Surveillance Summary: Youth Tobacco Use—Selected U.S. States, 2012-2013 Anna Teplinskaya, MPH,1 Robert B. Gerzoff, MS1 1Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Methods Data Source The Youth Tobacco Survey (YTS) is a state-based survey that collects data about tobacco use and other tobacco-related topics from students in grades 6 through 12. Individual state departments of health plan and implement the survey with assistance from the CDC Office on Smoking and Health. The YTS is intended to enhance the capacity of state agencies and organizations to design, implement, and evaluate tobacco prevention and control programs, which are intended to prevent young people from using tobacco and to help current users quit. The YTS is designed to protect student privacy by ensuring that student participation is anonymous and voluntary. The survey is administered during a single class period. Students complete a self-administered questionnaire in the classroom and record their responses on an answer sheet or booklet. The YTS questionnaire contains questions on tobacco use (cigarettes, cigars, pipes, smokeless tobacco, and bidis), exposure to secondhand smoke, smoking cessation, tobacco-related school curriculum, minors’ ability to purchase or obtain tobacco products, knowledge and attitudes about tobacco, and familiarity with pro-tobacco and anti-tobacco media messages. Before the survey is conducted, parental permission is obtained. Sampling The 2012-2013 state-specific YTS employed a two-stage cluster sample design. The first-stage sampling frame included separate lists of middle schools and high schools containing any of the eligible grades of public schools. Schools were selected with probability proportional to school enrollment size. The number of schools selected varied by state. At the second sampling stage, classes were randomly selected from a class schedule provided by each participating school. Class schedules were constructed to ensure that all students in the eligible grades were counted once only. All students in the selected classes were eligible to participate in the survey. The number of classes selected varied by state. Data Collection 1 Twenty states conducted the YTS during 2012-2013. Not all states were able to report both high school and middle school data, and data for some states were omitted because those states failed to achieve response rates ≥60%. Data for states that achieved overall response rates of ≥60% were weighted to adjust for nonresponse and varying probabilities of selection and to ensure that the sample reflected the entire state population proportions for school level (middle or high), sex (male or female), and race (white, black, Hispanic, and other). Thus, weighted estimates were representative samples of middle school and high school students in the respective state. In 2012, YTS