CONNECTICUT YOUTH TOBACCO SURVEY RESULTS 2017 Surveillance Report Connecticut Department of Public Health Tobacco Control Program The remainder of this page is intentionally left blank. 2017 CONNECTICUT YOUTH TOBACCO SURVEILLANCE Raul Pino, MD, MPH Commissioner Connecticut Department of Public Health FOR ADDITIONAL INFORMATION ABOUT TOBACCO USE BEHAVIORS AMONG CONNECTICUT YOUTH, PLEASE CONTACT: Connecticut Department of Public Health Community, Family Health and Prevention Section Tobacco Control Program 410 Capitol Avenue PO Box 340308, MS #11HLS Hartford, CT 06134-0308 Phone: 860-509-8251 Or visit: www.ct.gov/dph/CSHS or www.ct.gov/dph/tobacco Suggested citation: Sorosiak, D., Metcalf Walsh, B., Peng, J. (2018). Connecticut Youth Tobacco Survey Results; 2017 Surveillance Report. Hartford, CT: Connecticut Department of Public Health. All material appearing in this report is in the public domain and may be reproduced or copied without permission; however, citation of the source is appreciated. Community, Family Health and Prevention Section, Tobacco Control Program, New 8-10-2018 Acknowledgments Rosa M. Biaggi, MPH, MPA Public Health Section Chief Community, Family Health and Prevention Section Mark Keenan Public Health Section Chief Community, Family Health and Prevention Section This report was prepared by: Dawn Sorosiak, MBA Epidemiologist Community, Family Health and Prevention Section Contributors Mehul Dalal, MD, MSc, MHS Chronic Disease Director Community, Family Health and Prevention Section Celeste Jorge, MPH Epidemiologist Health Statistics and Surveillance Section Survey Research Unit Justin Peng, MPH Epidemiology Unit Supervisor Community, Family Health and Prevention Section Barbara Metcalf Walsh, BS Health Program Supervisor Community, Family Health and Prevention Section Tobacco Control Program Contents Introduction 1-2 Demographics of Survey Participants 4 Sample Description 2017 CT YTS Report Highlights 3 5-9 Ever Tobacco Use 10-11 Tobacco Product Tried First 14 Beliefs About the Dangers of Tobacco 15 Use of Flavored Tobacco Products 18 Current Tobacco Use Among Ever Users 20-21 Current Cigarette Smoking 24-25 Current Cigar Smoking 28-29 Current Tobacco Use Refused Sale of Tobacco Products Beliefs About Tobacco Addiction Number of Tobacco Products Currently Used Ever Cigarette Smoking Ever Cigar Smoking Ever E-Cigarette Use Current E-Cigarette Use Frequent E-Cigarette Use Reasons for Using E-Cigarettes 12-13 14 16-17 19 22-23 26-27 30-31 32-33 34 35 Obtaining E-Cigarettes 36 Ever Hookah Smoking 38-39 Brands of E-Cigarettes Ever Tried 37 Current Hookah Smoking 40-41 Ever Smokeless Tobacco Use 44-45 Current Any Other Tobacco Use 48-49 Ever Pipe Smoking Ever Any Other Tobacco Use 42-43 46-47 Secondhand Smoke Exposure at Home 50-51 Secondhand Smoke Exposure at School 54-55 Secondhand Smoke Exposure in a Vehicle Secondhand Smoke Exposure in a Public Place 52-53 56-57 Secondhand Smoke Exposure at Work 58-59 Living with Someone Who Uses Tobacco 62-63 Rules About Smoking Inside Students’ Homes 66-67 Any Secondhand Smoke Exposure Living with Someone Who Smokes Cigarettes 60-61 64-65 Contents Rules About Smoking Inside Students’ Family Vehicles 68-69 Exposure to E-Cigarette Aerosol 70-71 Belief About Tobacco Company Influence on Young People 74-75 Believe E-Cigarette Aerosol Causes Little or No Harm 72-73 Exposure in Stores to Ads and Promotions for Cigarettes and Other Tobacco Products 76-77 Exposure to E-Cigarette Ads and Promotions on the Internet, in Print and on TV 80-81 Received Ads or Coupons from a Tobacco Company 84-85 Exposure to Cigarette and Other Tobacco Use on TV and in Movies Exposure in Stores to E-Cigarette Ads and Promotions Tried to Stop Using Tobacco for Good 78-79 82-83 86-87 Healthcare Provider Inquiry and Advisement About Tobacco Use 88-89 Trends in Current Tobacco Use 92-93 Asthma Among Tobacco Users 90-91 Trends in Current Cigarette Smoking 94-95 Trends in Current Cigar Smoking 97-98 Current Cigarette Smoking and the CT Cigarette Excise Tax Trends in Current E-Cigarette Use 96 99-100 Trends in Current Hookah Smoking 101-102 Trends in Exposure to Secondhand Smoke in a Vehicle 105-106 Tables of Current Tobacco Use 109 Trends in Living with a Cigarette Smoker Trends in Exposure to Secondhand Smoke in a Public Place 103-104 107-108 Introduction The 2017 Connecticut School Health Survey (CSHS) is a comprehensive survey that consists of two components: the Youth Tobacco Component (YTC) and the Youth Behavior Component (YBC). This report covers data collected from the YTC. The YTC is known nationally as the Youth Tobacco Survey (YTS) and will be referred to as the YTS within this document. Between March and June of 2017, the Connecticut Department of Public Health (DPH) conducted the CSHS in cooperation with The Centers for Disease Control and Prevention (CDC). The Connecticut YTS is administered biennially. Prior to 2017, the Connecticut YTS was successfully completed in 2000, 2002, 2005, 2007, 2009, 2011, 2013 and 2015. YTS data are used by health and education officials to improve state programs that help prevent and control use of tobacco products among Connecticut’s youth. Selected Findings Tobacco Over one-third (34.4%) of Connecticut high school students report having ever tried some form of tobacco. This represents nearly 59,000 students. Rates of use ranged from 23.1% in grade 9 to 45.8% in grade 12. For high schools students overall, current use of tobacco is reported at 17.9%. And, the vast majority of youth are using flavored tobacco products. E-Cigarettes/Vaping Devices Although cigarette smoking has decreased significantly among Connecticut youth, the use of electronic cigarettes and vaping devices continues to increase at an alarming rate. Overall, current use among high school students is 14.7%, with usage increasing with age from 11.1% among those 15 years-old and younger to 20.8% among students 18 years-old and older. This is especially concerning because studies have shown that this type of nicotine use by teens increases their risk of also using combustible tobacco as youths and as young adults.† E-cigarettes are especially tempting for young people because they are available in flavors like cotton candy, bubble gum, fruit, peanut butter cup and chocolate cake. These enticing candy-, fruit- and dessert-flavored products may also bolster the belief among teens that e-cigarettes are not harmful. Another concerning finding is that more than half of e-cigarette users had used their vaping devices for substances other than nicotine, such as marijuana, THC or hash oil, or THC wax. The primary reason students gave for using e-cigarettes is a friend or family member uses them (41.6%), and nearly one-quarter used them because they are available in flavors. Users were also asked how they accessed these products during the past 30 days. The majority (59.3%) reported they obtained their e-cigarettes from a friend, while about 20% tried to buy them but were refused sale because they were under the age of 18. † National Academies of Sciences, Engineering, and Medicine. 2018. Public Health Consequences of E-Cigarettes. Washington, DC: The National Academies Press. doi: 10.17226/24952 ; also Bold KW, Kong G, Camenga DR, et al. Trajectories of E-Cigarette and Conventional Cigarette Use Among Youth. Pediatrics. 2018;141(1):e20171832. Page 1 Introduction Secondhand Smoke Exposure During the seven days prior to the survey, more than 45% of students had breathed the smoke from someone who was smoking a tobacco product. This represents more than 77,000 students. More than 1 in 4 students (27.3%) report living with someone who uses tobacco, and nearly 20% are living with a cigarette smoker. Cessation During the past year, about 41% of the students who used any form of tobacco stopped using it for a day or longer because they were trying to quit for good. Among cigarette smokers, nearly 43% tried to quit for good. Conclusions Although the use of combustible cigarettes has dropped significantly, high school youth are vaping more and are still being exposed to tobacco messaging, advertising and secondhand smoke. Although some preliminary studies have indicated that Electronic Nicotine Delivery Systems (e-cigarettes) may be safer than combustible cigarettes, the Surgeon General has concluded that nicotine poses a danger to youth, and its use in any form by youth is unsafe. Youth are generally unaware of the presence and level of nicotine in their e-cigarettes and can become addicted with only a few puffs. The vast majority of all adults began their tobacco use as teenagers. An estimated 95% of all tobacco users start before age 21. Systems, Policies and Environmental changes have been encouraged by the CDC in order to reduce tobacco initiation and use, especially among youth. The following are evidence-based strategies that could be adopted in Connecticut to reduce the number of students who are initiating tobacco use from year to year: ♦ Increasing the legal age for the sale of all tobacco products to 21. ♦ Youth are especially sensitive to price (see page 96), so increasing the price of tobacco products, corresponding with the taxes on combustible cigarettes, could help to prevent youth from purchasing these products and would likely result in decreased initiation and use, especially of electronic vape products. ♦ Restricting the sale of flavored tobacco products. ♦ Passing additional smoke-free laws, especially for workplaces, schools and public places in order to reduce exposure to secondhand smoke. ♦ Restricting the use of tobacco products in movies. ♦ Restricting the advertising of all tobacco products. Although there are restrictions on combustible cigarettes, there are none on the electronic vape products, and 49.1% of high school students report being exposed to these types of ads. This introduction highlights only a few areas covered on the Connecticut YTS. Considerably more information on tobacco product use, exposure to secondhand smoke, smoking cessation, minors’ ability to purchase or obtain tobacco products, knowledge and attitudes about tobacco, and familiarity with tobacco media messages is presented in the following report. Page 2 Sample Description All regular public schools in Connecticut containing grades 9, 10, 11 and 12 were included in the sampling frame. A two-stage cluster sample design was used to produce a representative sample of students in grades 9-12. School Level ꟷ The first-stage sampling frame consisted of all public schools containing any of grades 9-12. Schools were selected with probability proportional to school enrollment (i.e., the larger the number of students enrolled in a school, the more likely the school would be selected to participate). Class Level ꟷ The second sampling stage consisted of systematic equal probability (with a random start) of classes from each school that participated in the survey. All second period classes (or other period/required class chosen by the school) in the selected schools were included in the sampling frame. All students in the selected classes were eligible to participate in the survey. Overall Response Rates Schools ꟷ 76.00% (38 of the 50 sampled schools participated) Students ꟷ 85.05% (2,236 of the 2,629 sampled students completed usable questionnaires) Overall response rate ꟷ 76.00% * 85.05% = 64.64% Weighting A weight has been associated with each questionnaire to reflect the likelihood of sampling each student and to reduce bias by compensating for differing patterns of non-response. The weight used for estimation is given by: W = W1 * W2 * f1 * f2 * f3 * f4. Where, W1 = the inverse of the probability of selecting the school; W2 = the inverse of the probability of selecting the classroom within the school; f1 = a school-level non-response adjustment factor calculated by school size category (small, medium, large); f2 = a class adjustment factor calculated by school; f3 = a student-level non-response adjustment factor calculated by class; and f4 = a post-stratification adjustment factor calculated by gender, grade and race. The weighted results can be used to make important inferences concerning tobacco use risk behaviors of all regular public school students in grades 9 through 12 in Connecticut. Sampling The 2017 Connecticut YTS was made up of 75 questions—core questions developed by CDC and supplemental questions added by DPH. When sample size and prevalence rates allow, results are presented by sex, grade and race/ethnicity (non-Hispanic white, non-Hispanic black and Hispanic). The numbers of students in other racial or ethnic groups were too low for meaningful analysis. Statistical analyses were conducted on weighted data using SAS® software to account for the complex sampling designs. Prevalence estimates and 95% confidence intervals were computed for all variables. For this report, data are suppressed if there were fewer than 50 students in a subgroup or a relative standard error greater than 0.30. Differences between prevalence estimates were considered statistically significant based on t-test analysis, p<0.05. Subgroup comparisons that were statistically significant are highlighted in this report. The sampling design does not allow for analysis at the school or district level. Data