1. Tobacco Use in West Virginia 2018
West Virginia Health Statistics Center

2. Data Sources Through the WV Health Statistics Center (HSC)
Data for Adults:
Behavioral Risk Factor Surveillance System (BRFSS) - BRFSS is a landline and cell phone survey that collects information on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury. BRFSS, established by the U.S. CDC, is implemented in all 50 states, District of Columbia, and several territories. The HSC has been collecting WV BRFSS data since 1984, and approximately 6,000 adults participate each year. Prevalence of cigarette and smokeless tobacco use, never-smoking and former smoking, and quitting smoking are obtained from BRFSS. BRFSS is the largest health survey in the world.
Vital Statistics System (VSS) - The Vital Registration Office, established in 1917, is the state’s official repository of birth, death, marriage, and divorce records. These records are collectively referred to as Vital Records:
Birth Certificate Data - The Certificate of Live Birth form provides data on percentage of women who smoked during their pregnancy, their cigarette consumption, prenatal care and health insurance coverage. County data is routinely analyzed for the 20,000+ births in WV. Women usually complete the certificate while they are in the hospital.
Death Certificate Data - Rates of death can be calculated for smoking-related diseases.
Smoking-Attributable Mortality, Morbidity and Economic Costs (SAMMEC) - Death data (causes of death from 23 smoking-related categories) and BRFSS data are used to determine smoking-attributable mortality, years of potential life lost, and productivity losses using methodology detailed in the U.S. Surgeon General’s Report The Health Consequences of Smoking years of progress (December 2014).

3. Data for Youth: Other: Other Data Sources
Youth Tobacco Survey (YTS) - YTS is a school-based survey of students in grades 6-12 in regular public schools in WV, administered in the spring of odd-numbered years. State-level data are collected from 80+ questions all focusing on prevalence of tobacco product use, attitudes/knowledge and influences, access to tobacco, secondhand smoke exposure, etc. The YTS is a collaboration between the WV Division of Tobacco Prevention and the WV Department of Education, and supported by the HSC and U.S. CDC.
Other:
U.S. Census - The U.S. Census provides population data for many demographic characteristics (age, sex, race, and Hispanic origin) for the U.S., states and counties. These data are important in weighting of data sets, estimating populations, and calculating death rates. The census is conducted every 10 years, with postcensal estimates available every year and intercensal estimates available every 10 years.
Economic Data - Tobacco sales and tax data from the WV Department of Tax and Revenue are used to determine cigarette consumption per smoker and per capita, and to project decreased consumption that may result from tax increases.

4. Data Slides: Table of Contents
The slides presented in this Graph Series are intended to be presented with the SLIDE NOTES. The notes provide more information to help explain, interpret, and use the information correctly in communications. When available, U.S. data and state ranking are provided.

5. Data Slides: Table of Contents (continued)

6. Data Slides #A-Cig Demog
GENDER: There were no significant differences in prevalence of current smoking by gender.
AGE: By age, the highest prevalence of current smoking occurred among adults aged (36.4%), and this was significantly higher than the prevalence among adults aged 18-24, and adults aged 55 and older. These differences by age group were also observed when examining males and females separately, although the differences may not be significant.
EDUCATION: Prevalence declined with increasing education level. The highest prevalence was among adults with less than HS education (41.9%), significantly higher than the prevalence among adults in any other education level, and this was consistent for females and for males.
HOUSEHOLD INCOME: Prevalence declined with increasing household income. The highest prevalence was among adults with less than $15,000 annual household income (43.5%). The prevalence among adults with annual household income of $24,999 or less was significantly higher compared to adults with annual household income of $25,000 or higher, and this was also consistent for males and females.

7. Data Slides #A-Cig 1A
For many years the prevalence of former smoking has been nearly equal to that of current smoking among adults. In 2016, the prevalence of current smoking was 24.8% (about 356,382 smokers), the prevalence of former smoking was 26.3% (about 377,736 former smokers), and the prevalence of never-smoking was 48.9% (about 702,591 never-smokers).
From 2011 to 2016, there has been a significant decrease in the prevalence of current smoking (28.6% decreasing to 24.8%).

8. Data Slides #A-Cig 1B
From 2011 to 2016, there has been a significant decrease in the prevalence of current smoking, from 28.6% decreasing to 24.8%.

9. Data Slides #A-Cig 2A
The prevalence of current smoking in WV has significantly decreased, from 28.6% in 2011, to 24.8% in BRFSS data for adult current smoking has been collected since the 1980s. The 2016 data (illustrating the significant decline comparing 2011 to 2016) is the first evidence that never-smoking MS and HS students (aging into the adult population) are finally making an impact on the larger population of all adults.
Although decreases have occurred since 2011, the prevalence of adult current smoking in WV has been significantly higher than the U.S. prevalence. WV continues to jockey (with Kentucky) for the highest smoking prevalence rank of #1 or #2 (among all states plus D.C.).

