Youth and Tobacco Use

Youth use of tobacco products in any form is unsafe.

If cigarette smoking continues at the current rate among youth in this country, 5.6 million of today’s Americans younger than 18 will die early from a smoking-related illness. That’s about 1 of every 13 Americans aged 17 years or younger who are alive today.1

Background

Preventing tobacco product use among youth is critical to ending the tobacco epidemic in the United States.

  • Tobacco product use is started and established primarily during adolescence.1,2
    • Nearly 9 out of 10 cigarette smokers first try cigarette smoking by age 18, and 98% first try smoking by age 26.1
      • Each day in the U.S. about 1,600 youth under 18 years of age smoke their first cigarette and nearly 200 youth under 18 years of age become daily cigarette smokers.3,4
  • Flavorings in tobacco products can make them more appealing to youth.4
    • In 2018, 67% of high school students and 49% of middle school students who used tobacco products in the past 30 days reported using a flavored tobacco product during that time.5
  • Recent increases in the use of e-cigarettes is driving increases in tobacco product use among youth.6,7,8
    • The number of middle and high school students using e-cigarettes rose from 3.6 million in 2018 to 5.4 million in 2019—a difference of about 1.8 million youth.

Estimates of Current Tobacco Use Among Youth

Tobacco Product Use Among High School Students – 2019: In percentages: Any tobacco product: 31.2; E-cigarettes: 27.5; Cigars: 7.6; Cigarettes: 5.8; Smokeless Tobacco: 4.8; Hookah: 3.4; Pipe tobacco: 1.1

Tobacco Product Use Among High School Students – 2019

Electronic cigarettes (E-cigarettes)

  • Current (past 30 day) use of e-cigarettes went up among middle and high school students from 2011 to 2019.6,7,8,9
    • About 1 of every 10 middle school students (10.5%) reported in 2019 that they used electronic cigarettes in the past 30 days—an increase from 0.6% in 2011.
    • More than 1 of every 4 high school students (27.5%) reported in 2019 that they used electronic cigarettes in the past 30 days—an increase from 1.5% in 2011.

Cigarettes

  • From 2011 to 2019, current (past 30 day) cigarette smoking went down among middle and high school students.6,7,8,9
    • About 2 of every 100 middle school students (2.3%) reported in 2019 that they smoked cigarettes in the past 30 days—a decrease from 4.3% in 2011.
    • About 6 of every 100 high school students (5.8%) reported in 2019 that they smoked cigarettes in the past 30 days—a decrease from 15.8% in 2011.

Cigars

  • From 2011 to 2019, current use of cigars went down among middle school students and high school students.6,8,9
    • About 2 of every 100 middle school students (2.3%) reported in 2019 that they had used cigars in the past 30 days—a decrease from 3.5% in 2011
    • Nearly 8 of every 100 high school students (7.6%) reported in 2019 that they had used cigars in the past 30 days—a decrease from 11.6% in 2011.

Smokeless Tobacco

  • From 2011 to 2019, current use of smokeless tobacco went down among middle and high school students:6,8,9
    • Nearly 2 of every 100 middle school students (1.8%) reported in 2019 that they had used smokeless tobacco in the past 30 days—a decrease from 2.2% in 2011.
    • Nearly 5 of every 100 high school students (4.8%) reported in 2019 that they had used smokeless tobacco in the past 30 days—a decrease from 7.9% in 2011.

Hookah

  • From 2011 to 2019, current use of hookahs did not change in a meaningful way among middle school students and high school students.6,8,9
    • Nearly 2 of every 100 middle school students (1.6%) reported in 2019 that they had smoked hookah in the past 30 days. The prevalence was 1.0% in 2011.
    • About 3 of every 100 high school students (3.4%) reported in 2019 that they had smoked hookah in the past 30 days. The prevalence was 4.1% in 2011.

All Tobacco Product Use

  • In 2019, about 12 of every 100 middle school students (12.5%) and about 31 of every 100 high school students (31.2%) reported current use of a tobacco product.8
  • In 2019, nearly 1 of ever 4 middle school students (24.3%) and over half (53.3%) of high school students said they had ever tried a tobacco product.8
Teens in a classroom with a teacher

Many young people use two or more tobacco products.

  • In 2019, 4 of every 100 middle school students (4.0%) and nearly 11 of every 100 high school students (10.8%) reported current use of two or more tobacco products in the past 30 days.8
  • In 2019, about 12 of every 100 middle school students (11.5%) and about 30 of every 100 high school students (29.9%) said they had ever tried two or more tobacco products.8

Youth who use multiple tobacco products are at higher risk for developing nicotine dependence and might be more likely to continue using tobacco into adulthood.10

Tobacco Use* Among High School Students in 20198
Tobacco Product Overall Girls Boys
Any tobacco product 31.2% 30.6% 31.8%
Electronic cigarettes 27.5% 27.4% 27.6%
Cigarettes 5.8% 4.1% 7.3%
Cigars 7.6% 6.2% 9.0%
Smokeless tobacco 4.8% 1.8% 7.5%
Hookahs 3.4% 3.2% 3.6%
Pipe tobacco 1.1% 1.5%

 

