in Santa Clara County 2012

Tobacco Use in Santa Clara County 2012

Tobacco Use in Santa Clara County This report summarizes findings for Santa Clara County (SCC) from multiple surveys on tobacco. It reviews data on several topics concerning tobacco for adults and youth in the county, including: Tobacco use, including cigarette use and use of other tobacco products Secondhand smoke exposure Tobacco cessation Smoking-related attitudes and knowledge Tobacco and anti-tobacco marketing For adults, sources included the Behavioral Risk Factor Survey (2000-2009), 2010 Communities Putting Prevention to Work (CPPW) Behavioral Risk Factor Survey, 2009 California Health Interview Survey, 2008 California Tobacco Survey, 2007-08 California Vietnamese Adult Tobacco Use Survey, and 2011 Santa Clara County Vietnamese Adult Health Survey. For youth, sources included the California Healthy Kids Survey (2001-2010) and 2007-08 California Student Tobacco Survey. Results from the 2007-08 California Healthy Kids Survey are presented from the Supplemental Tobacco Module. Since the findings were based on a small sample of students, they should be viewed with caution. I. Key Findings The following are select key findings by major topic described in the report. Tobacco use One in 10 adults and 8% of middle and high school students are current smokers. Twenty-one percent (21%) of adults and 7% of middle and high school students have ever used other tobacco products. Secondhand smoke exposure Despite smoking restrictions at home, in vehicles, and at school, Santa Clara County residents continue to be exposed to secondhand smoke; for example, 17% of adults reported exposure at their workplace in the past week. Tobacco cessation Most adults and nearly half of middle and high school students who are current smokers have tried to quit smoking, but very few have used any quit methods, such as a nicotine substitute or self-help materials. The majority of adult smokers in the county (78%) have received quit advice from a health professional. Over half (56%) reported that a doctor or other health professional referred them to a smoking cessation program, but most (88%) did not try to quit after receiving the referral. Smoking-related attitudes and knowledge Overall, Santa Clara County adults are supportive of smoke-free policies, but there is limited support among parents, teachers, and community members to prevent youth tobacco use. Most youth do not have a favorable impression of smoking. 2

Tobacco and anti-tobacco marketing Youth are exposed to tobacco and anti-tobacco marketing messages mostly through TV and movies. II. Tobacco Use Tobacco use is the single leading preventable cause of death in the U.S. Nearly 1 in 5 deaths in the U.S. can be attributed to cigarette smoking and secondhand smoke exposure. 1 If tobacco use were decreased by 5% in California, an estimated $380 million a year would be saved on medical costs. 2 Cigarette Use Among Adults In Santa Clara County in 2009, 1 in 10 adults were current smokers. 3 This was less than the percentage of adults who smoked statewide (14%) and in the U.S. (18%) in 2008 (cigarette use in the past 30 days), 4 and lower than the Healthy People 2020 target of 12%. 5 Thirty-one percent (31%) reported smoking at least 100 cigarettes in their lifetimes (the definition of a lifetime smoker).3 From 2000 to 2009, the percentage of adults in Santa Clara County who ever smoked (4 to 34%) and who were current smokers (15% to ) decreased. 6 In 2009, 58% of current smokers reported that they smoked everyday and 42% smoked some days.3 Everyday smokers smoked an average of 11 cigarettes per day and someday smokers smoked an average of three cigarettes per day. Current smokers had smoked cigarettes regularly for an average of 12 years. 7 Figure 1: Percentage of Adults Who Were Current Smokers, 2000-2009 15% 15% 12% 11% 5% 2000 2004 2006 2009 Source: Santa Clara County Public Health Department, 2000-2009 Behavioral Risk Factor Survey 3