10. Data Slides #A-Cig 2B
The prevalence of current smoking appears to consistently decline with increasing age, comparing adults aged to older age groups. In 2016, the highest prevalence of current smoking was among adults aged 25-34, significantly higher than the prevalence among adults aged 18-24, and adults aged 55 years and older. There has been a significant decrease in the prevalence of current smoking among young adults aged years, from 38.5% in 2011, to 22.3% in 2016.

11. Data Slides #A-Cig 2C
There has been no significant difference in the prevalence of smoking among men and women in each age category. In 2016, the highest current smoking prevalence, 37.3%, was among men aged The prevalence of current smoking among men and women aged 65 and older is significantly lower than the prevalence in all other age categories.

12. Data Slides #A-Cig 2D
There are significant differences in prevalence of smoking among adults regarding education levels. Current smoking prevalence is inversely related to education level. The prevalence of current smoking among adults with less than HS is significantly higher than among all other education categories, and the prevalence among adults who have graduated college is significantly lower than among all other education categories. In 2016 by education category, the highest current smoking prevalence, 45.5%, was among men whose education was less than HS.

13. Data Slides #A-Cig 2E
Similar to education levels, current smoking prevalence is inversely related to household income. The prevalence of current smoking among adults with annual household income of $35,000 or greater is significantly lower than among adults with household income of $24,999 or below. In 2016, the highest current smoking prevalence, 45.4%, was among men whose annual household income was less than $15,000.

14. Data Slides #A-Cig 3A
Since 2012, the prevalence of never-smoking among adults aged has been significantly higher than the prevalence among adults aged This is likely due to the significant increase in never-smoking among MS and HS students, as these youth begin to age into the adult population. In 2016, the never-smoking prevalence among adults aged was 68.0%, significantly higher than the prevalence among adults aged of 43.9%.

15. Data Slides #A-Cig 3B
This slide illustrates data for adult women. From 2011 to 2016, the prevalence of never-smoking among women aged has not changed, and likewise for women aged 25-34, however the prevalence of never-smoking among women aged was significantly higher than the prevalence among women aged This is likely due to the significant increase in never-smoking among MS and HS females, as these youth begin to age into the adult population. In 2016, the prevalence of never-smoking among women aged was 71.6%, significantly higher than the prevalence among women aged of 46.8%.

16. Data Slides #A-Cig 4A
As the prevalence of never-smoking has increased over time, the prevalence of current smoking has significantly declined among young adults aged between 2011 (38.5%) and 2016 (22.3%). In 2016, the prevalence of current smoking among adults aged was 22.3%, significantly lower than the prevalence among adults aged 25-34, which was 36.4%.

17. Data Slides #A-Cig 4B
From 2011 to 2016, there were no significant changes in the prevalence of current smoking among women aged 18-24, and no significant changes in the prevalence among women aged In 2016, the prevalence of current smoking among women aged was 22.5%, significantly lower than the prevalence among women aged 25-34, which was 35.5%.

18. Data Slides #A-Cig 5A
There has been a significant decline in current smoking among adults aged between 2011 and This can be attributed to the changes (increase in never-smoking, plus decrease in current smoking) among HS students, as they age into adults aged In 2016, the prevalence of current smoking among adults aged was 30.2%, significantly lower than the prevalence in 2011, which was 40.1%.

19. Data Slides #A-Cig 5B
From 2011 to 2016, there was a significant decrease in the prevalence of current smoking among men aged 18-34, from 44.5% to 30.5%. There was a significant decrease in smoking among women aged from 2012 to 2016, from 40.1% to 29.9%.

20. Data Slides #A-Cig 6
The vast majority of all births in WV are among women aged 18-44, therefore women in this child-bearing age group are a special population for program intervention. From 2011 to 2016, there were no significant decreases in prevalence of current smoking among women aged in WV, and WV’s prevalence remains significantly higher than the U.S. (all states plus D.C.). In 2016, WV ranked #1, when the prevalence of current smoking among women aged was 30.9%, significantly higher and about double compared to the U.S. prevalence of 15.3%.

21. Data Slides #A-Cig 7
This graph depicts quit attempts measured among current smokers who quit smoking for one day or longer in the past 12 months in an effort to quit smoking. Comparing data in 2011 through 2016, there were no significant increases in quit attempts among adult current smokers. In 2016, the prevalence of quit attempts among current smokers was 54.7%, compared to the U.S. prevalence of 59.3%. WV’s ranking was #9 (ninth lowest prevalence) in the U.S. (among all states, D.C., Guam, Puerto Rico, and Virgin Islands).

