Smoking by teens has declined to record-low levels, according to the latest University of Michigan annual Monitoring the Future Study, which examines youth tobacco, alcohol and drug use in 2012 (data tables here).  The figure at left, which shows the percentage of high school seniors using alcohol, marijuana, cigarettes and smokeless tobacco in the past 30 days over the period 1975-2012, is highly informative.    Cigarette use continued a long-term decline, reaching 17%, the lowest prevalence since the survey’s introduction in 1975.  Cigarette use was lower than marijuana use (23%) for the fourth consecutive year.  Smokeless tobacco use among boys declined for the third consecutive year to 13.5%; use among girls was 1.6%.    As I noted in 2009, (here), anti-tobacco forces have a brilliant strategy for dealing with tobacco use research: If it’s good, take credit; if it’s bad, blame the industry.  In a press release, the Campaign for Tobacco Free Kids did a little of both.  It implied that the gains were attributable to FDA regulation and tax increases, but it claimed that “…the tobacco industry still spends $8.5 billion a year — nearly $1 million every hour — to market its deadly and addictive products …that entice youth.”   If the tobacco industry is responsible for youth smoking, which industry is responsible for marijuana use?   For high school seniors, alcohol is by far the drug of choice.  While alcohol prevalence declined substantially from over 70% around 1980, it remains far too high.  In 2012, more than 40% of high school seniors had an alcoholic drink in the past 30 days; 28% of them had been drunk.  This is astounding, given that the legal age to consume alcohol is 21 years.  It is especially worrisome when considering how many teens and young adults die in auto accidents.  With the exception of the elderly, this age group (15-24 years) has by far the highest death rates from auto accidents.  It comprises 14% of the U.S. population but accounts for 27% of auto deaths (2,498 in 2009).   Any use of drugs among children is a problem that should concern every American. We need to better understand the social and behavioral reasons why children experiment with and adopt substance use, in order to develop prevention strategies.  But we need to prioritize limited resources based on the relative impact of each substance on children’s health. Cigarettes and smokeless tobacco should not be ignored, but the MTF survey documents that alcohol is the major threat.    
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