GOSHEN — Despite state and local efforts, the number of adolescents who use tobacco products remains steady, according to results of the 2018 Indiana Youth Tobacco Survey.
Presented to the Elkhart County Health Board on Thursday, the survey indicated that nearly 22.9 percent of Indiana high-schoolers still use some tobacco products, not including the vaping product JUUL. Included in the number are the 18.5 percent who use general e-cigarettes, nearly 5 percent of high-schoolers who smoke cigarettes and 6.7 percent who smoke cigars or cigarillos. Some students reported using more than one product.
Not included in that category are 24 percent of high-schoolers who also use JUUL.
“It’s been over 50 years since the first surgeon general’s report was published in 1964 that identified tobacco use as a contributor to chronic disease and lung cancer,” said Katelin Rupp, director of Program Evaluation. “We have more than 50 years of evidence of the death and disease that tobacco causes. Things have changed and evolved over time.”
According to the data, a significant decline in cigarette usage has been reported since 2000.
Less than one in 50 middle-schoolers and one in 20 high-schoolers reported cigarette usage in 2018. In 2000, nearly one in 10 middle-schoolers smoked and one in three high-schoolers smoked, making the overall decline roughly 84 percent.
Overall tobacco usage isn’t decreasing though because e-cigarette usage has increased four-fold between 2012 to 2014 alone, the report said, and nearly doubled from 2016 to 2018. In 2012, 3.8 percent of high schoolers and 1.2 percent of middle schoolers vaped, but in 2018, the number was reported at 18.5 percent of high-schoolers and 5.5 percent of middle-schoolers.
Today, one in 10 middle-schoolers and one in three high-schoolers reported having tried JUUL, and 24.2 percent of high-schoolers reported current usage.
The numbers become more staggering with flavored tobacco products. Nearly 64 percent of high-schoolers have tried at least one flavored tobacco product.
According to the survey, two-thirds of high-schoolers around the state believe it’s easy to acquire tobacco products.
The Tobacco Prevention and Cessation Commission’s five-year strategic plan was created in 2015. Elkhart County Health board members questioned the lack of progress in the current plan.
“I think we really need to address these emerging products in an aggressive way,” Rupp said. “When we wrote the plan, youth rates were not skyrocketing. E-cigarette use rates among adults were 1 percent to 2 percent and it escaped us.”
Despite the numbers, more than six in 10 middle school students and five in 10 high school students agreed that all tobacco products are dangerous, however, children who used e-cigarettes commonly stated that they believed vaping less harmful that traditional cigarette smoking and other products.
The 2018 study also included marijuana usage for the first time in Indiana’s tobacco survey history. Nearly 4 percent of middle school students and 16 percent of high school students reported current use while 7.4 percent of middle-schoolers and 29 percent of high-schoolers reported ever trying marijuana.
“We’re interested in the patterns of co-use,” she said. “The rates are high, but they’re comparable to other surveys.”
The survey indicated that nearly a third of youth who currently use marijuana also use two or more tobacco products, including e-cigarettes, which can easily be modified for marijuana usage.
The coalition hopes eliminating risk factors for youth will help lower the number of teens engaged in tobacco usage. An estimated 70 percent of youth are exposed to tobacco ads in convenience stores, gas stations or supermarkets.
“Point-of-sale marketing encourages you to start using tobacco. The majority of teens are at the convenience store at least once a week,” she said. “It also disproportionately targets some communities.”
About 86 percent of tobacco industry marketing is spent at point-of-sale.
Rupp also discussed proximity of tobacco retailers to low-income neighborhoods. The study counted 1.2 tobacco retailers in Elkhart County per 1,000 people, with the highest density of retailers based on population in the northwest portion of the city of Elkhart.
The state program has been working toward tobacco cessation for several years in a variety of ways. Programs like Moses Jones’ Sweet Deception, which recently visited the county, and others, offer a glimpse into the tobacco industry’s marketing campaigns and fight the mindset that vaping is a safe alternative to smoking.
“I personally think we need to work on cultural competency and working with the populations that smoke the most,” she said. “I don’t think our strategics are laser focused on those populations. They were focused on reaching the general population and reaching the most people, instead of reaching the people that need the most help. I would like to see some change around both of those things for 2020.”
By the end of the year, the Tobacco Prevention and Cessation Commission is hoping to start a social media campaign. She added that counter marketing has proven most effective with youth, telling them how the tobacco industry is, “using them as guinea pigs and replacement smokers.”
“A health message doesn’t always work with youth,” she said. “They tend to think they’re invisible and aren’t thinking long-term about their health.”
The Indiana Tobacco Quitline is available for those in need of counselling. It includes a web-based online chat for folks not interested in phone conversations. Text to Quit also offers smokers the opportunity to opt-in to receive text message support, rather than using phone or webchat to correspond.