A brief history of tobacco in North Carolina

During the colonial era, North Carolina’s economy lagged behind states such as Virginia where agricultural economies flourished thanks to diverse crops. In North Carolina, farmers struggled to find crops that could be cultivated in the poor soil of the coastal plains. Tobacco was their salvation. A method for rapidly curing tobacco — particularly tobacco grown in sandy soil — developed by a slave increased the demand for North Carolina tobacco and farmers were quick to take advantage of the demand.

Smoking became a national habit during the Civil War when soldiers on both sides were given regular rations of the addictive leaf. In North Carolina, large factories popped up to manufacture pre-rolled cigarettes to sate the nation’s cravings; in 1880, manufacturers hand-rolled an estimated 2 million cigarettes.

The tobacco and cigarette markets fluctuated over the next century — the Great Depression tanked tobacco prices but soldiers once again received a ration of cigarettes during WWII which reinvigorated national demand — but the industry overall survived. That was until the U.S. Surgeon General’s infamous report arguing that smoking caused lung cancer and a host of other medical problems was released in 1964.

Smoking rates in the United States have steadily declined in the decades since as the restrictions on cigarettes, tobacco and smokers have increased. These declines prompted former cigarette giants to move on: American Tobacco left Durham in 1987, R.J. Reynolds left Winston-Salem in 1989 and Liggett and Myers, the last major cigarette manufacturer, left Durham in 2000. However, the tobacco industry in North Carolina is not nonexistent today: tobacco remains the states highest-earning crop generating $754 million annually and the state remains the country’s top tobacco producer.

So, how do tobacco farms not only survive but thrive? Well, although demand continues to decline nationally, the market for tobacco and cigarettes in Asia is booming. China alone is home to an estimated 270 million smokers, and the Asia Pacific region is estimated to contain 60% of smokers worldwide. Most of North Carolina’s tobacco is now shipped to these prospering markets.

That being said, the use of cigarettes and tobacco products in the United States is not unheard of. Many organizations such as the Truth Initiative, smokefree.gov and the Centers for Disease Control are attempting to improve their understanding of why demand for this addictive, carcinogenic substance persists.

The Youth Tobacco Survey

From 1999 to 2015, the Centers for Disease Control and Prevention (CDC) employed the State Tobacco Activities Tracking and Evaluation (STATE) System to administer the Youth Tobacco Survey (YTS). According to the CDC, “The YTS was developed to provide states with comprehensive data on both middle school and high school students regarding tobacco use, exposure to environmental tobacco smoke, smoking cessation, school curriculum, minors’ ability to purchase or otherwise obtain tobacco products, knowledge and attitudes about tobacco, and familiarity with pro-tobacco and anti-tobacco media messages. … Tobacco topics included are cigarette smoking prevalence, cigarette smoking frequency, smokeless tobacco products prevalence and quit attempts.”

Given the prevalence of tobacco in North Carolina, historically and presently, are the youth of the Tarheel State likely to smoke cigarettes or use smokeless tobacco products and are they more or less likely to do so than the young residents of other states? The following analysis of the results of the YTS explores these questions.

Analysis

Methodology

The data from the YTS was downloaded from data.world. It required no cleaning nor recoding. One should note that the survey was not administered every year (1999-2015) in all 50 states, so the data set appears to be incomplete.

The survey was administered to middle schoolers and high schoolers, but this analysis focused on high schoolers. When importing the data, the following filter was applied in order to limit the breadth of results to high schoolers only. Sex was also not a factor in this analysis, so the rows specifying “Male” or “Female” were filtered out as well.

library(tidyverse)
library(dplyr)
library(readxl)
youth.tobacco.survey <- read.csv("~/Documents/R/opinion_polling/csv-1.csv")
yts.hs <- youth.tobacco.survey %>% filter(Education == "High School")
yts.hs <- yts.hs %>% filter(Gender == "Overall")

The remaining dataframe (yts.hs) was used for the analysis that follows. The following questions guided the analysis: How likely are high schoolers in North Carolina to frequently smoke cigarettes/use smokeless tobacco products? Are these percentages increasing or decreasing? Is one — smokeless tobacco products* or cigarettes — more popular than the other? And how does the frequency or use of tobacco products by North Carolina high schoolers compare to national averages?

*Smokeless tobacco products include snus, snuff, chewing tobacco, dissolvable tobacco and dipping tobacco.

Frequency of Use

To evaluate the frequency of North Carolina high schooler’s tobacco use, the data frame created above was filtered to subset the appropriate data and then to include data only from North Carolinian students.

library(tidyverse)
library(dplyr)
cigarette.frequent <- yts.hs %>% filter(MeasureDesc == "Smoking Status") %>% filter(Response == "Frequent")
smokeless.frequent <- yts.hs %>% filter(MeasureDesc == "User Status") %>% filter(Response == "Frequent")
frequent.use <- rbind(cigarette.frequent, smokeless.frequent)
frequent.use.nc <- frequent.use %>% filter(LocationAbbr == "NC")

The following graph was created with the resulting filtered dataframe.