Collection The survey was administered during one class period. Procedures were designed to protect students’ privacy by assuring that student participation was anonymous and voluntary. Students completed the self-administered pencil-and-paper questionnaire in the classroom, recording their responses directly into the computer-scannable survey booklet. Before the survey was administered, schools were given the option of obtaining parental permission. The survey included questions about tobacco use, exposure to secondhand smoke, tobacco use cessation, minors’ ability to purchase or obtain tobacco products, knowledge and attitudes about tobacco and familiarity with tobacco media messages. Page 3 Demographics of Survey Participants 2017 CONNECTICUT YOUTH TOBACCO SURVEY DEMOGRAPHICS OF PARTICIPANTS Sex UNWEIGHTED WEIGHTED FREQUENCY % TOTAL 2,236 100 MALE 1,078 1,127 31 50.7 47.9 1.4 1,159 241 686 122 28 63.3 13.1 17.0 5.3 1.3 703 665 472 382 14 26.3 25.0 24.5 23.6 0.6 291 651 599 461 222 12 10.7 25.1 25.7 24.8 13.3 0.4 FEMALE MISSING Race/Ethnicity NON-HISPANIC WHITE NON-HISPANIC BLACK HISPANIC NON-HISPANIC OTHER MISSING Grade 9TH 10TH 11TH 12TH MISSING Age 14 YEARS OLD OR YOUNGER 15 YEARS OLD 16 YEARS OLD 17 YEARS OLD 18 YEARS OLD OR OLDER MISSING Page 4 2017 CT YTS Report Highlights EVER TOBACCO USE In 2017, 34.4% of high school students had ever tried some form of tobacco, including cigarettes, cigars, e- cigarettes, hookahs, pipes, chewing tobacco, snuff and dip (i.e., ever tobacco use). This represents approximately 58,800 students. Overall, the prevalence of ever tobacco use was significantly higher in grades 10 (29.8%), 11 (40.4%) and 12 (45.8%) than grade 9 (23.1%); and significantly higher in grades 11 (40.4%) and 12 (45.8%) than in grade 10 (29.8%). CURRENT TOBACCO USE On 1 or more of the 30 days prior to the survey, 17.9% of high school students had used some form tobacco (i.e., current tobacco use). This represents approximately 30,600 students. Overall, the prevalence of current tobacco use was significantly higher among non-Hispanic white (21.5%) than among non-Hispanic black (9.2%) and Hispanic (14.1%) students. The rate was also significantly higher in grades 11 (20.9%) and 12 (24.4%) than in grade 9 (11.7%); and significantly higher in grade 12 (24.4%) than in grade 10 (15.3%). EVER CIGARETTE SMOKING In their lifetime, 14.8% of high school students reported that they had ever tried cigarette smoking, even one or two puffs (i.e., ever cigarette smoking). This represents about 25,300 students. Overall, the prevalence of ever cigarette smoking was significantly higher among Hispanic (16.5%) than among non-Hispanic black (10.2%) students. And significantly higher in grades 11 (20.6%) and 12 (21.3%) than in grades 9 (7.3%) and 10 (10.9%). Among students who had ever smoked cigarettes, 49.0% had first tried cigarette smoking, even one or two puffs, when they were 14 years old or younger. CURRENT CIGARETTE SMOKING On 1 or more of the 30 days prior to the survey, 3.5% of high school students had smoked cigarettes (i.e., current cigarette smoking). This represents approximately 6,000 students. The prevalence of current cigarette smoking did not vary significantly by sex or grade. Estimates of current cigarette smoking for non-Hispanic black and Hispanic students are not reported due to small sample sizes; therefore, no comparisons by race/ethnicity could be made. EVER CIGAR SMOKING In 2017, 13.0% of high school students reported that they had ever tried cigar smoking, even one or two puffs (i.e., ever cigar smoking). This represents about 22,200 students. Overall, the prevalence of ever cigar smoking was significantly higher among male (16.4%) than among female (8.7%) students. And significantly higher in grades 10 (10.1%), 11 (17.7%) and 12 (20.5%) than in grade 9 (4.4%); and significantly higher in grades 11 (17.7%) and 12 (20.5%) than in grade 10 (10.1%). Page 5 2017 CT YTS Report Highlights CURRENT CIGAR SMOKING On 1 or more of the 30 days prior to the survey, 5.3% of high school students had smoked cigars (i.e., current cigar smoking). This represents approximately 9,100 students. Overall, the prevalence of current cigar smoking was significantly higher among males (7.2%) than among females (2.8%). And significantly higher in grade 11 (8.9%) than in grade 10 (3.2%). EVER E-CIGARETTE USE In 2017, 27.3% of high school students had ever tried e-cigarettes, even once or twice (i.e., ever e-cigarette use). This represents approximately 46,700 students. Overall, the prevalence of ever e-cigarette use was significantly higher among non-Hispanic white (31.5%) than among non-Hispanic black (15.1%) and Hispanic (24.2%) students. Also, significantly higher in grades 11 (31.0%) and 12 (37.2%) than in grade 9 (18.8%); and significantly higher in grade 12 (37.2%) than in grade 10 (23.6%). CURRENT E-CIGARETTE USE On 1 or more of the 30 days prior to the survey, 14.7% of high school students had used e-cigarettes (i.e., current e-cigarette use). This represents approximately 25,100 students. Overall, the prevalence of current e-cigarette use was significantly higher among non-Hispanic white (18.7%) than among Hispanic (9.3%) students. Also, significantly higher in grades 11 (16.8%) and 12 (20.4%) than in grade 9 (10.2%); and significantly higher in grade 12 (20.4%) than in grade 10 (12.0%). EVER HOOKAH SMOKING In their lifetime, 8.4% of high school students had ever tried smoking tobacco in a hookah, even one or two puffs (i.e., ever hookah smoking). This represents approximately 14,400 students. Overall, the prevalence of ever hookah smoking was significantly higher among Hispanic (10.9%) than among non-Hispanic white (7.5%) students. And significantly higher in grades 10 (7.7%), 11 (10.8%) and 12 (11.6%) than in grade 9 (3.9%). CURRENT HOOKAH SMOKING On 1 or more of the 30 days prior to the survey, 2.8% of high school students had smoked tobacco using a hookah (i.e., current hookah smoking). This represents approximately 4,800 students. The prevalence of current hookah smoking did not vary significantly by sex or race/ethnicity. Estimates of current hookah smoking for students in grades 9, 11 and 12 are not reported due to small sample sizes; therefore, no comparisons by grade could be made. EVER PIPE SMOKING In 2017, 3.9% of high school students had ever tried smoking tobacco in a pipe, even one or two puffs (i.e., ever pipe smoking). This represents approximately 6,700 students. Overall, the prevalence of ever pipe smoking did not vary significantly by sex, race/ethnicity or grade. Page 6 2017 CT YTS Report Highlights EVER SMOKELESS TOBACCO USE In 2017, 4.1% of high school students had ever tried chewing tobacco, snuff or dip, even just a small amount (i.e., ever smokeless tobacco use). This represents approximately 7,000 students. The prevalence of smokeless tobacco use was significantly higher in grade 11 (7.9%) than in grade 10 (2.5%). Estimates of ever smokeless tobacco use for females, non-Hispanic blacks and Hispanics are not reported due to small sample sizes; therefore, no comparisons by sex or race/ethnicity could be made. EVER ANY OTHER TOBACCO USE In 2017, 4.3% of high school students had ever tried any other form of tobacco, including roll-your-own- cigarettes, snus, dissolvable tobacco and bidis (i.e., ever any other tobacco use). This represents approximately 7,400 students. Overall, the prevalence of ever any other tobacco use was significantly higher among males (5.8%) than among females (2.6%). CURRENT ANY OTHER TOBACCO USE On 1 or more of the 30 days prior to the survey, 2.8% of high school students had used any other form of tobacco (i.e., current any other tobacco use). This represents approximately 4,800 students. The prevalence of current any other tobacco use was significantly higher among males (3.6%) than among females (1.5%). Estimates of current any other tobacco use for students in grades 9, 10 and 11 are not reported due to small sample sizes; therefore, no comparisons by grade could be made. SECONDHAND SMOKE EXPOSURE AT HOME On one or more of the seven days prior to the survey, 13.9% of high school students had been at home when someone smoked a tobacco product (i.e., recent secondhand smoke exposure at home). This represents approximately 23,800 students. Overall, the prevalence of recent secondhand smoke exposure at home was significantly higher among females (16.1%) than among males (11.9%). SECONDHAND SMOKE EXPOSURE IN A VEHICLE On one or more of the seven days prior to the survey, 16.3% of high school students had ridden in a vehicle when someone smoked a tobacco product (i.e., recent secondhand smoke exposure in a vehicle). This represents approximately 27,900 students. Overall, the prevalence of recent secondhand smoke exposure in a vehicle was significantly higher among non-Hispanic white (18.8%) than among non-Hispanic black (11.2%) and Hispanic (12.2%) students. Also, significantly higher in grades 11 (19.7%) and 12 (18.0%) than in grade 9 (11.7%). SECONDHAND SMOKE EXPOSURE AT SCHOOL On one or more of the seven days prior to the survey, 17.3% of high school students had breathed the smoke from someone who was smoking a tobacco product at their school (i.e., recent secondhand smoke exposure at school). This represents approximately 29,600 students. Overall, the prevalence of recent secondhand smoke exposure at school was significantly higher among non-Hispanic white (18.7%) than among non-Hispanic black (11.3%) students. Page 7 2017 CT YTS Report Highlights SECONDHAND SMOKE EXPOSURE IN A PUBLIC PLACE On one or more of the seven days prior to the survey, 32.4% of high school students had breathed the smoke from someone who was smoking a tobacco product in a public place (i.e., recent secondhand smoke exposure in a public place). This represents approximately 55,400 students. Overall, the prevalence of recent secondhand smoke exposure in a public place was significantly higher among females (38.2%) than among males (26.7%). And significantly higher among non-Hispanic white (34.9%) than among non-Hispanic black (25.6%) and Hispanic (27.2%) students. SECONDHAND SMOKE EXPOSURE AT WORK Among high school students who have a job and worked during the week before the survey, on one or more of the seven days prior to the survey, 26.1% had breathed the smoke from someone who was smoking a tobacco product at the place where they worked (i.e., recent secondhand smoke exposure at work). This represents approximately 10,500 students. Overall, the prevalence of recent secondhand smoke exposure at work was significantly higher among Hispanic (38.0%) than among non-Hispanic white (23.4%) students. ANY SECONDHAND SMOKE EXPOSURE On one or more of the seven days prior to the survey, 26.1% of high school students had breathed the smoke from someone who was smoking a tobacco product (i.e., any recent secondhand smoke exposure). This represents approximately 77,300 students. Overall, the prevalence of any recent secondhand smoke exposure was significantly higher among females (51.7%) than among males (38.7%). And significantly higher among nonHispanic white (48.7%) than among non-Hispanic black (35.8%) and Hispanic (40.0%) students. LIVING WITH TOBACCO USER In 2017, 27.3% of high school students were living with someone who was using tobacco. This represents approximately 46,700 students. Overall, the prevalence of living with a tobacco user did not vary significantly by sex, race/ethnicity or grade. EXPOSURE TO E-CIGARETTE AEROSOL On 1 or more of the 30 days before the survey, 28.5% of high school students had breathed the aerosol from someone who was using an e-cigarette in a public place. This represents approximately 48,700 students. Overall, the prevalence of exposure to e-cigarette aerosol was significantly higher among females (31.4%) than among males (25.3%). And significantly higher among non-Hispanic white (33.8%) than among non-Hispanic black (14.6%) and Hispanic (19.9%) students. Also, significantly higher in grade 11 (32.6%) than in grade 10 (24.6%). TRIED TO STOP USING TOBACCO FOR GOOD During the 12 months prior to the survey, 41.2% of high school students who had used tobacco during the past year had stopped using all tobacco products for a day or longer because they were trying to quit using tobacco for good. Overall, the prevalence of having tried to stop using tobacco for good did not vary significantly by sex, race/ethnicity or grade. Page 8 2017 CT YTS Report Highlights TRENDS IN CURRENT TOBACCO USE Between 2011 and 2017 there was a decrease, from 21.0% to 17.9%, in the percentage of high school students who had used some form of tobacco on 1 or more of the past 30 days. Between 2015 and 2017, the rate of current tobacco use increased from 14.2% to 17.9%, but the difference in rates was not statistically significant. TRENDS IN CURRENT CIGARETTE SMOKING Between 2000 and 2017 there was a significant decrease, from 25.6% to 3.5%, in the percentage of high school students who had smoked cigarettes on 1 or more of the past 30 days. Between 2015 and 2017, the rate of current cigarette smoking went from 5.6% to 3.5%, but the decrease was not statistically significant. TRENDS IN CURRENT CIGAR SMOKING Between 2000 and 2017 there was a 58% decrease, from 12.7% to 