Cigarette Use by Demographic Characteristics In SCC in 2009, a higher percentage of men than women were current smokers among adults in the county overall (13% vs. 7%) and all major races/ethnicities.3 A higher percentage of adults ages 25-34 (15%) and ages 45-54 (12%) than adults in other age groups were current smokers.3 A lower percentage of Asian/Pacific Islander adults (8%) smoked cigarettes compared to Hispanics (9%) and Whites (11%).3 Although results cannot be presented for African Americans in SCC due to small sample size, studies have found that African Americans statewide have a high smoking rate (19%). 8 There is a higher prevalence of smoking among adults in some Asian subgroups: 12% of Vietnamese (24% of men) were current smokers in 2011 and 21% of Filipinos (32% of men) were current smokers in 2009.3,9 The prevalence of smoking was highest among adults with some college (18%).3 A slightly higher percentage of adults born in the U.S. (11%) than outside the U.S. (9%) were current smokers.3 The prevalence of smoking among adults decreased with an increase in annual household income.3 A higher percentage of adults without health insurance (15%) were current smokers than adults with health insurance (9%).3 Although results cannot be presented for the Lesbian/Gay/Bisexual/Transgender/Questioning (LGBTQ) population in SCC due to small sample size, studies have found that the LGBTQ population statewide has a high smoking rate (22%).7 Table 1: Percentage of Adults Who Were Current Smokers Percent Santa Clara County Gender Male 13% Female 7% Age 18-24 8% 25-34 15% 35-44 9% 45-54 12% 55-64 11% 65+ 7% Race/Ethnicity White (men) 11% (13%) African American (CA)* (19%) Hispanic (men) 9% (11%) Asian/Pacific Islander (men) 8% (11%) Vietnamese (men)** 12% (24%) Filipino (men) 21% (32%) Education Less than high school 13% High school graduate 12% Some college 18% College degree or higher 6% Place of birth U.S. born 11% Born outside the U.S. 9% Household income Less than $20,000 19% $20,000-$49,999 13% $50,000-$74,999 $75,000 or more 9% Health insurance status Has health insurance 9% Does not have health insurance 15% *Centers for Disease Control and Prevention, Behavioral Risk Factor Survey, 2009 **Santa Clara County Public Health Department, 2011 Vietnamese Adult Health Survey Source: Unless otherwise noted, Santa Clara County Public Health Department, 2009 Behavioral Risk Factor Survey 4

Smoking Triggers Santa Clara County adults smoke in a variety of situations, referred to as smoking triggers. In 2008, most current smokers (79%) in Santa Clara County had their first morning cigarette within two hours of waking in the morning. Among current or occasional smokers, 43% sometimes or frequently smoked in clubs and 36% sometimes or frequently smoked while working or studying. Close friends and family may be important influences on a person s smoking behavior. A higher percentage of smokers than nonsmokers had one or more close friends and relatives who smoked: 88% of smokers compared to 71% of nonsmokers. 10 In 2007-08, social situations were highly influential in triggering smoking among Vietnamese men who smoked 71% smoked while socializing with friends and 57% smoked in coffee shops, restaurants, or bars. Thirty-five percent (35%) smoked while driving. 11 Age of Initiation In 2008, of all adults in Santa Clara County who ever smoked a cigarette, 3 in 5 (6) first smoked a whole cigarette before the age of 18. However, most (64%) began smoking regularly at ages 18 and older. Among nonsmoking adults (those who had smoked fewer than 100 cigarettes in their lifetime), most (82%) smoked fewer than 20 cigarettes and most (6) were between the ages of 18 and 24 when they had their last cigarette. 10 Purchasing Behaviors In 2008, most current smokers (94%) in Santa Clara County bought their cigarettes by the pack (66%) or carton (28%), and almost all (98%) bought their cigarettes in California. Current smokers reported usually paying on average $38 for a carton of cigarettes and $4.41 for a pack of cigarettes. Forty-three percent (43%) reported they worry about how much money they spend on cigarettes. The price of cigarettes influences current smokers: 36% reported it influenced how much they smoke, 64% where they bought their cigarettes, 32% what brand they bought, and 51% their desire to quit. Current smokers usually smoked Marlboros (57%) or Camels (14%). Half of current smokers usually bought their cigarettes at convenience stores, followed by liquor stores or drug stores (19%) and tobacco discount stores (14%). 10 Figure 2: Where Adult Current Smokers Usually Buy Their Cigarettes 1% 3% 5% CONVENIENCE STORE OR GAS STATION SUPERMARKET 14% LIQUOR OR DRUG STORE 5 TOBACCO DISCOUNT STORE 19% OTHER DISCOUNT STORE 8% MILITARY COMMISSARIES OTHER Source: California Tobacco Survey, 2008 5

