Youth Tobacco Surveillance — United States, 2003–2006 

LaTisha Marshall, MPH,1 Anna Teplinskaya, MD,1 Charlotte Steeh, PhD,1 Jennifer 

Kahende, PhD,1 Emmanuel Maurice, MS,1 Kat Asman, MSPH,2 Aneeqah Ferguson, MS,2

Heather Ryan, MPH,1 Peter Mariolis, PhD,1 Renee Arazola, MPH,1 Darylema Williams, 

MPH,1 Erica R. Causey, MPH,1 Natalie Whitney, MPH,1

 Mark Tabladillo, PhD1 

1

Office on Smoking and Health, National Center for Chronic Disease Prevention and 

Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 

2

Research Triangle Institute, Research Triangle Park, North Carolina 

Methods 

Sampling 

NYTS: The 2004 and 2006 NYTS employed a three-stage cluster sample design to 

produce a nationally representative sample of public, Catholic, and other private 

school students in grades 6–12. NYTS was stratified by census region, Metropolitan 

Statistical Area (MSA) status, and state. Non-Hispanic black, Hispanic, and Asian 

students were oversampled. 

2004 NYTS: In the first stage of sampling, 91 primary sampling units (PSUs) were 

selected from eight strata. In the second stage of sampling, from the selected PSUs, 

288 schools were selected with probability proportional to school enrollment size. Of 

these 288 eligible schools, 267 participated in the survey, thus, the school response 

rate was 93%. 

2006 NYTS: In the first stage of sampling, 91 PSUs were selected from eight strata. In 

the second stage of sampling, from the selected PSUs, 289 schools were selected with 

probability proportional to school enrollment size. Four schools in Louisiana were 

ineligible because of nonoperational status as a result of Hurricane Katrina. Of the 285 

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eligible schools, 261 participated in the survey, thus, the school response rate was 91.6%. 

For both the 2004 and 2006 NYTS, the third sampling stage consisted of 

approximately five classes of an either required subject (e.g., English or social studies) or 

time period that were randomly selected from a class schedule provided by each 

participating school. Class schedules were constructed to ensure that all students in the 

eligible grades were accounted for once and were not duplicated. All students in the 

selected classes were eligible to participate in the survey. 

The 2004 NYTS student response rate was 88.0%, resulting in an overall response 

rate (the school response rate multiplied by the student response rate) of 81.8% (n = 

27,933). The 2006 NYTS student response rate was 87.6%, resulting in an overall 

response rate (the school response rate multiplied by the student response rate) of 80.2 % 

(n = 27,038). 

A weighting factor was applied to each student record to adjust for nonresponse 

and for varying probabilities of selection. Weights were adjusted to ensure that the 

weighted proportions of students in each grade matched national population proportions 

on school level (middle school and high school), grade ( 6–12), sex, and race\ethnicity 

(non-Hispanic white, non-Hispanic black, Hispanic, and Asian). Final adjusted weights 

were scaled to ensure that the weighted count of students was equal to the total sample 

size. SAS and SUDAAN were used to compute 95% confidence intervals (CIs). Twosided t-tests were conducted to test for statistically significant differences between 

prevalence estimates. If the p-value was <0.05, then prevalence estimates were 

considered statistically significant. Estimates are not presented if < 35 cases were in the 

denominator because results were considered imprecise. 

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YTS. The state-specific YTS employed a two-stage cluster sample design. The first-stage 

sampling frame included separate lists of middle schools and high schools containing any 

or all of the eligible grades of public and/or private schools. Schools were selected with a 

probability proportional to school enrollment size. The number of schools selected varied 

by state. At the second sampling stage, classes were randomly selected from a class 

schedule provided by each participating school. Class schedules were constructed to 

ensure that all students in the eligible grades were counted once and were not duplicated. 

All students in the selected classes were eligible to participate in the survey. The number 

of classes selected varied by state. SAS and SUDAAN were used to compute 95% CIs. 

Estimates are not presented if <35 cases were in the denominator because results were 

considered imprecise. 

A total of 33 states conducted YTS at least one time during 2003 through 2006 

and are reported here. These states achieved overall response rates of ≥ 60% and data

were weighted to adjust for nonresponse and varying probabilities of selection and to 

ensure that the sample mirrors the entire state population proportions on school level, sex, 

and race. Weighted estimates are representative samples of middle school and high 

school students in the state. YTS student sample sizes ranged from 1,165 to 12,040. 

School response rates ranged from 68.3% to 100.0%; student response rates ranged from 

62.6% to 97.0%; and overall response rates ranged from 60.0% to 90.6% (Table 1). Only 

two states conducted a YTS more than two times during 2003–2006, therefore trends 

over time were not assessed. 

Data Collection 

Both the YTS and NYTS survey procedures were designed to protect student 

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privacy by ensuring that student participation was anonymous and voluntary. The survey 

was administered during one class period. Students completed a self-administered 

questionnaire in the classroom and recorded their responses on an answer sheet. Both 

questionnaires (NYTS and YTS) contained questions concerning tobacco use (cigarettes, 

† cigars, pipes, smokeless tobacco, bidis,* and kreteks ), exposure to secondhand smoke, 

smoking cessation, tobacco-related school curriculum, minors’ ability to purchase or

obtain tobacco products, knowledge and attitudes about tobacco, and familiarity with protobacco and anti-tobacco media messages. Before the surveys were conducted, local 

parental permission procedures were followed. 

*Bidis (or beedies) are small brown cigarettes from India consisting of tobacco wrapped in a leaf 

and tied with a thread. 

†Kreteks (i.e., clove cigarettes) are flavored cigarettes containing tobacco and clove extract. 

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