5.3%, in the percentage of high school students who had smoked cigars on 1 or more of the past 30 days. Between 2015 and 2017, there was an increase in the rate of current cigar smoking from 4.5% to 5.3%, but the change was not statistically significant. TRENDS IN CURRENT E-CIGARETTE USE Between 2011 and 2017, the percentage of high school students who had used e-cigarettes on 1 or more of the past 30 days increased 6-fold from 2.4% to 14.7%. Between 2015 and 2017, the rate of current use increased significantly from 7.2% to 14.7%. TRENDS IN CURRENT HOOKAH SMOKING Between 2011 and 2017, the percentage of high school students who had smoked tobacco using a hookah on 1 or more of the past 30 days decreased from 3.5% to 2.8%. Between 2015 and 2017, the rate of current hookah smoking decreased from 3.3% to 2.8%, but the change was not statistically significant. TRENDS IN LIVING WITH A CIGARETTE SMOKER Between 2000 and 2017, the percentage of high school students who were living with someone who smoked cigarettes decreased significantly from 39.9% to 19.8%. Between 2015 and 2017, the rate decreased from 24.5% to 19.8%, but the change was not statistically significant. TRENDS IN EXPOSURE TO SECONDHAND SMOKE IN A VEHICLE Between 2000 and 2017, the percentage of high school students who had ridden in a vehicle on one or more of the past seven days with someone who was smoking a tobacco product decreased significantly from 51.2% to 16.3%. Between 2015 and 2017, the rate decreased from 20.2% to 16.3%, but the change was not statistically significant. TRENDS IN EXPOSURE TO SECONDHAND SMOKE IN A PUBLIC PLACE Between 2011 and 2017, the percentage of high school students who had breathed the smoke from someone who was smoking a tobacco product in a public place on one or more of the past seven days decreased significantly from 47.1% to 32.4%. Between 2015 and 2017, the rate decreased from 38.9% to 32.4%, but the change was not statistically significant. Page 9 Ever Tobacco Use In 2017, 34.4% of Connecticut high school students reported that in their lifetime they had ever tried any form of tobacco, including cigarettes, cigars, chewing tobacco, snuff, dip, pipes, e-cigarettes and hookahs (i.e., ever tobacco use). This represents approximately 58,800 students. Results are shown in Table 1. See also page 10 for a chart of the results.  Overall for high school students, the prevalence of ever tobacco use: ♦ Does not vary significantly by sex or race/ethnicity; ♦ Is significantly higher in grades 10 (29.8%), 11 (40.4%) and 12 (45.8%) than in grade 9 (23.1%); and significantly higher in grades 11 (40.4%) and 12 (45.8%) than in grade 10 (29.8%). Ever Tobacco Use % 95% CI Total 34.4 (30.5-38.3) Male 36.3 (30.8-41.8) Female 32.0 (27.8-36.1) NH-White 35.9 (30.9-41.0) NH-Black 26.7 (18.9-34.6) Hispanic 35.9 (30.9-40.9) 9 23.1 (18.8-27.3) 10 29.8 (25.7-33.9) 11 40.4 (33.9-46.9) 12 45.8 (34.1-57.4) Table 1 Sex Race/Ethnicity Grade Figure 1: Number of Tobacco Products Ever Tried 3+ Products 10% 2 Products 8% 1 Product 16% 0 Products 66%  In their lifetime, approximately 16% of high school students have tried one tobacco product, 8% have tried two products, and 10% have tried 3 or more (See Figure 1).  Among ever tobacco users, about 47% have tried one tobacco product, 24% have tried two products, and 29% have tried 3 or more—data not shown in figure. Note: Significance based on t-test analysis. Page 10 Ever Tobacco Use Percentage of CT high school students who ever tried any form of tobaccoꟷby sex, race/ethnicity and grade TOTAL 34.4% MALE 36.3% FEMALE 32.0% NH-WHITE 35.9% NH-BLACK 26.7% HISPANIC 35.9% GRADE 9 23.1% GRADE 10 29.8% GRADE 11 40.4% GRADE 12 45.8% 0% 10% 20% 30% 40% 50% Page 11 Current Tobacco Use On 1 or more of the past 30 days, 17.9% of Connecticut high school students used some form of tobacco (i.e., current tobacco use). This represents approximately 30,600 students. Results are shown in Table 2. See also page 12 for a chart of the results.  Overall for high school students, the prevalence of current tobacco use: ♦ Does not vary significantly by sex; ♦ Is significantly higher among non-Hispanic white (21.5%) than among non-Hispanic black (9.2%) and Hispanic (14.1%) students; ♦ Is significantly higher in grades 11 (20.9%) and 12 (24.4%) than in grade 9 (11.7%); and significantly higher in grade 12 (24.4%) than in grade 10 (15.3%).  Among current tobacco users, 21.7% used tobacco on 20 or more of the past 30 days (i.e., frequent tobacco use)—data not shown in table. Figure 2: Number of Tobacco Products Currently Used 2 Products 4% 3+ Products 2% 1 Product 12% Current Tobacco Use % 95% CI Total 17.9 (14.2-21.7) Male 17.9 (12.6-23.2) Female 17.3 (14.0-20.7) NH-White 21.5 (17.2-25.7) NH-Black 9.2 (4.2-14.3) Hispanic 14.1 (10.5-17.6) 9 11.7 (8.5-15.0) 10 15.3 (12.1-18.6) 11 20.9 (15.2-26.7) 12 24.4 (16.3-32.5) Table 2 Sex Race/Ethnicity Grade  Approximately 12% of students currently use one tobacco product; 4% use two tobacco products; and 2% use three or more (See Figure 2).  Among current tobacco users in high school, about 64% currently use one product; 23% use two products; and 13% use three or more—data not shown in figure. 0 Products 82%  Among high school students who use tobacco, 9.1% reported that they often or always feel restless and irritable when they do not use tobacco for a while—data not shown in figure. Note: Significance based on t-test analysis. Page 12 Current Tobacco Use Percentage of CT high school students who used some form of tobacco on 1 or more of the past 30 daysꟷby sex, race/ethnicity and grade TOTAL 17.9% MALE 17.9% FEMALE 17.3% NH-WHITE 21.5% NH-BLACK 9.2% HISPANIC 14.1% GRADE 9 11.7% GRADE 10 15.3% GRADE 11 20.9% GRADE 12 24.4% 0% 10% 20% 30% 40% 50% Page 13 Tobacco Product Tried First  Among high school students who ever tried any tobacco product, 50% tried e-cigarettes first, 24% tried cigarettes first and 13% tried cigars first. Results are shown in Figure 3. Figure 3: Tobacco Product Tried First Cigarettes 24%  Among male students who ever tried any tobacco product, 43.3% tried ecigarettes first, 25.7% tried cigarettes first and 17.1% tried cigars first—data not shown in figure. E-Cigarettes 50%  Among female students who ever tried any tobacco product, 57.1% tried e-cigarettes first, 22.3% tried cigarettes first and 10.8% tried hookahs first—data not shown in figure. Cigars 13% Other Products 13% Refusal of Sale of Tobacco Products In the state of Connecticut, you must be 18 years old or older to legally purchase tobacco products. Among all students under 18 years old, 1.6% reported that during the past 30 days someone refused to sell them tobacco products because of their age. Results are shown in Figure 4. Figure 4: Refusal of Sale of Tobacco Products Due to Age 100% 80% 79.0% 60% 40% 1.6% 20% 0% DID NOT TRY TO BUY ANY TOBACCO PRODUCTS YES, WERE REFUSED SALE 19.4% NO, WERE NOT REFUSED SALE In 2017, among current tobacco users under the age of 18 years who tried to buy tobacco products during the past 30 days, 20.1% were refused sale because of their age—data not shown in figure. Page 14 Beliefs About the Health Dangers of Tobacco Students were asked how harmful they believe other tobacco products are in comparison to cigarettes. While about 23% believe cigars are less harmful (See Figure 5), about 55% think e-cigarettes are less dangerous than regular cigarettes (See Figure 6). FIGURE 5: STUDENTS' BELIEFS ABOUT THE DANGERS OF CIGARS COMPARED TO CIGARETTES More Harmful, 18.6% Equally Harmful, 58.6% Less Harmful, 22.8% FIGURE 6: STUDENTS' BELIEFS ABOUT THE DANGERS OF E-CIGARETTES COMPARED TO CIGARETTES More Harmful, 6.2% Equally Harmful, 39.2% Less Harmful, 54.6% Page 15 Beliefs About Tobacco Addiction Students were asked how addictive they believe other tobacco products are in comparison to regular cigarettes. While about 30% believe cigars and 24% think hookahs are less addictive, nearly 40% consider ecigarettes less addictive than regular cigarettes (See Tables 3-5). See also page 16 for a chart of the results. Table 3: Believe Cigars Are Less Addictive Sex Race/Ethnicity Grade  Overall for high school students, the prevalence of believing cigars are less addictive: ♦ Is significantly higher among males (37.6%) than among females (22.3%); ♦ Is significantly higher among non-Hispanic whites (31.0%) and non-Hispanic blacks (35.7%) than among Hispanics (22.3%); ♦ Does not vary significantly by grade.  Overall for high school students, the prevalence of believing hookahs are less addictive: ♦ Does not vary significantly by sex or grade; ♦ Is significantly higher among non-Hispanic blacks (33.1%) and Hispanics (28.5%) than among non-Hispanic whites (21.3%). 95% CI 30.1 (26.2-34.0) Male 37.6 (32.6-42.6) Female 22.3 (17.7-26.9) NH-White 31.0 (26.8-35.1) NH-Black 35.7 (25.9-45.6) Hispanic 22.3 (16.7-27.9) 9 27.4 (22.4-32.4) 10 33.5 (28.0-39.0) 11 12 32.6 (24.9-40.4) 26.5 (19.2-33.8) Table 4: Believe Hookahs Are Less Addictive Sex Race/Ethnicity Grade  Overall for high school students, the prevalence of believing e-cigarettes are less addictive: ♦ Is significantly higher among males (44.3%) than among females (35.3%); ♦ Does not vary significantly by race/ethnicity or grade. % Total % 95% CI Total 24.1 (20.3-27.9) Male 22.7 (17.8-27.7) Female 25.5 (20.1-30.8) NH-White 21.3 (17.2-25.4) NH-Black 33.1 (22.9-43.2) Hispanic 28.5 (23.7-33.2) 9 23.4 (18.6-28.1) 10 24.1 (20.0-28.2) 11 22.6 (13.6-31.7) 12 26.3 (17.8-34.8) Table 5: Believe E-Cigarettes Are Less Addictive Sex Race/Ethnicity Note: Significance based on t-test analysis. Grade % 95% CI Total 39.7 (36.9-42.4) Male 44.3 (40.0-48.7) Female 35.3 (31.7-38.8) NH-White 39.6 (36.4-42.8) NH-Black 46.9 (35.7-58.2) Hispanic 39.2 (34.6-43.8) 9 41.7 (36.8-46.6) 10 40.2 (34.5-46.0) 11 12 39.4 (32.1-46.8) 38.0 (30.9-45.1) Page 16 Beliefs About Tobacco Addiction Percentage of CT high school students who believe cigars, hookahs and e-cigarettes are less addictive than regular cigarettesꟷby sex, race/ethnicity and grade TOTAL 30.1% 24.1% MALE 39.7% 37.6% 22.7% 22.3% FEMALE NH-WHITE 44.3% 25.5% 35.3% 31.0% 21.3% 39.6% 35.7% 33.1% NH-BLACK 22.3% HISPANIC GRADE 9 28.5% 41.7% 33.5% 24.1% GRADE 11 40.2% 32.6% 22.6% 39.4% 26.5% 26.3% GRADE 12 0% 10% 20% Cigars Hookahs 39.2% 27.4% 23.4% GRADE 10 46.9% 30% 38.0% 40% 50% E-Cigarettes Page 17 Use of Flavored Tobacco Products Students were asked about their use of tobacco products that were flavored to taste like candy, fruit, chocolate, menthol (mint), alcohol (wine, cognac) or any other flavors during the past 30 days (one or more responses could be selected). Among current tobacco users, 57.7% used flavored e-cigarettes; 17.7% smoked flavored cigars and 5.2% smoked flavored tobacco in a hookah (See chart below). Flavored tobacco products used during the past 30 days 57.7% 17.7% 9.1% 5.2% E-Cigarettes Cigars Hookahs Other Tobacco Products Students were asked what flavors of tobacco products they had used during the past 30 days (one or more responses could be selected). Among current tobacco users, 48.3% used fruit-flavored products; 33.2% used menthol or mint flavored; 18.2% used tobacco products flavored like chocolate, candy, desserts or other sweets; 4.0% used products flavored like an alcoholic drink, such as wine, cognac, margaritas or other cocktails; and 10.7% used tobacco products flavored with some other flavor not listed as a selection (See chart below). In comparison, only 3.6% of current tobacco users used unflavored products during the past 30 days—data not shown in chart. Flavors of tobacco products used by current tobacco users during the past 30 days 48.3% 33.2% 18.2% 4.0% Fruit Menthol/Mint Candy/Desserts Alcoholic Drinks 10.7% Other Flavor Page 18 Number of Tobacco Products Currently Used by Current Cigarette Smokers and Current E-Cigarette Users More than one-half of current cigarette smokers use three or more tobacco products, compared to 15% of current e-cigarette users (See Figure 7). Sixty-one percent (61%) of current e-cigarette users use only e-cigarettes, compared to 11% of current cigarette smokers who only smoke cigarettes (See Figure 8). Figure 7: Number of Tobacco Products Currently Used by Current Cigarette Smokers 1 Product, 11% 3+ Products, 52% 2 Products, 37% Figure 8: Number of Tobacco Products Currently Used by Current E-Cigarette Users 3+ Products, 15% 2 Products, 24% 1 Product, 61% Page 19 Current Tobacco Use Among Ever Users Among high school students who ever tried e-cigarettes, 54.0% continue to use them and are now current users of those products. In comparison, about 25.4% of ever cigarette smokers are now current cigarette smokers. Additionally, 40.9% of students who ever tried cigars and 33.9% ever hookah users, report current use of those products. Results are shown in the chart below. Rates of current tobacco use among ever usersꟷby product type E-CIGARETTES 54.0% CIGARS 40.9% HOOKAHS 33.9% CIGARETTES 25.4% 0% 20% 40% 60% 80% 100% Page 20 Current Tobacco Use Among Ever Users Among ever users of e-cigarettes, 51.4% of males and 55.5% of females are current users of those products. For ever cigar smokers, 43.8% of males and 32.4% of females are current cigar smokers. Among ever hookah smokers, 30.5% of males and 36.9% of females are current hookah smokers; and 28.1% of male and 21.6% of female ever cigarette smokers are current cigarette smokers. None of the differences are statistically significant. Results are shown in the chart below. Rates of current tobacco use among ever usersꟷby product type and sex 51.4% E-CIGARETTES 55.5% 43.8% CIGARS 32.4% 30.5% HOOKAHS 36.9% 28.1% CIGARETTES 21.6% 0% 20% 40% Males 60% 80% 100% Females Page 21 Ever Cigarette Smoking In 2017, 14.8% of Connecticut high school students had ever tried cigarette smoking, even one or two puffs (i.e., ever cigarette smoking). This represents approximately 25,300 students. Results are shown in Table 6. See also page 22 for a chart of the results.  