Cigarette Use Among Middle and High School Students In Santa Clara County in 2009-10, 8% of middle and high school students reported cigarette use in the past 30 days. Current cigarette use and lifetime cigarette use were higher among Hispanic and African American students than White and Asian/PI students and students in the county overall. 12 In 2007-08, 5% of middle and high schools students had ever smoked cigarettes daily, and 29% of current smokers reported ever smoking to control their weight. 13 Since 2001-02, the percentage of students who smoked cigarettes in the past 30 days in the county overall and among most racial/ethnic groups remained relatively stable. 14 Figure 3: Percentage of Middle and High School Students with Current or Lifetime Cigarette Use 25% Cigarette use in past 30 days Lifetime, ever smoked 23% 21% 15% 5% 16% 15% 11% 11% 8% 8% 9% 5% SCC White Hispanic African American Asian/PI Source: California Healthy Kids Survey, 2009-10 Figure 4: Percentage of Middle and High School Students Who Smoked Cigarettes in the Past 30 Days by Race/Ethnicity, 2001-2010 Percent 18% 16% 14% 12% 8% 6% 4% 2% 2001-02 2003-04 2005-06 2007-08 2009-10 SCC White Hispanic African American Asian/PI Source: California Healthy Kids Survey, 2001-2010 6

Most students who had smoked cigarettes in the past 30 days usually acquired their cigarettes by being given them by a friend, purchasing them in a store, or giving money to someone to buy them. Of students who purchased cigarettes in the past 30 days, less than a quarter (23%) was asked to show proof of age. 13 Figure 5: How Middle and High School Students Who Smoked Cigarettes in the Past 30 Days Usually Acquired their Cigarettes BOUGHT THEM IN A STORE 8% 19% VENDING MACHING GAVE SOMEONE MONEY TO BUY THEM FOR ME 23% 7% BORROWED THEM FROM SOMEONE ELSE TOOK THEM FROM STORE OR FAMILY MEMBER FRIEND GAVE THEM TO ME 7% 7% OTHER PEOPLE GAVE THEM TO ME GOT THEM SOME OTHER WAY Note: Percentages exceed 10 due to rounding. Source: California Healthy Kids Survey, 2007-08. In 2009-10, White students who had ever smoked reported first smoking all or part of a cigarette at a later age than Hispanic, African American, and Asian/PI middle and high school students, and students in the county overall. The most common age for students in the county who had ever smoked to first smoke all or part of a cigarette was ages 12 and younger (44%). 12. Table 2: Age at Which Middle and High School Students Reported They First Smoked All or Part of a Cigarette by Race/Ethnicity (Among Students Who Had Ever Smoked) Race/Ethnicity Age 12 13-14 15-16 17 SCC 44% 31% 22% 3% White 24% 39% 34% 2% African American 53% 29% 16% * Asian/Pacific Islander 42% 3 25% 3% Hispanic 5 3 17% 3% *Results for African Americans for ages 17 and older are not presented due to small sample size. Source: California Healthy Kids Survey, 2009-10. In Santa Clara County in 2007-08, almost one-third (32%) of middle and high school students reported that at least one of their four closest friends smoked. If one of their best friends offered them a cigarette, 63% of students said they would definitely not smoke it, 21% said probably not, said probably yes, and 6% said definitely yes. 15 When asked this question in a slightly different way, 17% of 7

