Tobacco Use - Youth

Tobacco Use - Youth in United States

United States

Tobacco use has well-known and wide-ranging adverse impacts on health. People who use tobacco are at greater risk of heart disease, cancer and stroke. According to a report from the Surgeon General, tobacco use remains a leading cause of preventable death in the United States. While the use of cigarettes, cigars, pipe tobacco and smokeless tobacco has declined among youth in recent years, this decline has been countered with increases in the use of other emerging tobacco products, especially electronic cigarettes. Commonly known as e-cigs or vape pens, electronic cigarettes are now the most commonly used tobacco product among youth, surpassing cigarettes in 2014.

Youth are particularly vulnerable to peer pressure and tobacco companies use strategies to get tobacco users hooked early, such as flavored tobacco products. Nearly 9 in 10 cigarette smokers have their first cigarette by age 18. Each day in the U.S., about 1,600 youths smoke their first cigarette and 200 youths become smokers. An estimated 5.6 million young people under age 18 today will die prematurely from diseases caused by long-term tobacco use later in life. Further, cigarette smoking is responsible for approximately $225 billion in annual health care expenditures and an additional $156 billion in lost productivity annually in the U.S.

Tobacco use is heavily influenced by an individual’s family, friends, community and social environment. Family and friends can be especially important: Adolescents are, in general, more likely to start smoking if their best friend smokes, but a positive parenting style can decrease this risk. Among youth, populations that have higher rates of tobacco use include:

• Non-Hispanic white high school students compared with non-Hispanic Black students and non-Hispanic students who identify their race as other.
• Lesbian, gay and bisexual youth compared with heterosexual youth. 
• Students who are experiencing psychological distress compared with those who are not; the prevalence was significantly higher with each increase in level of psychological distress. 

The Centers for Disease Control and Prevention outlines efforts that, when implemented together, have been found to reduce and prevent youth tobacco use, including:

• Raising costs for tobacco products.
• Prohibiting smoking in indoor and public places.
• Raising the minimum age for tobacco sales to 21 years.
• Media messages countering tobacco product advertisements.
• Community programs and school policies encouraging tobacco-free environments and lifestyles.

Healthy People 2030 has several tobacco use objectives for adolescents, including reducing current use of tobacco products among adolescents, reducing the proportion of adolescents exposed to tobacco marketing and eliminating cigarette smoking initiation in adolescents and young adults.

Gentzke, Andrea S., Teresa W. Wang, Monica Cornelius, Eunice Park-Lee, Chunfeng Ren, Michael D. Sawdey, Karen A. Cullen, Caitlin Loretan, Ahmed Jamal, and David M. Homa. “Tobacco Product Use and Associated Factors Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021.” MMWR. Surveillance Summaries 71, no. 5 (March 11, 2022): 1–29. https://doi.org/10.15585/mmwr.ss7105a1.

O’Byrne, Kristin Koetting, C. Keith Haddock, and Walker S. C. Poston. “Parenting Style and Adolescent Smoking.” Journal of Adolescent Health 30, no. 6 (June 1, 2002): 418–25. https://doi.org/10.1016/S1054-139X(02)00370-1.

U.S. Department of Health and Human Services. “The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General.” Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. https://pubmed.ncbi.nlm.nih.gov/24455788/.

Xu, Xin, Sundar S. Shrestha, Katrina F. Trivers, Linda Neff, Brian S. Armour, and Brian A. King. “U.S. Healthcare Spending Attributable to Cigarette Smoking in 2014.” Preventive Medicine 150 (September 2021): 106529. https://doi.org/10.1016/j.ypmed.2021.106529.