Overall for high school students, the prevalence of ever cigarette smoking: ♦ Does not vary significantly by sex; ♦ Is significantly higher among Hispanic (16.5%) than among non-Hispanic black (10.2%) students; ♦ Is significantly higher in grades 11 (20.6%) and 12 (21.3%) than in grades 9 (7.3%) and 10 (10.9%).  Among students who ever smoked cigarettes, 49.0% first tried cigarette smoking, even one or two puffs, when they were 14 years old or younger—data not shown in table.  Among students who have never tried cigarette smoking, 12.1% or about 17,600 students said that they have been curious about trying cigarettes— data not shown in table. Ever Cigarette Smoking % 95% CI Total 14.8 (12.6-16.9) Male 16.1 (12.2-20.0) Female 13.2 (11.0-15.4) NH-White 15.1 (12.0-18.2) NH-Black 10.2 (5.6-14.8) Hispanic 16.5 (12.2-20.8) 9 7.3 (4.4-10.1) 10 10.9 (8.3-13.5) 11 20.6 (17.3-24.0) 12 21.3 (14.2-28.4) Table 6 Sex Race/Ethnicity Grade Last Time Smoked a Cigarette Students were asked when they last smoked a cigarette, even one or two puffs. Among ever cigarette smokers, 15.3% said they last smoked sometime during the past 7 days; 7.8% said between 8 and 30 days ago; 25.5% answered more than 30 days to 6 months ago; 13.4% said more than 6 months to less than 1 year ago; and 37.9% said it was 1 or more years ago—data not shown in table. Note: Significance based on t-test analysis. Page 22 Ever Cigarette Smoking Percentage of CT high school students who ever tried cigarette smokingꟷby sex, race/ethnicity and grade TOTAL 14.8% MALE 16.1% FEMALE 13.2% NH-WHITE 15.1% NH-BLACK 10.2% HISPANIC 16.5% GRADE 9 7.3% GRADE 10 10.9% GRADE 11 20.6% GRADE 12 21.3% 0% 10% 20% 30% 40% 50% Page 23 Current Cigarette Smoking On 1 or more of the past 30 days, 3.5% of Connecticut high school students smoked cigarettes (i.e., current cigarette smoking). This represents approximately 6,000 students. Results are shown in Table 7. See also page 24 for a chart of the results.  Overall for high school students, the prevalence of current cigarette smoking does not vary significantly by sex or grade.  Among current cigarette smokers, 15.7% smoked on 20 or more of the past 30 days (i.e., frequent cigarette smoking), while the majority (63.5%) smoked on 1 to 5 days—data not shown in table. Number of Cigarettes Smoked Per Day Among current cigarette smokers, on the days that they smoked during the past 30 days, 65% usually smoked less than one (i.e., one or more puffs but not a whole cigarette) to one cigarette, 25% smoked two to five, and 10% smoked six or more cigarettes per day—data not shown in table. Current Cigarette Smoking % 95% CI Total 3.5 (2.4-4.7) Male 4.2 (2.5-6.0) Female 2.7 (1.4-4.0) NH-White 4.5 (2.9-6.1) NH-Black * --- Hispanic * --- 9 * --- 10 3.2 (1.7-4.6) 11 4.9 (2.6-7.2) 12 5.5 (2.2-8.8) Table 7 Sex Race/Ethnicity Grade Access to Cigarettes Students were asked how they got their own cigarettes during the past 30 days (one or more answers could be selected). Among current cigarette smokers, 34.6% said they “bummed” them; 32.0% said they had someone else buy the cigarettes for them; and 23.8% said they bought the cigarettes themselves—data not shown in table. Note: Significance based on t-test analysis. *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 24 Current Cigarette Smoking Percentage of CT high school students who smoked cigarettes on 1 or more of the past 30 daysꟷby sex, race/ethnicity and grade TOTAL 3.5% MALE 4.2% FEMALE 2.7% NH-WHITE 4.5% NH-BLACK* HISPANIC* GRADE 9* GRADE 10 3.2% GRADE 11 4.9% GRADE 12 5.5% 0% 5% 10% 15% 20% 25% *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 25 Ever Cigar Smoking In 2017, 13.0% of Connecticut high school students had ever tried smoking cigars, cigarillos, or little cigars, such as Black and Milds, Swisher Sweets, Dutch Masters, White Owl or Phillies Blunts, even one or two puffs (i.e., ever cigar smoking). This represents approximately 22,200 students. Results are shown in Table 8. See also page 26 for a chart of the results.  Overall for high school students, the prevalence of ever cigar smoking: ♦ Is significantly higher among male (16.4%) than among female (8.7%) students; ♦ Does not vary significantly by race/ethnicity; ♦ Is significantly higher in grades 10 (10.1%), 11 (17.7%) and 12 (20.5%) than in grade 9 (4.4%); and significantly higher in grades 11 (17.7%) and 12 (20.5%) than in grade 10 (10.1%).  Among students who ever smoked cigars, 33.8% first tried cigar smoking, even one or two puffs, when they were 14 years old or younger—data not shown in table.  Among students who have never tried smoking cigars, 11.4% or about 17,000 students said that they have been curious about trying cigars—data not shown in table. Ever Cigar Smoking % 95% CI Total 13.0 (10.0-15.9) Male 16.4 (11.4-21.5) Female 8.7 (6.7-10.7) NH-White 13.7 (9.6-17.7) NH-Black 11.1 (6.2-16.1) Hispanic 11.7 (9.0-14.5) 9 4.4 (2.4-6.3) 10 10.1 (7.0-13.2) 11 17.7 (12.5-23.0) 12 20.5 (13.3-27.7) Table 8 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Page 26 Ever Cigar Smoking Percentage of CT high school students who ever tried smoking cigarsꟷby sex, race/ethnicity and grade TOTAL 13.0% MALE 16.4% FEMALE 8.7% NH-WHITE 13.7% NH-BLACK 11.1% HISPANIC 11.7% GRADE 9 4.4% GRADE 10 10.1% GRADE 11 17.7% GRADE 12 20.5% 0% 10% 20% 30% 40% 50% Page 27 Current Cigar Smoking On 1 or more of the past 30 days, 5.3% of Connecticut high school students smoked cigars (i.e., current cigar smoking). This represents approximately 9,100 students. Results are shown in Table 9. See also page 28 for a chart of the results.  Overall for high school students, the prevalence of current cigar smoking: ♦ Is significantly higher among male (7.2%) than among female (2.8%) students; ♦ Does not vary significantly by race/ethnicity; ♦ Is significantly higher in grade 11 (8.9%) than in grade 10 (3.2%). Current Cigar Smoking % 95% CI Total 5.3 (3.4-7.2) Male 7.2 (3.6-10.7) Female 2.8 (1.6-4.1) NH-White 6.2 (3.6-8.9) NH-Black * --- Hispanic 3.4 (1.6-5.3) 9 * --- 10 3.2 (1.7-4.6) 11 8.9 (6.0-11.8) 12 8.2 (2.7-13.8) Table 9 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 28 Current Cigar Smoking Percentage of CT high school students who smoked cigars on 1 or more of the past 30 daysꟷby sex, race/ethnicity and grade TOTAL 5.3% MALE 7.2% FEMALE 2.8% NH-WHITE 6.2% NH-BLACK* HISPANIC 3.4% GRADE 9* GRADE 10 3.2% GRADE 11 8.9% GRADE 12 8.2% 0% 5% 10% 15% 20% 25% *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 29 Ever E-Cigarette Use E-cigarettes are battery powered devices that usually contain a flavored nicotine-based liquid that is aerosolized and inhaled. They are sometimes referred to as vape-pens, hookah-pens, e-hookahs, e-cigars, e-pipes, personal vaporizers or mods. Some of the familiar brands are NJOY, Blu, Vuse, MarkTen, Logic, Vapin Plus, eGo, Halo and more recently, Juuls. In 2017, 27.3% of Connecticut high school students had ever tried e-cigarettes, even once or twice (i.e., ever e-cigarette use). This represents approximately 46,700 students. Results are shown in Table 10. See also page 30 for a chart of the results.  Overall for high school students, the prevalence of ever e-cigarette use: ♦ Does not vary significantly by sex; ♦ Is significantly higher among non-Hispanic white (31.5%) than among non-Hispanic black (15.1%) and Hispanic (24.2%) students; and significantly higher among Hispanic (24.2%) than among non-Hispanic black (15.1%) students; ♦ Is significantly higher in grades 11 (31.0%) and 12 (37.2%) than in grade 9 (18.8%); and significantly higher in grade 12 (37.2%) than in grade 10 (23.6%). Ever E-Cigarette Use % 95% CI Total 27.3 (22.7-32.0) Male 29.1 (23.1-35.1) Female 25.2 (20.1-30.4) NH-White 31.5 (26.1-36.8) NH-Black 15.1 (9.2-21.0) Hispanic 24.2 (15.6-28.9) 9 18.8 (14.9-22.7) 10 23.6 (19.7-27.6) 11 31.0 (22.4-39.5) 12 37.2 (24.7-48.7) Table 10 Sex Race/Ethnicity Grade  Among ever e-cigarette users, 40.5% first tried e-cigarettes, even once or twice, when they were 14 years old or younger; 41.8% were between 15 and 16 years old; and 17.7% were 17 years old or older—data not shown in table.  Among students who never tried e-cigarettes, 12.1% or about 15,000 students said that they have been curious about trying an e-cigarette, and 4.1% or approximately 5,100 students think that they will probably or definitely try an e-cigarette soon—data not shown in table.  Among students who ever used an e-cigarette device, 50.6% reported that they had used the device with a substance other than nicotine, such as marijuana, THC or hash oil, or THC wax—data not shown in table.  Students were asked about the types of e-cigarettes they ever used. Among students who ever tried ecigarettes, about 66% used only the rechargeable/refillable kind; 7% used only the disposable kind; and 27% used both types—data not shown in table. Note: Significance based on t-test analysis. Page 30 Ever E-Cigarette Use Percentage of CT high school students who ever tried e-cigarettesꟷby sex, race/ethnicity and grade TOTAL 27.3% MALE 29.1% FEMALE 25.2% NH-WHITE 31.5% NH-BLACK 15.1% HISPANIC 24.2% GRADE 9 18.8% GRADE 10 23.6% GRADE 11 31.0% GRADE 12 37.2% 0% 10% 20% 30% 40% 50% Page 31 Current E-Cigarette Use On 1 or more of the past 30 days, 14.7% of Connecticut high school students used e-cigarettes (i.e., current ecigarette use). This represents approximately 25,100 students. Results are shown in Table 11. See also page 32 for a chart of the results.  Overall for high school students, the prevalence of current e-cigarette use: ♦ Does not vary significantly by sex; ♦ Is significantly higher among non-Hispanic white (18.7%) than among Hispanic (9.3%) students; ♦ Is significantly higher in grades 11 (16.8%) and 12 (20.4%) than in grade 9 (10.2%); and significantly higher in grade 12 (20.4%) than in grade 10 (12.0%). Current E-Cigarette Use % 95% CI Total 14.7 (11.0-18.4) Male 14.8 (9.9-19.8) Female 14.0 (10.2-17.9) NH-White 18.7 (14.3-23.0) NH-Black * --- Hispanic 9.3 (6.6-12.0) 9 10.2 (6.9-13.5) 10 12.0 (8.8-15.3) 11 16.8 (10.5-23.0) 12 20.4 (13.4-27.4) Table 11 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 32 Current E-Cigarette Use Percentage of CT high school students who used e-cigarettes on 1 or more of the past 30 daysꟷby sex, race/ethnicity and grade TOTAL 14.7% MALE 14.8% FEMALE 14.0% NH-WHITE 18.7% NH-BLACK* HISPANIC 9.3% GRADE 9 10.2% GRADE 10 12.0% GRADE 11 16.8% GRADE 12 20.4% 0% 10% 20% 30% 40% 50% *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 33 Frequent E-Cigarette Use Among current e-cigarette users, 19.2% used e-cigarettes on 20 or more of the past 30 days (i.e., frequent ecigarette use). This represents approximately 4,800 students. Results are shown in Table 12.  Overall for high school students, the prevalence of frequent e-cigarette use: ♦ Is significantly higher among males (25.0%) than among females (12.9%); ♦ Does not vary significantly by grade. Frequent E-Cigarette Use % 95% CI Total 19.2 (13.5-24.9) Male 25.0 (16.5-33.5) Female 12.9 (7.4-18.4) NH-White 21.0 (14.7-27.3) NH-Black * --- Hispanic * --- 9 * --- 10 13.2 (7.5-18.9) 11 * --- 12 23.6 (14.2-33.0) Table 12 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 34 Reasons for Using E-Cigarettes Students were asked about the reasons they had used e-cigarettes.⸸ Among ever e-cigarette users, the most selected reason was “Friend or family member used them” (41.6%). Second was “I used them for some other reason” (33.0%), third was “They are available in flavors, such as mint, candy, fruit or chocolate” (23.9%), and fourth, “They are less harmful than other forms of tobacco, such as cigarettes” (16.0%). The percentage of ever users who selected any of the five other reason options was 5.6% or less. Results are shown in the chart below. REASONS FOR USING E-CIGARETTES 41.6% FRIEND OR FAMILY MEMBER USED THEM 33.0% USED THEM FOR SOME OTHER REASON 23.9% THEY ARE AVAILABLE IN FLAVORS 16.0% THEY ARE LESS HARMFUL THAN OTHER FORMS OF TOBACCO THEY CAN BE USED IN AREAS WHERE OTHER TOBACCO PRODUCTS ARE NOT ALLOWED 5.6% THEY ARE EASIER TO GET THAN OTHER TOBACCO PRODUCTS 3.7% THEY COST LESS THAN OTHER TOBACCO PRODUCTS 3.6% TO TRY TO QUIT USING OTHER TOBACCO PRODUCTS 3.5% FAMOUS PEOPLE ON TV OR IN MOVIES USE THEM <1.0% 0% 10% 20% 30% 40% 50% ⸸ Students could choose one or more answers. Page 35 Obtaining E-Cigarettes Students were asked how they got or where they bought the e-cigarettes they used in the past 30 days.