students said they would find it hard or very hard to say no or refuse a friend who offered them a cigarette to smoke. Twenty-two percent (22%) of students said that many or most/all of the adults they know smoke cigarettes, 57% knew some, and 21% knew none. 13 In Santa Clara County in 2007-08, among middle and high school students who were current smokers, half (5) reported usually smoking the Marlboro brand during the past 30 days, followed by no usual brand (18%), Newport (14%), Camel (9%), or some other brand (9%). Middle and high school students who were current smokers smoked cigarettes mostly outdoors (6) or at home or friends houses (35%). 15 Thirty-seven percent (37%) of current smokers (4% of all students) smoked cigarettes on school property in the past 30 days in 2009-10. 12 Figure 6: Where Middle and High School Students Smoke Cigarettes 7 6 5 4 3 32% 35% 35% 27% 2% 3% 4% 4% 5% 6% 6% 12% 16% 19% Work Public buildings Source: California Student Tobacco Survey, 2007-08. School Car Sports or other social events All Students Home Current Smokers* Friends' houses In Santa Clara County in 2007-08, nearly half (45%) of middle and high school students who were current smokers in the county reported usually smoking menthol-flavored cigarettes. Among current smokers, a slightly lower percentage of White students (4) than Asian/PI (46%) and Hispanic (44%) students reported usually smoking menthol-flavored cigarettes. Although results cannot be presented for African Americans in SCC due to small sample size, 55% of African American students statewide who were current smokers usually smoked menthol-flavored cigarettes. 15 Among adolescents ages 12 to 17, national data found that the proportion of menthol smokers was higher among African American smokers (72%) than Hispanic smokers (47%) and non-hispanic White smokers (41%). 16 Figure 7: Percentage of Middle and High School Students that Usually Smoked Menthol-Flavored Cigarettes by Race/Ethnicity (Among Current Smokers) 11% 6 Outdoors Percent of Current Smokers 5 4 3 Source: California Student Tobacco Survey, 2007-08. 45% 46% 44% All SCC Asian/Pacific Islander Hispanic 4 White 8

Use of Other Tobacco Products Among Adults In 2008, 21% of Santa Clara County adults had ever used any tobacco products other than cigarettes such as chewing tobacco, snuff, cigars, pipes, or any other form of tobacco use 19% had ever smoked cigars, cigarillos, or little cigars; 8% had ever used chewing tobacco or snuff; and 7% had ever smoked a Hookah pipe. 10 In 2008, few adults in Santa Clara County had heard of emerging tobacco products. Thirteen percent (13%) of adults had heard of snus, 7% had heard of Ariva, and 11% had heard of Eclipse, Accord, Exalt, Revel, Omni, or Advance. Results are not presented on the percentage of adults in SCC using these products due to small sample size. 10 In 2010, fewer than 1% of adults currently used chewing tobacco, snuff, or snus. 17 Half (5) of current smokers reported smoking cigarettes with low levels of nicotine and tar (low-yield cigarettes), 33% did not smoke low-yield cigarettes, and 18% were unsure. (Percentages do not add to 10 due to rounding.) 10 Use of Other Tobacco Products Among Middle and High School Students In 2009-10, 8% of middle and high school students in Santa Clara County had ever used smokeless tobacco or other tobacco products. Current smokeless tobacco use and lifetime smokeless tobacco use was higher among Hispanic and African American students than White and Asian/PI students and students in the county overall. 12 Similar to cigarette use, White students who had ever used these products reported first use at a later age than Hispanic, African American, and Asian/PI middle and high school students, and students in the county overall. Among students who had ever used smokeless tobacco or other tobacco products, the most common age for first use was ages 12 or younger (4). 12 OTHER TOBACCO PRODUCTS* Smokeless tobacco - Chewing tobacco - comes in the form of loose leaf, plug, or twist - Snuff - finely ground tobacco that can be dry, moist, or packaged in sachets - Snus - flavored, scentless, spitless tobacco that comes in small teabaglike pouches that has the appearance of chewing gum Bidis small, thin hand-rolled flavored or unflavored cigarettes imported from India and other Southeast Asian countries; wrapped in plants native to Asia; may be secured with a colorful string at one or both ends Kreteks also known as clove cigarettes; imported from Indonesia and typically contains a mixture of tobacco, cloves, and other additives Hookahs sometimes called water pipes; used to smoke specially made tobacco available in different flavors; mouthpiece shared often in groups EMERGING TOBACCO PRODUCTS* Smokeless tobacco - Ariva a lozenge containing compressed powdered tobacco - Exalt - Swedish snus - Revel - American smokeless tobacco product Source: Stepanov I, Jensen J, Hatsukami D, Hecht SS. Nicotine & Tobacco Research 2006, 8(2): 309 313. Low-yield cigarettes (e.g. Eclipse, Accord, Omni, Advance) cigarettes promoted as having fewer harmful chemicals or carcinogens *Centers for Disease Control and Prevention, Smoking & Tobacco Use Fact Sheets In Santa Clara County in 2007-08, 19% of middle and 9

