Tobacco Use

Introduction

This toolkit summarizes content from the Tobacco Use Evidence Accelerator and the MCHbest database. The peer-reviewed literature supporting this work can be found in the Established Evidence database. Use the resources below as you develop effective evidence-based/informed programs and measures.

From the MCH Block Grant Guidance. Tobacco product use in any form is unsafe, and tobacco product use is typically established during adolescence. Tobacco product use in youths is associated with depression, anxiety, and stress.¹ In 2022, 16.5% of high school students reported using any tobacco product, 14.1% reported using e-cigarettes.² Youth who are more likely to use tobacco products include American Indian/Alaskan Native youth, those identifying as LGB or transgender, those reporting severe psychological distress, those with low family affluence, and those with low academic achievement.²

Goal. To reduce the percent of adolescents who currently use tobacco products.

Note. Access other related measures in this Population Domain through the Toolkits page.

Detail Sheet: Start with the MCH Block Grant Guidance

DEFINITION

Numerator:

Number of adolescents in grades 9 through 12 who reported any use of tobacco products (including electronic vapor products, cigarettes, cigars, or smokeless tobacco) in the past 30 days

Denominator:

Number of adolescents in grades 9 through 12

Units: 100

Text: Percent

HEALTHY PEOPLE 2030 OBJECTIVE

Related to Tobacco Use (TU) Objective 04: Reduce current tobacco use in adolescents. (Baseline: 18.3% of students in grades 6 through 12 used cigarettes, e-cigarettes, cigars, smokeless tobacco, hookah, pipe tobacco, and/or bidis in the past 30 days in 2018, Target: 11.3%)

DATA SOURCES

Youth Risk Behavior Surveillance System (YRBSS)

MCH POPULATION DOMAIN

Adolescent Health

MEASURE DOMAIN

Health Behavior

1. Accelerate with Evidence—Start with the Science

The first step to accelerate effective, evidence-based/informed programs is ensuring that the strategies we implement are meaningful and have high potential to affect desired change. Read more about using evidence-based/informed programs and then use this section to find strategies that you can adopt or adapt for your needs.

Evidence-based/Informed Strategies: MCHbest Database

The following strategies have emerged from studies in the scientific literature as being effective in advancing the measure. Use the links below to read more about each strategy or access the MCHbest database to find additional strategies.

Chart of Evidence-Linked Strategies and Tools
Evidence-Informed			Evidence-Based
Mixed Evidence	Emerging Evidence	Expert Opinion	Moderate Evidence	Scientifically Rigorous
	Community Mobilization with Additional Interventions to Restrict Minors’ Access to Tobacco Products (2014) Comprehensive Tobacco Control Policies (2022) Healthcare Professional and Provider Engagement (2008) Retailer Compliance Programs (2020) Smoke-Free Policies (2022) Tobacco Prevention School Curricula (2019) Tobacco-Free Social Norms (2019) Tobacco Advertising and Marketing (2022) Youth Empowerment Programs (2021)	E-Cigarette Regulations (2022)	Focused Public Health Campaigns (2022) School-Based Prevention Skills-Building Programs (2018)	Cell Phone-Based Tobacco Cessation Interventions (2018) Health Care Provider Reminder Systems for Tobacco Cessation (2017) Incentives and Competitions to Increase Smoking Cessation (2014) Internet-Based Tobacco Cessation Interventions (2018) Mass Media Campaigns Against Tobacco Use (2019) Minimum Tobacco Age Laws (2020) Reducing Out-of-Pocket Costs for Evidence-Based Cessation Treatments (2014) Statewide Comprehensive Tobacco Programs (2019) Tobacco Quitlines (2021) Tobacco Taxes/Increasing Unit Prices (2021)

Field-Based Strategies: Find promising programs from AMCHP’s Innovation Hub

One practice from state-/community-based programs is found in the Association of Maternal and Child Health Program’s (AMCHP’s) Innovation Hub: Tobacco Free Program (National, 2020). However, several national programs have emerged as promising approaches for advancing the NPM for specific communities or populations.

FDA’s Youth Tobacco Prevention Plan (2020). Resources to stop youth use of tobacco, especially e-cigarettes.
CDC’s Youth Smoking and Tobacco Use Resources (2024). Resources to help youth reject or quit vaping and all other tobacco use.
American Lung Association’s Helping Teens Quit Program (2024). Prevention and cessation resources.
AAP’s Youth Tobacco Cessation Resources. Resources for pediatricians and other healthcare professionals who care for youth in helping their patients quit successfully.

2. Think Upstream with Planning Tools—Lead with the Need

The second step in developing effective, evidence-based/informed programs challenges us to plan upstream to ensure that our work addresses issues early and is measurable in “turning the curve” on big issues that face MCH populations. Read more about moving from root causes to responsive programs and then use this section to align your work with the data and needs of your populations.

Move from Need to Strategy

Use Root-Cause Analysis (RCA) and Results-Based Accountability (RBA) tools to build upon the science to determine how to address needs.

Planning Tools: Use these tools to move from data to action

3. Work Together with Implementation Tools—Move from Planning to Practice

The third step in developing effective, evidence-based/informed programs calls us to work together to ensure that programs are implementable and moveable within the realities of Title V programs and lead to improved health outcomes for all people. Read more about implementation tools designed for MCH population change and then use this section to develop responsive strategies to bring about change that is responsive to the needs of your populations.

Additional MCH Evidence Center Resources: Access supplemental materials from the literature

Key Resources

Decades of research show that the most effective youth tobacco use prevention strategies are comprehensive and include interventions at multiple levels.^3,4,10,27 Effective public health approaches need to be extended to include e-cigarettes and other emerging tobacco products to combat the youth tobacco epidemic.^17,27 The literature also discusses the importance of addressing the SDOH leading to adolescent tobacco initiation, such as decreasing the physical ability to purchase tobacco products or advocating for price-increasing policies to discourage adolescent tobacco purchasing.^14,15

Search the Established Evidence database for peer-reviewed research articles related to strategies for reducing adolescent tobacco use.

Find field-based resources focused on reducing tobacco use relevant to Title V programs in the MCH Digital Library.

Additional Resources:

Find field-based resources focused on tobacco use in adolescents relevant to Title V programs in the MCH Digital Library.
Search the Established Evidence database for peer-reviewed research articles related to strategies for reducing tobacco use.
Request Technical Assistance from the MCH Evidence Center
MCH Evidence Center Frameworks and Toolkits:

Implementation Resources: Use these field-generated resources to affect change

Practice. The following tools can be used to translate evidence to action to advance this NPM:

quitSTART App (SmokeFreeTeen). App for adolescent tobacco users seeking to quit by creating a structured plan, and providing tailored information.
Tobacco Prevention Toolkit (Stanford Medicine REACH Lab). These courses support educators and parents in teaching about tobacco prevention.

Partnership. The following organizations focus efforts on decreasing adolescent tobacco use:

Become an Ex. Mayo Clinic-supported set of anti-tobacco and smoking cessation advice, guides, and tools for all ages.
Truth Initiative. Provides educational resources, disseminates anti-tobacco research, and runs anti-tobacco media campaigns.

References

Introductory References: From the MCH Block Grant Guidance

¹ Centers for Disease Control and Prevention. Youth and Tobacco Use. 2022 November 10. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm
²Park-Lee E, Ren C, Cooper M, Cornelius M, Jamal A, Cullen KA. Tobacco Product Use Among Middle and High School Students - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(45):1429-1435. Published 2022 Nov 11. doi:10.15585/mmwr.mm7145a1
https://www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7145a1-h.pdf

Evidence Tools Tobacco Use