⸸ Among current e-cigarette users, the most common selection was “From a friend” (59.3%). Second was “A vape shop or other store that only sells e-cigarettes” (18.2%), third was “A gas station or convenience store” (16.5%), and fourth, “On the Internet” (11.1%). The percentage of current users who selected any of the five other options was 4.6% or less. Results are shown in the chart below. WAYS OF OBTAINING E-CIGARETTES 59.3% FRIEND 18.2% VAPE SHOP 16.5% GAS STATION OR CONVENIENCE STORE INTERNET 11.1% FAMILY MEMBER 4.6% 1.7% PERSON OTHER THAN FRIEND OR FAMILY MEMBER SOME OTHER PLACE 1.5% DRUG STORE 1.3% 1.1% MALL KIOSK OR STAND GROCERY STORE <1.0% 0% 10% 20% 30% 40% 50% 60% ⸸ Students could choose one or more answers. Page 36 Brands of E-Cigarettes Ever Tried Students were asked which brands of e-cigarettes they had ever tried.⸸ Among students who knew the brand name of at least one device they had ever tried, “Some other brand not listed here” (60.9%) was the response selected most often, second was “Blu” (23.8%), and third was “Vuse” (11.1%). Results are shown in the chart below. BRANDS OF E-CIGARETTES EVER TRIED OTHER BRAND 60.9% BLU 23.8% VUSE LOGIC VAPIN PLUS 11.1% 8.2% 5.8% EGO 4.6% 4.0% NJOY HALO MARKTEN 1.8% <1.0% 0% 20% 40% 60% 80% 100% ⸸ Students could choose one or more answers. Page 37 Ever Hookah Smoking A hookah, or a water pipe, is a smoking device that consists of a bowl mounted on a vessel of water which is provided with a long tube and arranged so that smoke is drawn through the water where it is cooled and carried up the tube to be inhaled. Shisha is a specially made tobacco that is used in a hookah. This type of tobacco comes in different flavors that are appealing to teenagers, such as apple, cherry, chocolate, coconut and watermelon. Although many users believe hookah Ever Hookah Smoking smoking is less harmful, it is not a safe alternative to cigarette smoking since it carries many of the same 95% CI % Table 13 1 health risks. 8.4 (6.5-10.2) Total In 2017, 8.4% of Connecticut high school students had ever tried smoking tobacco in a hookah, even one or two puffs (i.e., ever hookah smoking). This represents approximately 14,400 students. Results are shown in Table 13. See also page 38 for a chart of the results.  Overall for high school students, the prevalence of ever hookah smoking: ♦ Does not vary significantly by sex; ♦ Is significantly higher among Hispanic (10.9%) than among non-Hispanic white (7.5%) students; ♦ Is significantly higher in grades 10 (7.7%), 11 (10.8%) and 12 (11.6%) than in grade 9 (3.9%). Sex Male 8.6 (6.5-10.7) Female 8.0 (5.3-10.6) NH-White 7.5 (5.4-9.5) NH-Black * --- Hispanic 10.9 (8.1-13.6) 9 3.9 (2.0-5.9) 10 7.7 (5.6-9.8) 11 10.8 (7.7-13.9) 12 11.6 (6.8-16.4) Race/Ethnicity Grade  Among students who have never tried smoking tobacco in a hookah, 12.3% or about 19,300 students said that they have been curious about trying hookah smoking—data not shown in table. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Note: Significance based on t-test analysis. *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. 1 Page 38 Ever Hookah Smoking Percentage of CT high school students who ever tried smoking tobacco in a hookahꟷby sex, race/ethnicity and grade TOTAL 8.4% MALE 8.6% FEMALE 8.0% NH-WHITE 7.5% NH-BLACK* HISPANIC 10.9% GRADE 9 3.9% GRADE 10 7.7% GRADE 11 10.8% GRADE 12 11.6% 0% 5% 10% 15% 20% 25% *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 39 Current Hookah Smoking On 1 or more of the past 30 days, 2.8% of Connecticut high school students smoked tobacco in a hookah (i.e., current hookah smoking). This represents approximately 4,800 students. Results are shown in Table 14. See also page 40 for a chart of the results.  Overall for high school students, the prevalence of current hookah smoking does not vary significantly by sex or race/ethnicity.  Students were asked where they had smoked tobacco in a hookah during the past 30 days. The choices were, ‘At my house’, ‘At a friend’s house’, ‘At a family member’s house, other than my house’, ‘At a hookah bar’, ‘At a café or restaurant’ and ‘Some other place not listed here’. More than one response could be selected. Among current hookah users, 44.2% had smoked at a friend’s house; 38.4% at their own house; 11.4% at a hookah bar; 11.0% at some other place; 9.3% at another family member’s house; and 2.3% at a café or restaurant—data not shown in table. Current Hookah Smoking % 95% CI Total 2.8 (1.8-3.9) Male 2.6 (1.4-3.8) Female 2.9 (1.4-4.5) NH-White 2.3 (1.3-3.3) NH-Black * --- Hispanic 4.5 (2.5-6.5) 9 * --- 10 3.7 (2.3-5.1) 11 * --- 12 * --- Table 14 Sex Race/Ethnicity Grade  Approximately 22% of students believe that people cause little or no harm to themselves if they smoke tobacco in a hookah some days but not every day. Among current hookah users, that percentage nearly triples to about 60%—data not shown in table. Note: Significance based on t-test analysis. *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 40 Current Hookah Smoking Percentage of CT high school students who smoked tobacco in a hookah on 1 or more of the past 30 daysꟷby sex, race/ethnicity and grade TOTAL 2.8% MALE 2.6% FEMALE 2.9% NH-WHITE 2.3% NH-BLACK* HISPANIC 4.5% GRADE 9* GRADE 10 3.7% GRADE 11* GRADE 12* 0% 5% 10% 15% 20% 25% *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 41 Ever Pipe Smoking In 2017, 3.9% of Connecticut high school students had ever tried smoking tobacco in a pipe, even one or two puffs (i.e., ever pipe smoking). This represents approximately 6,700 students. Results are shown in Table 15. See also page 42 for a chart of the results.  Overall for high school students, the prevalence of ever pipe smoking does not vary significantly by sex, race/ethnicity or grade. Data for current pipe smoking will not be presented in this report due to unreliable estimates. Ever Pipe Smoking % 95% CI Total 3.9 (2.7-5.2) Male 5.0 (2.4-7.6) Female 2.9 (1.7-4.1) NH-White 4.5 (2.7-6.3) NH-Black * --- Hispanic 3.6 (2.1-5.2) 9 * --- 10 3.1 (1.6-4.7) 11 5.7 (3.0-8.5) 12 5.3 (2.2-8.4) Table 15 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 42 Ever Pipe Smoking Percentage of CT high school students who ever tried smoking tobacco in a pipeꟷby sex, race/ethnicity and grade TOTAL 3.9% MALE 5.0% FEMALE 2.9% NH-WHITE 4.5% NH-BLACK* HISPANIC 3.6% GRADE 9* GRADE 10 3.1% GRADE 11 5.7% GRADE 12 5.3% 0% 5% 10% 15% 20% 25% *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 43 Ever Smokeless Tobacco Use In 2017, 4.1% of Connecticut high school students had ever tried chewing tobacco, snuff or dip, such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits or Copenhagen, even just a small amount (i.e., ever smokeless tobacco use). This represents approximately 7,000 students. Results are shown in Table 16. See also page 44 for a chart of the results.  Overall for high school students, the prevalence of ever smokeless tobacco use is significantly higher in grade 11 (7.9%) than in grade 10 (2.5%).  In 2017, 1.6% of high school students used smokeless tobacco on 1 or more of the past 30 days (i.e., current smokeless tobacco use)—data not shown in table. Data for current smokeless tobacco use by sex, race/ethnicity and grade will not be presented in this report due to unreliable estimates. Ever Smokeless Tobacco Use % 95% CI Total 4.1 (2.3-5.9) Male 6.7 (2.4-7.6) * --- NH-White 4.9 (2.7-6.3) NH-Black * --- Hispanic * --- 9 * --- 10 2.5 (1.6-4.7) 11 7.9 (3.0-8.5) 12 4.9 (2.2-8.4) Table 16 Sex Female Race/Ethnicity Grade Note: Significance based on t-test analysis. *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 44 Ever Smokeless Tobacco Use Percentage of CT high school students who ever tried smokeless tobaccoꟷby sex, race/ethnicity and grade TOTAL 4.1% MALE 6.7% FEMALE* NH-WHITE 4.9% NH-BLACK* HISPANIC* GRADE 9* GRADE 10 2.5% GRADE 11 7.9% GRADE 12 4.9% 0% 5% 10% 15% 20% 25% *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 45 Ever Any Other Tobacco Use In 2017, 4.3% of Connecticut high school students had ever tried any other form of tobacco, including roll-yourown-cigarettes, snus, dissolvable tobacco and bidis (i.e., ever any other tobacco use). This represents approximately 7,400 students. Results are shown in Table 17. See also page 46 for a chart of the results.  Overall for high school students, the prevalence of ever any other tobacco use: ♦ Is significantly higher among males (5.8%) than among females (2.6%); ♦ Does not vary significantly by race/ethnicity or grade. Ever Any Other Tobacco Use % 95% CI Total 4.3 (2.9-5.6) Male 5.8 (3.5-8.2) Female 2.6 (1.5-3.7) NH-White 5.1 (3.1-7.3) NH-Black * --- Hispanic 3.0 (1.5-4.4) 9 * --- 10 * --- 11 5.9 (3.1-8.7) 12 7.6 (3.9-11.3) Table 17 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 46 Ever Any Other Tobacco Use Percentage of CT high school students who ever tried any other form of tobaccoꟷby sex, race/ethnicity and grade TOTAL 4.3% MALE 5.8% FEMALE 2.6% NH-WHITE 5.1% NH-BLACK* HISPANIC 3.0% GRADE 9* GRADE 10* GRADE 11 5.9% GRADE 12 7.6% 0% 5% 10% 15% 20% 25% *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 47 Current Any Other Tobacco Use On 1 or more of the past 30 days, 2.8% of Connecticut high school students used any other form of tobacco, including roll-your-own-cigarettes, snus, dissolvable tobacco and bidis (i.e., current any other tobacco use). This represents approximately 4,800 students. Results are shown in Table 18. See also page 48 for a chart of the results. Current Any Other Tobacco Use  Overall for high school students, the prevalence of current any other tobacco use: ♦ Is significantly higher among males (3.6%) than among females (1.5%); ♦ Does not vary significantly by race/ethnicity. % 95% CI Total 2.8 (1.7-3.8) Male 3.6 (2.1-5.1) Female 1.5 (0.9-2.0) NH-White 2.7 (1.3-4.1) NH-Black * --- Hispanic 2.3 (1.0-3.6) 9 * --- 10 * --- 11 * --- 12 4.0 (1.9-6.2) Table 18 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 48 Current Any Other Tobacco Use Percentage of CT high school students who used any other form of tobacco on 1 or more of the past 30 daysꟷby sex, race/ethnicity and grade TOTAL 2.8% MALE FEMALE 3.6% 1.5% NH-WHITE 2.7% NH-BLACK* HISPANIC 2.3% GRADE 9* GRADE 10* GRADE 11* GRADE 12 4.0% 0% 5% 10% 15% 20% 25% *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 49 Secondhand Smoke Exposure at Home On one or more of the past seven days, 13.9% of Connecticut high school students were at home while someone smoked a tobacco product (i.e., recent secondhand smoke exposure at home). This represents approximately 23,800 students. Results are shown in Table 19. See also page 50 for a chart of the results.  Overall for high school students, the prevalence of recent secondhand smoke exposure at home: ♦ Is significantly higher among females (16.1%) than among males (11.9%); ♦ Does not vary significantly by race/ethnicity or grade. SHS Exposure at Home % 95% CI Total 13.9 (11.1-16.7) Male 11.9 (7.8-16.0) Female 16.1 (13.4-18.9) NH-White 14.9 (11.2-18.7) NH-Black 12.5 (7.0-18.0) Hispanic 13.4 (9.0-17.6) 9 13.3 (9.3-17.2) 10 15.0 (10.7-19.3) 11 14.7 (8.5-20.9) 12 12.9 (8.5-17.3) Table 19 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Abbreviation: SHS = secondhand smoke Page 50 Secondhand Smoke Exposure at Home Percentage of CT high school students who were at home on 1 or more of the past 7 days while someone smoked a tobacco product ꟷby sex, race/ethnicity and grade TOTAL 13.9% MALE 11.9% FEMALE 16.1% NH-WHITE 14.9% NH-BLACK 12.5% HISPANIC 13.4% GRADE 9 13.3% GRADE 10 15.0% GRADE 11 14.7% GRADE 12 12.9% 0% 5% 10% 15% 20% 25% Page 51 Secondhand Smoke Exposure in a Vehicle On one or more of the past seven days, 16.3% of Connecticut high school students rode in a vehicle when someone was smoking a tobacco product (i.e., recent secondhand smoke exposure in a vehicle). This represents approximately 27,900 students. Results are shown in Table 20. See also page 52 for a chart of the results.  Overall for high school students, the prevalence of recent secondhand smoke exposure in a vehicle: ♦ Does not vary significantly by sex; ♦ Is significantly higher among non-Hispanic white (18.8%) than among non-Hispanic black (11.2%) and Hispanic (12.2%) students; ♦ Is significantly higher in grades 11 (19.7%) and 12 (18.0%) than in grade 9 (11.7%). SHS Exposure in a Vehicle % 95% CI Total 16.3 (13.6-19.0) Male 14.6 (10.7-18.5) Female 18.1 (14.9-21.2) NH-White 18.8 (14.7-22.9) NH-Black 11.2 (5.5-16.9) Hispanic 12.2 (8.2-16.2) 9 11.7 (7.9-15.6) 10 16.3 (12.0-20.6) 11 19.7 (15.8-23.7) 12 18.0 (13.1-22.9) Table 20 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Abbreviation: SHS = secondhand smoke Page 52 Secondhand Smoke Exposure in a Vehicle Percentage of CT high school students who were in a vehicle on 1 or more of the past 7 days when someone was smoking a tobacco product ꟷby sex, race/ethnicity and grade TOTAL 16.3% MALE 14.6% FEMALE 18.1% NH-WHITE 18.8% NH-BLACK 11.2% HISPANIC 12.2% GRADE 9 11.7% GRADE 10 16.3% GRADE 11 19.7% GRADE 12 18.0% 0% 5% 10% 15% 20% 25% Page 53 Secondhand Smoke Exposure at School On one or more of the past seven days, 17.3% of Connecticut high school students breathed the smoke from someone who was smoking a tobacco product at their school, including school buildings, school grounds and school parking lots (i.e., recent secondhand smoke exposure at school). This represents approximately 29,600 students. Results are shown in Table 21. See also page 54 for a chart of the results.  