student sample sizes ranged from 941 to 2,461. School response rates ranged from 70.8% to 100.0 %, student response rates ranged from 79.0% to 91.3%; and overall response rates ranged from 60.3% to 91.3%. In 2013, YTS student sample sizes ranged from 1,209 to 4,092. School response rates ranged from 68.1% to 100.0 %, student response rates ranged from 60.4% to 93.7%; and overall response rates ranged from 60.4% to 85.5% (Table 1). Analysis SAS-callable SUDAAN 10 (RTI International, Research Park, NC) was used to compute estimates and 95% confidence intervals (CI). Results with <35 cases in the denominator were considered imprecise and are not presented. 2 Table 1. Sample sizes and response rates for middle schools and high schools, by state—Youth Tobacco Survey, 2012–2013 State Student Sample Size (n) a School Response Rate (%) Student Response Rate (%) Overall Response Rate (%) Middle School 2012 2013 2012 2013 2012 2013 2012 2013 Alabama 1485 - 92.00 - 85.10 - 78.29 - Arizona - 1209 - 90.00 - 88.63 - 79.77 Connecticut - 2946 - 82.00 - 88.84 - 72.85 Delaware 2431 - 100.00 - 91.28 - 91.28 - Georgia - 2100 - 83.67 - 93.70 - 78.40 Hawaii - 1980 - 100.00 - 67.20 - 67.20 Indiana - 2483 - 74.13 - 91.99 - 68.20 Kansas - 1731 - 68.05 - 89.41 - 60.84 Mississippi 1739 . 82.00 . 83.68 . 68.62 . Missouri - 1838 - 76.19 - 87.06 - 66.33 North Carolina - 3927 - 88.23 - 85.53 - 75.47 North Dakota - 2008 - 94.59 - 90.36 - 85.48 Ohio 941 - 70.83 -. 86.40 - 61.20 - Oklahoma - 3080 - 86.20 - 83.60 - 72.07 South Carolina - 1605 - 74.00 - 85.37 - 63.17 South Dakota - 2014 - 83.33 - 88.52 - 73.77 West Virginia - 2224 - 98.00 - 82.67 - 81.02 Wisconsin 1741 - 84.00 - 86.83 - 72.93 - High School Alabama 1500 - 96.00 - 81.52 - 78.26 - Connecticut - 2488 - 85.18 - 85.03 - 72.43 Delaware 2252 - 95.00 - 84.31 - 80.09 - Georgia - 1776 - 70.00 - 89.56 - 62.69 Hawaii - 1455 - 100.00 - 60.42 - 60.42 Indiana - 2718 - 78.33 - 83.34 - 65.28 Mississippi 1657 - 82.00 - 82.64 - 67.76 - Nebraska 2461 - 81.66 - 78.95 - 64.47 - New Jersey 1850 - 72.97 - 82.66 - 60.32 - North Carolina - 4092 - 81.37 - 83.37 - 67.84 North Dakota - 2048 - 93.93 - 87.22 - 81.93 South Carolina - 1609 - 78.00 - 84.02 - 65.53 West Virginia - 1685 - 100.00 - 81.51 - 81.51 Wisconsin 1539 - 80.00 - 82.60 - 66.08 - a Number who completed the survey. 3 Table 2. Percentage of middle school and high school students who were current tobacco usersa , by product and state—Youth Tobacco Survey, 2012–2013 State Any Tobaccob Cigarettes Cigars Smokeless Tobacco Pipes Bidis % (95%CI) % (95%CI) % (95%CI) % (95%CI) % (95%CI) % (95%CI) 2012 2013 2012 2013 2012 2013 2012 2013 2012 2013 2012 2013 Middle school Alabama 14.0 (±2.9) - 7.5 (±1.9) - 6.0 (±1.7) - 5.7 (±1.8) - 3.7 (±1.2) - 1.7 (±0.7) - Arizona - 6.8 (±1.6) - 3.3 (±1.1) - 3.0 (±0.7) - 2.2 (±0.8) - 4.2 (±1.6) - 2.2 (±1.2) Connecticut - 2.4 (±0.9) - 1.4 (±0.7) - 1.3 (±0.7) - 0.7 (±0.6) - 0.9 (±0.7) - 0.5 (±0.6) Delaware 7.2 (±1.5) 4.1 (±1.2) 3.4 (±1.3) 1.9 (±0.6) 2.0 (±0.7) 0.8 (±0.5) Georgia - 9.4 (±1.8) - 3.2 (±1.1) - 4.4 (±1.3) - 3.5 (±1.0) - 2.9 (±1.1) - 1.3 (±0.5) Hawaii - 6.4 (±2.4) - 4.0 (±1.7) - 1.1 (±1.0) - 1.5 (±1.2) - 2.7 (±0.8) - 1.1 (±0.5) Indiana - 5.9 (±1.4) - 3.7 (±1.0) - 2.4 (±0.7) - 1.5 (±0.6) - 1.6 (±0.6) - 0.7 (±0.4) Kansas - 2.7 (±1.0) - 1.2 (±0.8) - 0.7 (±0.3) - 1.2 (±0.6) - 0.9 (±0.5) - 0.4 (±0.4) Mississippi 10.6 (±2.8) - 5.8 (±1.8) - 4.2 (±1.5) - 4.8 (±1.9) - 1.9 (±0.8) - 0.9 (±0.4) - Missouri - 6.0 (±1.7) - 4.0 (±1.3) - 2.1 (±0.7) - 2.2 (±0.8) - 1.5 (±0.6) - 0.6 (±0.4) North Carolina - 6.1 (±1.2) - 2.5 (±0.7) - 2.3 (±0.7) - 2.1 (±0.6) - 2.0 (±0.5) - 0.8 (±0.3) North Dakota - 6.0 (±1.6) - 3.4 (±1.0) - 1.5 (±0.6) - 2.6 (±0.9) - 2.1 (±0.7) - 0.5 (±0.3) Ohio 6.0 (±2.1) - 3.7 (±1.5) 2.6 (±1.7) 2.5 (±0.9) 1.8 (±1.5) - 0.4 (±0.4) - Oklahoma - 9.8 (±2.2) - 4.8 (±1.1) - 3.8 (±1.2) - 5.2 (±1.5) - 3.2 (±1.0) - 1.7 (±0.6) South Carolina - 9.7 (±2.0) - 4.8 (±1.2) - 4.8 (±1.4) - 3.5 (±1.4) - 2.6 (±0.6) - 0.9 (±0.5) South Dakota - 6.4 (±2.7) - 3.5 (±1.7) - 1.6 (±0.7) - 3.3 (±1.6) - 2.2 (±1.2) - 0.7 (±0.5) West Virginia - 13.4 (±3.1) - 7.5 (±2.1) - 4.5 (±1.3) - 8.1 (±2.3) - 2.8 (±1.0) - 0.9 (±0.3) Wisconsin 3.8 (±1.0) - 2.5 (±0.8) - 1.6 (±0.7) - 1.2 (±0.5) - 1.3 (±0.6) - 0.4 (±0.3) - Median 7.2 6.4 4.1 3.5 3.4 2.3 2.5 2.2 1.9 2.2 0.8 0.8 High School Alabama 31.6 (±3.6) - 19.3 (±3.0) - 16.0 (±2.8) - 12.6 (±2.4) - 6.4 (±1.4) - 2.5 (±1.2) - Connecticut - 16.8 (±2.1) - 8.9 (±1.7) - 9.0 (±1.4) - 4.9 (±1.0) - 4.8 (±1.0) - 1.8 (±0.6) Delaware 20.7 (±2.3) - 14.1 (±2.1) - 10.2 (±1.6) - 4.4 (±0.9) - 2.4 (±0.7) - 1.1 (±0.5) - Georgia - 21.7 (±2.7) - 12.0 (±2.6) - 11.3 (±1.7) - 5.4 (±1.5) - 5.9 (±1.2) - 1.8 (±0.7) Hawaii - 10.7 (±2.4) - 5.8 (±2.4) - 3.2 (±1.2) - 2.6 (±1.4) - 4.5 (±1.2) - 1.3 (±0.7) Indiana - 22.0 (±2.7) - 13.7 (±2.4) - 11.6 (±2.0) - 6.6 (±1.3) - 5.3 (±1.2) - 1.5 (±0.7) Mississippi 27.6 (±3.8) - 18.1 (±4.0) - 11.9 (±2.0) - 9.6 (±2.9) - 4.3 (±1.2) - 1.4 (±1.0) - Nebraska 18.1 (±2.9) - 11.7 (±2.2) - 7.0 (±1.5) - 6.6 (±1.9) - 3.3 (±0.8) - 1.2 (±0.7) - New Jersey 15.0 (±2.7) - 9.3 (±2.4) - 6.3 (±1.3) - 3.4 (±1.1) - 5.2 (±1.4) - c - North Carolina - 24.5 (±1.9) - 13.5 (±1.5) - 12.6 (±1.4) - 8.3 (±1.5) - 7.2 (±1.0) - 2.2 (±0.7) North Dakota - 23.8 (±3.4) - 16.2 (±3.4) - 8.4 (±1.7) - 10.0 (±1.5) - 4.6 (±1.2) - 1.4 (±0.6) South Carolina - 27.1 (±2.6) - 15.3 (±2.9) - 14.0 (±2.1) - 8.8 (±1.6) - 5.8 (±1.5) - 1.9 (±0.5) West Virginia - 28.8 (±3.3) - 18.6 (±2.7) - 11.9 (±2.0) - 14.7 (±2.6) - 4.1 (±1.2) - 1.2 (±0.4) Wisconsin 19.4 (±2.7) - 13.1 (±2.5) - 9.2 (±1.5) - 5.8 (±1.4) - 4.9 (±1.1) - 1.6 (±0.7) - Median 20.1 22.9 13.6 13.6 9.7 11.4 6.2 7.4 4.6 5.0 1.4 1.6 Abbreviations: CI = confidence interval; a Current use was use on at least 1 day during the 30 days before the survey.