22. Data Slides #A-Cig 8
The 2014 US Surgeon General’s Report detailed 23 causes of smoking-attributable mortality in SAMMEC. Between 2009 and 2013, the 4,240 estimated annual deaths are comprised of an estimated 1,800 deaths among women and 2,440 deaths among men, whose smoking lead to their deaths. The highest mortality categories are lung cancer (1,238 annual deaths), COPD (1,210 annual deaths), and coronary/ischemic heart disease (838 annual deaths). In 2013 in WV, the 10 leading causes of death included the following, and those in BOLD are smoking-related causes of death (from WV VSS):
Nephritis, Nephrotic Syndrome & Nephrosis
Influenza and Pneumonia
Alzheimer's Disease
Diabetes Mellitus
Cerebrovascular Disease
Dementia
Accidents, All Forms
Chronic Lower Respiratory Disease
Diseases of the Heart
Malignant Neoplasms

23. Data Slides #A-County: Tob
Five years of BRFSS data are combined to allow estimating prevalence at the county level. This table provides county-level prevalence for adult current tobacco use (use every day or some days, of either cigarettes or smokeless tobacco). County rankings are presented, as well as weighted frequencies (estimated number of tobacco users), and notes about significance. The prevalence in Kanawha, Monongalia, and Putnam counties was significantly lower than the WV average, and the prevalence in Calhoun, Lincoln, Logan, Nicholas, Webster, Wetzel, and Wyoming counties was significantly higher. Webster County ranked #1 among all WV counties for the highest prevalence of current tobacco use, 47.9%, during During these five years, the WV prevalence was 33.2% (about 481,190 tobacco users).

24. Data Slides #A-County: Tob (continued)
Continue from previous slide notes.

25. Data Slides #A-County: Cig
This table provides county-level adult current smoking prevalence, county rankings, weighted frequencies (estimated number of smokers), and notes about significance. The prevalence in Grant, Monongalia, and Pendleton counties was significantly lower than the WV average, and the prevalence in Calhoun and Wyoming counties was significantly higher. Calhoun County ranked #1 among all WV counties with high prevalence of current smoking, 38.0%, during During these five years, the WV prevalence was 26.5% (about 384,532 adult smokers).
For state-level current cigarette smoking data by demographics, refer to Data Slide #A-Cig Demog.

26. Data Slides #A-County: Cig (continued)
Continue from previous slide notes.

27. Data Slides #A-County: Slt (continued)
This table provides county-level prevalence for adult current smokeless tobacco use (use every day or some days). County rankings are presented, as well as weighted frequencies (estimated number of smokeless tobacco users), and notes about significance. The prevalence in Berkeley, Cabell, Hancock, Jefferson, Kanawha, Monongalia, Ohio, and Wood counties was significantly lower than the WV average, and the prevalence in Grant and Lincoln counties was significantly higher. Lincoln County ranked #1 among all WV counties for the highest prevalence of current smokeless tobacco use, 18.9%, during During these five years, the WV prevalence was 8.9% (about 128,757 smokeless tobacco users).
Notice that the prevalence among all MEN in WV was 17.2% (about 121,987 users) and the prevalence among all WOMEN was 0.9% (about 6,770 users) during this time. However, county-level data is not available for current smokeless tobacco use among men only, due to small sample sizes and resulting data that may be unreliable.
For state-level current smokeless tobacco use data by demographics, refer to Data Slide #A-Slt Demog.

28. Data Slides #A-County: Slt
Continue from previous slide notes

29. Data Slides #A-Spec 1A
The new birth certificate form, completed for women who have had a live birth, established a new baseline for smoking during pregnancy, beginning in The percentage of women smoking during pregnancy in 2015, 25.4%, was significantly lower than the percentage in 2014, 27.9%. The percentage of WV women who smoked during pregnancy was significantly higher than the U.S. percentage in 2015 (25.3% in WV compared to 7.8% in U.S). WV ranked #1 in 2015, among 49 states plus DC.
Note: Due to revisions in the 2015 dataset, earlier graphs stated 25.4%, but updated data is now 25.3% (as of , WV Health Statistics Center).

30. Data Slides #A-Spec 1B
In 2014, a new baseline was established from data collected through the new birth certificate form used by 49 states plus D.C. In 2016, the percentage of smoking during pregnancy was significantly higher among the Medicaid population (40.1%), more than triple the rate of smoking among women who gave birth who had other types of insurance (11.6%).