Tobacco Use* Among Middle School Students in 20198
Tobacco Product Overall Girls Boys
Notes:
*“Current use” is determined by respondents indicating that they have used a tobacco product on at least 1 day during the past 30 days.Any tobacco product includes cigarettes, cigars, smokeless tobacco (including chewing tobacco, snuff, dip, snus, and dissolvable tobacco), tobacco pipes, bidis, hookah, and electronic cigarettes.
Any tobacco product 12.5% 12.4% 12.5%
Electronic cigarettes 10.5% 10.8% 10.2%
Cigarettes 2.3% 2.5% 2.1%
Cigars 2.3% 2.0% 2.7%
Smokeless tobacco 1.8% 2.7%
Hookahs 1.6% 1.8% 1.3%
Pipe tobacco

Factors Associated With Youth Tobacco Product Use

Factors associated with youth tobacco product use include the following:

  • Social and physical environments2,11
    • The way mass media show tobacco product use as a normal activity can make young people want to try these products.
    • Youth are more likely to use tobacco products if they see people their age using these products.
    • High school athletes are more likely to use smokeless tobacco than those of the same age who are not athletes.12
    • Young people may be more likely to use tobacco products if a parent uses these products.
  • Biological and genetic factors1,2,11
    • There is evidence that youth may be sensitive to nicotine and that teens can feel dependent on nicotine sooner than adults.
    • Genetic factors may make quitting smoking harder for young people.
    • A mother’s smoking during pregnancy may increase the likelihood that her children will become regular smokers.
  • Mental health: There is a strong relationship between youth smoking and depression, anxiety, and stress.2
  • Personal views: When young people expect positive things from smoking, such as coping with stress better or losing weight, they are more likely to smoke.2,11
  • Other influences that affect youth tobacco use include:2,10,11
    • Lower socioeconomic status, including lower income or education
    • Not knowing how to say “no” to tobacco product use
    • Lack of support or involvement from parents
    • Accessibility, availability, and price of tobacco products
    • Doing poorly in school
    • Low self-image or self-esteem
    • Seeing tobacco product advertising in stores, on television, the Internet, in movies, or in magazines and newspapers
Teens looking at a phone.

Reducing Youth Tobacco Product Use

National, state, and local program activities have been shown to reduce and prevent youth tobacco product use when implemented together. These activities include:

  • Higher costs for tobacco products (for example, through increased taxes)2,10,11
  • Prohibiting smoking in indoor areas of workplaces and public places2,10,11
  • Raising the minimum age of sale for tobacco products to 21 years13
  • TV and radio commercials, posters, and other media messages aimed at kids and teens in order to counter tobacco product ads2,10,14
  • Community programs and school and college policies that encourage tobacco-free places and lifestyles2,10,14
  • Community programs that lower tobacco advertising, promotions, and help make tobacco products less easily available2,10,14

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

  • Being part of a religious group or tradition
  • Racial/ethnic pride and strong racial identity
  • Higher academic achievement

It is important to keep working to prevent and reduce the use of all forms of tobacco product use among youth.

References

  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: 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 2019 Feb 28].
  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, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012 [accessed 2019 Feb 28].
  3. Substance Abuse and Mental Health Services Administration. 2018 National Survey on Drug Use And Health: Detailed Tablesexternal icon. Substance Abuse and Mental Health Data Archive [accessed 4 Dec 2019].
  4. Centers for Disease Control and Prevention. Flavored Tobacco Product Use Among Middle and High School Students—United States, 2014. Morbidity and Mortality Weekly Report, 2015;64(38):1066–70 [accessed 2019 Feb 28].
  5. Cullen KA, Liu ST, Bernat JK, et al. Flavored Tobacco Product Use Among Middle and High School Students — United States, 2014–2018. Morbidity and Mortality Weekly Report, 2019;68:839–844.
  6. Gentzke AS, Creamer M, Cullen KA, et al. Vital Signs: Tobacco Product Use Among Middle and High School Students—United States, 2011–2018. Morbidity and Mortality Weekly Report 2019;68:157–164.
  7. Cullen KA, Gentzke AS, Sawdey MD, et al. e-Cigarette Use Among Youth in the United States, 2019external icon. JAMA. Published online November 05, 2019.
  8. Wang TW, Gentzke AS, Creamer MR et al. Tobacco Product Use and Associated Factors Among Middle and High School Students—United States, 2019. Morbidity and Mortality Weekly Report, 2019;68(12) [accessed 2019 Dec 6].
  9. 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 2019 Feb 28].
  10. 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 2019 Feb 28].
  11. Centers for Disease Control and Prevention. E-Cigarette 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, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016 [accessed 2019 Feb 28].
  12. Centers for Disease Control and Prevention. Combustible and Smokeless Tobacco Use Among High School Athletes—United States, 2001–2013. Morbidity and Mortality Weekly Report, 2015;64(34):935–9 [accessed 2019 Feb 28].
  13. King BA, Jama AO, Marynak KL, Promoff GR. Attitudes Toward Raising the Minimum Age of Sale for Tobacco Among U.S. Adultsexternal icon. American Journal of Preventive Medicine 2015-49(4):583-8 [accessed 2019 Feb 28].
  14. 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 2019 Feb 28].

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.