Making cigarettes more difficult to obtain can help discourage young people from starting or continuing smoking. Activities to decrease young people’s access to cigarettes are part of a comprehensive approach to reducing the number of young people who start smoking. In Hawai‘i it is illegal to sell cigarettes to persons under the age of 18 years and much effort has gone into increasing compliance with the law. In fact, Hawai‘i has one of the highest compliance rates in the nation. Nevertheless, many young people still have access to cigarettes through other sources. Monitoring how and where minors acquire cigarettes is important for planning interventions to address these sources of cigarettes.

Students were asked how they usually got their cigarettes during the past 30 days. This report includes the answers of current smokers under the age of 18. Response options included: purchased at a store such as a convenience store, supermarket, discount store, or gas station; purchased from a vending machine; gave someone else money to buy them for me; borrowed (or bummed) them from someone else; a person 18 years old or older gave them to me; took them from a store or family member; or got them some other way.

Related Healthy People 2010 Indicator for current report
27-14a Increase the number of states (including the District of Columbia) with a < 5% sales rate of tobacco products to minors.

Cessation

Tobacco use is highly addictive and quitting can be difficult. It often takes multiple attempts before a person is able to finally quit. Although it is possible to quit using tobacco without help, evidence shows that people who use support services such as classes, self-help materials and telephone quitlines have a higher chance of success.¹ Many young people try to quit smoking each year, but few use cessation programs.

The quit attempt report includes the responses of current and frequent smokers. The report includes the percentage of smokers who had stopped smoking for one day or longer, during the last 12 months, because they were trying to quit, and the percentage whose last quit attempt lasted less than one month.

The cessation program report includes the responses from students who have ever used tobacco in any form and those who currently use tobacco and have ever participated in a program to help them quit using tobacco.

Related Healthy People 2010 Indicator for current report
27-7 Among adolescents in grades 9-12, increase the percentage of smokers who try to quit.

Mass Media

Young people are surrounded by images promoting tobacco use. According to the Campaign for Tobacco Free Kids, the tobacco industry spends $48.2 million per year on marketing in Hawai‘i. Research studies have found young people to be twice as sensitive to tobacco advertising as adults and that up to one-third of underage experimentation with smoking is attributable to tobacco company advertising.¹ Countering these pro-tobacco images with mass media campaigns providing information that will motivate children and adolescents to remain tobacco-free are part of a comprehensive approach to reducing tobacco use.²

The tobacco use in media report includes the responses of all students who have seen anti-tobacco advertisements on TV, the Internet or radio in the past 30 days. It also includes the percentage of students who report seeing some or most of the time: actors using tobacco on TV or in the movies, athletes using tobacco on TV, ads for tobacco on the Internet, and any of the above.

Related Healthy People 2010 Indicator for current report
27-16 Eliminate tobacco advertising and promotions that influence adolescents and young adults.

Prevalence

Tobacco use is the leading cause of preventable death and illness in Hawai’i and the United States.3 Cigarettes are the most commonly used form of tobacco, but tobacco is also available in cigars, smokeless tobacco (SLT—such as chewing tobacco, snuff or dip), pipe tobacco, Bidis4 and Kreteks.5 Tobacco is habit forming in all its forms and tobacco addiction primarily begins during adolescence. In the long term smoking increases the risk of lung and other cancers, heart disease and emphysema. Current smoking by young people is associated with serious health problems such as reduced lung capacity and physical fitness.6

The prevalence reports cover lifetime (ever) use of tobacco and current (with in the past 30 days) tobacco use. The lifetime report includes students who have ever tried cigarettes (even 1 or 2 puffs); ever used chewing tobacco, snuff or dip such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits or Copenhagen; ever tried smoking cigars, ever smoked Bidis or Kreteks and ever used any form of tobacco (cigarettes, cigars, SLT, Bidis or Kreteks). The current report includes students who have used cigarettes, cigars, SLT, Bidis, pipes or any of the previous forms of tobacco on one or more of the past 30 days.

Related Healthy People 2010 Indicator for current report
27-2a Reduce the use of tobacco products by adolescents in the past month.

School

Students spend a significant portion of their waking hours at school; hence schools can play a crucial role in preventing and reducing tobacco use in children and adolescents. Hawaii schools have implemented comprehensive anti-tobacco policies whereby smoking is not allowed on any public school campus, by anyone or at anytime. Evidence shows that education programs that include instruction on the physical and social consequences of tobacco use, social influences on tobacco use, peer norms, and life skills can prevent or reduce tobacco use among students.7

The anti-tobacco curriculum report includes the percentage of all students who report that they were taught in class about the dangers of tobacco use, the reasons young why young people smoke, and that most of their peers do not smoke. The report also includes the percentage of students who practiced ways to say “no” to tobacco in class. The time interval covered by these questions is not identical across years. In 2000 (spring survey) and 2003 (fall survey) students were asked to report on the above during this school year. From 2005 onward, students were asked about classroom exposure during the past 12 months.