31. Data Slides #A-Spec 2
For each year 2011 to 2016, there was no significant difference in prevalence of current smoking among African American, Non-Hispanic adults in WV, compared to White, Non-Hispanic adults in WV. In 2016, the prevalence of current smoking among African American, Non-Hispanic adults was 32.4%, compared to 24.7% among White, Non-Hispanic adults. Although prevalence may not differ, African American smokers suffer disproportionately higher rates of smoking-related diseases compared to Whites, which may be associated with the high prevalence of menthol cigarette use among African Americans [Alexander, LA, et al. (March 12, 2016). Why we must continue to investigate menthol’s role in the African American smoking paradox. Nicotine & Tobacco Research. 12, 2016estigate-Menthol-s-Role].

32. Data Slides #A-Spec 3
Low SES is defined as annual household income of less than $25,000 and education level of less than HS/GED. From 2011 to 2016, no significant changes occurred in the prevalence of current smoking among Low SES adults, nor among non-Low SES adults. In every year, the prevalence of current smoking was significantly higher among the Low SES adults, compared to non-Low SES adults. In 2016, the prevalence of current smoking among Low SES adults was 49.9%, significantly higher than among non-Low SES adults, which was 22.1%.

33. Data Slides #A-Spec 4
In 2016, the prevalence of current smoking and the prevalence of current tobacco use (use of cigarettes or smokeless tobacco) was significantly higher among adults with Medicaid health care coverage, compared to adults with other coverage. There was no significant difference comparing the prevalence of smokeless tobacco use among men, by health care coverage. In 2016, the prevalence of current tobacco use among adults covered by Medicaid was 51.4%, significantly higher than the prevalence among adults with other health care coverage, which was 24.7%.

34. Data Slides #A-Spec 5
The prevalence of current smoking among WV adults aged 55 and older has remained fairly constant from 2011 to The prevalence of current smoking among women aged 55 and older was significantly lower compared to the prevalence among men in The prevalence of current smoking among adults aged 55 and older was 16.7% in 2016, significantly lower than the prevalence among all WV adults, which was 24.8%.

35. Data Slides #A-Spec 6
Tobacco use, specifically cigarette smoking, is a cause of or exacerbating factor for many chronic diseases. While the prevalence of current smoking appears to be declining from 2011 to 2016 among adults diagnosed with certain chronic conditions, there were no significant declines.
In 2016, the prevalence of current smoking among all adults was 24.8%.
The prevalence of current smoking among adults diagnosed with arthritis %;
with current asthma %;
with cancer %;
with COPD %;
with diabetes %;
with cardiovascular disease %;
with hypertension --- NA;
with kidney disease %;
overweight or obese %.
In 2016, the prevalence of current smoking was significantly higher among adults diagnosed with asthma (32.3%), and COPD (45.3%), compared to the prevalence of smoking among all WV adults.

36. Data Slides #A-Spec 7A
Tobacco use is often a form of self-medication for adults with mental health conditions. Similar to the previous graph, this graph presents data on current tobacco use (use of cigarettes or smokeless tobacco every day or some days). From 2011 to 2016, the prevalence of current tobacco use among adults diagnosed with depression was significantly higher than the prevalence of current tobacco use among all adults. In 2016, the prevalence of current tobacco use among adults diagnosed with depression was 40.7%, compared to the prevalence of current tobacco use among all adults, which was 31.3%. In 2016, the prevalence was significantly higher among men compared to women, due to the higher prevalence of smokeless tobacco use among men. No significant changes in the prevalence occurred from 2011 to 2016.

37. Data Slides #A-Spec 7B
From 2011 to 2016, the prevalence of current smoking among adults diagnosed with depression was significantly higher than the prevalence of current smoking among all adults. In 2016, the prevalence of current smoking among adults diagnosed with depression was 36.0%, compared to the prevalence of current smoking among all adults, which was 24.8%. There were no significant differences by gender.

38. Data Slides #A-Spec 8A
From 2011 to 2016, there was no significant change in current smoking among adults, regardless of heavy drinking status. In 2016, the prevalence of current smoking was significantly higher among heavy drinking adults (more than 1 drink per day for women; more than 2 drinks per day for men), which was 51.0%, compared to the prevalence of current smoking among not heavy drinking adults, which was 23.6%.
In 2016, the prevalence of heavy drinking among all adults in WV was 3.5%, significantly lower than the U.S. prevalence of 6.4%, and WV’s rank was #54, the #1 lowest (among all states, D.C., Guam, Puerto Rico, and Virgin Islands).
However, WV’s prevalence of smoking among heavy drinkers was 51.0%, significantly higher than the U.S. prevalence of smoking among heavy drinkers, 32.0%, in 2016.

