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Youth and Tobacco Use

Background

  • Smoking and smokeless tobacco use are initiated and established primarily during adolescence.1,2,3 Nearly 9 out of 10 smokers started smoking by age 18, and 99% started by age 26.1,2,3,4
    • Each day in the United States, more than 3,200 people younger than 18 years of age smoke their first cigarette, and an estimated 2,100 youth and young adults who have been occasional smokers become daily cigarette smokers.2,4
    • If smoking persists at the current rate among youth in this country, 5.6 million of today’s Americans younger than 18 years of age are projected to die prematurely from a smoking-related illness. This represents about one in every 13 Americans aged 17 years or younger alive today.4
  • In 2012, 6.7% of middle school and 23.3% of high school students currently used tobacco products, including cigarettes, cigars, hookahs, snus, smokeless tobacco, pipes, bidis, keteks, dissolvable tobacco, and electronic cigarettes.5
  • Current cigarette smoking among middle school and high school youth declined between 2000 and 2011.5
  • From 2011–2012, electronic cigarette use doubled among middle and high school students, and hookah use increased among high school students.5
  • Current use of smokeless tobacco is about half of what it was in the mid-1990s. However, only a modest decline has occurred since 2010 and no change occurred between 2012 and 2013. Smokeless tobacco use remains a mostly male behavior.6
  • Concurrent use of multiple tobacco products is prevalent among youth. Among high school students who report currently using tobacco, almost one-third of females and one-half of males report using more than one tobacco product in the past 30 days.2

Estimates of Current Tobacco Use Among Youth

 

Estimates of Current Use* of 10 Tobacco Products Among High School Students in 20125
Tobacco ProductOverallFemalesMales
Any tobacco product†23.3%18.1%28.3%
Cigarettes14.0%11.7%16.3%
Cigars12.6%8.4%16.7%
Smokeless tobacco6.4%1.5%11.2%
Hookahs5.4%4.5%6.2%
Pipes4.5%3.2%5.8%
Electronic cigarettes2.8%1.9%3.7%
Snus2.5%0.9%3.9%
Kreteks1.0%0.5%1.5%
Bidis0.9%0.5%1.3%
Dissolvable tobacco0.8%0.6%1.0%

 

Estimates of Current Use* of 10 Tobacco Products Among Middle School Students in 20125
Tobacco ProductOverallFemalesMales
*Current use of cigarettes was determined by asking, "During the past 30 days, on how many days did you smoke cigarettes?"
Current use of cigars was determined by asking, "During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars?"
Current use of smokeless tobacco was determined by asking, "During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip?"
Current use of a pipe was determined by asking, "During the past 30 days, on how many days did you smoke tobacco in a pipe?"
In 2011, current use of bidis and kreteks was determined by asking, "During the past 30 days, on how many days did you smoke bidis?" and "During the past 30 days, on how many days did you smoke kreteks?"
In 2012, current use of bidis and kreteks was determined by asking, "During the past 30 days, which of the following products (bidis and kreteks) have you used on at least 1 day?"
Current use of hookahs, snus, dissolvable tobacco, and electronic cigarettes was determined by asking, "During the past 30 days, which of the following products (hookah, snus, dissolvable tobacco, and electronic cigarettes) have you used on at least 1 day?"

†Includes use for ≥1 day in the past 30 days of any of the following: cigarettes, cigars, smokeless tobacco, tobacco pipes, bidis, kreteks, hookahs, snus, dissolvable tobacco, or electronic cigarettes.
Any tobacco product†6.7%5.6%7.8%
Cigarettes3.5%3.2%3.8%
Cigars2.8%2.4%3.2%
Smokeless tobacco1.7%1.2%2.2%
Hookahs1.3%1.0%1.5%
Pipes1.8%1.7%1.9%
Electronic cigarettes1.1%0.8%1.5%
Snus0.8%0.6%1.0%
Kreteks0.5%0.4%0.7%
Bidis0.6%0.4%0.7%
Dissolvable tobacco0.5%0.4%0.6%

Factors Associated With Youth Tobacco Use

Some factors associated with youth tobacco use appear to be similar across different types of tobacco products and include the following categories:1,2,7

  • Social and Physical Environments
    • Social norms portrayed in tobacco advertising and in movies promote smoking in young people.
    • Boys and young men are more likely to use certain types of tobacco, although sex differences have narrowed.
  • Small Social Groups: Family and Peer Groups
    • Young people are more likely to use tobacco if their peers use tobacco.
    • Young people are more likely to use tobacco if they perceive tobacco use is acceptable or normative among their peers.
    • Parental smoking may promote smoking among young people.
  • Cognitive and Affective Processes
    • There is a strong relationship between youth smoking and negative affect, such as depression, anxiety, and stress.
    • Expectations of positive outcomes from smoking, such as coping with stress and controlling weight, are related to youth tobacco use.
  • Biological and Genetic Factors
    • There is evidence that youth may be sensitive to nicotine and that teens can feel dependent on nicotine sooner than adults.
    • Genetic factors may mean that it is more difficult for some people to quit smoking once they have started.
  • Other influences that have been demonstrated to affect tobacco use include:
    • Low socioeconomic status
    • Lack of skills to resist influences to tobacco use
    • Lack of parental support or involvement
    • Accessibility, availability, and price of tobacco products
    • Low levels of academic achievement
    • Low self-image or self-esteem
    • Exposure to tobacco advertising
    • Aggressive behavior (e.g., fighting, carrying weapons)

Reducing Youth Tobacco Use

National, state, and local program activities have been shown to reduce and prevent youth tobacco use when implemented in concert with each other. They include the following:2,8

  • Counteradvertising mass-media campaigns (i.e., TV and radio commercials, posters, and other media messages targeted toward youth to counter protobacco marketing)
  • Community programs and school and college policies and interventions coordinated and implemented in conjunction with efforts to create tobacco-free social norms
  • Community interventions that reduce tobacco advertising, promotions, and commercial availability of tobacco products
  • Higher costs for tobacco products through increased excise taxes
  • Prohibiting smoking in worksites and public places

Some social and environmental factors have been found to be related to lower smoking levels among youth. Among these are:2

  • Religious participation
  • Racial/ethnic pride and strong racial identity
  • Higher academic achievement and aspirations

References

  1. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health, 1994 [accessed 2014 Feb 14].
  2. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health, 2012 [accessed 2014 Feb 14].
  3. Campaign for Tobacco-Free Kids. The Path to Smoking Addiction Starts at Very Young Ages [PDF–164.63 KB]. Washington: Campaign for Tobacco-Free Kids, 2009 [accessed 2014 Feb 14].
  4. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: 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 [accessed 2014 Feb 14].
  5. Centers for Disease Control and Prevention. Tobacco Product Use Among Middle and High School Students—United States, 2011 and 2012. Morbidity and Mortality Weekly Report 2013;62(45):893–7[accessed 2014 Feb 14].
  6. Johnston LD, O'Malley PM, Bachman PM, Schulenberg JE. Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 2013 [PDF–829 KB]. Ann Arbor (MI): University of Michigan, Institute for Social Research, 2014 [accessed 2014 Feb 14].
  7. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta: 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, 2000 [accessed 2014 Feb 14].
  8. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—2014. Atlanta: 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 [accessed 2014 Feb 14].

For Further Information

Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Office on Smoking and Health
E-mail: tobaccoinfo@cdc.gov
Phone: 1-800-CDC-INFO

Media Inquiries: Contact CDC's Office on Smoking and Health press line at 770-488-5493.

 
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