high school students who were current smokers (4% of all students) used chewing tobacco on school property in the past 30 days. 15 In 2007-08 in Santa Clara County, 8% of middle and high school students reported use of cigars, cigarillos, or little cigars in the past 30 days. 13 Four percent (4%) of middle and high school students had tried kreteks, 3% had tried bidis, and 3% had tried both. 15 Figure 8: Percentage of Middle and High School Students with Current or Lifetime Smokeless Tobacco Use by Race/Ethnicity 14% 12% 8% 6% 4% 2% Smokeless tobacco use in past 30 days Lifetime, used smokeless tobacco 6% 6% 3% 3% 4% SCC White Hispanic African American Asian/PI 8% 6% 12% 1% 3% Source: California Healthy Kids Survey, 2009-10 Table 3: Age at Which Middle and High School Students Reported They First Used Smokeless Tobacco or Other Tobacco Products by Race/Ethnicity (Among Students Who Had Ever Used Smokeless Tobacco or Other Tobacco Products. Race/Ethnicity Age 12 13-14 15-16 17 SCC 4 29% 27% 4% White 33% 42% 4% African American 49% 24% 21% * Asian/Pacific Islander 37% 28% 32% 4% Hispanic 48% 29% 4% *Results for African Americans for ages 17 and older cannot be presented due to small sample size. III. Secondhand Smoke Exposure Two-thirds of adults (67%) in Santa Clara County in 2009 reported completely prohibiting smoking inside their household. Twenty-three percent (23%) of adults only allowed smoking in the front or backyards, 5% of adults had no restrictions on smoking inside the house, and 5% had some other smoking rules in their household.3 From 2000 to 2009, the proportion of adults who reported that they placed no 10

restrictions on smoking in their households declined, while those allowing smoking only in the front or backyard increased. The percentage of adults who completely prohibit smoking in their households has remained stable.6 In 2009, adults in the county that allowed smoking inside the home reported smoking inside the home an average of 2.7 days per week.7 In 2008, among current smokers who had ever had a ban on smoking in their home, 72% ever reduced the number of cigarettes they smoked as a result of having a home smoking ban. 10 Figure 9: Household Smoking Rules, 2000-2009 8 6 4 Completely prohibited No restrictions Only in front or backyard Current smokers 2000 2004 2006 2009 Source: Santa Clara County Public Health Department, 2000-2009 Behavioral Risk Factor Survey Among Santa Clara County middle and high school students in 2007-08, a lower percentage of White students (24%) than African American (3), Hispanic (33%), and Asian/Pacific Islander (31%) students reported living with someone that smoked cigarettes. Thirty-eight percent (38%) were in the same room with someone who was smoking cigarettes on one or more of the previous seven days. Nineteen percent (19%) were in the same room at home with someone who was smoking cigarettes on one or more of the previous seven days, and 3 in 10 (3) lived with someone who smoked cigarettes. A quarter (25%) said smoking was allowed inside their home. 15 In addition to exposure at home, Santa Clara County residents are also exposed to secondhand smoke at work, in the car, and at public places. In Santa Clara County in 2010, 17% of adults reported indoor exposure to secondhand smoke at their workplace in the past week, 13% reported indoor exposure at public places in the past week, and 3% reported exposure to secondhand smoke while riding in a vehicle in the past week. A lower percentage of White adults than adults from other races reported secondhand smoke exposure indoors at their workplace (9% vs. 23%) and at public places other than work (7% vs. 18%) in the past week. Secondhand smoke exposure indoors at public places other than work decreased as education and income increased. 17 Among Santa Clara County middle and high school students in 2007-08, 22% rode in a car with someone who was smoking cigarettes on one or more of the previous seven days. A lower percentage of Asian/Pacific Islander (18%) students than White (23%) or Hispanic (24%) students rode in a car with someone who was smoking cigarettes on one or more of the previous seven days. Although results cannot be presented for African American students in SCC due to small sample size, studies have found that 26% of African American students statewide rode in a car with someone who was smoking cigarettes on one or more of the previous seven days. 15 11