39. Data Slides #A-Spec 8B
From 2011 to 2016, there were no significant changes in the prevalence of current smoking among binge drinking adults, but there was a significant decrease in current smoking among not binge drinking adults (from 25.8% to 22.3%). In 2016, the prevalence of current smoking was significantly higher among binge drinking adults (4 or more drinks per occasion for women; 5 or more drinks per occasion for men), which was 43.3%, than the prevalence of current smoking among not binge drinking adults, which was 22.3%.
In 2016, the prevalence of binge drinking among all adults in WV was 11.3%, significantly lower than the U.S. prevalence of 16.9%, and WV’s rank was #54, the #1 lowest (among all states, D.C., Guam, Puerto Rico, and Virgin Islands).
However, WV’s prevalence of smoking among binge drinkers was 43.3%, significantly higher than the U.S. prevalence of smoking among binge drinkers, 28.0%, in 2016.

40. Data Slides #A-Slt Demog
The prevalence of smokeless tobacco use among adults in WV is usually reported for men only, since the prevalence among women is very low and usually unreliable.
AGE: By age, the highest prevalence of current smokeless tobacco use occurred among men aged (20.6%), and this was significantly higher than the prevalence among men aged 65 and older. Among men aged 35-44, there was a spike in smokeless use in 2015, followed by a significant decrease in These fluctuations may occur within demographic groups from year to year, but no significant changes have been observed in the use of smokeless by men overall.
EDUCATION: By education, prevalence seemed to decline with increasing education level. The highest prevalence was among men with less than HS education (20.8%), significantly higher than the prevalence among men with college education (7.7%).
HOUSEHOLD INCOME: There appears to be no clear trend in prevalence of smokeless tobacco use among men concerning household income. The highest prevalence was among men with less than $15,000-$24,999 annual household income (19.5%).

41. Data Slides #A-Slt 1
There was no significant change in the prevalence of current smokeless tobacco use among WV men from 2011 to In 2016, the WV prevalence among men was 15.9%, significantly higher than the U.S. prevalence of 6.5%. The prevalence among WV women is usually very low (1.5% in 2016), therefore WV prevalence is usually reported as use among men only.
In 2016, WV ranked #2 in the nation with high prevalence of men using smokeless tobacco (among all states, D.C., Guam, Puerto Rico, and Virgin Islands).

42. Data Slides #A-Slt 2
From 2011 to 2016, there were no changes in the prevalence of current smokeless tobacco use among men in the age categories of years or years. In 2016, there was no significant difference when comparing the current smokeless tobacco use prevalence among men aged 18-24, 20.6%, to men aged 25-34, which was 18.5%.

43. Data Slides #A-Slt 3
The prevalence of dual use, defined as current smokeless tobacco use among men who are current smokers, has not changed from 2011 to In 2016, there were about 180,666 men who were current smokers, and about 26,190 of them (a prevalence of 14.5%) were also currently using smokeless tobacco products. The prevalence of dual use among WV women is very low (2.1% in 2016), therefore WV prevalence is usually reported as dual use among men only.

44. Data Slides #Y-Tob 1A
The prevalence of never-tobacco use (never use of cigarettes, smokeless, or cigars) among HS students has significantly increased from 2000 to 2005, from 2005 to 2009, and from 2011 to The prevalence has significantly increased among MS students in similar manner. While the HS prevalence has remained significantly lower than the MS prevalence, positive changes are occurring in both populations. In 2017, the prevalence of never-tobacco use among HS students in WV was 53.3%, representing about 39,697 students, compared to about 12,983 HS students who were current tobacco users.
Due to the introduction and marketing of new products, students have more choices in their nicotine products. Beginning in 2013, data on 12 tobacco products were collected: cigarettes, cigars, smokeless, snus, pipe tobacco, flavored and clove cigars, roll-your-own, flavored cigarettes, e-cigs, hookah, and dissolvable products. The prevalence of “never-tobacco of any kind” is slightly lower compared to the prevalence based on the former definition, indicated by the short lines in the graph.

45. Data Slides #Y-Tob 1B
The prevalence of never-tobacco use among HS students is significantly higher among females, compared to males, predominantly influenced by greater levels of never-smokeless tobacco and never-cigar use among females. The prevalence of never-tobacco use has significantly increased among males and females from 2000 to In 2017, the prevalence of never-tobacco use among HS females was 56.6%, compared to the prevalence among HS males of 50.4%.
Note the shorter, lower trendlines for the prevalence of “never-tobacco, any of 12 kinds,” similar to the previous slide.

