Data Show Big-City Teens Smoke Less

Posted on May 31, 2016

Washington, D.C. – The Big Cities Health Coalition (BCHC) released data today showing that teenagers who live in the largest, most urban cities typically smoke less than other American teens. Many of the same jurisdictions have passed evidence-based laws to curb youth smoking. The release coincides with World No Tobacco Day, May 31, which is sponsored annually by the World Health Organization (WHO) to highlight the health risks associated with tobacco and encourage governments to adopt tobacco reduction strategies. The data are featured on the Big Cities Health Inventory data platform, on online resource that compiles unique public health statistics for 28 large American cities.

The data are from 2013 and are sourced from the Youth Risk Behavior Survey (or a comparable local instrument), which collects cigarette-usage rates among high school students. The 13 cities included in this analysis are: Baltimore, MD; Boston, MA; Chicago, IL; Denver, CO; Detroit, MI; Houston, TX; Las Vegas (Clark County), NV; Los Angeles, CA; Miami (Miami-Dade County), FL; New York, NY; Philadelphia, PA; San Antonio (Bexar County), TX; and Washington, D.C. Every city had a lower smoking rate than the national average, except for Washington, D.C., which matched the national rate of 15.7%.

“These data show that the hard-fought battle that has been raging against teen smoking  for decades is being won in the nation’s big urban centers,” said Chrissie Juliano, MPP, Director of the Big Cities Health Coalition. “Teens who live in big cities smoke less than other American teens. Cities have always been at the forefront of banning smoking in public places, and today they are finding new ways to keep kids from lighting up, like raising the tobacco sale age and regulating e-cigarettes. Public health leaders and elected officials across the country should take note and increase their investment in cities, where smoking cessation programs are most effective."

The available data for BCHC members in 2013 can be found below, with additional years available on the data platform.

Percent of High School Students Who Currently Smoke - 2013

Baltimore, MD                                      7.0

Boston, MA                                          7.9

Chicago, IL                                         10.7

Denver, CO                                        11.0

Detroit, MI                                           3.4

Houston, TX                                       11.3

Las Vegas (Clark County), NV             7.8

Los Angeles, CA                                   6.7

Miami (Miami-Dade County), FL          7.5

New York, NY                                       8.2

Philadelphia, PA                                   7.5

San Antonio (Bexar County), TX         11.3

Washington, D.C.                               15.7

U.S. Total                                          15.7

A number of cities in the Coalition are using innovative policy levers and programming to reduce smoking among the populations they serve, especially youth. For example, many have raised the tobacco sale age from 18 to 21, including Boston, Chicago, Kansas City (MO),New York, Santa Clara County, and San Francisco. Research has shown that these “Tobacco 21” policies are effective in curbing youth smoking. A March 2015 report by the Institute of Medicine concluded that raising the age will have a dramatic impact on public health and save lives.  The report found that the policy, which is rapidly growing in popularity, will significantly reduce the number of adolescents and young adults who start smoking and over time will reduce adult smoking by about 12%.

Another successful anti-tobacco strategy for cities is regulating the use of e-cigarettes for teens. Seattle, Boston, Chicago, Los Angeles, Minneapolis, New York, Philadelphia, Sacramento, and San Francisco, for example, have done so. According to the federal government’s 2015 National Youth Tobacco Survey, there was a 10-fold increase in e-cigarette use among high school students between 2011 and 2015. This finding makes e-cigarettes the most popular tobacco product among youth.  Earlier this month, the U.S. Food and Drug Administration released a deeming rule, which, among other things, regulates the sale of e-cigarettes to minors. Once it takes effect, the rule will stop millions of American teens from starting a tobacco habit before reaching adulthood. To date, some 95% of adult smokers started before they were 21.

While the United States has made tremendous progress in reducing smoking, tobacco use remains the nations number one cause of preventable death. According to the U.S. Surgeon General, it kills more than 480,000 people and costs the nation about $170 billion in health care expenses each year. These deaths and costs are entirely preventable.

The Big Cities Health Coalition (BCHC) is a forum for the leaders of America’s largest metropolitan health departments to exchange strategies and jointly address issues to promote and protect the health and safety of their residents. Collectively, BCHC member jurisdictions directly impact more than 54 million people, or one in six Americans. The Big Cities Health Coalition is an independent project of the National Association of City and County Health Officials. For more information, please visit

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