TIME Research

U.S. Teen Trends In Sex, Bullying, Booze and More

Teenager Smoking Cigarette Boys
Getty Images

Good news: Today's teens experience notably low rates of bullying, drinking, pregnancy and unprotected sex

The latest statistics on teenagers paint a rosy portrait of American teens. They’re drinking, smoking and bullying less than they used to, and fewer are getting pregnant.

“Adolescence is an inherently risky time,” says Dr. Stephanie Zaza, the director of the U.S. Centers for Disease Control and Prevention’s (CDC) division of adolescent and school health. “They are stretching their wings. We can’t eliminate all risk, but we are seeing overall good trends in all areas.”

Here’s a snapshot on teen behavior, based on recent reports:

Bullying

Recent data from the U.S. Department of Education’s National Center for Education Statistics showed bullying at school was on the decline. Bullying among kids ages 12 to 18 dropped to 22% in 2013. The rate is lower than the 28-32% that was reported in all other survey years since 2005. Even cyberbullying—the use of electronic services to harass someone—has dropped. Only 6.9% of students reported being cyberbullied in 2013 compared to 9% in 2011.

Zaza adds that bullying has often targeted LGBTQ youth, and with increasing acceptance and major policy changes regarding same-sex marriage in the news, social norms regarding sexuality may be changing too, and that may contribute to less fighting.

Smoking

Teens are smoking less, too. In the last CDC National Youth Risk Behavior Survey (YRBS), which analyzes health risk behaviors among high school students, revealed that the high school smoking rate had dropped to 15.7%, the lowest recorded level since the survey started in 1991. It meant that the CDC had met its goal of lowering the adolescent smoking rate to under 16% by 2020, several years early.

Zaza says what’s responsible is a combination of widespread public health initiatives and changing social norms. “When you look at excise taxes, smoking bans, quit lines, campaigns and innovations in therapies, you see this amazing trend in adult and youth tobacco use,” says Zaza. “With all of those changes came a really big change in the social norms around smoking.”

Still, data from the CDC suggests that while high schools are smoking fewer cigarettes, e-cigarette use tripled among middle and high schoolers in just one year.

Drinking

The number of students who drink alcohol also dropped. Though it was still high at 35%, teens reported less physical fighting in school, and most students who were sexually active used condoms.

Sex and Babies

National teen pregnancy rates are also at a record low, with recent data from the U.S. Department of Health and Human Services (HHS) showing a continuous drop over the last 20 years, with a 10% decline just between 2012 and 2013. It’s unclear what is driving the decrease, but it appears teenagers are less sexually active than they have been in the past, and teens that are sexually active report using some form of birth control.

“There’s no doubt birth control and sex education are the most important factors in reducing unintended teen pregnancy,” Cecile Richards, president of Planned Parenthood said in an email. “Teens are increasingly using IUDs and implants, which are the most reliable methods of birth control.”

America’s teen pregnancy rate is at a record low, but it’s still higher than many developing countries.

Texting While Driving etc.

Zaza says she’s worried about the number of teens who text and drive—41%—as well as the nearly 18% of teens who report using prescription drugs without a prescription.

“I worry about these numbers,” says Zaza, adding that there’s still room for improvement.

TIME tobacco

Big Tobacco Sues British Government Over Effort to Strip Logos From Cigarette Packaging

New laws would strip logos from cigarette packages

Tobacco companies are fighting a recently passed law that would strip logos and branding from cigarette packages to in order to make them less enticing to consumers in the United Kingdom.

Philip Morris International, which owns the Marlboro band, filed suit Friday in a British court seeking to stop regulators from imposing standardized packaging on cigarettes. Philip Morris argues that such regulations would unlawfully deprive the company of use its own trademarks.

“Countries around the world have shown that effective tobacco control can co-exist with respect for consumer freedoms and private property,” Philip Morris said in a statement.

Under the new law, traditional cigarette logos would be replaced with large, graphic health warnings. Australia enacted a similar law in 2012.

According to Philip Morris, Marlboro was the ninth most valuable brand in the world in 2014 with an estimated value of $67 billion.

TIME Smoking

Bribery Is The Best Way To Quit Smoking, Study Shows

People really don't want to lose money

A new study found that the best way to get people to quit smoking was to bribe them.

Published in the New England Journal of Medicine, the study found that even more important than rewarding people with cash if they quit was the threat of losing money if they weren’t successful.