46. Data Slides #Y-Tob 2
The prevalence of current tobacco use (cigarettes, smokeless, cigars, or pipes) among HS students has significantly decreased from 2000 to The prevalence has significantly decreased among MS students in similar manner. While the HS prevalence has remained significantly higher than the MS prevalence, positive changes are occurring in both populations. In 2017, the prevalence of current tobacco use among HS students in WV was 17.6% (about 12,983 students), and the prevalence among MS students was 7.9% (about 4,517 students).
As previously noted, including other tobacco products in the definition results in prevalence that is slightly higher, as indicated by the short trendlines in the graph.
Note that the prevalences of HS and MS current tobacco use have been reduced to 1/3 of what they were in 2000.

47. Data Slides #Y-Tob 3
This table presents prevalence of ever trying or current use of various tobacco products among HS students. Data were first collected on these products beginning in In 2017, the prevalence among HS students of ever trying any of the 9 products was 54.3% (about 41,030 students), and the prevalence of current use of any of the 9 products was 19.5% (about 15,035 students). The only prevalence illustrating significant differences by gender were in the categories of ever trying/current use of smokeless tobacco (the prevalence among males was 29.8%/16.7%, compared to the prevalence among females of 12.5%/2.8%).
In 2017, the prevalence among current smokers of current use of any other tobacco product was 84.2% (about 6,348 students), which means they are getting nicotine from a variety of products.
From 2013 to 2017, the only product showing significant increase in prevalence was e-cigs, which will be discussed in other slides.

48. Data Slides #Y-Tob 4A
From 2013 to 2017, the prevalence among HS students of ever trying e-cigs more than doubled from 15.5% (about 12,396 students) to 35.9% (about 27,223 students). Notably, the prevalence of never-smoking students trying e-cigs dramatically increased eleven-fold, from 623 never-smokers in 2013, to 6,974 never-smokers in The vast majority of current smokers, 85.7% (about 6,468 students) had tried e-cigs in 2017.

49. Data Slides #Y-Tob 4B
From 2013 to 2017, the prevalence of current use of e-cigs among HS students increased significantly from 4.9% (about 3,900 students) to 14.1% (about 10,637 students), however the change from 2015 to 2017 is negligible, both in prevalence and estimated number of students. The prevalence of never-smoking students currently using e-cigs increased from 165 never-smokers in 2013, to 2,378 never-smokers in Over half of all HS current smokers (51.6%, about 3,831 students) were current e-cig users in 2017.

50. Data Slides Y-Cig 1A
The prevalence of never-smoking (never smoking cigarettes, not even 1-2 puffs) among HS students has significantly increased from 2000 to 2005, from 2005 to 2009, and from 2013 to The prevalence has significantly increased among MS students in a similar manner. While the HS prevalence has remained significantly lower than the MS prevalence, positive changes are occurring in both populations. In 2017, the prevalence of never-smoking among HS students in WV was 63.4%, representing about 46,877 students, compared to about 7,582 current smokers.
In 2000, about 54,996 students (grades 6-12) were never-smokers, and by 2017 that number had increased to about 94,689 never-smokers (grades 6-12).

51. Data Slides #Y-Cig 1B
The prevalence of never-smoking among HS females has significantly increased from 25.4% in 2000 to 63.6% in 2017, and similar changes occurred in the prevalence among MS females, from 53.4% in 2000 to 83.3% in While the HS prevalence has remained significantly lower than the MS prevalence, positive changes are occurring in both populations.
Combining both HS and MS females, there were 26,539 never-smokers in 2000, which has nearly doubled to 45,744 in 2017 (note that the WV population of MS and HS students has declined about 10% from 2000 to 2017). If these MS and HS females can continue to be never-smokers as they enter adulthood, they may experience the health benefits of a smoke-free life, smoke-free pregnancies, and smoke-free homes.

52. Data Slides #Y-Cig 1C
The prevalence of never-smoking among HS students has significantly increased from 25.7% in 2000 (about 21,506 HS students), to 63.4% in 2017 (about 46,877 HS students), but there were no significant differences by gender. In 2017, there were about 46,877 never-smokers, compared to about 7,582 current smokers.

53. Data Slides #Y-Cig 1D
Between the years 2000 and 2017, there were significant increases in the prevalence of never-smoking among HS students in all grade levels. In 2017, there were no significant difference in the prevalence of never-smoking comparing across grade levels. In 2017, the prevalence of never-smoking was 67.0% among 9th graders, 68.7% among 10th graders, 60.0% among 11th graders, and 57.2% among 12th graders.

54. Data Slides #Y-Cig 2A
The prevalence of current smoking is the most common measure for youth tobacco use in the U.S. In WV from 2000 to 2017, the prevalence among HS students decreased significantly from 38.5% (about 32,683 students) to 10.3% (about 7,582 students). The prevalence among MS students significantly decreased from 18.1% (about 11,542 students) to 4.5% (about 2,592 students). While the HS prevalence remains significantly higher than the MS prevalence, significant changes have occurred in both groups.

