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In 2019, 2.6% of adolescents and young adults aged 12 to 25 began smoking cigarettes in the past year.
Background
Because cigarette smoking typically begins during adolescence, tobacco use is often described as a “pediatric disease.” Nearly 90 percent of adult daily smokers in the United States began smoking by age 18, and 98 percent first smoked by age 26. Nicotine is highly addictive; initiation of smoking during adolescence is linked to persistent smoking in adulthood and the many adverse health effects caused by smoking. Further, exposure to nicotine during adolescence may harm normal brain development, which continues until age 25. Specifically, nicotine exposure may impair development of brain regions involved in attention, learning, and impulse control, and it may prime the brain for addiction to other drugs.
Understanding trends in youth initiation of tobacco products – including cigarettes, electronic cigarettes, cigars, and smokeless tobacco – helps policy makers determine how to allocate prevention resources more effectively. Effective strategies to reduce youth initiation of tobacco use include federal regulation of tobacco products; significant increases in tobacco prices, including excise taxes; smokefree air laws; restrictions on tobacco advertising and promotion; restricting the availability of tobacco products to youth; mass-media public education campaigns; and full implementation of comprehensive state and community tobacco control programs. On December 20, 2019, the President signed legislation to amend the Federal Food, Drug, and Cosmetic Act, and raise the federal minimum age of sale of tobacco products from 18 to 21 years.
Measure
The percentage of individuals among those aged 12 to 25 years who said they had initiated cigarette smoking during the past 12 months.
The percentage of individuals among those aged 12 to 25 years who said they had initiated cigar smoking during the past 12 months.
The percentage of individuals among those aged 12 to 25 years who said they had initiated smokeless tobacco use during the past 12 months.
The percentage of individuals among those aged 12 to 25 years who said they had initiated use of any of these tobacco products during the past 12 months.
Note: Initiation measures included a numerator of the number of adolescents and young adults aged 12 to 25 years who used the specified tobacco product for the first time in the past 12 months and a denominator of the number of adolescents and young adults aged 12 to 25 years who did not use the specified tobacco product in their lifetime or who used the specified tobacco product for the first time in the past 12 months.
Note: Cigars include premium cigars, little filtered cigars, and cigarillos.
Note: E-cigarettes are not included in the tobacco-related questions of the National Household Survey on Drug Use and Health that is used as the data source for these measures.
Healthy People 2030 Target
- Eliminate the initiation of the use of cigarettes among adolescents and young adults.
Healthy People 2030 is a set of goals set forth by the Department of Health and Human Services.
Note: Goals are indicated as blue line on Detailed Trend Graphs.
Data Source
Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Use and Health, 2008-2019.
Note: NSDUH, like many surveys, experienced significant challenges and changes during the 2020 fielding. The COVID-19 pandemic interrupted data collection in mid-March, and the survey did not resume until September of 2020. In the interim, many aspects of daily life were drastically altered, and these may have affected substance use behaviors. Beginning in October of 2020, data collection became almost entirely web-based, with very few in-person interviews. Overall response rates, and particularly youth interview response rates, dropped, and many interviews were not completed. As a result, 2020 data may not be internally consistent (i.e., Q1 to Q4) or comparable with previous survey years. Data points from 2020 are therefore not included in this report.