In addition to setting household smoking rules, adults in Santa Clara County also place smoking restrictions on their vehicles: 91% never allowed smoking inside any vehicle in 2010. Seven percent (7%) sometimes allowed smoking in at least one vehicle, 2% always allowed smoking, and fewer than 1% had no vehicle smoking policy or did not own or lease a vehicle. 17 In 2007-08, 88% of middle and high school students in Santa Clara County reported that there is a rule at school for students and/or adults that no one is allowed to use tobacco in the school building or on the schoolyard. Of students whose schools have a no-tobacco rule for students and/or adults, nearly 2 in 10 (19%) reported that most or all of students who use tobacco break the rule, and over 3 in 10 (31%) reported that they had seen adults break the rule. Less than half (45%) of students reported that when a student breaks the school s no-tobacco rule they are suspended, and 25% reported that a parent conference is a consequence for a student who breaks the rule. Forty-four percent (44%) reported that they did not know what happens when a student breaks the rule. 15 Figure 10: Consequences Reported by Middle and High School Students for Breaking Their School s No-Tobacco Rule 5 45% 4 35% 3 25% 15% 5% 45% 14% Suspended Gets a ticket Referred to a special class Source: California Student Tobacco Survey, 2007-08 13% Referred to an adult counselor 6% Referred to a peer counselor 25% Parent conference 44% Don't know IV. Tobacco Cessation In Santa Clara County in 2009, 64% of current smokers stopped smoking for one day or longer in the past 12 months because they were trying to quit.3 Of Vietnamese men who were current smokers in 2007-08, about 7 had tried to quit for more than one day in the past 12 months. 11 In 2010, of current smokers in Santa Clara County who quit smoking or tried to quit smoking, 5% received one-on-one counseling from a health professional to help quit and 2% called a telephone line to help them quit on their last quit attempt. Only a quarter of all adults (24%), regardless of smoking status, were aware of any telephone quitline services to help them quit smoking. 17 12

In 2008, current or former smokers used a variety of quit methods to adjust to life without cigarettes: 27% had used a nicotine substitute; 16% had used counseling advice or self-help materials, and 15% used an antidepressant prescription pill. 10 It was uncommon for Vietnamese men who were current or former smokers to have used a quit method such as a nicotine substitute or self-help materials on their last quit attempt. Seventy-seven percent (77%) did not use any quit method. 11 Half of smokers (5) agreed that smokers who use nicotine replacement therapy (NRT) are able to smoke a lot less. However, an equal proportion (5) reported that the cost of NRT is a major barrier to using it. Over three-quarters of smokers (77%) did not believe that most smokers who use NRT to quit are successful. 10 Table 4: Attitudes and Beliefs of Current Adult Smokers Regarding Quitting % Agreed Most smokers who use NRT to quit are successful 23% NRT is only useful for initial withdrawal symptoms during a quit attempt 45% NRT helps smokers handle situations in which they can't smoke 6 Smokers who use NRT are able to smoke a lot less 5 The major barrier preventing smokers from using NRT is its cost 48% Smokers can quit on their own without any pharmaceutical aids 64% I could stop smoking anytime I wanted 46% Nicotine patches or gum are a sure way for smokers to quit when they want to 31% TV Advertisements for nicotine patches or gums are accurate when they claim it will make smokers quit 19% Source: California Tobacco Survey, 2008 In 2008, more than 3 in 4 (78%) of current and recent former smokers reported that a doctor or other health professional advised them to stop smoking in the last 12 months. Fifty-six percent (56%) reported that a doctor or other health professional referred them to a smoking cessation program, but most (88%) did not try to quit after receiving the referral. 10 In 2007-08, fewer Vietnamese men who were current smokers (54%) than was the case for all adult smokers in the county in 2008 responded that a doctor, nurse, or other health professional advised them to stop smoking in the past 12 months. Advice from health professionals was influential in quit attempts: Nearly half (47%) who received such advice subsequently tried to quit. 11 In 2008, most current smokers planned to quit in the near future: 37% said they will quit in the next six months; and 22% said they will quit in the next month. Twenty-five percent (25%) said they might quit in the future, and 17% never expected to quit. 10 In 2007-08, three-quarters of Vietnamese men who were 13

