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In 2018, 2.3% of children and adolescents aged 12 to 17 began smoking cigarettes in the past year.
Introduction
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. Initiation of smoking during adolescence is linked to persistent smoking in adulthood and the many adverse health effects caused by smoking.
Understanding trends in youth initiation of tobacco products – including cigarettes, electronic cigarettes, cigars, and smokeless tobacco – enables policy makers to target 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 17 years and 18 to 25 years who said they had initiated cigarette smoking during the past 12 months.
The percentage of individuals among those aged 12 to 17 years and 18 to 25 years who said they had initiated cigar smoking during the past 12 months.
The percentage of individuals among those aged 12 to 17 years and 18 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 17 years and 18 to 25 years who said they had initiated use of any of these tobacco products during 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 for the data source of these measures.
Healthy People 2020 Target
- Reduce the initiation of the use of tobacco products by children and adolescents aged 12 to 17 years to 5.8 percent.
- Reduce the initiation of the use of cigarettes by children and adolescents aged 12 to 17 years to 4.3 percent.
- Reduce the initiation of the use of smokeless tobacco products by children and adolescents aged 12 to 17 years to 0.6 percent.
- Reduce the initiation of the use of cigars by children and adolescents aged 12 to 17 years to 2.9 percent.
- Reduce the initiation of the use of tobacco products by young adults aged 18 to 25 years to 8.9 percent.
- Reduce the initiation of the use of cigarettes by young adults aged 18 to 25 years to 6.4 percent.
- Reduce the initiation of the use of smokeless tobacco products by young adults aged 18 to 25 years to 0.2 percent.
- Reduce the initiation of the use of cigars by young adults aged 18 to 25 years to 4.3 percent.
Healthy People 2020 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, 2002-2018.
Trends and Most Recent Estimates
By Type of Tobacco Product, Excluding E-cigarettes
Ages 12-17
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Cigarettes, Cigars and Smokeless Tobacco
|
4.6 | 4.2 - 5.0 |
Cigarettes
|
2.3 | 2.0 - 2.6 | |
Smokeless Tobacco
|
1.2 | 1.0 - 1.4 | |
Cigars
|
2.0 | 1.7 - 2.2 | |
Ages 18-25
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Cigarettes, Cigars and Smokeless Tobacco
|
7.1 | 7.1 - 6.6 |
Cigarettes
|
3.4 | 3.0 - 3.7 | |
Smokeless Tobacco
|
1.2 | 1.0 - 1.4 | |
Cigars
|
3.7 | 3.3 - 4.0 | |
Cigarettes, Cigars and Smokeless Tobacco
Ages 12-17 by Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Both Sexes
|
4.6 | 4.2 - 5.0 |
Male
|
5.0 | 4.4 - 5.5 | |
Female
|
4.2 | 3.7 - 4.8 | |
Ages 18-25 by Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Both Sexes
|
7.1 | 7.1 - 6.6 |
Male
|
8.1 | 7.3 - 8.9 | |
Female
|
6.2 | 5.5 - 6.8 | |
Ages 12-17 by Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
All Races
|
4.6 | 4.2 - 5.0 |
Non-Hispanic White
|
5.9 | 5.3 - 6.5 | |
Non-Hispanic Black
|
3.2 | 2.3 - 4.1 | |
Hispanic
|
3.5 | 2.7 - 4.2 | |
Ages 18-25 by Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
All Races
|
7.1 | 7.1 - 6.6 |
Non-Hispanic White
|
8.4 | 7.6 - 9.2 | |
Non-Hispanic Black
|
4.4 | 3.3 - 5.5 | |
Hispanic
|
5.8 | 4.8 - 6.8 | |
By Age
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Ages 12-17
|
4.6 | 4.2 - 5.0 |
Ages 18-25
|
7.1 | 7.1 - 6.6 | |
Cigarettes
Ages 12-17 by Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Both Sexes
|
2.3 | 2.0 - 2.6 |
Male
|
2.1 | 1.7 - 2.5 | |
Female
|
2.5 | 2.1 - 2.9 | |
Ages 18-25 by Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Both Sexes
|
3.4 | 3.0 - 3.7 |
Male
|
3.4 | 3.4 - 2.9 | |
Female
|
3.3 | 3.3 - 2.8 | |
Ages 12-17 by Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
All Races
|
2.3 | 2.0 - 2.6 |
Non-Hispanic White
|
2.9 | 2.4 - 3.3 | |
Non-Hispanic Black
|
1.4 | 0.8 - 2.0 | |
Hispanic
|
1.9 | 1.3 - 2.6 | |
Ages 18-25 by Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
All Races
|
3.4 | 3.0 - 3.7 |
Non-Hispanic White
|
3.6 | 3.6 - 3.1 | |
Non-Hispanic Black
|
2.3 | 2.3 - 1.5 | |
Hispanic
|
3.5 | 3.5 - 2.7 | |
By Age
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Ages 12-17
|
2.3 | 2.0 - 2.6 |
Ages 18-25
|
3.4 | 3.0 - 3.7 | |
Smokeless Tobacco
Ages 12-17 by Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Both Sexes
|
1.2 | 1.0 - 1.4 |
Male
|
1.7 | 1.3 - 2.0 | |
Female
|
0.8 | 0.6 - 1.0 | |
Ages 18-25 by Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Both Sexes
|
1.2 | 1.0 - 1.4 |
Male
|
1.7 | 1.4 - 2.1 | |
Female
|
0.7 | 0.5 - 1.0 | |
