Selected Tobacco-Use Behaviors and Dietary Patterns Among High School Students -- United States, 1991

In the United States, 30% of all cancer deaths and 87% of lung cancer deaths are attributable to tobacco use (1); approximately 35% of all cancer deaths are associated with diet (2). Because tobacco-use behaviors and dietary patterns (particularly diets high in fat and low in fruits, vegetables, and grains) established during youth may extend into adulthood and may increase the risk for cancer and other chronic diseases, these behaviors should be monitored and addressed among youth (1,3). This article presents self-reported data on the prevalence of selected tobacco-use behaviors and dietary patterns associated with risk for cancer and other chronic diseases among U.S. students in grades 9-12 during 1991.

The national school-based Youth Risk Behavior Survey (YRBS) is a component of CDC's Youth Risk Behavior Surveillance System (YRBSS), which periodically measures the prevalence of priority health-risk behaviors among youth through representative national, state, and local surveys (4). The 1991 YRBS used a three-stage sample design to obtain a sample of 12,272 students representative of students in grades 9-12 in the 50 states and the District of Columbia. Students were asked "Have you ever tried cigarette smoking, even one or two puffs?"; "During the past 30 days, on how many days did you smoke cigarettes?"; and "During the past 30 days, did you use chewing tobacco, ... or snuff, ...?" Frequent cigarette use was defined as cigarette smoking on 20 or more of the 30 days preceding the survey. Students also were asked about foods they had consumed the previous day, including fruit; fruit juice; green salad; cooked vegetables; hamburger, hot dogs, or sausage; french fries or potato chips; and cookies, doughnuts, pie, or cake. The total number of servings * of fruit, fruit juice, green salads, and cooked vegetables was estimated by adding the number of servings of fruits and vegetables consumed during the day preceding the survey. Similarly, the total number of servings of foods typically high in fat content was estimated by adding the number of servings of hamburger, hot dogs, or sausage; french fries or potato chips; and cookies, doughnuts, pie, or cake eaten during the day preceding the survey.

Of all students in grades 9-12, 70.1% reported having tried cigarette smoking, and 12.7% reported frequent cigarette use during the 30 days preceding the survey (Table 1). The prevalence of frequent cigarette use was significantly greater among white students (15.4%) than among Hispanic (6.8%) or black (3.1%) students. The percentage of students who tried cigarette smoking and used cigarettes frequently increased significantly between ninth and 12th grade; 12th-grade students were nearly twice as likely as ninth-grade students to use cigarettes frequently (15.6% and 8.4%, respectively).

Smokeless tobacco use was reported by 10.5% of all students and was significantly more likely among male students (19.2%) than female students (1.3%). White male students (23.6%) were significantly more likely than any other group to report smokeless tobacco use.

Of all students, 12.9% reported consuming five or more (range: 0-8) servings of fruits and vegetables during the day preceding the survey (Table 2). Male students (15.2%) were significantly more likely than were female students (10.5%) to consume five or more servings of fruits and vegetables during the day preceding the survey. White students (13.9%) were significantly more likely to consume five or more servings of fruits and vegetables than were Hispanic students (9.7%) or black students (6.8%).

Of all students, 64.9% reported eating no more than two (range: 0-6) servings of foods typically high in fat content during the day preceding the survey (Table 2). Female students (72.9%) were significantly more likely than male students (57.2%) to eat no more than two servings of foods typically high in fat content during the day preceding the survey.

Reported by: American Cancer Society, Atlanta. Div of Adolescent and School Health, Div of Nutrition, and Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report are consistent with results from other recent national surveys that measured tobacco-use behaviors and dietary patterns among youth (5-7). The YRBS data can be used by public health and education agencies, as well as by voluntary organizations, to assist in targeting priorities and in program management. For example, CDC's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) has provided the findings in this report to the American Cancer Society (ACS), which will use these data to monitor progress toward achieving primary goals for their comprehensive school health education initiative (8). These goals are consistent with national health objectives for the year 2000 that address tobacco-use behaviors and dietary patterns associated with risk for cancer and other chronic diseases (objectives 2.5, 2.6, 3.5, and 3.9) (3).

The comprehensive school health education initiative is one of four core program initiatives (including patient resources, information, and guidance; tobacco control; and breast cancer detection) identified by ACS to reduce risk for and impact of cancer throughout the 1990s. The primary goals for the comprehensive school health education initiative are 1) reducing the proportion of ninth- and 12th-grade students who have tried cigarette smoking from 65% and 75% to 42% and 48%, respectively; 2) reducing the proportion of ninth- and 12th-grade students who smoked cigarettes on 20 or more of the last 30 days from 8% and 16%, to 4% and 8%, respectively; 3) reducing the proportion of male high school students who use chewing tobacco or snuff from 19% to 12%; 4) increasing the proportion of high school students who daily consume five or more servings of fruits and vegetables from 13% to 35%; and 5) increasing the proportion of high school students who daily eat no more than two servings of selected foods typically high in fat content from 65% to 80%.

To attain these primary goals, ACS has established the following three enabling goals: 1) to increase the proportion of states that require schools to implement comprehensive school health education; 2) increase the average proportion of the nation's school districts that require comprehensive school health education to be implemented across each grade range (i.e., kindergarten-6, 7-9, and 10-12); and 3) increase the average proportion of U.S. schools that implement comprehensive school health education across each grade range. These goals are consistent with the national health objectives for the year 2000 to increase the proportion of schools providing nutrition education (objective 2.19), tobacco-use prevention education (objective 3.10), and quality school health education (objective 8.4) (8).

Specific strategies ACS will implement to attain the primary and enabling goals include developing and promoting cancer prevention and control curricula for comprehensive school health education; promoting state and school district policies to require planned, sequential, comprehensive school health education that includes the cancer prevention and control curricula; increasing awareness of the need for comprehensive school health education and the status of school health education; and promoting the adoption of comprehensive school health education among schools nationwide.

The use of YRBS data by ACS illustrates how the YRBSS can be used to help plan and implement national, state, and local health promotion programs. Additional information about the YRBSS is available from the Division of Adolescent and School Health, NCCDPHP, CDC, Mailstop K-33, 1600 Clifton Road, NE, Atlanta, GA 30333.

References

1. CDC. Reducing the health consequences of smoking: 25 years of progress -- a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411.

2. National Research Council. Diet and health: implications for reducing chronic disease risk. Washington, DC: National Academy Press, 1989.

3. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

4. Kolbe LJ. An epidemiological surveillance system to monitor the prevalence of youth behaviors that most affect health. Health Education 1990;21:44-8.

5. CDC. Tobacco use among high school students -- United States, 1990. MMWR 1991;40:617-9.

6. CDC. Cigarette smoking among youth -- United States, 1989. MMWR 1991;40:712-5.

7. American School Health Association, Association for the Advancement of Health Education, Society for Public Health Education. The National Adolescent Student Health Survey. Oakland, California: Third Party Publishing, 1989.

8. American Cancer Society. Report of the Planning Advisory Council. Atlanta: American Cancer Society, 1990.

• Students who replied that they did not consume a particular type of food were assigned a frequency of 0; students who replied that they consumed a particular type of food "once only" were assigned a frequency of 1; and students who replied that they consumed a particular type of food "twice or more" were assigned a frequency of 2.

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