55. Data Slides #Y-Cig 2B
The converse of HS smokers is HS students who are not currently smoking cigarettes, which includes never-smokers, experimenters who smoke sporadically, and established smokers who have quit. In 2017, the prevalence of not currently smoking was 92% among students in all grades From 2000 to 2017, the prevalence of not currently smoking has increased significantly among HS and MS students. The prevalence of not currently smoking among HS students remains significantly lower compared to MS students.

56. Data Slides #Y-Cig 2C
The prevalence of current smoking among HS students decreased significantly from 38.5% in 2000 (about 32,683 HS students) to 10.3% in 2017 (about 7,582 HS students), but there were no significant differences comparing males to females.

57. Data Slides #Y-Cig 2D
From 2000 and 2017, there were significant decreases in the prevalence of current smoking among HS students in all grades. In 2017, the prevalence of current smoking was 8.6% among 9th graders, 7.1% among 10th graders, 12.4% among 11th graders, and 13.7% among 12th graders.

58. Data Slides #Y-Cig 2E
This graph compares the prevalence of current smoking among HS students in WV to those in the U.S. during the years when the data were collected in both populations. The WV prevalence was significantly higher than the U.S. prevalence in all years, however during 2002 to 2011, the average annual rate of decline in WV was greater than the average annual rate of decline in the U.S. From 2000 to 2017, the prevalence of current smoking among HS students in WV decreased 73% (from 38.5% to 10.3%).

59. Data Slides #Y-Cig 3
While there have been no significant changes in the prevalence of age-of-onset by age 12 among HS students who have ever smoked, the dramatic change has been the weighted frequencies. In 2000, there were over 25,000 HS ever-smokers who had started by the time they were 12 years old, but that estimate declined to less than 10,000 students in 2017.
According to research, half of all smokers who become dependent on nicotine, have done so by the time they are smoking 7-8 cigarettes per month [DiFranza, JR, et al. (2007). Symptoms of tobacco dependence after brief intermittent use: The development and assessment of nicotine dependence in Youth-2 study. Archives of Pediatrics].
Early age of onset for smoking is linked to heavier daily smoking, longer history of smoking, and less success in quitting smoking [Campaign for Tobacco-Free Kids (updated January 12, 2017). The path to tobacco addiction starts at very young ages.

60. Data Slides #Y-Cig 4
The Susceptibility Index is a CDC defined indicator. Data from 5 survey questions are used to determine the Index. From 2000 to 2017, there were significant changes among HS students in the prevalence and weighted frequency of every measure in the Susceptibility Index:
The Established smokers decreased from 33.8% to 6.8%, or about 27,100 students to 4,786 students.
Experimenters decreased from 39.5% to 28.0%, or about 31,619 students to 19,687students.
Susceptible Never-Smokers increased from 7.1% to 14.3%, or about 5,715 students to 10,085 students.
Non-Susceptible Never-Smokers increased from 19.6% to 50.9%, or about 15,716 students to 35,832 students.
Note: Enrollment of public HS students decreased about 10% from 2000 to 2017.

61. Data Slides #Y-Cig 5
The YTS data allow us to define types of smokers among HS students. This bar chart illustrates the significant changes in estimated populations of cigarette smoking indicators among HS students in WV from 2000 to 2017:
Never-smokers more than doubled, from 21,506 to 46,877.
Ever-smokers who were not currently smoking decreased from 28,655 to 17,133.
Current smokers were those who smoked in the past 30 days, but not heavily or regularly. This group decreased from 12,691 to 4,369.
Other categories, grouped together decreased from 8,304 to 1,848, and include:
frequent = smoked 20+ days in past 30 days.
daily = smoked every day in past 30 days.
heavy = smoked 6+ cigs/day.
The most heavily addicted were current, frequent, daily, heavy smokers. This group decreased dramatically from 11,284 to 1,314.

62. Data Slides #Y-Slt 1
The prevalence of never-smokeless tobacco use among MS males has significantly increased from 68.3% in 2000, to 84.6% in The prevalence significantly increased among HS males from 51.8% to 70.2%, the first instance illustrating a significant increase in prevalence among HS males since data collection began in The prevalence among MS males remains significantly higher compared to the HS males. In 2000, about 44,810 male students (grades 6-12) were never-smokeless tobacco users, and in 2017, that increased to about 52,199 male students (grades 6-12).

63. Data Slides #Y-Slt 2
The prevalence of current smokeless tobacco use among MS males has significantly decreased from 14.9% in 2000, to 7.0% in There has been no significant decrease among HS males, however the trend indicates a steady decline. The prevalence among HS males has remained significantly higher than that of the MS males. The WV prevalence among HS males in 2015 (22.8%) was significantly higher than the U.S. prevalence of 10.0% (from the NYTS).
The prevalence of current use among females in HS and MS has remained low, but is still monitored.

