouri Youth and Tobacco, 2007-2017Percentage of middle and high school current smokers who tried to quit

smoking in past year

Middle School

High School

10.2 7.4 5.3 10.6 11.08.9

0

20

40

60

80

100

2007 2009 2011 2013 2015 2017

Missouri Youth and Tobacco, 2007-2017: High SchoolPercentage of current cigarette smokers/tobacco users who ever participated

in a program to help them quit

Figure 11

Figure 12


Youth Access to Cigarettes

In 2017, among high school smokers younger than 18 years of age, 13.9 percent usually got their

cigarettes by buying them in a store or gas station in the 30 days prior to the survey (Figure 13).

Influences to Use Tobacco

Living with someone who smokes

A significantly greater percentage of middle and high school students who smoked lived with

someone that smoked compared to students who had never tried smoking (Figure 14). This is

particularly true for middle school students (81.2%) compared to high school students (60.5%).

*Middle school data from 2015, question was not asked on the 2017 survey.

20.0

9.315.1 14.7 14.4 13.9

0.0

20.0

40.0

60.0

80.0

100.0

2007 2009 2011 2013 2015 2017

Missouri Youth and Tobacco, 2007-2017: High SchoolPercentage of current smokers under age 18

Usual way of getting their cigarettes in past 30 daysBought in a store or gas station

81.2*

60.570.5*

55.8

38.3*30.1

0

20

40

60

80

100

Middle School High School

Missouri Youth and Tobacco, 2017*Percentage of students who live with someone that smokes tobacco

products, by student smoking statusCurrentlysmokescigarettes

Triedcigarettes, butdoes notsmoke now

Never triedsmoking

Figure 13

Figure 14


Tobacco Product Promotion

In 2015, a significantly greater percentage of middle school smokers would wear or use

something with a tobacco company name or picture on it than students who tried, but did not

smoke now or students who had never tried smoking (Figure 15).

*Question was not asked on the 2017 survey.

There was a significant increase from 2015 to 2017 in the percent of middle and high school

students who used the Internet and saw ads for tobacco products sometimes, most of the time or

always (Figure 16).

54.1

23.7

7.6

0

20

40

60

80

100

Current smokers Tried smoking, does not smoke now Never tried smoking

Missouri Youth and Tobacco, 2015: Middle SchoolPercentage of students who would use or wear anything with a tobacco

company name or picture on it, by smoking status

38.132.9

43.3 40.4

0

20

40

60

80

100


Missouri Youth and Tobacco, 2015-2017Percentage of students who used the Internet and saw ads for tobacco

products sometimes, most of the time or always

2015

2017

Figure 15

Figure 16


Dangers of Tobacco Use Education

Media Messages

There was no significant change in the percentage of high school students who saw or heard

anti-smoking ads during the past 30 days between 2007 to 2017 (Figure 17). The percentage of

middle school students who saw or heard ads about the dangers of smoking increased

significantly from 2013 to 2015.

Talking with parent or guardian

The percentage of middle school students whose parents or guardians talked with them, about

not using any type of tobacco product in the past 12 months, declined significantly from 2011 to

2013 (Figure 18).

62.756.4 51.9 55.8

72.5 69.474.469.0

60.868.5

78.7 77.8

0

20

40

60

80

100

2007 2009 2011 2013 2015 2017

Missouri Youth and Tobacco, 2007-2017Percentage of middle and high school students who saw or heard ads

about the dangers of smoking cigarettes on TV, the Internet or radio during past 30 days

Middle School

High School

68.9 69.1 66.0

45.0 48.7 53.9

0

20

40

60

80

100

2007 2009 2011 2013 2015 2017

Missouri Youth and Tobacco, 2007-2017: Middle SchoolPercentage of students who have discussed not using tobacco with a

parent or guardian in the past 12 months

Figure 17

Figure 18


Secondhand Smoke Exposure

In 2017, 28.5 percent of middle and 30.9 percent of high school students had someone smoke in

their home while they were there on one or more of the past seven days (Figure 19). The

prevalence of both middle and high school students who were exposed to secondhand smoke in

their home was significantly greater for students who had tried cigarettes than for those who had

never tried smoking.

In 2017, 30.8 percent of middle and 36.6 percent of high school students rode in a vehicle when

someone who was smoking on one or more of the past seven days (Figure 20). The prevalence

of both middle and high school students who were exposed to secondhand smoke in a car was

significantly greater for individuals who had ever tried cigarettes than for those who had never

tried smoking.