By comparing five different smoking cessation techniques among over 2,000 CVS Caremark employees, the study found that techniques requiring an up-front cash deposit that would be taken away if the participant didn’t successfully quit were much more effective than those that simply offered a cash reward.

“It leveraged people’s natural aversion to losing money,” lead author Dr. Scott Halpern of the Perelman School of Medicine at the University of Pennsylvania told Reuters.

Many more people were willing to enroll in a simple reward-based program than to put down money up front, but according to Halpern, the deposit programs were twice as effective as the more popular reward programs, and five times more effective than providing free non-smoking aids like nicotine replacement therapy.

The study found that group programs were no more effective than individual-based ones.

“The trick now is to refine the deposit programs so they’ll be more popular without losing much, if any, of their effectiveness,” Halpern told Reuters Health.

TIME Research

The New Science of How to Quit Smoking

cigarettes and money
Getty Images

Two studies shed light on promising new ways to make kicking the habit easier, using both biology and behavior

Studies show that most smokers want to quit. So why are some people more successful at cutting out nicotine than others? The latest studies looking at the brains and behavior of smokers may provide some explanations.

Some people may be hardwired to have an easier time giving up their cigarettes, suggests one new trial described in the journal Neuropsychopharmacology. It turns out that some smokers start out with a particularly rich network of brain neurons in an area called the insula, which regulates cravings and urges and communicates cues: like seeing a cigarette or smelling tobacco smoke, then wanting to light up. Joseph McClernon, an associate professor of psychiatry and behavioral sciences at Duke University School of Medicine, ran MRI scans of 85 smokers who puffed more than 10 cigarettes a day. The smokers were then randomly assigned to continue smoking their brand or to smoke low-nicotine cigarettes, along with nicotine replacement therapy, for 30 days. All of the people in the study were then told to stop smoking and given nicotine replacement for 10 weeks.

MORE The Best Way to Quit Smoking Isn’t E-Cigs

Those who relapsed during that time tended to have lower activity in the insula, particularly in the connections between the insula and other motor areas that translate cravings into action, while those who successfully kicked the habit showed more robust activity in this brain region. The pattern remained strong despite how many cigarettes the smokers smoked.

“We’ve known for a while that some people seem to be able to quit and other people can’t,” says McClernon. “This gives us a better sense of what neural mechanisms might underlie those differences.”

The results suggest that it might be possible to identify people who may have a harder time quitting—a quick MRI scan of their brains would reveal how much activity they have in their insula—and provide them with more support in their attempts to quit. “Some smokers might benefit from more intensive, longer duration or even different types of interventions to stop smoking,” says McClernon. “They might need a higher, different level of care to help them make it through.”

But how much this system can be manipulated to help smokers quit isn’t clear yet. Previous studies show how potentially complicated the insula’s connections may be—smoking patients who have strokes and damage to the insula suddenly lose their desire to smoke and quit almost cold turkey. McClernon believes that the richer connections may not only promote interactions between cravings and behavior, but also enhance the connections that can inhibit or suppress those urges as well. Having a more intense communication in the insula may help strengthen the ability to quiet urges and inhibit the desire to smoke, despite cues and the urge to light up.

MORE Taking Medication May Make It Easier to Quit Smoking

But even if you’re not blessed with a brain that’s wired to make quitting easy, you still have options. In another study, published in the New England Journal of Medicine, scientists studied one of the oldest and most reliable ways to motivate people: money. In that trial, Dr. Scott Halpern from the University of Pennsylvania and his colleagues assigned 2,538 employees of CVS Caremark to one of five different smoking cessation programs. All received free access to nicotine replacement and behavioral therapy, and some were also assigned to an individual reward program in which they could earn up to $800 if they remained abstinent at six months. Another group was assigned another individual deposit program which was similar, except they had to pay $150 to participate, which they got back if they remained abstinent. Others were assigned to group versions of the reward and deposit programs so that what they received depended on how many in their group quit successfully.

Not shockingly, more people who were assigned to the reward program (90%) agreed to participate than people who were assigned to the deposit strategy (14%), likely because most people weren’t wiling to put their own money on the line. But when Halpern looked more closely at those who did enroll, the smokers in the deposit programs were twice as likely to be abstinent at six months than those in the reward group and five times as likely to be smoke-free than those who received only free counseling and nicotine replacement.

MORE Paying People Could Help Them Quit Smoking

That’s not entirely surprising, says Halpern, since having some of their own money at risk provided more motivation for the smokers to quit. When it comes to incentivizing smoking cessation, “adding a bit of stick is better than having just a pure carrot,” he says.

