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America's Children in Brief: Key National Indicators of Well-Being, 2020

Regular Cigarette Smoking

Smoking has serious long-term consequences, including the risk of smoking-related diseases and premature death, as well as the increased health care costs of treating associated illnesses.42 More than 480,000 annual deaths are attributable to tobacco use, making tobacco more lethal than all other illicit substances. Nearly 90% of smokers start smoking before age 18. Each day, more than 1,500 youth, ages 12–17, smoke their first cigarette, and another nearly 1,000 youth and young adults who are occasional smokers become daily smokers.43 The high rate of incidence and the consequences of cigarette smoking underscore the importance of studying patterns of smoking among adolescents. However, the rates represented here do not reflect data on vaping among youth.

Figure 15: Percentage of 8th-, 10th-, and 12th-grade students who reported smoking cigarettes daily in the past 30 days by metropolitan status, 2019
Figure 15: Percentage of 8th-, 10th-, and 12th-grade students who reported smoking cigarettes daily in the past 30 days by metropolitan status, 2019

NOTE: Daily cigarette smoking is defined as the use of one or more cigarettes per day in the past 30 days. The U.S. Office of Management and Budget classifies some counties as within a metropolitan statistical area. The remaining counties are considered nonmetropolitan. Nonmetropolitan counties include counties in micropolitan statistical and rural areas.

SOURCE: National Institute on Drug Abuse, Monitoring the Future Survey.

  • Approximately 1% of 8th- and 10th-grade students and 2% of 12th-grade students reported smoking cigarettes daily in the past 30 days in 2019.
  • In 2019, 5% of 12th-grade students living in nonmetropolitan areas reported daily cigarette use in the past 30 days. This was higher than the 2% of 12th-grade students living in metropolitan areas reporting daily cigarette use in the past month.
  • Among 10th-grade students living in nonmetropolitan areas in 2019, 2% reported daily cigarette use in the past month compared with 1% of 10th-grade students living in metropolitan areas.
  • There was no significant difference between the 2% of 8th-grade students living in nonmetropolitan areas compared with the 1% of 8th-grade students living in metropolitan areas who reported daily cigarette use in the past 30 days.
  • Overall, a higher percentage of 8th-, 10th-, and 12th-grade students living in nonmetropolitan areas reported daily cigarette use in the past 30 days.

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42 U.S. Department of Health and Human Services. (2014). The health consequences of smoking—50 years of progress. A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK179276/pdf/Bookshelf_NBK179276.pdf

43 Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068). Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, Populations Survey Branch. Retrieved from https://store.samhsa.gov/product/key-substance-use-and-mental-health-indicators-in-the-united-states-results-from-the-2018-national-survey-on-Drug-Use-and-Health/PEP19-5068