28.5 30.9

74.4

49.247.7 46.8

25.0 23.7

0

20

40

60

80

100


Missouri Youth and Tobacco, 2017Percentage of middle and high school students, by smoking status

Someone smoked tobacco products in their home while they were there on one or more of past seven days

All students

Currently smokes

Tried smoking, butdoes not smoke now

Never tried smoking

30.836.6

77.3 78.7

52.7 53.6

27.3 25.8

0

20

40

60

80

100



Rode in a vehicle when someone was smoking tobacco products on one or more of past seven days

All students

Currently smokes


Never tried smoking

Figure 19

Figure 20


About one-half of middle (44.6%) and high school (50.6%) students breathed smoke from

someone who was smoking at a public indoor or outdoor place on one or more of the past seven

days during 2017 (Figure 21). Among students who had never tried smoking cigarettes, 41.5

percent of middle and 42.9 percent of high school students were exposed to secondhand smoke

in a public place.

In 2017, 21.6 percent of middle and 6.6 percent of high school students had participated in

community activities to educate the public about the dangers of secondhand smoke (Figure 22).

No data was available for middle school students in 2013.

44.650.6

83.1 79.7

66.4 65.4

41.5 42.9

0

20

40

60

80

100



Breathed smoke from someone smoking in indoor or at outdoor public places on one or more of past seven days

All students

Currently smokes


Never tried smoking

18.8 21.6

8.6 6.4 6.6

0

20

40

60

80

100

2013 2015 2017

Missouri Youth and Tobacco, 2013-2017Percentage of middle and high school students who had participated in

community activities to educate the public about the dangers of secondhand smoke

Middle school

High School

Figure 21

1 Figure 1

Figure 22


Secondhand Smoke Policies and Beliefs

The percentage of middle school students who lived in homes where smoking was allowed

significantly decreased from 34.3 percent in 2007 to 22.3 percent in 2017 (Figure 23). The

percentage of middle school students who thought smoking should never be allowed in homes

increased significantly from 80.7 percent in 2007 to 86.0 percent in 2017.

The percentage of high school students who lived in homes where smoking was allowed

decreased significantly from 34.2 percent in 2007 to 26.8 percent in 2017 (Figure 24).

34.3 31.3 27.8 25.3 26.322.3

80.7 84.2 85.2 84.8 85.6 86.0

0

20

40

60

80

100

2007 2009 2011 2013 2015 2017

Missouri Youth and Tobacco, 2007-2017: Middle SchoolPercentage of students who lived in homes where smoking was allowed

Thought smoking should never be allowed in homes

Lived in homes wheresmoking was allowed

Thought smoking shouldnever be allowed in homes

34.2 30.8 30.2 28.5 24.8 26.8

74.179.0 79.5 81.2 80.1

73.2

0

20

40

60

80

100

2007 2009 2011 2013 2015 2017

Missouri Youth and Tobacco, 2007-2017: High SchoolPercentage of students who lived in homes where smoking was allowed

Thought smoking should never be allowed in homes

Lived in home wheresmoking was allowed

Thought smoking shouldnever be allowed inhomes

Figure 23

Figure 24


In 2017, about one-third of middle and high school students rode in or drove family vehicles in

which smoking was allowed and the vast majority thought that smoking should never be allowed

in vehicles (Figure 25).

In 2017, almost half of middle and high school students breathed smoke from someone who was

smoking in indoor or outdoor public places (such as school buildings, stores, restaurants,

stadiums, school grounds, parking lots, and parks) on one or more of the past seven days (Figure

26). The majority of middle (91.5%) and high school (87.7%) students thought smoking should

never be allowed in indoor public places.

31.2 33.5

82.676.4

0

20

40

60

80

100

Middle school High school

Missouri Youth and Tobacco, 2017Percentage of middle and high school students

Rode in family vehicles in which smoking was allowedThought smoking should never be allowed in vehicles

Rode in family vehicle inwhich smoking wasallowed

Thought smoking shouldnever be allowed infamily vehicles

44.650.6

91.5 87.7

0

20

40

60

80

100

Middle school High school

Missouri Youth and Tobacco, 2017Percentage of middle and high school students

Breathed smoke at a public placeThought smoking should never be allowed in indoor public places

Breathed smoke atpublic place

Thought smokingshould never beallowed in indoorpublic places

Figure 25

Figure 26


Secondhand Smoke in the Workplace

In 2017, among high school students who worked during the seven days before the survey, 27.1

percent breathed smoke from someone who was smoking tobacco products in the place where

they worked (Figure 27). The percentage of students who were exposed to secondhand smoke in

the place where they worked declined significantly from 2007 to 2015; however, the percentage

increased significantly from 2015-2017.