Finding the perfect balance of stick and carrot, however, may be more challenging. Halpern believes that from the perspective of an employer, insurer or government, offering even higher rewards than the $800 in the study and lowering the deposit slightly might still provide benefits to all parties. Smokers cost an average of $4,000 to $6,000 more each year in health services than non-smokers, he says, so offering even as much as $5,000 can still result in cost savings for employers, many of whom are now dangling financial incentives in front of their smoking employees to motivate them to quit.

How the financial carrot is proffered is also important, says Halpern. Now, most employers or insurers reward quitting in more hidden ways, with bonuses in direct deposit accounts or with lower premiums. While helpful, these aren’t as tangible to people, and humans respond better to instant gratification. “They’re rewarding people in ways that are essentially blind to the way human psychology works,” he says. “The fact that the benefits occur in the future make them a whole lot less influential than if people were handed money more quickly. Our work suggests that in addition to thinking about the size of the incentive, it’s fundamentally important to think about how to deliver that money.”

Another factor that can make financial incentives more powerful is to make the experience more enjoyable, either by introducing some competition in a group setting or encouraging smokers along the way. In the study, smokers in the group programs were not any more successful than those in the individual regimes, but that may be because the employees didn’t know each other. Grouping colleagues in the same office might have more of an effect, says Halpern. Either way, he says, incorporating such incentives to help more people quit smoking is “really a win-win.”

Read next: The Best Way to Quit Smoking Isn’t E-Cigs

Listen to the most important stories of the day.

TIME medicine

The Best Way to Quit Smoking Isn’t E-Cigs

496660067
Peter Dazeley—Getty Images

In the latest in-depth review of studies investigating which smoking cessation methods work best, experts say there isn’t enough evidence to support using e-cigarettes to kick the habit

The U.S. Preventive Services Task Force, a government-convened group of experts, says that if you want to quit smoking, you’re better off with drug-based methods, behavior modification programs or a combination of both—not puffing on e-cigarettes. There isn’t enough evidence to support claims that e-cigs, which have been touted as the latest way to wean people off tobacco, can actually help people quit.

The task force focused on studies that investigated how effective various smoking cessation methods are, for both adults and pregnant women. Drugs that address nicotine’s effects on the body, as well as nicotine replacement options, are better ways to quit, and the data suggest that they are even more effective if used together. In addition, behavioral interventions, including support groups and counseling sessions, can boost quit rates from 7-13% compared to rates of 5-11% among those who don’t use them.

MORE: E-Cigs Are Smokers’ Favorite Quitting Tool

“We have an embarrassment of riches in terms of a menu of things to offer patients who want to quit smoking,” says Dr. Francisco Garcia, director and chief medical officer of the Pima County Health Department in Arizona and member of the task force. “But every individual is different; some might respond better to behavioral therapy, some might respond better to varenicline, some might feel nicotine replacement is important to bridge them away from tobacco use.” For most people, it’s a matter of discussing with the smoker which method has the most appeal, and which one they are more likely to stick with long enough to go smoke-free.

But for certain populations, there isn’t enough data to support one strategy over another. Among pregnant women, for example, there haven’t been many studies to show how drug-based methods might affect the developing fetus, so it’s hard to determine if the benefits of quitting outweigh he risks represented by the medications. So for now, the task force advises that pregnant women rely on behavioral, non-drug strategies to help them stop smoking.

MORE: This Is The New Best Way to Quit Smoking, Study Finds

And for e-cigarettes, the data is sparse. The panel concluded that there was “insufficient” evidence to determine whether e-cigarettes improve or hinder quit rates.

TIME Addiction

Health Experts Angry FDA Still Doesn’t Regulate E-Cigarettes

TIME.com stock photos E-Cig Electronic Cigarette Smoke
Elizabeth Renstrom for TIME

Prominent medical groups are asking the government to hurry up

A year has passed since the U.S. Food and Drug Administration (FDA) proposed new regulations for e-cigarettes, cigars and waterpipe tobacco, to prevent them from being sold to minors and to require manufacturers to add health warnings to labels—but the new rules still haven’t gone into effect.

Now, public health experts are urging action, arguing it’s unacceptable that it’s taken so long given data shows use of these products among minors has spiked.