The smoking on campus report includes all students and covers the percentage of students who report smoking or using smokeless tobacco (SLT—chewing tobacco, snuff or dip) on school campus in the past 30 days. It also includes the percent of all students who report that any teachers or other school employees smoke on their school campus.

Related Healthy People 2010 Indicator for current report
27-11 Increase the proportion of smoke-fee and tobacco-free middle, junior high and senior high schools.

Secondhand Smoke (SHS)

Secondhand smoke (SHS) is the combination of exhaled smoke from a smoker and “sidestream” smoke from the burning tip of a cigarette. Secondhand smoke (sometimes called involuntary smoking, environmental tobacco smoke, and passive smoking) is a known cause of lung cancer, heart disease and chronic lung ailments such as bronchitis and asthma.8 According to a recent U.S. Surgeon General Report, SHS exposure causes diseases and premature death in children and adults who do not smoke. Children exposed to SHS have an increased risk of sudden infant death syndrome (SIDS), acute respiratory infections, ear problems and more severe asthma. The scientific evidence indicates that there is no safe level of exposure to SHS.9

The SHS exposure report includes the percentage of all students, never smokers, and current cigarette smokers who were in the same room or car with someone who was smoking on at least 1 of the past 7 days. It also includes the percentage of all students who were exposed to SHS in a room or car within the past 7 days.

Related Healthy People 2010 Indicator for current report
27-9 Reduce the proportion of children who live in homes in which someone smokes inside the house > 4 days per week.

1Campaign for Tobacco-Free Kids. The Toll of Tobacco in Hawai‘i. 2005. factsheet
2Task Force on Community Preventive Services. The guide to community preventive services: tobacco use prevention and control. American Journal of Preventive Medicine. 2001;20(Suppl 2): 1-88.
3McGinnes JM, Foege WH. Actual causes of death in the United States. JAMA 1993; 270:2207-12.
4Bidis or “Beedies” are small brown cigarettes from India consisting of tobacco wrapped in a leaf tied with thread. They are often flavored.
5Kreteks are cigarettes containing clove extract.
6U.S. Department of Health and Human Services. Preventing tobacco use among young people: a report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention; 1994.
7Centers for Disease Control and Prevention. Guidelines for school health programs to prevent tobacco use and addiction. Morbidity and Mortality Weekly Report Recommendations and Reports. 1994;43(RR-2):1-18.
8Campaign for Tobacco-Free Kids. Health Harms for Secondhand Smoke. Factsheet. January 25, 2007.
9U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.