Overall for high school students, the prevalence of recent secondhand smoke exposure at school: ♦ Does not vary significantly by sex or grade; ♦ Is significantly higher among non-Hispanic white (18.7%) than among non-Hispanic black (11.3%) students. SHS Exposure at School % 95% CI Total 17.3 (14.0-20.6) Male 15.2 (11.4-19.0) Female 19.2 (15.0-23.4) NH-White 18.7 (14.4-23.1) NH-Black 11.3 (5.4-17.3) Hispanic 16.7 (12.5-20.9) 9 16.8 (10.0-23.7) 10 16.8 (11.1-22.4) 11 17.5 (12.7-22.4) 12 18.2 (14.0-22.4) Table 21 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Abbreviation: SHS = secondhand smoke Page 54 Secondhand Smoke Exposure at School Percentage of CT high school students who breathed the smoke from someone who was smoking a tobacco product at their school on 1 or more of the past 7 daysꟷby sex, race/ethnicity and grade TOTAL 17.3% MALE 15.2% FEMALE 19.2% NH-WHITE 18.7% NH-BLACK 11.3% HISPANIC 16.7% GRADE 9 16.8% GRADE 10 16.8% GRADE 11 17.5% GRADE 12 18.2% 0% 5% 10% 15% 20% 25% Page 55 Secondhand Smoke Exposure in a Public Place On one or more of the past seven days, 32.4% of Connecticut high school students breathed the smoke from someone who was smoking a tobacco product in a public place (i.e., recent secondhand smoke exposure in a public place). This represents approximately 55,400 students. Results are shown in Table 22. See also page 56 for a chart of the results.  Overall for high school students, the prevalence of recent secondhand smoke exposure in a public place: ♦ Is significantly higher among females (38.2%) than among males (26.7%); ♦ Is significantly higher among non-Hispanic white (34.9%) than among non-Hispanic black (25.6%) and Hispanic (27.2%) students; ♦ Does not vary significantly by grade. SHS Exposure in a Public Place % 95% CI Total 32.4 (29.1-35.6) Male 26.7 (23.0-30.3) Female 38.2 (34.2-42.3) NH-White 34.9 (30.8-39.1) NH-Black 25.6 (19.2-32.0) Hispanic 27.2 (22.3-32.1) 9 29.9 (25.0-34.8) 10 30.8 (24.2-37.4) 11 35.4 (30.4-40.5) 12 33.5 (25.4-41.6) Table 22 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Abbreviation: SHS = secondhand smoke Page 56 Secondhand Smoke Exposure in a Public Place Percentage of CT high school students who breathed the smoke from someone who was smoking a tobacco product in a public place on 1 or more of the past 7 daysꟷby sex, race/ethnicity and grade TOTAL 32.4% MALE 26.7% FEMALE 38.2% NH-WHITE 34.9% NH-BLACK 25.6% HISPANIC 27.2% GRADE 9 29.9% GRADE 10 30.8% GRADE 11 35.4% GRADE 12 33.5% 0% 10% 20% 30% 40% 50% Page 57 Secondhand Smoke Exposure at Work On one or more of the past seven days, 26.1% of Connecticut high school students** breathed the smoke from someone who was smoking a tobacco product at the place where they work (i.e., recent secondhand smoke exposure at work). This represents approximately 10,500 students. Results are shown in Table 23. See also page 58 for a chart of the results.  Overall for high school students, the prevalence of recent secondhand smoke exposure at work: ♦ Does not vary significantly by sex or grade; ♦ Is significantly higher among Hispanic (38.0%) than among non-Hispanic white (23.4%) students. SHS Exposure at Work** % 95% CI Total 26.1 (20.8-31.4) Male 27.6 (20.9-34.2) Female 25.0 (18.1-32.0) NH-White 23.4 (18.0-28.9) NH-Black * --- Hispanic 38.0 (26.3-49.8) 9 * --- 10 29.6 (19.4-39.9) 11 26.8 (19.1-34.5) 12 23.6 (15.8-31.4) Table 23 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Abbreviation: SHS = secondhand smoke *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. **Among students who have a job and worked during the past seven days. Page 58 Secondhand Smoke Exposure at Work Percentage of CT high school students** who breathed the smoke from someone who was smoking a tobacco product at the place where they work on 1 or more of the past 7 daysꟷby sex, race/ethnicity and grade TOTAL 26.1% MALE 27.6% FEMALE 25.0% NH-WHITE 23.4% NH-BLACK* HISPANIC 38.0% GRADE 9* GRADE 10 29.6% GRADE 11 26.8% GRADE 12 23.6% 0% 10% 20% 30% 40% 50% *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. **Among students who have a job and worked during the past seven days. Page 59 Any Secondhand Smoke Exposure On one or more of the past seven days, 45.2% of Connecticut high school students breathed the smoke from someone who was smoking a tobacco product (i.e., any recent secondhand smoke exposure). This represents approximately 77,300 students. Results are shown in Table 24. See also page 60 for a chart of the results.  Overall for high school students, the prevalence of any recent secondhand smoke exposure: ♦ Is significantly higher among females (51.7%) than among males (38.7%); ♦ Is significantly higher among non-Hispanic white (48.7%) than among non-Hispanic black (35.8%) and Hispanic (40.0%) students; ♦ Does not vary significantly by grade. Any SHS Exposure % 95% CI Total 45.2 (41.5-48.9) Male 38.7 (34.1-43.4) Female 51.7 (47.1-56.3) NH-White 48.7 (43.5-53.8) NH-Black 35.8 (28.7-42.9) Hispanic 40.0 (34.9-45.1) 9 41.5 (35.6-48.5) 10 43.9 (36.1-51.6) 11 49.9 (43.5-56.4) 12 45.7 (38.3-53.0) Table 24 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Abbreviation: SHS = secondhand smoke Page 60 Any Secondhand Smoke Exposure Percentage of CT high school students who breathed the smoke from someone who was smoking a tobacco product on 1 or more of the past 7 daysꟷby sex, race/ethnicity and grade TOTAL 45.2% MALE 38.7% FEMALE 51.7% NH-WHITE 48.7% NH-BLACK 35.8% HISPANIC 40.0% GRADE 9 41.5% GRADE 10 43.9% GRADE 11 49.9% GRADE 12 45.7% 0% 20% 40% 60% 80% 100% Page 61 Living with Someone Who Uses Tobacco In 2017, 27.3% of Connecticut high school students were living with someone who uses tobacco. This represents approximately 46,700 students. Results are shown in Table 25. See also page 62 for a chart of the results.  Overall for high school students, the prevalence of living with someone who uses tobacco does not vary significantly by sex, race/ethnicity or grade.  Among current tobacco users, 40.5% were living with someone who uses tobacco. In comparison, the percentage of students who do not currently use tobacco and were living with a tobacco user was significantly lower (24.4%)—data not shown in table. Living with Tobacco User % 95% CI Total 27.3 (24.1-30.5) Male 26.8 (22.7-30.8) Female 28.2 (24.5-31.9) NH-White 28.7 (24.4-33.0) NH-Black 24.2 (19.4-28.9) Hispanic 26.4 (20.5-32.3) 9 26.5 (21.1-31.9) 10 28.9 (23.4-34.3) 11 28.3 (23.3-33.4) 12 25.9 (19.1-32.8) Table 25 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Page 62 Living with Someone Who Uses Tobacco Percentage of CT high school students living with someone who uses tobaccoꟷby sex, race/ethnicity and grade TOTAL 27.3% MALE 26.8% FEMALE 28.2% NH-WHITE 28.7% NH-BLACK 24.2% HISPANIC 26.4% GRADE 9 26.5% GRADE 10 28.9% GRADE 11 28.3% GRADE 12 25.9% 0% 10% 20% 30% 40% 50% Page 63 Living with Someone Who Smokes Cigarettes In 2017, 19.8% of Connecticut high school students were living with someone who smokes cigarettes. This represents approximately 33,900 students. Results are shown in Table 26. See also page 64 for a chart of the results.  Overall for high school students, the prevalence of living with someone who smokes cigarettes does not vary significantly by sex, race/ethnicity or grade.  Among current cigarettes smokers, 28.7% were living with someone who smokes cigarettes—data not shown in table. Living with Cigarette Smoker % 95% CI Total 19.8 (16.2-23.1) Male 18.2 (14.4-22.0) Female 21.8 (17.3-26.3) NH-White 19.8 (15.0-24.7) NH-Black 19.1 (15.5-22.7) Hispanic 21.0 (16.4-25.7) 9 19.9 (14.1-25.8) 10 20.6 (15.8-25.3) 11 20.6 (15.6-25.6) 12 18.5 (13.2-23.8) Table 26 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Page 64 Living with Someone Who Smokes Cigarettes Percentage of CT high school students living with someone who smokes cigarettesꟷby sex, race/ethnicity and grade TOTAL 19.8% MALE 18.2% FEMALE 21.8% NH-WHITE 19.8% NH-BLACK 19.1% HISPANIC 21.0% GRADE 9 19.9% GRADE 10 20.6% GRADE 11 20.6% GRADE 12 18.5% 0% 10% 20% 30% 40% 50% Page 65 Rules About Smoking Inside Students’ Homes In 2017, 11.5% of Connecticut high school students lived in a home where smoking is always allowed or allowed at some times or in some places (not including decks, garages or porches). This represents approximately 19,700 students. Results are shown in Table 27. See also page 66 for a chart of the results.  Overall for high school students, the prevalence of living in a home where smoking is always or sometimes allowed: ♦ Does not vary significantly by sex or grade; ♦ Is significantly higher among Hispanic (15.3%) than among non-Hispanic white (10.8%) students. Smoking Always or Sometimes Allowed Inside Home % 95% CI Total 11.5 (9.1-13.9) Male 12.0 (9.1-15.0) Female 10.9 (8.1-13.8) NH-White 10.8 (8.1-13.5) NH-Black 12.0 (6.9-17.1) Hispanic 15.3 (11.8-18.7) 9 10.6 (7.0-14.2) 10 13.9 (9.4-18.5) 11 11.5 (7.3-15.7) 12 10.0 (6.1-14.0) Table 27 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Page 66 Rules About Smoking Inside Students’ Homes Percentage of CT high school students who live in a home where smoking is always allowed or allowed at some times or in some places ꟷby sex, race/ethnicity and grade TOTAL 11.5% MALE 12.0% FEMALE 10.9% NH-WHITE 10.8% NH-BLACK 12.0% HISPANIC 15.3% GRADE 9 10.6% GRADE 10 13.9% GRADE 11 11.5% GRADE 12 10.0% 0% 5% 10% 15% 20% 25% Page 67 Rules About Smoking Inside Students’ Family Vehicles In 2017, 15.3% of Connecticut high school students reported that, in the vehicles they and their family members own or lease, smoking is always or sometimes allowed. This represents approximately 26,200 students. Results are shown in Table 28. See also page 68 for a chart of the results.  Overall for high school students, the prevalence of always or sometimes allowing smoking in family vehicles: ♦ Does not vary significantly by sex or race/ethnicity; ♦ Is significantly higher in grade 11 (18.9%) than in grade 12 (12.5%). Smoking Always or Sometimes Allowed Inside Vehicles % 95% CI Total 15.3 (12.6-17.9) Male 14.8 (11.2-18.4) Female 15.8 (12.2-19.5) NH-White 16.2 (12.4-20.1) NH-Black 12.2 (7.3-17.1) Hispanic 15.6 (11.2-19.9) 9 14.1 (10.7-17.5) 10 15.6 (11.4-19.8) 11 18.9 (14.5-23.3) 12 12.5 (8.2-16.9) Table 28 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Page 68 Rules About Smoking Inside Students’ Family Vehicles Percentage of CT high school students who report that smoking is always or sometimes allowed in family vehiclesꟷby sex, race/ethnicity and grade TOTAL 15.3% MALE 14.8% FEMALE 15.8% NH-WHITE 16.2% NH-BLACK 12.2% HISPANIC 15.6% GRADE 9 14.1% GRADE 10 15.6% GRADE 11 18.9% GRADE 12 12.5% 0% 5% 10% 15% 20% 25% Page 69 Exposure to E-Cigarette Aerosol On 1 or more of the past 30 days, 28.5% of Connecticut high school students breathed the aerosol from someone who was using an e-cigarette in a public place. This represents approximately 48,700 students. Results are shown in Table 29. See also page 70 for a chart of the results.  Overall for high school students, the prevalence of exposure to e-cigarette aerosol in a public place during the past 30 days: ♦ Is significantly higher among females (31.4%) than among males (25.3%); ♦ Is significantly higher among non-Hispanic white (33.8%) than among non-Hispanic black (14.6%) and Hispanic (19.9%) students; ♦ Is significantly higher in grade 11 (32.6%) than in grade 10 (24.6%). Exposure to E-Cigarette Aerosol % 95% CI Total 28.5 (23.4-33.6) Male 25.3 (19.6-31.0) Female 31.4 (26.6-36.3) NH-White 33.8 (27.6-39.9) NH-Black 14.6 (9.8-19.5) Hispanic 19.9 (15.3-24.6) 9 26.2 (18.1-34.2) 10 24.6 (19.4-29.8) 11 32.6 (26.1-39.1) 12 30.7 (22.0-39.3) Table 29 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Page 70 Exposure to E-Cigarette Aerosol Percentage of CT high school students who breathed the aerosol from someone who was using an e-cigarette in a public place on 1 or more of the past 30 daysꟷby sex, race/ethnicity and grade TOTAL 28.5% MALE 25.3% FEMALE 31.4% NH-WHITE 33.8% NH-BLACK 14.6% HISPANIC 19.9% GRADE 9 26.2% GRADE 10 24.6% GRADE 11 32.6% GRADE 12 30.7% 0% 10% 20% 30% 40% 50% Page 71 Believe E-Cigarette Aerosol Causes Little or No Harm In 2017, 37.1% of Connecticut high school students believed that breathing the aerosol from e-cigarettes causes little or no harm. This represents approximately 63,400 students. Results are shown in Table 30. See also page 72 for a chart of the results.  Overall for high school students, the prevalence of believing that breathing e-cigarette aerosol causes little or no harm: ♦ Is significantly higher among males (44.4%) than among females (29.7%); ♦ Does not vary significantly by race/ethnicity or grade.  