The percentage of high school students who thought employers should never allow smoking in

workplaces increased significantly from 68.1 percent in 2007 to 87.7 percent in 2017 and among

middle school students from 82.4 percent in 2007 to 91.5 percent in 2017 (Figure 28).

Note: 2013 data for high school students are not available.

52.6

41.4 42.9

15.221.1

27.1

0

20

40

60

80

100

2007 2009 2011 2013 2015 2017

Missouri Youth and Tobacco, 2007-2017: High SchoolPercentage of students who were exposed to secondhand smoke in

place where they worked

82.4 87.3 84.0 83.790.9 91.5

68.173.9 76.0

86.0 87.7

0

20

40

60

80

100

2007 2009 2011 2013 2015 2017

Missouri Youth and Tobacco, 2007-2017Percentage of students who think employers should never allow

smoking in places where people work

Middle School

High School

Figure 27

Figure 28


Survey Methodology

The Missouri Youth Tobacco Survey (YTS) was conducted by the Missouri Department of Health and

Senior Services (DHSS) with middle and high school students every odd-numbered spring from 2003

through 2011 and with middle school students only from 2013 through 2017. The Missouri Youth Risk

Behavior Survey (YRBS) was administered by the Missouri Department of Elementary and Secondary

Education (DESE) with high school students in odd-numbered springs from 1995 through 2011, and then

by DHSS from 2013 through 2017.

Both paper and pencil surveys were supported by the CDC, which provided funding for survey

administration, and performed school sampling, data tabulation, weighting and primary analysis. DHSS

staff administered the surveys by obtaining participation of randomly selected schools, securing class

schedules and randomly selecting classes for participation, providing survey materials to participating

schools, and collecting and processing completed surveys for shipping to the CDC.

Sampling Design

All regular and charter public schools in Missouri containing grades 6-8 in which 6th grade was not the

highest grade in the building were included in the sampling frame for middle schools. Buildings

containing grades 9-12 were included in the sampling frame for high schools. A two-stage cluster sample

design was used to produce a separate representative sample of students for middle and high school.

In the first-stage sampling, schools were randomly selected with probability proportional to the school

enrollment size. In the second stage, systematic equal probability sampling with a random start was used

to select classes from each school that participated in the survey. All classes in the selected schools were

included in the second-stage sampling frame. All students in the selected classes were eligible to

participate in the survey. School and student participation was anonymous and confidential. Passive

parental permission was utilized unless the school district required active permission.

Response rates

Response rates were calculated by multiplying the school participation rate by the student participation

rate for middle schools and high schools. The response rate must be equal to or greater than 60 percent for

data to be weighted to adjust for unequal probability selection of each student and to reduce bias by

compensating for differing patterns of non-response.

Sufficient responses for weighting the data have been obtained each year the YTS was conducted in

Missouri. In 2017, 33 of 42 (78.6%) sampled middle schools participated with 1,813 of 1,957 (91.8%)

sampled middle school students completing usable questionnaires. The overall response rate was 72.8

percent.

Sufficient responses for weighting the data have been obtained each year the YRBS was conducted in

Missouri, except in 2011. In 2017, 28 of 39 (71.8%) sampled high schools and 1,864 of 2,199 (84.8%)

sampled high school students completed usable questionnaires. The overall response rate was 60 percent.


Strategies for Reducing Tobacco Use among Missouri Youth

Results from the 2017 Missouri Youth Tobacco Survey and Youth Risk Behavior Survey

showed continued progress in reducing cigarette smoking that was first reported in “Missouri

Youth Tobacco Survey 2003-2009.” To continue the progress, the following evidence-based

strategies should be fully implemented.