Ages 12-17 by Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
All Races
|
1.2 | 1.0 - 1.4 |
Non-Hispanic White
|
1.7 | 1.4 - 2.0 | |
Non-Hispanic Black
|
0.4 | 0.1 - 0.7 | |
Hispanic
|
1.0 | 0.5 - 1.4 | |
Ages 18-25 by Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
All Races
|
1.2 | 1.0 - 1.4 |
Non-Hispanic White
|
1.7 | 1.3 - 2.0 | |
Non-Hispanic Black
|
0.8 | 0.3 - 1.2 | |
Hispanic
|
0.4 | 0.2 - 0.6 | |
By Age
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Ages 12-17
|
1.2 | 1.0 - 1.4 |
Ages 18-25
|
1.2 | 1.0 - 1.4 | |
Cigars
Ages 12-17 by Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Both Sexes
|
2.0 | 1.7 - 2.2 |
Male
|
2.4 | 2.0 - 2.7 | |
Female
|
1.6 | 1.3 - 1.9 | |
Ages 18-25 by Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Both Sexes
|
3.7 | 3.3 - 4.0 |
Male
|
4.4 | 3.8 - 5.0 | |
Female
|
2.9 | 2.4 - 3.3 | |
Ages 12-17 by Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
All Races
|
2.0 | 1.7 - 2.2 |
Non-Hispanic White
|
2.5 | 2.1 - 2.9 | |
Non-Hispanic Black
|
1.7 | 1.1 - 2.4 | |
Hispanic
|
1.3 | 0.9 - 1.8 | |
Ages 18-25 by Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
All Races
|
3.7 | 3.3 - 4.0 |
Non-Hispanic White
|
4.5 | 3.9 - 5.0 | |
Non-Hispanic Black
|
2.1 | 1.3 - 2.8 | |
Hispanic
|
2.6 | 1.9 - 3.3 | |
By Age
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018) | |
|---|---|---|---|
| Percent | 95% Confidence Interval | ||
|
Ages 12-17
|
2.0 | 1.7 - 2.2 |
Ages 18-25
|
3.7 | 3.3 - 4.0 | |
Evidence-based Resources
The Cancer Control P.L.A.N.E.T. web portal contains tobacco control resources that support collaboration, identify evidence-based approaches, and list research-tested interventions. To identify high-risk populations and prioritize cancer control efforts, state and county-level tobacco data can be found on State Cancer Profiles.
Additional Information on Tobacco Use Initiation
For the public
- 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.
For health professionals
- Cigarette Smoking: Health Risks and How to Quit (PDQ®)–Patient Version. National Cancer Institute.
- Treating Tobacco Use and Dependence. Agency for Healthcare Research and Quality.
- Julius B. Richmond Center. American Academy of Pediatrics.
- Best Practices for Comprehensive Tobacco Control Programs—2014. Centers for Disease Control and Prevention.
- Healthcare Provider Resources: Smoking and Tobacco Use. Centers for Disease Control and Prevention.
- For Healthcare Professionals. Smokefree.gov
- Prevention and Cessation of Tobacco Use in Children and Adolescents: Primary Care Interventions. U.S. Preventive Services Task Force.
Scientific reports
- Smoking and Tobacco Control Monographs. Monograph 19: The Role of the Media in Promoting and Reducing Tobacco Use. National Cancer Institute.
- Smoking and Tobacco Control Monograph 21: The Economics of Tobacco and Tobacco Control. National Cancer Institute.
- CDC Grand Rounds: Current Opportunities in Tobacco Control. Centers for Disease Control and Prevention. MMWR 2010;59(16):487–492.
- Cigarette use among high school students – United States, 1991–2009. Centers for Disease Control and Prevention. MMWR 2010;59(26):797–801.
- Tobacco product use among middle and high school students – United States, 2011–2017. Centers for Disease Control and Prevention. MMWR 2013;62(45): 893-897.
- Smoking initiation associated with specific periods in the life course from birth to young adulthood: data from the National Longitudinal Survey of Youth 1997. Chen X, Jacques-Tiura AJ. Am J Public Health 2014;104(2):e119–26.
- Tobacco Use: A Pediatric Disease. Committee on Environmental Health, Committee on Substance Abuse, Committee on Adolescence, and Committee on Native American Child Health. Pediatrics. 2009, 124 (5) 1474-1487.
- Individual- and community-level correlates of cigarette-smoking trajectories from age 13 to 32 in a U.S. population-based sample. Fuemmeler B, Lee CT, Ranby KW, Clark T, et al. Drug Alcohol Depend. 2013;132(1–2):301–8.
- Risk factors for adolescent smoking: parental smoking and the mediating role of nicotine dependence. Selya AS, Dierker LC, Rose JS, Hedeker D, Mermelstein RJ. Drug Alcohol Depend. 2012;124(3):311–8.
- 2014 Surgeon General’s Report - The Health Consequences of Smoking: 50 Years of Progress. SurgeonGeneral.gov.
- 2012 Surgeon General’s Report—Preventing Tobacco Use Among Youth and Young Adults. Centers for Disease Control and Prevention.
- Tobacco Product Use and Associated Factors Among Middle and High School Students. Wang TW, Gentzke AS, Creamer MR, et al. United States, 2019. MMWR Surveill Summ 2019;68(No. SS-12):1–22.
Year Range
2002-2018
Recent Summary Trend Year Range
2014-2018
Summary Tables
Smoking
Recent Summary Trend
Falling
Desired Direction
Falling