Health Topics
Tobacco Use
School Health Guidelines


Every day, approximately 4,000 American youth aged 12-17 try their first cigarette, and an estimated 1,140 young people become daily cigarette smokers.1 Most start this deadly habit not fully understanding that nicotine in tobacco is as addictive as heroin, cocaine, or alcohol. Most also underestimate the health consequences, even though tobacco use is the leading cause of preventable death in the United States. School programs to prevent tobacco use among young people can make a major contribution to the health of the nation, particularly when these programs are combined with community efforts.

Benefits of Preventing Tobacco Use Among Young People

  • Helps prevent long-term health problems and premature death.
  • Promotes optimal health and decreases school days missed because of respiratory illnesses.
  • Dramatically decreases the likelihood that a young person will be a regular tobacco user as an adult.

Consequences of Tobacco Use

  • Tobacco use causes more premature deaths in the United States than any other preventable risk.
  • Cigarette smoking causes heart disease; stroke; chronic lung disease; and cancers of the lung, mouth, pharynx, esophagus, and bladder.2,3
  • Cigarette smoking increases coughing, shortness of breath, and respiratory illnesses; decreases physical fitness; and adversely affects blood cholesterol levels.2,3
  • Smokeless tobacco is not a safe alternative to cigarettes. Using it causes cancers of the mouth, pharynx, and esophagus; gum recession; and an increased risk for heart disease and stroke.2,3
  • Smoking cigars increases the risk of oral, laryngeal, esophageal, and lung cancers.3,4
  • Secondhand smoke puts children in danger of developing severe respiratory diseases and may hinder the growth of their lungs.3,5
  • Exposure to secondhand smoke as a child or adolescent may increase the risk of developing lung cancer as an adult,7 and may contribute to new cases of asthma or worsen existing asthma.3,5
  • Tobacco use causes stained teeth, bad breath, and foul-smelling hair and clothes.2

Tobacco Use By Teens

  • Although the percentage of high school students who smoke has declined in recent years, rates remain high: 20% of high school students report current cigarette use (smoked cigarettes on at least 1 day during the 30 days before the survey).6
  • Forty-six percent of high school students have ever tried cigarette smoking, even one or two puffs.6
  • Eleven percent of high school students have smoked a whole cigarette before age 13.6
  • Nearly nine percent of high school students (15% of male and 2% of female students) used smokeless tobacco (e.g., chewing tobacco, snuff, or dip), on at least 1 day during the 30 days before the survey.6 Adolescents who use smokeless tobacco are more likely than nonusers to become cigarette smokers.3
  • Fourteen percent of high school students smoked cigars, cigarillos, or little cigars on at least 1 day during the 30 days before the survey.6
  • The younger people begin smoking cigarettes, the more likely they are to become strongly addicted to nicotine.2
  • Young people who try to quit suffer the same nicotine withdrawal symptoms as adults who try to quit.2
  • Among high school students who are current smokers, 51% have tried to quit smoking cigarettes during the 12 months before the survey.6

Current Cigarette Use* Among High School Students,
United States, 1991-2009

 Year Percentage
1991 27.5
1993 30.5
1995 34.8
1997 36.4
1999 34.8
2001 28.6
2003 21.9
2005 23.0
2007 20.0
2009 19.5

*Smoked cigarettes on 1 or more of the 30 days before the survey.

The Opportunity

Well-designed, well-implemented school programs to prevent tobacco use and addiction:

  • Have proved effective in preventing tobacco use.
  • Provide prevention education during the years when the risk of becoming addicted to tobacco is greatest.
  • Provide a tobacco-free environment that establishes nonuse of tobacco as a norm and offers opportunities for positive role modeling.
  • Can help prevent the use of other drugs, especially if the program addresses the use of these substances.

CDC�s Guidelines for School Health Programs

CDC�s Guidelines for School Health Programs to Prevent Tobacco Use and Addiction were designed to help achieve national health and education goals. They were developed in collaboration with experts from 29 national, federal, and voluntary agencies and are based on an extensive review of research and practice.