current smokers indicated that they would like to quit and 36% were planning to quit in the next 30 days. 11 In 2007-08, nearly 2 in 5 (38%) Santa Clara County middle and high school students who were current smokers reported that they would like to quit smoking. Nearly half (46%) of students who were current smokers reported that they had tried to quit smoking one or more times, 13 and the same percentage had stayed off cigarettes for six months or longer when they last tried to quit. 15 More than 8 in 10 students (82%) who were current smokers believed they would be able to quit smoking cigarettes now if they wanted. Few students who were current tobacco users had ever participated in programs at school and 6% outside of school or had ever called the 1-800-NO-BUTTS California tobacco hotline to quit using tobacco (9%). 15 Of those students who used tobacco in the past 12 months, 17% went to a special group or class to try to quit, 14% talked to an adult at school about how to quit, and 25% talked to a peer helper about how to quit. 13 V. Smoking-related Attitudes & Knowledge In 2010, Santa Clara County adults showed strong support for smoke-free indoor air policies in the workplace: 88% said that smoking should never be allowed indoors at workplaces. Support was higher among women (91%) than men (85%) and higher among those with a college degree (94%) than those without a college degree (less than high school: 88%; high school or GED: 87%; some post-high school: 81%). 17 In 2008, almost half (45%) of adults said they would be willing to support an additional tax of $1 or more on a pack of cigarettes if all the money raised was used to fund programs aimed at preventing smoking among children and other healthcare programs. Seventy-nine percent (79%) thought that licensing fees should pay for enforcement of laws prohibiting tobacco sales to minors, and 87% thought tobacco advertising should not be in stores where children go. 10 Although parents/guardians are involved in helping their children stay tobacco free, exposure to tobacco prevention information is lacking in schools and classrooms. In 2007-08, 4 in 5 (81%) Santa Clara County middle and high school students said that either one or both of their parents/guardians had told them not to smoke cigarettes. 15 Only one-third (33%) said their teacher or a guest speaker talked to their class about NOT using tobacco in the past 12 months. 15 The majority of students are not taught about tobacco use or secondhand smoke in school. Thirty percent (3) said their teachers talked about the reasons why people their age smoke or do NOT smoke in the past 12 months. 15 Only 1 in 5 (19%) stated that their teachers talked about how many people their age do NOT smoke in the past 12 months. 15 Thirty-four percent (34%) said their teachers talked about the effects of secondhand smoke in the past 12 months. 15 Less than half (43%) had had lessons about tobacco and its harmful effects on the body at school in the past 12 months, and only 3 in 10 (3) practiced different ways to refuse or say no to tobacco offers at school in the past 12 months. 13 Only a quarter (25%) reported that they went to a school assembly or event about the harmful effects of tobacco use in past 12 months. 15 14

The information students learn about tobacco in school or the lack thereof may not prepare them to make important decisions regarding tobacco. Four in 10 reported not receiving any information in school to make decisions about not using tobacco in the past 12 months and 13% said the information they received was not helpful. 15 Fifteen percent (15%) said what they learned in school did not help them feel it was okay to say no to friends who offered them cigarettes in the past 12 months, and 39% did not learn anything to help them feel it was okay to say no. 15 Less than half (47%) reported that the information they received in school was helpful in making decisions about not using tobacco in the past 12 months because they decided not to start using tobacco (39%) or they were thinking about quitting (8%). Similarly, less than half (46%) said that what they learned in school helped them feel it was okay to say no to friends who offered them cigarettes in the past 12 months. 15 Students reported limited activities in the community to discourage tobacco use. One in 4 (25%) ever attended community activities that discouraged people their age from using tobacco in the past 12 months. 15 Only 23% said there are services or programs to help people quit smoking, and only 17% said there are activities to keep youth from getting tobacco products. However, over half (54%) said that youth in their community get a ticket from the police if they are caught with cigarettes. 15 Figure 11: Community Activities to Discourage Tobacco Use Reported by Middle and High School Students 25% 23% 15% 5% 14% 16% 15% 17% 9% Reduce tobacco company support for car races, rodeos, etc. Support for a youth tobacco control group Reduce exposure to secondhand tobacco smoke Keep youth from getting tobacco products Reduce the amount of tobacco advertising Help people quit smoking Source: California Student Tobacco Survey, 2007-08 Most students are knowledgeable about smoking s health risks and the role tobacco companies play in promoting cigarette use, but not about prevalence or addiction patterns among youth. In 2007-08, 84% of middle and high school students in Santa Clara County said that it is definitely or probably NOT safe to smoke for only a year or two, as long as they quit after that. Ninety-one percent (91%) reported that the smoke from other people s cigarettes is definitely or probably harmful to them. Ninety percent (9) believed that tobacco companies definitely or probably try to get people addicted to cigarettes. Eighty- 15