64. Data Slides #Y-Slt 3
Dual use, the prevalence of current smokeless tobacco use among current smokers, has significantly increased among HS males from 2000 to While it appears that the prevalence among MS males increased during this time, the change is not statistically significant. There are no significant differences in the prevalence of dual use among HS males compared to MS males.
Notice that the estimated population sizes have changed due to the fact that there are fewer current smokers (also explaining the wide CI in 2017 HS males):
In 2000, there were 6,547 HS male dual users, and that decreased to 2,304 in 2017.
In 2000, there were 2,546 MS male dual users and that dropped to 585 in 2017.

65. Data Slides #Y-Slt 4
This bar chart depicts changes in the estimated number of smokeless tobacco users among HS males in WV. From 2000 to 2017, there was an increase in the estimated number of never-users, and decreases in all other categories, even among the daily users, decreasing from 3,571 to 3,223 HS males. There was a significant increase in the prevalence of HS males never-smokeless tobacco use, but no significant differences in the other measures during this time.
Note: Enrollment of public HS students decreased about 10% from 2000 to 2017.

66. Data Slides #Y-SHS 1
2007 was the first survey year assessing smoke-free homes and students’ attitudes concerning secondhand smoke (SHS) and smoke-free venues. From 2007 to 2017, there were significant increases in the prevalence of living in a smoke-free home, among all HS students, and also among nonsmoking students. No significant changes occurred in the prevalence among smoking students. The prevalence of living in a smoke-free home is significantly higher among nonsmoking students than among smoking students.
From 2007 to 2017, the decrease in weighted frequency of smoking students living in smoke-free homes (8,894 decreasing to 3,119) was likely due to the significant decrease in the number of smoking students during that time.
In 2017, the prevalence among HS nonsmoking students of living in a smoke-free home was 77.9%, significantly higher than the prevalence of 43.5% among smoking HS students. Research indicates that there is a strong correlation between living in a smoke-free home and youth choosing to not take up smoking [Wakefield, MA, et al. (2000). Effect of restrictions on smoking at home, at school, and in public places on teenage smoking: Cross sectional study. British Medical Journal, 2000;321(7257):333–7].

67. Data Slides #Y-SHS 2
Several YTS questions measure attitudes and knowledge concerning SHS and smoke-free venues. In 2017, there were significant differences in the prevalence, by smoking status:
74.0% of nonsmoking students were not exposed to SHS in their home, while only 34.2% of smoking students were not exposed to SHS in their home.
72.0% of nonsmoking students were not exposed to SHS in their family car, while only 25.4% of smoking students were not exposed to SHS in their family car.
87.9% of nonsmoking students believed that SHS is harmful, a significantly higher prevalence compared to 71.6% of smoking students, however smoking HS students responded at a very high level in agreement.
79.4% of nonsmoking students believed that SHS should never be allowed in their home, while only 31.3% of smoking students believed that SHS should never be allowed in their home.
80.3% of nonsmoking students believed that SHS should never be allowed in cars, while only 30.3% of smoking students believed that SHS should never be allowed in cars.

68. Data Slides #O-Tax 1
West Virginia began assessing a state excise tax per pack of cigarettes in the 1950s. While the price per pack has increased greatly since 1955, the level of the state excise tax has not maintained the same increase. According to the U.S. Surgeon General (2014), increasing the price of cigarettes by increasing excise taxes is an effective policy intervention to prevent initiation of tobacco use, promote cessation, and reduce the prevalence and intensity of tobacco use among adolescents and young adults. In 2016, the average state excise tax was $1.65 per pack. On July 1, 2016, WV’s tax was increased from $0.55 to $1.20 (a 65 cent increase), and WV’s ranking increased from 46th to 33rd (among states plus DC).

69. Data Slide #O-SHS 1 Data Slides #Y-Slt 3
Back in the 1990s when counties began to enact Clean Indoor Air regulations, the standard regulation allowed smoking in designated areas. By 2007, every WV county had a minimal regulation, but in 2002, the standard regulation of “100% workplace coverage” emerged. Currently, 33 of WV’s 55 counties have adopted these regulations, indicated in red in the graph above. About 61% of WV’s population live in these 33 counties.

70. For More Information and Data Reports Contact:
West Virginia Health Statistics Center
Dan Christy, Director
Birgit Shanholtzer, Epidemiologist
Director, Epidemiology & Statistical Services
(304)
Kathi Elkins, Epidemiologist
(304)
West Virginia Division of Tobacco Prevention
Jim Kerrigan, Director
(304)