Key Principles

School programs to prevent tobacco use and addiction will be most effective if they:

  • Prohibit tobacco use at all school facilities and events.
  • Encourage and help students and staff to quit using tobacco.
  • Provide developmentally appropriate instruction in grades K�12 that addresses the social and psychological causes of tobacco use.
  • Are part of a coordinated school health program through which teachers, students, families, administrators, and community leaders deliver consistent messages about tobacco use.
  • Are reinforced by communitywide efforts to prevent tobacco use and addiction.


The guidelines include seven recommendations for ensuring a quality school program to prevent tobacco use.

  1. Policy
    Develop and enforce a school policy on tobacco use. The policy, developed in collaboration with students, parents, school staff, health professionals, and school boards, should:
    • Prohibit students, staff, parents, and visitors from using tobacco on school premises, in school vehicles, and at school functions.
    • Prohibit tobacco advertising (e.g., on signs, T-shirts, or caps or through sponsorship of school events) in school buildings, at school functions, and in school publications.
      Require that all students receive instruction on avoiding tobacco use.
    • Provide access and referral to cessation programs for students and staff.
    • Help students who violate tobacco-free policies to quit using tobacco rather than just punishing them.
  2. Instruction
    Provide instruction about the short- and long-term negative physiologic and social consequences of tobacco use, social influences on tobacco use, peer norms regarding tobacco use, and refusal skills. This instruction should:
    • Decrease the social acceptability of tobacco use and show that most young people do not smoke.
    • Help students understand why young people start to use tobacco and identify more positive activities to meet their goals.
    • Develop students� skills in assertiveness, goal setting, problem solving, and resisting pressure from the media and peers to use tobacco.

    Programs that only discuss tobacco�s harmful effects or attempt to instill fear do not prevent tobacco use.

  3. Curriculum
    Provide tobacco-use prevention education in grades K�12.
    • This instruction should be introduced in elementary school and intensified in middle/ junior high school, when students are exposed to older students who typically use tobacco at higher rates.
    • Reinforcement throughout high school is essential to ensure that successes in preventing tobacco use do not dissipate over time.
  4. Training
    Provide program-specific training on tobacco-use prevention for teachers. The training should include reviewing the curriculum, modeling instructional activities, and providing opportunities to practice implementing the lessons. Well-trained peer leaders can be an important adjunct to teacher-led instruction.
  5. Family Involvement
    Involve parents or families in supporting school-based programs to prevent tobacco use. Schools should:
    • Promote discussions at home about tobacco use by assigning homework and projects that involve families.
    • Encourage parents to participate in community efforts to prevent tobacco use and addiction.
  6. Tobacco-Use Cessation Efforts
    Support cessation efforts among students and school staff who use tobacco. Schools should provide access to cessation programs that help students and staff stop using tobacco rather than punishing them for violating tobacco-use policies.
  7. Evaluation
    Assess the tobacco-use prevention program at regular intervals. Schools can use CDC�s Guidelines for School Health Programs to Prevent Tobacco Use and Addiction to assess whether they are providing effective policies, curricula, training, family involvement, and cessation programs.

June 2008


  1. Substance Abuse and Mental Health Services Administration. Results From the 2005 National Survey on Drug Use and Health. [pdf 943K] (Office of Applied Studies, NSDUH Series H-27, DHHS Publication No. SMA 05�4061) [Accessed 2008 Jun 13]. Rockville, MD.
  2. CDC. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. [pdf 28M] Atlanta, GA: U.S. Department of Health and Human Services, 1994. [Accessed 2008 Jun 23].
  3. CDC. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, 2004.  [Accessed 2008 Jun 23].
  4. CDC. Cigar smoking among teenagers�United States, Massachusetts, and New York, 1996 [pdf 302K]  Morbidity & Mortality Weekly Report 1997;46(20):433�439. [Accessed 2008 Jun 23].
  5. CDC. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, 2006. [Accessed 2008 Jun 23].
  6. [00_yrbsmmwr.htm]

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Page last reviewed: October 28, 2008
Page last modified: June 03, 2010
Content source: National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health