Promote quitting by adults and youth

These survey results show significant differences between youth that have never tried smoking

cigarettes and those that are current smokers with regard to influences to smoke. One such

influence is living with someone that smokes. In 2015, 81.2 percent of middle school smokers

lived with someone that smoked compared to 38.3 percent of students who had never tried

smoking cigarettes. Among high school smokers in 2017, 60.5 percent lived with someone that

smoked compared to 30.1 percent of students who had never tried smoking cigarettes. Missouri’s

adult smoking prevalence in 2016 was 22.1 percent.3 To continue reducing smoking among

young people, efforts to promote quitting among adult smokers should continue, such as through

the cessation assistance provided by the Missouri Tobacco Quitline (1-800-QUIT- NOW) or

www.quitnow.net/Missouri. Although the Missouri Tobacco Quitline does not currently offer

services to individuals under 18 years of age, tobacco cessation services should be promoted and

provided to youth tobacco users. The Adolescent Cessation in Every School (ACES) is a toolkit

for schools interested in providing evidence-based tobacco cessation services to adolescents in a

school setting and can be found at http://www.cessationineveryschool.com. Smokefree Teen

(https://teen.smokefree.gov) offers free tools and tips that can increase teen’s chances of quitting

successfully. There is also a free smartphone app for teens who want to quit smoking called

quitSTART available at https://smokefree.gov/apps-quitstart. The app takes the information smokers

provide about their smoking history and gives them tailored tips, inspiration, and challenges to help

them become smoke-free and live a healthier life.

Increase the price of tobacco products

Increasing the price of tobacco products is one of the most effective methods of decreasing use

among both adults and youth.4 Missouri’s state tax of 17 cents on a package of cigarettes is the

lowest of all states. The state has not increased its tax rate for over 10 years.5 Increasing the cost

would make cigarettes less affordable for youth as well as adults.

Create tobacco free environments

Creating smokefree environments not only reduces exposure to secondhand smoke, but has also

been shown to contribute to less smoking initiation by youth due to less modeling of the behavior

by adults. An 11-year longitudinal study found that 100 percent smokefree workplace laws were

associated with significantly lower odds of initiating smoking among adolescents and young

adults.6 Efforts to increase the number of smokefree workplaces in Missouri have resulted in 42

municipalities enacting smokefree ordinances covering one or more of these: public places,


workplaces, restaurants, and bars. Forty of the 42 are comprehensive covering public places,

workplaces, restaurants and bars.7 The 2017 YRBS revealed that among high school students

who worked in the past seven days, 27.1 percent were exposed to secondhand tobacco smoke

while at work. Efforts to create smokefree workplaces should increase, and involve youth in

advocating for tobacco free environments.

Decrease social acceptability of tobacco

The percentage of middle and high school students who saw or heard anti-smoking ads in the

past 30 days had not significantly changed from 2007-2017. In 2017, 69.4 percent of middle

school students and 77.8 percent of high school students saw or heard anti-smoking ads in the

past 30 days. Mass-reach health communication interventions, particularly through television,

have been shown to reduce tobacco use initiation among youth.8 Efforts should be made to

secure funding to support strong anti-tobacco mass communication interventions that counter

tobacco product promotions. Additionally, mass communication interventions should be

expanded to include other media platforms such as digital and internet media to reach more

young people.


References

1 Missouri Department of Health and Senior Services. Smoking attributable deaths 2005-2015.

Available at https://webapp01.dhss.mo.gov/MOPHIMS/ProfileBuilder?pc=10. Accessed March

7, 2018.

2 CDC. Office on Smoking and Health. Youth and Tobacco Facts. Available at:

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm

Accessed March 7, 2018. 3 Missouri Behavioral Risk Factor Surveillance System. Missouri Department of Health and

Senior Services. Available at http://www.health.mo.gov/data/brfss/index.php. Accessed March 7,

2018.

4 Community Preventive Services Task Force. The Community Guide. Tobacco Use and

Secondhand Smoke Exposure: Interventions to Increase the Unit Price of Tobacco Products.

Available at: http://www.thecommunityguide.org/tobacco/increasingunitprice.html. Accessed

March 7, 2018.

5 Campaign for Tobacco-Free Kids. State Cigarette Excise Tax Rates and Rankings Fact Sheet

available at: http://www.tobaccofreekids.org/research/factsheets/pdf/0097.pdf. Accessed March

7, 2018.

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Percentages of New and Current Smokers among Adolescents and Young Adults: An 11-Year

Longitudinal Study. JAMA Pediatrics. 2015:169(9):e152285. Accessed March 7, 2018.

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8 Community Preventive Services Task Force. The Community Guide. Tobacco Use and

Secondhand Smoke Exposure: Mass-Reach Health Communication Interventions. Available at:

http://www.thecommunityguide.org/tobacco/massreach.html. Accessed March 13, 2018.

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm

http://www.thecommunityguide.org/tobacco/increasingunitprice.html

http://www.tobaccofreekids.org/research/factsheets/pdf/0097.pdf

http://www.thecommunityguide.org/tobacco/massreach.html

missouri youth and tobacco, 2007-2017

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