Softening of monthly cigarette use in youth and the need to harden measures in surveillance

Objective: To assess changes in monthly smoking in its relationship to daily smoking and heavier smoking in high school seniors. Public health agencies often report only “current use” of cigarettes among youth as any use in the past 30 days, even though additional measures are collected. Monthly use is a crude and changing indicator. Methods: Results from 1975 to 2013 from Monitoring The Future Project were plotted and analyzed by linear regression. Results: From 1975 to 2013, the percentage of monthly smokers who smoked daily decreased by 29% (21.2 percentage points) and monthly smokers who smoked 10+ cigarettes/day dropped by 57% (28 percentage points); the percentage of daily smokers who smoked 10+ cigarettes/day decreased by 40% (26.5 percentage points). Conclusion: Additional measures of frequency and intensity of use of cigarettes and other tobacco/nicotine products need to be more regularly reported. These results indicate softening rather than hardening of “current smoking” and have important implications for tobacco surveillance and for tobacco research because of a) increased likelihood of quitting smoking, b) health effects of cigarette smoking, and c) similar and interacting issues related to measuring the use of all tobacco/nicotine products