This visualization reveals that although cigarettes were once significantly more popular than smokeless tobacco products, that has not been true since 2013. In 1999, 2.1% of high schoolers frequently used smokeless tobacco products, but more than 10% — 15.5%, to be specific — of high schoolers frequently smoked cigarettes. In 2015, 3% of high schoolers reported frequently using smokeless tobacco products and just 2.5% reported frequently smoking cigarettes.

These statistics reveal a triumph for anti-tobacco campaigns but a disheartening trend as well. Frequent cigarette use declined by 13.4% between 1999 and 2015, but frequent use of smokeless tobacco products rose slightly by 0.9%. The following visualization, which compares the rates of high schoolers who have tried smokeless tobacco products with the rate of those who frequently use such products reveals that this increase cannot be attributed to an increase in the rate of high schoolers who have ever tried smokeless tobacco products.

smokeless.ever <- yts.hs %>% filter(MeasureDesc == "User Status") %>% filter(Response == "Ever")
smokeless.use <- rbind(smokeless.frequent, smokeless.ever)
smokeless.use.nc <- smokeless.use %>% filter(LocationAbbr == "NC")

Comparison to National Averages

As the YTS dataset did not originally include national averages, those had to be calculated and that was done so with the following commands for every year for which data was collected in North Carolina (see above).

cig99 <- cigarette.frequent %>% filter(YEAR == "1999")
mean(cig99$Data_Value)
smo99 <- smokeless.frequent %>% filter(YEAR == "1999")
mean(smo99$Data_Value)

The national means and North Carolina were compiled into one dataframe that was then used to create the following graphs.

The first graph is a visual comparison of national annual averages of frequent cigarette use by high schoolers with annual frequent cigarette use by North Carolina high schoolers.

It is evident that North Carolina’s annual rates of frequent cigarette smoking by high schoolers is for the most part consistent with national trends, which reflect the previously mentioned declining popularity of cigarettes. The next graph is a visual comparison of national annual averages of frequent smokeless tobacco product use by high schoolers with annual frequent use of these products by North Carolina high schoolers. (It should be noted that the scale of percentages for this graph is very different from that of the previous graph.)

Interestingly, the national averages and rates of frequent use of smokeless tobacco products are almost mirror opposites — one increases while the other decreases and so on. One has to wonder if perhaps these fluctuations might correlate with changes to the rates of high schoolers who have ever tried smokeless tobacco products. The following visualization includes that data. National averages were calculated with the previously mentioned method.

The national rate of students ever trying smokeless tobacco products dropped almost 10% between 1999 and 2015 but fell less than 6% in North Carolina (and is presently higher (15.9%) than the national rate (14.8%)). However, while the national rate of frequent users has also declined, North Carolina has seen the slight uptick previously mentioned.

That being said, the differences between these statistics and those regarding frequent use are minimal. All of these visualizations regarding the use of smokeless tobacco products by high schoolers reflect that although the number of high schoolers trying these products is declining, the number of those who frequently use smokeless tobacco products is not.

Conclusion

Although the number of high schoolers trying smokeless tobacco products is declining, the number of those who frequently use smokeless tobacco products is not. This suggests that there is a segment of the population not being reached effectively by anti-tobacco campaigns.

Anti-tobacco campaigns have obviously effectively decreased the popularity of cigarettes in North Carolina high schools. Their efforts have not been inhibited by the prominence of tobacco in North Carolina’s rural communities because North Carolina’s annual rates of frequent cigarette smoking by high schoolers is for the most part consistent with national trends.

Anti-tobacco campaigns should, in North Carolina and nationally, consider turning more of their attention to smokeless tobacco products. Although cigarettes were once significantly more popular than smokeless tobacco products, that has not been true since 2013.

Smokeless tobacco products such as snuff and chewing tobacco are less lethal but still unsafe alternatives to smoking. Mouth, tongue, cheek, and gum cancer, cancer in the esophagus and pancreatic cancer have all been linked to use of these products and the 30 known carcinogenic chemicals they contain. Moreover, these products may cause rapid gum and tooth decay, heart disease and high blood pressure, increased risk of heart attack and stroke and increased risk of early delivery and stillbirth when used during pregnancy.

So while less lethal, these products are not the “safe” smoking alternatives manufacturers tend to market them as. On top of that, there is absolutely no proof that smokeless tobacco products help smokers quit smoking. Anti-tobacco campaigns should make sure that high schoolers are aware of misleading advertising and the risks associated with these products.