Earlier this week, 31 health and medical groups including the American Academy of Pediatrics, the American Academy of Family Physicians and the American Heart Association wrote a letter to President Obama asking for the federal government to finalize the “long-overdue” regulation. The medical groups say cigar and e-cigarette brands are using marketing tactics that they feel appeal directly to young people, like promoting candy and fruit-flavored products, and they want regulations to put an end to it.

“It’s no wonder use of e-cigarettes by youth has skyrocketed,” the letter reads. “This process has already taken far too long. We cannot afford more delays that allow tobacco companies to target our kids with a new generation of tobacco products.”

Health experts are concerned over a recent U.S. Centers of Disease Control and Prevention (CDC) report that showed e-cigarette use among middle school and high school students tripled between 2013 to 2014 and hookah use doubled. The report showed that e-cigarette use among high schoolers increased from 4.5% in 2013 to 13.4% in 2014, which is a rise from approximately 660,000 students to 2 million.

“My concern is always the first-time users,” says Shyam Biswal, a professor in the department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health. “It’s bad it took so long to make a dent in [conventional] tobacco users, and we are now starting something else, and we are just waiting and waiting and waiting. We don’t have the data that e-cigarettes are a gateway [to other tobacco products], so we just wait. It should not be like that.”

In a statement sent to TIME, the FDA said it “remains concerned about the significant increase in e-cigarette and hookah usage among youth.” The agency wrote:

These staggering increases in such a short time underscore why FDA intends to regulate these additional products to protect public health. Rulemaking is a complex process, and this particular proposed rule resulted in more than 135,000 public comments for the agency to review and consider. FDA is committed to moving forward expeditiously to finalize the rule that will extend its authority to additional tobacco products such as e-cigarettes, cigars, pipe tobacco, and other currently unregulated tobacco products.

Stanton Glantz, a professor of medicine at the University of California, San Francisco Center for Tobacco Control Research & Education, said he hopes that when the regulation is finalized there are no loopholes. “Given that the White House has blocked eliminating menthol from cigarettes for years despite strong evidence—including from the FDA’s own analysis that doing so would protect public health—I am not holding my breath,” he said.

Several states and local governments have regulated items like e-cigarettes on their own. Data shows at least 42 states and 1 territory currently prohibit the sale of e-cigarettes or vaping/alternative tobacco products to minors.

“I just hope that the final FDA rule does not do anything to make that process more difficult,” said Glantz.

The medical groups concluded in their letter that “further delay will only serve the interests of the tobacco companies, which have a long history of using product design and marketing tactics to attract children to harmful and addictive products.”

When asked for a comment about the letter, the White House’s Office of Management and Budget referred TIME to the FDA.

TIME Addiction

Hawaii Set to Become First State to Raise Smoking Age to 21

TIME.com stock photos E-Cig Electronic Cigarette Smoke
Elizabeth Renstrom for TIME

The bill covers both cigarette and e-cigarette use

Hawaii is set to become the first state to pass a law banning the sale, use and possession of cigarettes and e-cigarettes to people under the age of 21.

If a bill approved by Hawaii lawmakers on Friday is signed into law by Governor David Ige, adolescents will be prohibited from smoking, buying and possessing both conventional cigarettes and e-cigarettes. First-time offenders will be fined $10, and after that they can be charged a $50 fine or be required to complete community service, the Associated Press reports.

Some local governments have raised the smoking age to 21 in certain counties and cities — New York City among them — but if the bill becomes law, Hawaii will be the first state to do so.

Though the rates of high-school-age smokers have dropped in recent years, some 2.3 million children and young adults started smoking in 2012. In addition, a recent report from the U.S. Centers for Disease Control and Prevention revealed that e-cigarette use among middle-school and high school students tripled in one year.

If the Hawaii bill passes, it will go into effect Jan. 1, 2016.

[AP]

TIME Smoking

The United States of Smoking

As New Orleans bans smoking in bars, see where in America people light up the most

At 12:01 am, Wednesday morning, it became illegal to light up a cigarette in a bar in New Orleans, a city famed for its nightlife. Orleans Parish, where New Orleans is located, had an adult smoking rate of 19.9 percent in 2012, the most recent year for which nationwide data is available. The median rate for all counties was 20.8 percent, according to CountyHealthRankings.org, which is published by the University of Wisconsin Population Health Institute. The tables below show the counties with the highest percentage of adult smokers and those with the lowest percentage of smokers in the United States for which numbers are available.

