Crossover Trends in Current Cigarette Smoking Between Racial and Ethnic Groups of US Adolescents Aged 12–19 Years Old, 1999–2018

Objective: To examine the racial difference and trends in cigarette smoking among adolescents from 1999 to 2018. Methods: We analyzed the data of 10,760 adolescents aged 12–19 who participated in the National Health and Nutrition Examination Surveys (NHANES), 1999–2018. Current tobacco smoking (CTS) was defined as participants with serum cotinine ≥10 ng/mL. Adjusted biennial prevalence ratios (abiPR: the ratio associated with a two-year increase in time) were estimated. Results: Diverging trends in CTS prevalence were revealed in adolescents. The steepest decrease occurred in Hispanics aged 12–17, with 15% declining every two calendar years [abiPR = 0.85(0.77, 0.94)]. The sharpest increase occurred with Blacks aged 18–19 years [abiPR = 1.06(0.99, 1.14)]. A crossover of prevalence trend between Blacks and Whites occurred in adolescents aged 18–19 years old due to the diverging trends. The average CTS prevalence was significantly higher in Whites than in Blacks in the early [(1999–2008, 13.65% (11.85%, 15.46%) vs. 8.80% (7.55%, 10.04%)], but Blacks had a higher average in recent years [(2009–2018, 8.32% (6.53%, 10.12%) vs. 7.77% (5.86%, 9.68%)]. For adolescents aged 18–19 years, the survey cycles or calendar years linearly explained 71% of the variations in the prevalence for Hispanics, 60% for Whites, but only 1% for Blacks. Conclusions: A crossover in the trend of current tobacco smoking occurred between 1999 and 2018 due to an increase in prevalence among Black adolescents and a significant decrease in prevalence among other racial groups.