Monitoring Changing Tobacco Use Behaviors: 2000 - 2014 Maryland Department of Health and Mental Hygiene Cigarette Restitution Fund Center for Tobacco Prevention and Control State Fiscal Year 2015 Larry Hogan Governor State of Maryland Boyd Rutherford Lieutenant Governor State of Maryland Van Mitchell Secretary Department of Health and Mental Hygiene Statutory Authority and Requirements Maryland’s Health-General Article, Title 13, Subtitle 10, requires the Maryland Department of Health and Mental Hygiene (DHMH) to conduct a biennial tobacco study and report specific findings to the Maryland Governor and the General Assembly. The appendices to this report provide the detailed data for indicators DHMH is required to report in its biennial tobacco study for underage youth. THIS PAGE HAS BEEN LEFT BLANK INTENTIONALLY 1 Table of Contents Suggested Citation ......................................................................................................................... 5 Cover Letter ..................................................................................................................................... 6 In Brief ............................................................................................................................................... 8 Commonly Used Acronyms Found in this Report ..................................................................... 11 About this Report .......................................................................................................................... 12 Data in this Report ................................................................................................................. 12 Behavioral Risk Factor Surveillance System ...................................................................... 13 Maryland Healthier Communities Survey .......................................................................... 13 Youth Risk Behavior Survey .................................................................................................. 14 Youth Tobacco Survey ......................................................................................................... 14 Youth Tobacco and Risk Behavior Survey ......................................................................... 14 YTRBS Survey Sample and Weighted Demographics ...................................................... 15 Initiation of Tobacco Use ............................................................................................................. 16 Progression in Cigarette Smoking – First Whole Cigarette to Everyday Smoking ........ 18 Chapter Conclusions ............................................................................................................ 22 Use of Tobacco Products ............................................................................................................. 24 Use of Multiple Types of Tobacco Products ....................................................................... 24 Adolescent Use of Types of Tobacco Products .......................................................... 25 Adult Use of Cigarettes, Cigars, or Smokeless Tobacco ................................................. 32 Chapter Conclusions ............................................................................................................ 34 Use of Electronic Smoking Devices ............................................................................................ 36 ESDs are Not an FDA Approved Smoking Cessation Aide .............................................. 38 Utilization of ESDs in Business/Workplace .......................................................................... 38 Use of ESDs in Maryland ....................................................................................................... 39 Use by Adults ................................................................................................................... 39 Use by Adolescents ........................................................................................................ 40 Chapter Conclusions ............................................................................................................ 41 Underage Access to Tobacco .................................................................................................... 42 Youth Access Sources .......................................................................................................... 44 Federal Synar Program ......................................................................................................... 46 The Synar Program in Maryland .......................................................................................... 47 Chapter Conclusions ............................................................................................................ 49 2 Adult Cessation of Tobacco Use ................................................................................................ 50 Chapter Conclusions ............................................................................................................ 52 Exposure to Secondhand Smoke ............................................................................................... 54 Chapter Conclusions ............................................................................................................ 56 Attitudes and Beliefs Toward Tobacco Use ............................................................................... 58 Maryland Youth ..................................................................................................................... 58 Maryland Adults .................................................................................................................... 59 Chapter Conclusions ............................................................................................................ 60 Adult Demographic Profiles by Smoking Status - 2014 ........................................................... 62 Adolescent Cigarette Smoking Rates, By Select Demographic Characteristics ................ 63 Tobacco and Health .................................................................................................................... 64 Chapter Conclusions ............................................................................................................ 67 APPENDICES PROVIDING STATUTORY DATA ............................................................................... 68 Underage Middle/High School Youth Combined Data ................................................... 70 A. Percent Current Underage Tobacco Use ................................................................ 72 B. Number of Current Underage Tobacco Users ........................................................ 73 C. Percent Current Underage Minority Tobacco Use ................................................. 74 D. Number of Current Underage Minority Tobacco Users ......................................... 75 E. Percent Underage Youth First Tried Tobacco, Past 12 Months .............................. 76 F. Number of Underage Youth First Tried Tobacco, Past 12 Months ......................... 77 G. Percent Underage Youth Who Quit Tobacco, Past 12 Months ............................ 78 H. Number of Underage Youth Who Quit Tobacco, Past 12 Months ........................ 79 Adult Population Data .......................................................................................................... 80 I. Percent and Number of Current Adult Tobacco Use .............................................. 82 J. Percent and Number of Current Minority Adult Tobacco Use .............................. 83 K. Percent and Number of Pregnant Females Smoking During Pregnancy ........... 84 L. Percent and Number of Adults First Tried Tobacco, Past 12 Months .................... 85 M. Percent and Number of Adults Who Quit Using Tobacco, Past 12 Months ........ 86 N. Percent and Number of Households with Resident Adult Smoker and Minor Children ............................................................................................................................ 87 APPENDICES PROVIDING OTHER DATA ....................................................................................... 88 O. Percent Current Underage High School Use of Products, Fall 2014 .................... 90 P. Percent Current Underage Middle School Use of Products, Fall 2014 ................. 91 Q. Percent Current Underage High School Cigarette Smoking, 2000-2014 ........... 92 3 R. Percent Current Middle School Cigarette Smoking, 2000-2014 ........................... 93 S. Percent Current Adult Cigarette Smoking, 1995-2014 ........................................... 94 T. Millions of Packs of Cigarettes Sold in Maryland, 2001-2015 ................................ 94 U. CHART: Adult Smoking Rate and Millions of Packs of Cigarettes Sold, 2001-2014 ........................................................................................................................................... 94 THE REMAINDER OF THIS PAGE HAS BEEN LEFT BLANK INTENTIONALLY 4 Suggested Citation: Maryland Department of Health and Mental Hygiene. Monitoring Changing Tobacco Use Behaviors: 2000 - 2014. Baltimore: Maryland Department of Health and Mental Hygiene, Prevention and Health Promotion Administration, Primary Care and Community Health Bureau, Center for Tobacco Prevention and Control, May 2016. THE REMAINDER OF THIS PAGE HAS BEEN LEFT BLANK INTENTIONALLY 5 STATE OF MARYLAND DHMH HeaHh