Trends and Most Recent Estimates
By Type of Tobacco Product
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
All Tobacco Products
|
5.7 | 5.4 - 6.1 |
Cigarettes
|
2.6 | 2.3 - 2.8 | |
Smokeless Tobacco
|
1.3 | 1.1 - 1.5 | |
Cigars
|
2.7 | 2.5 - 3.0 | |
Cigarettes, Cigars and Smokeless Tobacco
By Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Both Sexes
|
5.7 | 5.4 - 6.1 |
Male
|
6.7 | 6.2 - 7.2 | |
Female
|
4.8 | 4.3 - 5.2 | |
By Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
All Races
|
5.7 | 5.4 - 6.1 |
Non-Hispanic White
|
6.9 | 6.4 - 7.4 | |
Non-Hispanic Black
|
3.6 | 3.0 - 4.3 | |
Hispanic
|
5.0 | 4.3 - 5.8 | |
Cigarettes
By Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Both Sexes
|
2.6 | 2.3 - 2.8 |
Male
|
2.8 | 2.5 - 3.2 | |
Female
|
2.3 | 2.0 - 2.6 | |
By Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
All Races
|
2.6 | 2.3 - 2.8 |
Non-Hispanic White
|
3.0 | 2.7 - 3.4 | |
Non-Hispanic Black
|
1.5 | 1.1 - 2.0 | |
Hispanic
|
2.3 | 1.9 - 2.9 | |
Smokeless Tobacco
By Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Both Sexes
|
1.3 | 1.1 - 1.5 |
Male
|
1.7 | 1.5 - 1.9 | |
Female
|
0.9 | 0.7 - 1.1 | |
By Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
All Races
|
1.3 | 1.1 - 1.5 |
Non-Hispanic White
|
1.6 | 1.4 - 1.9 | |
Non-Hispanic Black
|
0.5 | 0.3 - 0.9 | |
Hispanic
|
1.2 | 0.9 - 1.6 | |
Cigars
By Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Both Sexes
|
2.7 | 2.5 - 3.0 |
Male
|
3.4 | 3.0 - 3.8 | |
Female
|
2.0 | 1.8 - 2.3 | |
By Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
All Races
|
2.7 | 2.5 - 3.0 |
Non-Hispanic White
|
3.3 | 3.0 - 3.7 | |
Non-Hispanic Black
|
2.0 | 1.6 - 2.5 | |
Hispanic
|
2.1 | 1.6 - 2.6 | |
Additional Information on Tobacco Use Initiation
- Tobacco. National Cancer Institute.
- Consumer Guide: Let’s Make the Next Generation Tobacco-Free. U.S. Department of Health and Human Services.
- Tobacco and Cancer. American Cancer Society.
- Youth Tobacco Prevention. Centers for Disease Control and Prevention.
- Youth and Tobacco. U.S. Food and Drug Administration.
- Tobacco Control Evidence-Based Programs Listing. National Cancer Institute.
- Julius B. Richmond Center. American Academy of Pediatrics.
- 2016 Surgeon General’s Report – E-Cigarette Use Among Youth and Young Adults. Centers for Disease Control and Prevention.
- 2014 Surgeon General’s Report - The Health Consequences of Smoking: 50 Years of Progress. Centers for Disease Control and Prevention.
- 2012 Surgeon General’s Report—Preventing Tobacco Use Among Youth and Young Adults. Centers for Disease Control and Prevention.
- Prevention and Cessation of Tobacco Use in Children and Adolescents: Primary Care Interventions. U.S. Preventive Services Task Force.
- Smoking and Tobacco Control Monograph 21: The Economics of Tobacco and Tobacco Control. National Cancer Institute.
- Vital Signs: Tobacco Product Use Among Middle and High School Students – United States, 2011-2018. Gentzke AS, Creamer M, Cullen KA, et al. MMWR. 2019; 68(6):157-164.
- Trends in the Age of Cigarette Smoking Initiation Among Young Adults in the U.S. From 2002 to 2018. Barrington-Trimis JL, Braymiller JL, Unger JB, McConnell R, Stokes A, et al. JAMA Netw Open. 2020;3(10):e2019022.
- Cigarette use among high school students – United States, 1991–2009. Centers for Disease Control and Prevention. MMWR. 2010;59(26):797–801.
- Age of initiation of cigarillos, filtered cigars and/or traditional cigars among youth: Findings from the Population Assessment of Tobacco and Health (PATH) study, 2013-2017. Chen B, Sterling KL, Bluestein MA, Kuk AE, Harrell MB, et al. PLoS One. 2020;15(12):e0243372.
- Tobacco Product Use and Associated Factors Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021. Gentzke AS, Wang TW, Cornelius M, et al. MMWR. Surveill Summ. 2022;71:1-29
- The Tobacco Control Vaccine: a population-based framework for preventing tobacco-related disease and death. King BA, Graffunder C. Tob. Control. 2018;27(2):123-124.
- Boosting the Tobacco Control Vaccine: recognizing the role of the retail environment in addressing tobacco use and disparities. Kong AY, King BA. Tob. Control. 2021;30(e2):e162-e168.
- Notes from the Field: E-Cigarette Use Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021. Park-Lee E, Ren C, Sawdey MD, et al. MMWR. 2021;70(39):1387–1389