five percent (85%) believed that tobacco companies definitely or probably try to get young people to start smoking by using advertisements that are attractive to young people, and the same percentage believed that if tobacco companies knew for sure that smoking hurts people they would definitely or probably not stop selling cigarettes. Three-quarters correctly answered that breathing smoke from someone else s cigarette can cause lung cancer (74%), and that smoking cigarettes makes asthma worse (75%). Only 28% correctly answered that most young people do not smoke cigarettes, and only 36% correctly answered that teenagers are not too young to get addicted to tobacco. 15 Most students do not view smoking favorably in terms of its effects on physical appearance and health or peer image. In 2007-08, over 8 of middle and high school students in Santa Clara County agreed or very much agreed that smoking makes your teeth yellow (87%), makes you smell bad (81%), and is bad for your health (82%). Over 8 disagreed or very much disagreed that smoking is cool (88%), smoking helps you make friends (84%), or that smoking makes kids look grown up (82%). Twenty-eight percent (28%) agreed or very much agreed that smoking helps you relax, and 22% agreed or very much agreed that smoking helps control your weight. 13 VI. Tobacco & Anti-tobacco Marketing The majority of youth reported seeing anti-tobacco marketing when they watched TV; fewer youth were exposed to anti-tobacco marketing through other media (i.e. radio and billboards). In 2007-08, most (71%) middle and high school students in Santa Clara County had seen or heard commercials about the dangers of cigarette smoke in the past 30 days. Sixty-two percent (62%) said they saw stories/ads a lot or sometimes about dangers of smoking tobacco or chewing tobacco when watching TV. However, only 4 in 10 (38%) said they heard ads a lot or sometimes about NOT smoking or NOT chewing tobacco when listening to radio, and only 43% said they saw ads a lot or sometimes about NOT smoking or NOT chewing tobacco when seeing billboards. 15 Similarly, most youth reported exposure to tobacco marketing through TV or the movies, and to a lesser extent through the internet, consumer products, or sports events, fairs or community events. In 2007-08, 81% had seen actors using tobacco most or some of the time when watching TV or going to movies. Thirty-seven percent (37%) had seen internet ads most or some of the time for tobacco products. Thirteen percent (13%) bought or received anything that had a tobacco logo on it. A quarter (25%) said that they would definitely or probably ever use or wear something with a tobacco logo on it, and 18% said students are allowed to wear or use something that has a tobacco name or picture on it at school. Thirty-six percent (36%) said they saw ads for cigarettes or chewing tobacco a lot or sometimes when going to sports events, fairs or community events. 15 16

1 Centers for Disease Control and Prevention. Tobacco-related Mortality Fact Sheet. 2 Prevention Institute and The California Endowment with The Urban Institute. Reducing Health Care Costs through Prevention, August 2007. 3 Santa Clara County Public Health Department, 2009 Behavioral Risk Factor Survey. 4 Centers for Disease Control and Prevention, 2000-2008 Behavioral Risk Factor Surveillance System. 5 U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Health People 2020 Objectives, Access to Quality Health Services. 6 Santa Clara County Public Health Department, 2000-2009 Behavioral Risk Factor Survey. 7 California Health Interview Survey, 2009. 8 Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2009. 9 Santa Clara County Public Health Department, 2011 Vietnamese Adult Health Survey. 10 California Tobacco Survey, 2008. 11 California Vietnamese Adult Tobacco Use Survey, 2007-08. 12 California Healthy Kids Survey, 2009-10. 13 California Healthy Kids Survey, 2007-08. 14 California Healthy Kids Survey, 2001-2010. 15 California Student Tobacco Survey, 2007-08. 16 Caraballo, R. S., & Asman, K. (2010). Epidemiology of menthol cigarette use in the United States. Tobacco Induced Diseases, 9(Suppl. 1), S1. doi:10.1186/1617-9625-9-s1-s1. 17 Communities Putting Prevention to Work, Behavioral Risk Factor Survey, 2010. Cover Photograph: KhruschovS/Bigstock.com 17