Among ever e-cigarette users, 52.7% believe that breathing e-cigarette aerosol causes little or no harm. The percentage of never e-cigarette users who believe the aerosol causes little or no harm is significantly lower (28.8%)—data not shown in table. Believe E-Cigarette Aerosol Causes Little or No Harm % 95% CI Total 37.1 (33.9-40.3) Male 44.4 (39.4-49.4) Female 29.7 (25.4-34.1) NH-White 37.9 (33.8-42.1) NH-Black 41.7 (31.4-52.0) Hispanic 34.5 (28.3-40.7) 9 37.6 (31.2-44.0) 10 39.4 (34.6-44.1) 11 35.2 (28.2-42.3) 12 36.7 (30.1-43.4) Table 30 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Page 72 Believe E-Cigarette Aerosol Causes Little or No Harm Percentage of CT high school students who believe breathing the aerosol from e-cigarettes causes little or no harmꟷby sex, race/ethnicity and grade TOTAL 37.1% MALE 44.4% FEMALE 29.7% NH-WHITE 37.9% NH-BLACK 41.7% HISPANIC 34.5% GRADE 9 37.6% GRADE 10 39.4% GRADE 11 35.2% GRADE 12 36.7% 0% 10% 20% 30% 40% 50% Page 73 Belief About Tobacco Company Influence on Young People In 2017, 67.2% of Connecticut high school students believed that tobacco companies try to get young people under the age of 18 to use tobacco products. This represents approximately 114,900 students. Results are shown in Table 31. See also page 74 for a chart of the results.  Overall for high school students, the prevalence of believing tobacco companies try to get young people to use tobacco does not vary significantly by sex, race/ethnicity or grade. Believe Tobacco Companies Try to Get Young People to Use Tobacco % 95% CI Total 67.2 (62.8-71.5) Male 67.5 (62.8-72.2) Female 66.5 (60.7-72.3) NH-White 69.1 (64.0-74.1) NH-Black 59.4 (48.6-70.2) Hispanic 66.4 (60.3-72.6) 9 69.3 (63.7-74.8) 10 64.1 (58.4-69.9) 11 67.0 (60.9-73.1) 12 68.2 (59.9-76.6) Table 31 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Page 74 Belief About Tobacco Company Influence on Young People Percentage of CT high school students who believe tobacco companies try to get young people to use tobaccoꟷby sex, race/ethnicity and grade TOTAL 67.2% MALE 67.5% FEMALE 66.5% NH-WHITE 69.1% NH-BLACK 59.4% HISPANIC 66.4% GRADE 9 69.3% GRADE 10 64.1% GRADE 11 67.0% GRADE 12 68.2% 0% 20% 40% 60% 80% 100% Page 75 Exposure in Stores to Advertisements and Promotions for Cigarettes and Other Tobacco Products In 2017, 49.1% of Connecticut high school students most of the time or always saw advertisements or promotions for cigarettes or other tobacco products when they went into convenience stores, supermarkets or gas stations. This represents approximately 73,200 students. Results are shown in Table 32. See also page 76 for a chart of the results.  Overall for high school students, the prevalence of most of the time or always being exposed to ads and promos for cigarettes or other tobacco products when they went into stores does not vary significantly by sex, race/ethnicity or grade. Exposure to Cigarette and Other Tobacco Product Ads and Promos in Stores % 95% CI Total 49.1 (44.8-53.4) Male 47.9 (42.7-53.1) Female 50.1 (45.6-54.7) NH-White 49.5 (44.1-55.0) NH-Black 53.1 (44.0-62.3) Hispanic 49.2 (45.1-53.2) 9 46.9 (42.2-51.7) 10 48.6 (43.2-54.0) 11 48.9 (42.4-55.4) 12 52.7 (46.9-58.5) Table 32 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Page 76 Exposure in Stores to Advertisements and Promotions for Cigarettes and Other Tobacco Products Percentage of CT high school students who were exposed to ads and promos for cigarettes and other tobacco products in stores ꟷby sex, race/ethnicity and grade TOTAL 49.1% MALE 47.9% FEMALE 50.1% NH-WHITE 49.5% NH-BLACK 53.1% HISPANIC 49.2% GRADE 9 46.9% GRADE 10 48.6% GRADE 11 48.9% GRADE 12 52.7% 0% 20% 40% 60% 80% 100% Page 77 Exposure to Cigarette and Other Tobacco Use on Television and in Movies In 2017, 16.8% of Connecticut high school students most of the time or always saw actors and actresses on television or in movies using cigarettes or other tobacco products. This represents approximately 26,800 students. Results are shown in Table 33. See also page 78 for a chart of the results.  Overall for high school students, the prevalence of most of the time or always seeing actors or actresses using cigarettes or other tobacco products: ♦ Is significantly higher among females (20.3%) than among males (13.4%); ♦ Is significantly higher among non-Hispanic blacks (31.0%) and Hispanics (20.6%) than among non-Hispanic whites (13.0%); and significantly higher among non-Hispanic black (31.0%) than among Hispanic (20.6%) students; ♦ Does not vary significantly by grade. See Actors and Actresses Using Cigarettes and Other Tobacco % 95% CI Total 16.8 (14.1-19.6) Male 13.4 (11.3-15.6) Female 20.3 (15.9-24.8) NH-White 13.0 (10.7-15.4) NH-Black 31.0 (23.6-38.4) Hispanic 20.6 (16.3-25.0) 9 14.9 (11.0-18.8) 10 18.4 (14.9-21.9) 11 17.1 (12.5-21.6) 12 16.9 (11.8-22.0) Table 33 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Page 78 Exposure to Cigarette and Other Tobacco Use on Television and in Movies Percentage of CT high school students who see actors and actresses on television and in the movies using cigarettes and other tobacco products ꟷby sex, race/ethnicity and grade TOTAL 16.8% MALE 13.4% FEMALE 20.3% NH-WHITE 13.0% NH-BLACK 31.0% HISPANIC 20.6% GRADE 9 14.9% GRADE 10 18.4% GRADE 11 17.1% GRADE 12 16.9% 0% 10% 20% 30% 40% 50% Page 79 Exposure to E-Cigarette Advertisements and Promotions on the Internet, in Print and on Television In 2017, 11.6% of Connecticut high school students, when using the internet, reading magazines or newspapers, or watching television, most of the time or always saw advertisements or promotions for e-cigarettes. This represents approximately 19,100 students. Results are shown in Table 34. See also page 80 for a chart of the results.  Overall for high school students, the prevalence of most of the time or always being exposed to e-cigarette ads and promos on the Internet, in print or on television: ♦ Does not vary significantly by sex; ♦ Is significantly higher among non-Hispanic blacks (19.8%) and Hispanics (14.5%) than among non-Hispanic whites (9.8%); ♦ Is significantly higher in grade 10 (15.1%) than in grade 9 (9.9%). Exposure to E-Cigarette Ads and Promos on Internet, in Print or on TV % 95% CI Total 11.6 (9.8-13.4) Male 11.1 (8.6-13.6) Female 12.1 (10.0-14.2) NH-White 9.8 (7.6-11.9) NH-Black 19.8 (12.8-26.7) Hispanic 14.5 (11.2-17.8) 9 9.9 (7.7-12.1) 10 15.1 (11.0-19.1) 11 11.5 (7.4-15.6) 12 10.1 (6.7-13.5) Table 34 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Page 80 Exposure to E-Cigarette Advertisements and Promotions on the Internet, in Print and on Television Percentage of CT high school students who were exposed to ads and promos for e-cigarettes on the internet, in print or on television ꟷby sex, race/ethnicity and grade TOTAL 11.6% MALE 11.1% FEMALE 12.1% NH-WHITE 9.8% NH-BLACK 19.8% HISPANIC 14.5% GRADE 9 9.9% GRADE 10 15.1% GRADE 11 11.5% GRADE 12 10.1% 0% 5% 10% 15% 20% 25% Page 81 Exposure in Stores to E-Cigarette Advertisements and Promotions In 2017, 25.3% of Connecticut high school students most of the time or always saw advertisements or promotions for e-cigarettes when they went to convenience stores, supermarkets or gas stations. This represents approximately 40,000 students. Results are shown in Table 35. See also page 82 for a chart of the results.  Overall for high school students, the prevalence of most of the time or always being exposed to e-cigarette advertisements and promotions in stores does not vary significantly by sex, race/ethnicity or grade. Exposure to E-Cigarette Ads and Promos in Stores % 95% CI Total 25.3 (22.0-28.6) Male 23.5 (19.5-27.6) Female 27.0 (22.8-31.2) NH-White 26.4 (22.0-30.7) NH-Black 25.3 (18.4-32.2) Hispanic 25.4 (21.9-28.8) 9 23.8 (18.6-29.0) 10 26.8 (22.3-31.2) 11 23.1 (16.5-29.8) 12 28.0 (22.9-33.1) Table 35 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Page 82 Exposure in Stores to E-Cigarette Advertisements and Promotions Percentage of CT high school students who were exposed to ads and promos for e-cigarettes in storesꟷby sex, race/ethnicity and grade TOTAL 25.3% MALE 23.5% FEMALE 27.0% NH-WHITE 26.4% NH-BLACK 25.3% HISPANIC 25.4% GRADE 9 23.8% GRADE 10 26.8% GRADE 11 23.1% GRADE 12 28.0% 0% 10% 20% 30% 40% 50% Page 83 Received Advertisements or Coupons from a Tobacco Company During the past 30 days, 12.1% of Connecticut high school students received advertisements or coupons from a tobacco company through the mail, email, the internet, a text message, Facebook, Twitter, Snap Chat or other social media. This represents approximately 20,700 students. Results are shown in Table 36. See also page 84 for a chart of the results.  Overall for high school students, the prevalence of receiving ads or coupons from a tobacco company does not vary significantly by sex, race/ethnicity or grade.  Among current tobacco users, 17.4% received ads or coupons from a tobacco company in the past 30 days, compared with 10.9% of students who do not currently use tobacco. The difference is statistically significant—data not shown in table. Received Ads or Coupons from a Tobacco Company % 95% CI Total 12.1 (9.8-14.3) Male 12.5 (10.0-14.9) Female 11.3 (8.2-14.4) NH-White 11.4 (8.7-14.1) NH-Black 14.8 (8.7-20.8) Hispanic 12.7 (9.7-15.6) 9 13.6 (10.2-17.0) 10 12.7 (8.6-16.8) 11 10.3 (6.9-13.8) 12 11.5 (8.0-14.9) Table 36 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Page 84 Received Advertisements or Coupons from a Tobacco Company Percentage of CT high school students who received ads or coupons from a tobacco company during the past 30 daysꟷby sex, race/ethnicity and grade TOTAL 12.1% MALE 12.5% FEMALE 11.3% NH-WHITE 11.4% NH-BLACK 14.8% HISPANIC 12.7% GRADE 9 13.6% GRADE 10 12.7% GRADE 11 10.3% GRADE 12 11.5% 0% 5% 10% 15% 20% 25% Page 85 Tried to Stop Using Tobacco for Good During the past 12 months, 41.2% of high school students who had used tobacco during the past year, stopped using all tobacco products for a day or longer because they were trying to quit using tobacco for good. Results are shown in Table 37. See also page 86 for a chart of the results.  Overall for tobacco users, the prevalence of stopping the use of all tobacco products for at least one day because they were trying to quit for good does not vary significantly by sex, race/ethnicity or grade.  Among students who smoked cigarettes during the past year, 42.7% stopped for a day or longer because they were trying to quit for good—data not shown in table. Tried to Stop Using Tobacco Products for Good % 95% CI Total 41.2 (31.9-50.5) Male 44.8 (31.6-57.9) Female 35.5 (25.7-45.3) NH-White 36.1 (26.0-46.1) NH-Black * --- Hispanic 48.0 (32.7-63.3) 9 43.7 (28.7-58.7) 10 49.7 (35.1-64.3) 11 40.3 (22.3-58.3) 12 35.6 (21.1-50.1) Table 37 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 86 Tried to Stop Using Tobacco for Good Percentage of CT high school tobacco users who tried to quit using tobacco products for good during the past 12 monthsꟷby sex, race/ethnicity and grade TOTAL 41.2% MALE 44.8% FEMALE 35.5% NH-WHITE 36.1% NH-BLACK* HISPANIC 48.0% GRADE 9 43.7% GRADE 10 49.7% GRADE 11 40.3% GRADE 12 35.6% 0% 20% 40% 60% 80% 100% *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 87 Healthcare Provider Inquiry and Advisement About Tobacco Use During the past 12 months, 60.5% of high school students had been asked by a healthcare provider, such as a doctor, dentist or nurse, if they used tobacco of any kind or had been advised not to use tobacco of any kind. Results are shown in Table 38. See also page 88 for a chart of the results.  Overall for high school students, the prevalence of having had a healthcare provider ask them if they used tobacco or advise them not to use tobacco: ♦ Does not vary significantly by sex; ♦ Is significantly higher among non-Hispanic white (64.3%) than among non-Hispanic black (50.8%) and Hispanic (55.7%) students; ♦ Is significantly higher in grade 12 (65.3%) than in grade 9 (55.4%). Healthcare Provider Inquiry and Advisement About Tobacco Use % 95% CI Total 60.5 (56.6-64.5) Male 58.0 (52.6-63.4) Female 63.3 (57.6-68.9) NH-White 64.3 (60.4-68.1) NH-Black 50.8 (43.6-58.0) Hispanic 55.7 (49.8-61.5) 9 55.4 (50.8-60.1) 10 59.0 (53.2-64.9) 11 62.7 (56.0-69.4) 12 65.3 (58.3-72.3) Table 38 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. Page 88 Healthcare Provider Inquiry and Advisement About Tobacco Use Percentage of CT high school students who, in the past 12 months, had a healthcare provider ask them if they use or advise them not to use tobacco ꟷby sex, race/ethnicity and grade TOTAL 60.5% MALE 58.0% FEMALE 63.3% NH-WHITE 64.3% NH-BLACK 50.8% HISPANIC 55.7% GRADE 9 55.4% GRADE 10 59.0% GRADE 11 62.7% GRADE 12 65.3% 0% 20% 40% 60% 80% 100% Page 89 Asthma Among Tobacco Users In 2017, among students who reported having asthma and currently use some form of tobacco, 20.2% had an episode of asthma or an asthma attack during the past 12 months. This represents approximately 2,800 students. Results are shown in Table 39. See also page 90 for a chart of the results.  