2005 Massachusetts Youth Risk Behavior Survey
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CHAPTER 2
TOBACCO USE
INTRODUCTION
Tobacco use is the leading preventable cause of death in the United States, yet in 2004 an estimated 70 million
Americans age 12 and older reported current use of tobacco, including cigarettes, cigars, smokeless tobacco, and
pipe tobacco (2a). Tobacco use is responsible for one in every five deaths in the United States (2b). Tobaccorelated health problems such as heart disease, cancer, stroke, and chronic respiratory illness are the leading
causes of death each year. Additionally, smokeless tobacco use (chewing tobacco or snuff) causes oral cancer
and other health problems (2c).
Tobacco use among young people poses especially serious risks. Research indicates that the earlier young
people begin to smoke the greater their permanent lung damage and the more likely they are to become heavily
addicted (2d). Since 1997, tobacco use among adolescents has gradually declined, but may have begun to level
off (2e). Still, more than one-quarter of U.S. high school students use some form of tobacco (2f). Adolescent
tobacco use not only threatens health, but it is also associated with drinking and illegal drug use, and with poor
school performance.
From 1993 to 2002, the Massachusetts Department of Education allocated Health Protection Fund monies,
derived from a state tax on tobacco products, to school districts across the Commonwealth to support
comprehensive school health education, with a focus on tobacco use prevention. In that time, Massachusetts
middle and high schools significantly increased attention to tobacco prevention education and other health
education topics (2g). However, that attention may have declined in recent years since the elimination of the
Health Protection Fund.
The Massachusetts Education Reform Law of 1993 made it illegal for students, school staff, and visitors to smoke
or use tobacco products on school property at any time. Since then, the proportion of adolescent smokers
reporting that they had smoked on school property has dropped significantly, though it is still higher than the
national average.
The 2005 MYRBS asked students to report their history and current use of cigarettes and smokeless tobacco
both on and off school property. The survey also asked questions about recent cigar smoking, and about
students' attempts to quit smoking.
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2005 Massachusetts Youth Risk Behavior Survey
KEY FINDINGS FROM THE 2005 MASSACHUSETTS YRBS

Lifetime and current cigarette smoking have decreased significantly over the past decade, with only
half (51%) of all students reporting lifetime smoking and one-fifth (21%) reporting current smoking in
2005 as compared to 72% and 36%, respectively, in 1995.

The rate of daily smoking has dropped by more than half in the past ten years.

Among current smokers, 43% had smoked cigarettes on school property within the past month.

Smokeless tobacco use dropped significantly in the mid to late 1990’s, but has remained relatively
stable since. In 2005, 4% of adolescents reported using smokeless tobacco in the past month.

Male and female students were equally as likely to report any cigarette smoking, but males were
significantly more likely to report smokeless tobacco use and cigar smoking.