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Activities to decrease young people’s access to cigarettes are part of a comprehensive approach to reducing the number of young people who start smoking. In Hawai‘i it is illegal to sell cigarettes to persons under the age of 18 years and much effort has gone into increasing compliance with the law. In fact, Hawai‘i has one of the highest compliance rates in the nation. Nevertheless, many young people still have access to cigarettes through other sources. Monitoring how and where minors acquire cigarettes is important for planning interventions to address these sources of cigarettes. Students were asked how they usually got their cigarettes during the past 30 days. This report includes the answers of current smokers under the age of 18. Response options included: purchased at a store such as a convenience store, supermarket, discount store, or gas station; purchased from a vending machine; gave someone else money to buy them for me; borrowed (or bummed) them from someone else; a person 18 years old or older gave them to me; took them from a store or family member; or got them some other way. Related Healthy People 2010 Indicator for current report 27-14a Increase the number of states (including the District of Columbia) with a < 5% sales rate of tobacco products to minors. Cessation Tobacco use is highly addictive and quitting can be difficult. It often takes multiple attempts before a person is able to finally quit. Although it is possible to quit using tobacco without help, evidence shows that people who use support services such as classes, self-help materials and telephone quitlines have a higher chance of success.¹ Many young people try to quit smoking each year, but few use cessation programs. The quit attempt report includes the responses of current and frequent smokers. The report includes the percentage of smokers who had stopped smoking for one day or longer, during the last 12 months, because they were trying to quit, and the percentage whose last quit attempt lasted less than one month. The cessation program report includes the responses from students who have ever used tobacco in any form and those who currently use tobacco and have ever participated in a program to help them quit using tobacco. Related Healthy People 2010 Indicator for current report 27-7 Among adolescents in grades 9-12, increase the percentage of smokers who try to quit. Mass Media Young people are surrounded by images promoting tobacco use. According to the Campaign for Tobacco Free Kids, the tobacco industry spends $48.2 million per year on marketing in Hawai‘i. Research studies have found young people to be twice as sensitive to tobacco advertising as adults and that up to one-third of underage experimentation with smoking is attributable to tobacco company advertising.¹ Countering these pro-tobacco images with mass media campaigns providing information that will motivate children and adolescents to remain tobacco-free are part of a comprehensive approach to reducing tobacco use.² The tobacco use in media report includes the responses of all students who have seen anti-tobacco advertisements on TV, the Internet or radio in the past 30 days. It also includes the percentage of students who report seeing some or most of the time: actors using tobacco on TV or in the movies, athletes using tobacco on TV, ads for tobacco on the Internet, and any of the above. Related Healthy People 2010 Indicator for current report 27-16 Eliminate tobacco advertising and promotions that influence adolescents and young adults. Prevalence Tobacco use is the leading cause of preventable death and illness in Hawai’i and the United States.3 Cigarettes are the most commonly used form of tobacco, but tobacco is also available in cigars, smokeless tobacco (SLT—such as chewing tobacco, snuff or dip), pipe tobacco, Bidis4 and Kreteks.5 Tobacco is habit forming in all its forms and tobacco addiction primarily begins during adolescence. In the long term smoking increases the risk of lung and other cancers, heart disease and emphysema. Current smoking by young people is associated with serious health problems such as reduced lung capacity and physical fitness.6 The prevalence reports cover lifetime (ever) use of tobacco and current (with in the past 30 days) tobacco use. The lifetime report includes students who have ever tried cigarettes (even 1 or 2 puffs); ever used chewing tobacco, snuff or dip such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits or Copenhagen; ever tried smoking cigars, ever smoked Bidis or Kreteks and ever used any form of tobacco (cigarettes, cigars, SLT, Bidis or Kreteks). The current report includes students who have used cigarettes, cigars, SLT, Bidis, pipes or any of the previous forms of tobacco on one or more of the past 30 days. Related Healthy People 2010 Indicator for current report 27-2a Reduce the use of tobacco products by adolescents in the past month. School Students spend a significant portion of their waking hours at school; hence schools can play a crucial role in preventing and reducing tobacco use in children and adolescents. Hawaii schools have implemented comprehensive anti-tobacco policies whereby smoking is not allowed on any public school campus, by anyone or at anytime. Evidence shows that education programs that include instruction on the physical and social consequences of tobacco use, social influences on tobacco use, peer norms, and life skills can prevent or reduce tobacco use among students.7 The anti-tobacco curriculum report includes the percentage of all students who report that they were taught in class about the dangers of tobacco use, the reasons young why young people smoke, and that most of their peers do not smoke. The report also includes the percentage of students who practiced ways to say “no” to tobacco in class. The time interval covered by these questions is not identical across years. In 2000 (spring survey) and 2003 (fall survey) students were asked to report on the above during this school year. From 2005 onward, students were asked about classroom exposure during the past 12 months. The smoking on campus report includes all students and covers the percentage of students who report smoking or using smokeless tobacco (SLT—chewing tobacco, snuff or dip) on school campus in the past 30 days. It also includes the percent of all students who report that any teachers or other school employees smoke on their school campus. Related Healthy People 2010 Indicator for current report 27-11 Increase the proportion of smoke-fee and tobacco-free middle, junior high and senior high schools. Secondhand Smoke (SHS) Secondhand smoke (SHS) is the combination of exhaled smoke from a smoker and “sidestream” smoke from the burning tip of a cigarette. Secondhand smoke (sometimes called involuntary smoking, environmental tobacco smoke, and passive smoking) is a known cause of lung cancer, heart disease and chronic lung ailments such as bronchitis and asthma.8 According to a recent U.S. Surgeon General Report, SHS exposure causes diseases and premature death in children and adults who do not smoke. Children exposed to SHS have an increased risk of sudden infant death syndrome (SIDS), acute respiratory infections, ear problems and more severe asthma. The scientific evidence indicates that there is no safe level of exposure to SHS.9 The SHS exposure report includes the percentage of all students, never smokers, and current cigarette smokers who were in the same room or car with someone who was smoking on at least 1 of the past 7 days. It also includes the percentage of all students who were exposed to SHS in a room or car within the past 7 days. Related Healthy People 2010 Indicator for current report 27-9 Reduce the proportion of children who live in homes in which someone smokes inside the house > 4 days per week. 1Campaign for Tobacco-Free Kids. The Toll of Tobacco in Hawai‘i. 2005. factsheet 2Task Force on Community Preventive Services. The guide to community preventive services: tobacco use prevention and control. American Journal of Preventive Medicine. 2001;20(Suppl 2): 1-88. 3McGinnes JM, Foege WH. Actual causes of death in the United States. JAMA 1993; 270:2207-12. 4Bidis or “Beedies” are small brown cigarettes from India consisting of tobacco wrapped in a leaf tied with thread. They are often flavored. 5Kreteks are cigarettes containing clove extract. 6U.S. Department of Health and Human Services. Preventing tobacco use among young people: a report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention; 1994. 7Centers for Disease Control and Prevention. Guidelines for school health programs to prevent tobacco use and addiction. Morbidity and Mortality Weekly Report Recommendations and Reports. 1994;43(RR-2):1-18. 8Campaign for Tobacco-Free Kids. Health Harms for Secondhand Smoke. Factsheet. January 25, 2007. 9U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.
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