Overall for current tobacco users with asthma, the prevalence of having had an episode of asthma or an asthma attack does not vary significantly by race/ethnicity. Asthma Episodes or Attacks Among Current Tobacco Users % 95% CI Total 20.2 (13.2-27.3) Male * --- Female 27.1 (19.3-34.9) NH-White 19.1 (10.7-27.5) NH-Black * --- Hispanic 24.2 (13.8-34.6) 9 * --- 10 25.7 (14.2-37.2) 11 * --- 12 * --- Table 39 Sex Race/Ethnicity Grade Note: Significance based on t-test analysis. *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 90 Asthma Among Tobacco Users Percentage of CT high school students who currently use tobacco and have asthma who had an asthma episode or attack in the past 12 months ꟷby sex, race/ethnicity and grade TOTAL 20.2% MALE* FEMALE 27.1% NH-WHITE 19.1% NH-BLACK* HISPANIC 24.2% GRADE 9* GRADE 10 25.7% GRADE 11* GRADE 12* 0% 10% 20% 30% 40% 50% *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Page 91 Trend in Current Tobacco Use PERCENTAGE OF CT HIGH SCHOOL STUDENTS WHO USED TOBACCO DURING THE PAST 30 DAYSꟷBY YEAR 20.8% 18.7% 17.9% 14.2% 2011 2013 2015 2017 Between 2011 and 2017, there was a decrease in the percentage (20.8% to 17.9%) of high school students who used some form of tobacco, which includes cigarettes, cigars, chewing tobacco, snuff, dip, pipes, e-cigarettes and hookahs, on 1 or more of the past 30 days. Between 2015 and 2017, the rate of current use increased from 14.2% to 17.9%; although, the difference was not statistically significant. Page 92 Trends in Current Tobacco Use Percentage of CT high school students who used tobacco in the past 30 days ꟷby year and sex 30% 26.5% 24.0% 25% 20% 17.9% 16.3% 15% 17.3% 14.9% 13.1% 11.9% 10% 5% 0% 2010 2011 2012 2013 2014 MALES 2015 2016 2017 2018 FEMALES  Between 2011 and 2017, the rate of current tobacco use among high school males decreased significantly from 26.5% to 17.9%. Among females, it increased from 14.9% to 17.3%, although the change was not statistically significant.  Between 2015 and 2017, the increase in current tobacco use among female students from 11.9% to 17.3% was statistically significant.  In 2011, 2013 and 2015, the prevalence of current tobacco use was significantly higher among males than among females (26.5% vs. 14.9%; 24.0% vs. 13.1%; and 16.3% vs. 11.9%, respectively). Page 93 Trend in Current Cigarette Smoking PERCENTAGE OF CT HIGH SCHOOL STUDENTS WHO SMOKED CIGARETTES DURING THE PAST 30 DAYSꟷBY YEAR 25.6% 22.0% 17.0% 16.9% 15.3% 14.0% 8.9% 5.6% 3.5% 2000 2002 2005 2007 2009 2011 2013 2015 2017 Between 2000 and 2017, there was a significant decrease in the percentage (25.6% to 3.5%) of high school students who smoked cigarettes on 1 or more of the past 30 days. Between 2015 and 2017, the decrease from 5.6% to 3.5% was not statistically significant. Page 94 Trends in Current Cigarette Smoking Percentage of CT high school students who smoked cigarettes in the past 30 days ꟷby year and sex 30% 26.0% 25% 20% 23.3% 24.9% 20.7% 18.2% 18.6% 16.0% 15% 15.8% 15.2% 10% 16.1% 14.4% 10.4% 11.8% 7.3% 5% 5.6% 4.2% 5.6% 2.7% 0% 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 MALES FEMALES  Between 2000 and 2017, the rate of current cigarette smoking among high school males decreased significantly from 24.9% to 4.2%; and decreased significantly among females from 26.0% to 2.7%.  From 2015 to 2017, current cigarette smoking decreased among both male and female students. Neither change was statistically significant.  In 2011 and 2013, the prevalence of current cigarette smoking was significantly higher among male than among female students (16.1% vs. 11.8% and 10.4% vs. 7.3%, respectively). Page 95 Current Cigarette Smoking and the CT Cigarette Excise Tax Percentage of CT high school students who currently smoke cigarettes and the CT cigarette excise taxꟷby year $5.00 30% $4.35 25.6% $4.50 25% $4.00 $3.65 22.0% $3.40 $3.40 $3.50 20% 17.0% 16.9% $3.00 $3.00 15.3% 15% $2.50 14.0% $2.00 10% $2.00 $1.51 8.9% $1.50 $1.11 5.6% $1.00 5% 3.5% $0.50 0% 2000 2002 2005 2007 CIGARETTE SMOKING 2009 2011 2013 2015 2017 $0.50 $- CT CIGARETTE EXCISE TAX Between 2000 and 2017, the CT excise tax on a pack of cigarettes went from $0.50 to $4.35, an 870% increase. During that same time, the percentage of CT high school students who currently smoked cigarettes went from 25.6% to 3.5%, a decrease of more than 86%. Page 96 Trend in Current Cigar Smoking PERCENTAGE OF CT HIGH SCHOOL STUDENTS WHO SMOKED CIGARS DURING THE PAST 30 DAYSꟷBY YEAR 12.7% 11.1% 11.3% 10.5% 9.6% 9.1% 9.0% 4.5% 2000 2002 2005 2007 2009 2011 2013 2015 5.3% 2017 Between 2000 and 2017, there was a 58% decrease in the percentage (12.7% to 5.3%) of high school students who smoked cigars on 1 or more of the past 30 days. Between 2015 and 2017, the increase from 4.5% to 5.3% was not statistically significant. Page 97 Trends in Current Cigar Smoking Percentage of CT high school students who smoked cigars in the past 30 days ꟷby year and sex 20% 18.2% 17.8% 15.6% 16.0% 15% 13.8% 14.3% 13.2% 10% 6.5% 5% 7.2% 6.7% 6.2% 4.8% 4.7% 4.6% 4.4% 3.8% 2.5% 2.8% 0% 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 MALES FEMALES  Between 2000 and 2017, the rate of current cigar smoking among high school males decreased significantly from 18.2% to 7.2%; and decreased significantly among females from 6.7% to 2.8%.  From 2015 to 2017, current cigar smoking increased among both male and female students. Neither change was statistically significant.  Every survey year between 2000 and 2017, the prevalence of current cigar smoking was significantly higher among males than among females. Page 98 Trend in Current E-Cigarette Use PERCENTAGE OF CT HIGH SCHOOL STUDENTS WHO USED E-CIGARETTES DURING THE PAST 30 DAYSꟷBY YEAR 14.7% 7.2% 5.3% 2.4% 2011 2013 2015 2017 Between 2011 and 2017, the percentage of high school students who used e-cigarettes on 1 or more of the past 30 days increased 6-fold from 2.4% to 14.7%. Between 2015 and 2017, the increase from 7.2% to 14.7% was statistically significant. Page 99 Trends in Current E-Cigarette Use Percentage of CT high school students who used e-cigarettes in the past 30 days ꟷby year and sex 20% 14.8% 15% 14.0% 10% 8.3% 6.9% 6.0% 5% 3.3% 3.7% 1.5% 0% 2010 2011 2012 2013 2014 MALES 2015 2016 2017 2018 FEMALES  Between 2011 and 2017, the rate of current e-cigarette use among high school males increased significantly from 3.3% to 14.8%; and increased significantly among females from 1.5% to 14.0%.  From 2015 to 2017, current e-cigarette use increased significantly among both male (8.3% to 14.8%) and female (6.0% to 14.0%) students.  In 2011 and 2013, the prevalence of current e-cigarette use was significantly higher among male than among female students (3.3% vs. 1.5% and 6.9% vs. 3.7%, respectively). Page 100 Trend in Current Hookah Smoking PERCENTAGE OF CT HIGH SCHOOL STUDENTS WHO SMOKED TOBACCO USING A HOOKAH DURING THE PAST 30 DAYS ꟷBY YEAR 4.7% 3.5% 3.3% 2.8% 2011 2013 2015 2017 Between 2011 and 2017, the percentage of high school students who smoked tobacco using a hookah on 1 or more of the past 30 days decreased from 3.5% to 2.8%. Between 2015 and 2017, the decrease from 3.3% to 2.8% was not statistically significant. Page 101 Trends in Current Hookah Smoking Percentage of CT high school students who smoked tobacco in a hookah in the past 30 days ꟷby year and sex 10% 8% 6% 4% 5.2% 3.7% 3.6% 4.1% 2.9% 3.3% 2.9% 2.6% 2% 0% 2010 2011 2012 2013 2014 MALES 2015 2016 2017 2018 FEMALES  Between 2011 and 2017, the rate of current hookah smoking among high school males decreased from 3.7% to 2.6%, but the difference was not statistically significant.  Among males, from 2015 to 2017, current hookah smoking decreased from 3.7% to 2.6%, but the change was not statistically significant. Among female students, the rate did not change between 2015 and 2017.  The prevalence of current hookah smoking did not vary significantly between male and female students during any survey year from 2011 through 2017. Page 102 Trend in Living with a Cigarette Smoker PERCENTAGE OF CT HIGH SCHOOL STUDENTS WHO LIVE WITH SOMEONE WHO SMOKES CIGARETTESꟷBY YEAR 39.9% 37.4% 35.8% 33.9% 33.0% 30.2% 29.0% 24.5% 19.8% 2000 2002 2005 2007 2009 2011 2013 2015 2017 Between 2000 and 2017, the percentage of high school students who lived with someone who smokes cigarettes decreased significantly from 39.9% to 19.8%. Between 2015 and 2017, the decrease from 24.5% to 19.8% was not statistically significant. Page 103 Trends in Living with a Cigarette Smoker Percentage of CT high school students who live with someone who smokes cigarettes ꟷby year and sex 50% 41.6% 40% 36.7% 38.0% 34.6% 38.2% 30% 34.6% 32.9% 36.5% 34.4% 29.2% 33.2% 31.2% 26.3% 27.7% 20% 28.9% 21.8% 22.7% 18.2% 10% 0% 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 MALES FEMALES  Between 2000 and 2017, among high school males, the rate of living with a cigarette smoker decreased significantly from 38.2% to 18.2%; it also decreased significantly among females from 41.6% to 21.8%.  From 2015 to 2017, the prevalence of living with someone who smoked cigarettes decreased among male and female students, but neither change was statistically significant.  In 2011 and 2015, the prevalence of living with a cigarette smoker was significantly higher among females than among males (32.9% vs. 27.7% and 26.3% vs. 22.7%, respectively). Page 104 Trend in Exposure to Secondhand Smoke in a Vehicle PERCENTAGE OF CT HIGH SCHOOL STUDENTS WHO RODE IN A VEHICLE DURING THE PAST SEVEN DAYS WITH SOMEONE WHO WAS SMOKING A TOBACCO PRODUCTꟷBY YEAR 51.2% 46.4% 41.7% 40.9% 34.4% 31.0% 24.8% 20.2% 16.3% 2000 2002 2005 2007 2009 2011 2013 2015 2017 Between 2000 and 2017, the percentage of high school students who rode in a vehicle on one or more of the past seven days with someone who was smoking a tobacco product decreased significantly from 51.2% to 16.3%. Between 2015 and 2017, the decrease from 20.2% to 16.3% was not statistically significant. Page 105 Trends in Exposure to Secondhand Smoke in a Vehicle Percentage of CT high school students who rode in a vehicle during the past seven days with someone who was smoking a tobacco product ꟷby year and sex 60% 53.6% 48.4% 50% 49.0% 40% 45.5% 42.2% 44.3% 36.6% 37.8% 32.6% 39.5% 30% 32.4% 29.7% 20% 25.4% 22.2% 18.1% 24.0% 18.3% 14.6% 10% 0% 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 MALES FEMALES  Between 2000 and 2017, among high school males, the rate of riding in a vehicle with someone who was smoking a tobacco product decreased significantly from 49.0% to 14.6%; it also decreased significantly among females from 53.6% to 18.1%.  From 2015 to 2017, the prevalence of riding in a vehicle with someone who was smoking a tobacco product decreased among male and female students, but neither change was statistically significant.  In 2005 and 2015, the prevalence of riding in a vehicle with someone who was smoking was significantly higher among females than among males (45.5% vs. 37.8% and 22.2% vs. 18.3%, respectively). Page 106 Trend in Exposure to Secondhand Smoke in a Public Place PERCENTAGE OF CT HIGH SCHOOL STUDENTS WHO WERE EXPOSED TO SECONDHAND SMOKE IN A PUBLIC PLACE DURING THE PAST SEVEN DAYSꟷBY YEAR 47.1% 42.2% 38.9% 32.4% 2011 2013 2015 2017 Between 2011 and 2017, the percentage of high school students who breathed the smoke from someone who was smoking a tobacco product in a public place on one or more of the past seven days decreased significantly from 47.1% to 32.4%. Between 2015 and 2017, the decrease from 38.9% to 32.4% was statistically significant. Page 107 Trends in Exposure to Secondhand Smoke in a Public Place Percentage of CT high school students were exposed to secondhand smoke in a public place during the past seven days ꟷby year and sex 60% 53.1% 47.7% 50% 40% 46.9% 38.2% 41.1% 37.0% 30% 31.1% 26.7% 20% 10% 0% 2010 2011 2012 2013 2014 MALES 2015 2016 2017 2018 FEMALES  Between 2011 and 2017, among high school males, the rate of having been exposed to secondhand smoke in a public place decreased significantly from 41.1% to 26.7%; it also decreased significantly among females from 53.1% to 38.2%.  From 2015 to 2017, the prevalence of having been exposed to secondhand smoke in a public place decreased among males, but the change was not statistically significant. Among females, the rate decreased significantly from 46.9% to 38.2%.  Every survey year between 2011 and 2017, the prevalence of having been exposed to secondhand smoke in a public place was significantly higher among female than among male students. Page 108 Tables of Current Tobacco Use 2017 Current Tobacco Use Among CT High School Students Any Tobacco Demographics Cigars Cigarettes % 95% CI % 95% CI % 95% CI Total 17.9 (14.2-21.7) 3.5 (2.4-4.7) 5.3 (3.4-7.2) Male 17.9 (12.6-23.2) 4.2 (2.5-6.0) 7.2 (3.6-10.7) Female 17.3 (14.0-20.7) 2.7 (1.4-4.0) 2.8 (1.6-4.1) NH-White 21.5 (17.2-25.7) 4.5 (2.9-6.1) 6.2 (3.6-8.9) NH-Black 9.2 (4.2-14.3) * --- * --- Hispanic 14.1 (10.5-17.6) * --- 3.4 (1.6-5.3) 9 11.7 (8.5-15.0) * --- * --- 10 15.3 (12.1-18.6) 3.2 (1.7-4.6) 3.2 (1.7-4.6) 11 20.9 (15.2-26.7) 4.9 (2.6-7.2) 8.9 (6.0-11.8) 12 24.4 (16.3-32.5) 5.5 (2.2-8.8) 8.2 (2.7-13.8) Sex Race/Ethnicity Grade E-Cigarettes Demographics Hookahs Any Other Tobacco % 95% CI % 95% CI % 95% CI Total 14.7 (11.0-18.4) 2.8 (1.8-3.9) 2.8 (1.7-3.8) Male 14.8 (9.9-19.8) 2.6 (1.4-3.8) 3.6 (2.1-5.1) Female 14.0 (10.2-17.9) 2.9 (1.4-4.5) 1.5 (0.9-2.0) NH-White 18.7 (14.3-23.0) 2.3 (1.3-3.3) 2.7 (1.3-4.1) NH-Black * --- * --- * --- Hispanic 9.3 (6.6-12.0) 4.5 (2.5-6.5) 2.3 (1.0-3.6) 9 10.2 (6.9-13.5) * --- * --- 10 12.0 (8.8-15.3) 3.7 (2.3-5.1) * --- 11 16.8 (10.5-23.0) * --- * --- 12 20.4 (13.4-27.4) * --- 4.0 (1.9-6.2) Sex Race/Ethnicity Grade *Estimates based on unweighted cases fewer than 50 or with a relative standard error greater than 30% are not presented. Notes: (1) Current use is defined as having used a product on 1 or more of the 30 days preceding the survey; (2) ‘Any Tobacco’ includes cigarettes, cigars, chewing tobacco, snuff, dip, pipes, e-cigarettes and hookahs; (3) ‘Any Other Tobacco’ includes roll-your-own cigarettes, snus, dissolvable tobacco and bidis. Page 109