Current smokers were significantly more likely to report other substance related risk behaviors, and
less likely to be receiving good grades
RESULTS
CIGARETTE SMOKING
Lifetime Cigarette Smoking and Early Initiation of Smoking
About half (51%) of all students reported having ever tried smoking cigarettes. This represents a significant
decrease from 62% in 2001. Lifetime cigarette smoking has been decreasing among Massachusetts
adolescents since 1995, when 72% reported having ever smoked cigarettes. (Figure 2a)
Figure 2a. Tobacco Use among Massachusetts High School Students, 1995 - 2005
2001
2003
10
15.6
13.1
11.8
13.5
20
8.4
6.0
4.9
4.4
4.1
4.4
30
2005
14.6
14.5
12.6
10.4
7.3
6.4
40
35.7
34.4
30.3
26.0
20.9
20.5
50
1999
23.9
24.3
23.4
19.3
15.3
13.2
Percent of Students
60
1997
53.2
50.7
70
1995
71.5
69.1
67.4
61.9
80
na
0
Lifetime
cigarette
smoking (*)
Early intiation
of cigarette
smoking (*)
Current cigarette Daily cigarette
smoking (*)
smoking (*)
Smokeless
tobacco use (*)
Cigar smoking
(*) Statistically significant decrease from 1995 to 2005, p < .05
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2005 Massachusetts Youth Risk Behavior Survey
Thirteen percent (13%) of all students smoked their first cigarette before age 13.
Early initiation of tobacco use
has declined over the past decade.
Youth of Other/Multiple Ethnicity and Hispanic youth were somewhat more likely than other youth to have tried
smoking ever and to have begun smoking before age 13, but no ethnic differences in tobacco use were
statistically significant.
Black
Hispanic
Asian
30
Other
4.9
2.4
2.1
6.1
7.7
10
7.0
5.2
4.0
7.1
7.3
20
21.1
19.3
17.5
13.6
24.3
40
12.8
11.5
15.6
14.1
15.7
Percent of Students
50
White
Daily cigarette
smoking
Smokeless
tobacco use
14.4
9.7
10.7
9.3
18.2
60
49.7
52.7
54.5
46.9
57.1
Figure 2b. Tobacco Use among Massachusetts High School Students by Race/Ethnicity,
2005
0
Lifetime
cigarette
smoking
Early initiation of
cigarette
smoking
Current
cigarette
smoking
Cigar smoking
9th Grade
10th Grade
11th Grade
40
10.5
14.2
14.6
15.4
10
3.6
4.7
4.4
4.8
20
4.9
5.9
5.9
9.0
30
18.8
20.0
19.8
23.5
12th Grade
15.1
12.6
11.3
13.0
Percent of Students
50
44.1
60
50.9
54.3
54.3
Figure 2c. Tobacco Use among Massachusetts High School Students by Grade, 2005
Daily cigarette
smoking (*)
Smokeless tobacco
use
0
Lifetime cigarette
smoking (*)
Early initiation of
cigarette smoking
Current cigarette
smoking
Cigar smoking
(*)Statistically significant increase from 9th to 12th grade, p < .05
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2005 Massachusetts Youth Risk Behavior Survey
Students who reported having smoked a whole cigarette for the first time before age 13 were significantly more
likely than their peers who started smoking later to report:




Current (having smoked once in the past 30 days) smoking (58% vs. 15%)
Daily smoking (30% vs. 3%)
Using smokeless tobacco (13% vs. 3%)
Cigar Smoking (30% vs. 10%)
Current smoking
One-fifth (21%) of all students smoked a cigarette in the 30 days before the survey (i.e., current smoking).
Current smoking was similar among male and female adolescents. (Figure 2d)
(*) Statistically significant difference between male and female students, p< .05
Among current smokers, 38% smoked cigarettes on five or fewer of the past 30 days and 31% smoked every
day. Six percent (6%) of all students were daily smokers.
Among current smokers, the number of cigarettes smoked per day varied. Seventeen percent (17%) of current
smokers smoked less than one cigarette on the days that they smoked. The single largest group of current
smokers (43%) smoked two to five cigarettes per day. Nine percent (9%) of current smokers smoked more than
half a pack (11 or more cigarettes) per day.
Among daily smokers, 97% smoked more than one cigarette per day. Twenty-seven percent (27%) of daily
smokers smoked at least half a pack of cigarettes (11 or more cigarettes) per day.
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2005 Massachusetts Youth Risk Behavior Survey
Smoking Cessation
Whether or not they were still daily smokers, 14% of all students had ever smoked daily for any period of 30 days
during their lifetimes. These students are called “ever-regular” smokers. Ever-regular smoking is used to
measure smoking cessation.
Sixty-three percent (63%) of all ever –regular smokers had tried to quite smoking at least once.
Among those ever-regular smokers who did try to quit at least once, 81% were still smoking at the time of the
survey (i.e., current smoking), and nearly half (45%) were daily smokers at the time of the survey.
Nearly one-fifth of ever-regular smokers (19%) had tried to quit three or more times in their lives. Eighty-three
percent (83%) of these students were still smoking (i.e. current smokers) at the time of the survey, and 45% were
daily smokers.
Among current smokers in 2005, 44% had tried to quit smoking at least once, and one third (34%) had tried to
quit smoking tried to quit three or more times.
OTHER TOBACCO USE: SMOKELESS TOBACCO AND CIGARS
Four percent (4%) of all students used smokeless tobacco (i.e., chewing tobacco, snuff, or dip) in the 30 days
before the survey.
As in previous years, male students were significantly more likely than female students to report smokeless
tobacco use (8% vs. 1%, respectively). (see Figure 2d)
Twelve percent (14%) of students reported smoking a cigar in the 30 days before the survey. Rates were higher
for males (20%) than females (7%).
There were no significant racial/ethnic differences in the rate of cigar smoking or use of smokeless tobacco.
Most adolescents who had used smokeless tobacco (61%) or smoked cigars (61%) in the past month were also
current cigarette smokers.
TOBACCO USE ON SCHOOL PROPERTY
Nine percent (9%) of all students smoked cigarettes on school property in the 30 days before the survey.
Among current smokers, 43% reported smoking on school property in the past month, significantly lower than the
54% of current smokers who reported smoking at school in 1995.
Just 2% of all students used smokeless tobacco on school property in the 30 days before the survey. Among
students who reported any smokeless tobacco use, however, more than half (54%) used smokeless tobacco on
school property, a proportion that has not changed significantly over the past decade.
TOBACCO USE AND OTHER SUBSTANCE USE
Compared to students who had never tried cigarette smoking, those who had tried smoking in their lifetimes were
significantly more likely to have ever had a drink of alcohol (94% vs. 58% respectively), and to have used
marijuana (73% vs. 18%) or another illegal drug (30% vs. 3%) in their lifetimes.
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2005 Massachusetts Youth Risk Behavior Survey
Current smokers were more likely than those who had never smoked or not smoked recently (i.e., non-smokers)
to report drinking, binge drinking, marijuana use, and other illegal drug use in the 30 days before the survey. (see
Figure 2e)
TOBACCO USE AND ACADEMIC ACHIEVEMENT
Compared to peers who did not use tobacco, students who used tobacco were significantly less likely to have
received mostly A’s, B’s, or C’s in the 12 months before the survey (see Table 2). For example, only 74% of
current smokers received mostly A’s, B’s, or C’s in the past year, compared to 88% of non-smokers.
PROTECTIVE FACTORS FOR TOBACCO USE
Students who were involved in volunteer work or community service were significantly less likely than their peers
who were not involved in these activities to be current smokers (16% vs. 24% respectively).
Similarly, current smoking was significantly less common among students who participated in extra-curricular
activities compared to students who did not participate in extra-curricular activities (14% vs. 27% respectively).
Students who reported having a supportive adult in their life were significantly less likely to report current
smoking. This was seen among students who reported they had a parent or adult family member they could talk
to about things that were important to them (18% vs. 31%) and students who believed they had a teacher or other
school staff member they could talk to if they had a problem (18% vs. 29%).
Figure 2e. Other Substance-Related Risk Behaviors of Massachusetts High School Cigarette
Smokers and Non-Smokers, 2005
Smokers
82.2
90
67.8
57.6
70
60
28.0
40
17.9
30
5.4
20
15.4
50
Non-smokers
38.5
Percent of Students
80
10
0
Drank alcohol in past 30
days(*)
Any binge drinking in
past 30 days(*)
Used marijuana in past Used any illegal drug
30 days(*)
other than marijuana in
past 30 days(*)
(*) Statistically significant difference between smokers and non-smokers, p< .05
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2005 Massachusetts Youth Risk Behavior Survey
Table 2. Significant Associations between Tobacco Use Behaviors and Academic
Achievement among Massachusetts High School Students, 2005
Ever tried cigarette smoking
Smoked before age 13
Current smoking
Daily smoking
Smokeless tobacco use
Cigar use
Mostly A's, B's, or C's
p-value
yes
78.6
.000**
no
90.3
yes
70.9
no
86.5
yes
74.1
no
87.5
yes
68.2
no
85.9
yes
73.9
no
85.0
yes
78.1
no
85.5
.000**
.000**
.000**
.000**
.000**
(**) Statistically significant difference between groups, p<.01
ADDITIONAL FINDINGS
Certain groups of students were significantly more likely than their peers to report current tobacco use:

Students in rural school districts were more likely than students in urban or suburban districts to be daily
smokers (9% vs. 6% for both suburban and urban).