Counties With Highest Percentage of Smokers in 2012
Scott, Tennessee 51.1
Limestone, Texas 49.2
Northwest Arctic, Alaska 48.2
Ripley, Missouri 47.1
Upshur, Texas 46.8
Calhoun, West Virginia 46.2
Greene, Illinois 45.7
Menominee, Wisconsin 45.6
North Slope, Alaska 45.3
Gallatin, Kentucky 45.1
Counties With Lowest Percentage of Smokers in 2012
Madison, Idaho 3.1
Cache, Utah 4.6
Utah, Utah 5.4
Davis, Utah 6.3
Nicollet, Minnesota 6.6
Summit, Utah 7.5
York, Virginia 7.5
Wasatch, Utah 7.8
Washington, Utah 7.8
Montgomery, Maryland 7.9

Read next: New Orleans Smoking Ban Takes Effect

Listen to the most important stories of the day.

TIME public health

New Orleans Smoking Ban Takes Effect

Judy Hill, owner of the Ooh Poo Pah Doo Bar in New Orleans, enjoys a smoke just days before the new city smoking ordinance on April 17, 2015.
David Grunfield—The Times-Picayune/Landov Judy Hill, owner of the Ooh Poo Pah Doo Bar in New Orleans, enjoys a smoke just days before the new city smoking ordinance on April 17, 2015.

You can no longer smoke in bars, restaurants or casinos

At the stroke of midnight on April 22, it became illegal to smoke in bars, restaurants and casinos in New Orleans.

Smoking is now also prohibited in fairgrounds and within 5 feet of Lafayette Square, as well as in outdoor sports stadiums, except during concerts, festivals and parades, WDSU News reports.

“People will be able to breathe fresh air, and it’ll be a good thing overall,” Hannah Bourque, who works on Bourbon Street, told WDSU.

But while many cheer the public health benefits of the ban, not all small business owners in the city are thrilled.

“It’s that overall bohemian kind of free spirit that we have in New Orleans that makes it so unique, and it’s why people love it,” Shelly Waguespack, owner of Pat O’Briens, told the New York Times. She is one of the businesses joining with Harrah’s, the city’s casino, to sue over the ban.

The New Orleans city council unanimously passed the ban in January. The city was one of the last in the U.S. to allow smoking in bars and restaurants, and decided on the new rules for the safety of restaurant staff and performers.

TIME Baseball

The San Francisco Giants Could Become the First MLB Team to Ban Chewing Tobacco

Minnesota Twins v San Francisco Giants
Brace Hemmelgarn—Getty Images A general view of the exterior of AT&T Park following the game between the San Francisco Giants and the Minnesota Twins on May 23, 2014 in San Francisco, California.

Players have been dipping for as long as anyone can remember, but that could soon change

A San Francisco city ordinance could make the Giants the first team in Major League Baseball to ban chewing tobacco on the field.

City supervisors voted unanimously on Tuesday to ban smokeless tobacco in playing fields throughout the city and specifically targeted baseball—a sport infamous for the player’s use of tobacco, according to a statement from the Campaign for Tobacco-Free Kids, which pushed for the law.

The ordinance must pass one more vote and, if San Francisco Mayor Ed Lee signs, the rule will be implemented on Jan. 1 2016—in time for the MLB baseball season.

Jess Montejano, a legislative aide for the ban’s chief sponsor, Supervisor Mark Farrell, told TIME that legislators began working on the ordinance in the beginning part of 2015 because “it’s a serious health issue” in which “kids are seeing their athletic heroes chewing tobacco on the baseball diamond.”

Montejano also added the San Francisco Giants “are fully aware of the intention” and that proponents of the ban believed the team would support MLB’s stance on the issue of chewing tobacco.

After the law was initially proposed in late Feb., MLB issued a statement saying that it “has long supported a ban of smokeless tobacco at the Major League level” and that it had been seeking “a ban of its use on-field in discussions with the Major League Baseball Players Association.”

A study published April 10 from the University of California San Francisco suggested that seeing players chewing tobacco was akin to product endorsement. It found that “modeling of smokeless tobacco use by…elite athletes is strongly associated with smokeless tobacco initiation among adolescent males.” The study also cited an NCAA statistic that found that 52.3% of collegiate baseball players tried smokeless tobacco at least once in 2012 to 2013.

When asked if the ban would essentially force players to quit, Montejano cited former MLB pitcher Curt Schilling, who blames tobacco for his mouth cancer. “Schilling said it was the worst thing about his life and if he could change one thing from his younger years it would be to quit.”

Your browser is out of date. Please update your browser at http://update.microsoft.com