Sexual minority youth (i.e., students who either identified as gay, lesbian, or bisexual or had any samesex sexual contact) were more likely than other students to be current smokers (50% vs. 19%) and daily
smokers (20% vs. 6%) and to report using smokeless tobacco (9% vs. 4%).
 Homeless students (i.e. students not at home with their parents) were more likely than their peers to
report current smoking (53% vs. 19%) and daily smoking (24% vs. 6%) and to report using smokeless
tobacco (12% vs. 4%).
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2005 Massachusetts Youth Risk Behavior Survey
CONCLUSIONS AND RECOMMENDATIONS
The 2005 MYRBS results highlight substantial progress in reducing tobacco use among Massachusetts youth
since the mid-1990’s. Additionally, Massachusetts’ rate of current smoking among adolescents is significantly
below the national average for high school students (2h). The significant decreases in lifetime, current, and daily
cigarette smoking, smokeless tobacco use, cigar smoking, and smoking on school property are very
encouraging. However, the absence of continued change in these measures in the past two years suggests that
we may have reached a plateau in our efforts to eliminate tobacco use among youth in the Commonwealth.
Half of all Massachusetts adolescents have tried cigarettes and one in five is a current smoker. Changing
widespread patterns of tobacco use among adolescents is a difficult and complex task. Research evidence
suggests that providing information about the harmful effects of tobacco use is rarely enough, by itself, to curb
adolescent smoking. Rather, effective tobacco prevention education programs are those that focus on helping
students recognize peer and media pressure and on helping them develop the skills to resist such pressure (2d,
2h). Additionally, because tobacco use is associated with other risk behaviors, tobacco prevention education
should be integrated into comprehensive school health programs. The Massachusetts Comprehensive Health
Curriculum Framework (2i) and the CDC’s Guidelines for School Health Programs to Prevent Tobacco Use and
Addiction (2j) are useful starting places to help districts develop school health education programs that
encourage young people to make healthy choices. The vast majority of students who do smoke have tried to quit
at least once. Unfortunately, most of these attempts have not been successful, especially among those who
have developed a regular smoking habit. School- and/or community-based cessation programs aimed at
adolescents would offer these students more support and guidance. Many school districts currently offer
cessation programs and adolescent tobacco users should be encouraged to take advantage of these
opportunities. The findings reported here emphasize the importance of early and repeated tobacco prevention
education, beginning well before high school and reinforced at every grade level. Until recently, tobacco tax
revenues approved by Massachusetts voters in 1992 supported stronger youth tobacco prevention and
comprehensive school health programs across the state. With the elimination of these funds in 2002, many
districts have had to scale back their health education programming by reducing staff and/or the number of health
classes offered. The leveling off of declines in tobacco use over the past two years may be influenced, at least in
part, by reductions in anti-tobacco programs in schools.
Finally, we are disturbed by the facts that four in ten current smokers report smoking on school property and over
half of smokeless tobacco users report engaging in that behavior on school property. Strong and consistent
enforcement of school anti-tobacco policies is essential in providing a tobacco-free environment for students and
staff.
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2005 Massachusetts Youth Risk Behavior Survey
CHAPTER 2: REFERNCES
2a. Substance Abuse and Mental Health Services Administration, Office of Applied Statistics. (2005). 2004
National Survey on Drug Use and Health [on-line]. Retrieved December 9, 2006, from www.samhsa.gov.
2b. Centers for Disease Control and Prevention 91997). Smoking-attributable mortality and years of potential life
lost – United States, 1994. Morbidity and Mortality Weekly Report, 46, 441-451.
2c. Public Health Service. (1986). The health consequences of using smokeless tobacco: A report of the
advisory committee to the Surgeon General. (NIH Publication No. 86-2874). Bethesda, MD: U.S. Department of
Health and Human Services.
2d. Public Health Service (1994). Preventing tobacco use among young people: A report of the Surgeon
General. (DHHS Publication No. 0455-B-02). Washington, DC: U.S. Government Printing Office.
2e. Johnston, L. D., O'Malley, P. M., Bachman, J. G. & Schulenberg, J. E. (December 19, 2005). Decline in teen
smoking appears to be nearing its end. University of Michigan News and Information Services: Ann Arbor, MI.[Online]. Available: www.monitoringthefuture.org; accessed December 9, 2006.
2f. Centers for Disease Control and Prevention (2006). Youth Risk Behavior Surveillance, 2005. Morbidity and
Mortality Weekly Report, 55, No. SS-5.
2g. Massachusetts Department of Education. (1999). The 1998 Massachusetts School Health Education Profile
Report. Malden, MA: Author.
2h. Reid, D.K., McNeill, A.D., & Glynn, T.J. (1995). Reducing the prevalence of smoking in youth in Western
countries: An international review. Tobacco Control, 4, 266-277.
2i. Massachusetts Department of Education. (1999). Massachusetts Comprehensive Health Curriculum
Framework. Malden, MA: Author.
2j. Centers for Disease Control and Prevention. (1994). Guidelines for school health programs to prevent
tobacco use and addiction. Morbidity and Mortality Weekly Report, 43(RR-2), 1-18.
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