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Introduction
Cigarette smoking is the leading preventable cause of disease, disability, and death in the United States. Smoking causes cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon and rectum, anus, as well as acute myeloid leukemia. Tobacco use is initiated and established primarily during adolescence (defined as ages 10-19): nearly 90 percent of adult cigarette smokers in the U.S. first tried cigarettes by age 18, and 98 percent first tried cigarettes by age 26. Each day in the U.S., around 1,600 youth aged 18 or younger smoke their first cigarette and another 200 become daily cigarette smokers.
E-cigarettes (also known as vapes or Electronic Nicotine Delivery Systems) are battery-powered devices that convert a liquid (“e-liquid”) into an aerosol. E-liquids typically contain nicotine, flavorings, vegetable glycerin, propylene glycol, and other chemicals. Besides nicotine, e-cigarette aerosol may contain heavy metals, volatile organic compounds, and fine and ultrafine particles that can be inhaled deeply into the lungs by both users and bystanders. Nicotine use among youth increases the risk of lifelong tobacco addiction and can also increase the risk for future addiction to other drugs.
Teen cigarette smoking prevalence peaked around 1996/1997 but has been declining since. However, a substantial portion of youth use other tobacco products, including cigars, smokeless tobacco, and hookah. Youth use of more than one tobacco product (dual use) is also common. Since 2014, e-cigarettes have been the most commonly used tobacco product among youth. In 2019, more than 3.6 million U.S. youth, including 1 in 5 high school students and 1 in 20 middle school students, were current users of e-cigarettes.
There are many factors associated with youth tobacco use, including social, environmental, cognitive, and genetic influences. In addition, the Surgeon General’s 2012 report concluded that tobacco advertising, promotion, and depictions of smoking in movies are causally related to youth tobacco use. Initiation of smoking during adolescence is linked to persistent smoking during adult life 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 effective 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 high school students (grades 9–12) who reported use of cigarettes, cigars, smokeless tobacco, or e-cigarettes on at least 1 day during the 30 days before the survey.
Note: To be consistent with the Healthy People 2020 Targets, measures for all products except e-cigarettes are based on data from YRBSS.
Healthy People 2020 Target
- Reduce to 21 percent the proportion of adolescents in grades 9–12 who used tobacco products in the past 30 days.
- Reduce to 16 percent the proportion of adolescents in grades 9–12 who smoked cigarettes in the past 30 days.
- Reduce to 6.9 percent the proportion of adolescents in grades 9–12 who used smokeless (chewing tobacco or snuff) tobacco in the past 30 days.
- Reduce to 8 percent the proportion of adolescents in grades 9–12 who smoked cigars in the past 30 days.
There is no Healthy People 2020 target for use of e-cigarettes.
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
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Youth Risk Behavior Surveillance System (YRBSS), 1999–2017.
E-Cigarettes Data: Centers for Disease Control and Prevention, National Youth Tobacco Survey (NYTS), 2011–2019.
Trends and Most Recent Estimates
By Type of Tobacco Product, Excluding E-cigarettes
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2017) | |
---|---|---|---|
Percent of adolescents | 95% Confidence Interval | ||
![]() ![]() |
Cigarettes, Cigars and Smokeless Tobacco![]() |
14.0 | 12.2 - 15.9 |
Cigarettes![]() |
8.8 | 7.2 - 10.7 | |
Smokeless tobacco![]() |
5.5 | 4.4 - 6.7 | |
Cigars![]() |
8.0 | 7.2 - 8.9 |
Cigarettes, Cigars and Smokeless Tobacco
By Sex
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2017) | |
---|---|---|---|
Percent of adolescents | 95% Confidence Interval | ||
![]() ![]() |
Both Sexes![]() |
14.0 | 12.2 - 15.9 |
Male![]() |
17.3 | 15.3 - 19.4 | |
Female![]() |
10.7 | 8.9 - 12.7 |
By Race/Ethnicity
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2017) | |
---|---|---|---|
Percent of adolescents | 95% Confidence Interval | ||
![]() ![]() |
All Races![]() |
14.0 | 12.2 - 15.9 |
Non-Hispanic White![]() |
16.8 | 14.3 - 19.7 | |
Non-Hispanic Black![]() |
10.2 | 8.5 - 12.3 | |
Hispanic![]() |
10.5 | 9.1 - 12.2 |
Cigarettes
By Sex
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2017) | |
---|---|---|---|
Percent of adolescents | 95% Confidence Interval | ||
![]() ![]() |
Both Sexes![]() |
8.8 | 7.2 - 10.7 |
Male![]() |
9.8 | 8.3 - 11.6 | |
Female![]() |
7.8 | 6.0 - 9.9 |
By Race/Ethnicity
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2017) | |
---|---|---|---|
Percent of adolescents | 95% Confidence Interval | ||
![]() ![]() |
All Races![]() |
8.8 | 7.2 - 10.7 |
Non-Hispanic White![]() |
11.1 | 9.0 - 13.6 | |
Non-Hispanic Black![]() |
4.4 | 3.2 - 5.9 | |
Hispanic![]() |
7.1 | 5.8 - 8.6 |
Smokeless Tobacco
By Sex
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2017) | |
---|---|---|---|
Percent of adolescents | 95% Confidence Interval | ||
![]() ![]() |
Both Sexes![]() |
5.5 | 4.4 - 6.7 |
Male![]() |
9.0 | 7.3 - 11.0 | |
Female![]() |
1.9 | 1.4 - 2.6 |
By Race/Ethnicity
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2017) | |
---|---|---|---|
Percent of adolescents | 95% Confidence Interval | ||
![]() ![]() |
All Races![]() |
5.5 | 4.4 - 6.7 |
Non-Hispanic White![]() |
6.8 | 5.3 - 8.7 | |
Non-Hispanic Black![]() |
3.6 | 2.5 - 5.1 | |
Hispanic![]() |
3.7 | 2.8 - 5.0 |
Cigars
By Sex
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2017) | |
---|---|---|---|
Percent of adolescents | 95% Confidence Interval | ||
![]() ![]() |
Both Sexes![]() |
8.0 | 7.2 - 8.9 |
Male![]() |
10.5 | 9.4 - 11.7 | |
Female![]() |
5.4 | 4.6 - 6.4 |
By Race/Ethnicity
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2017) | |
---|---|---|---|
Percent of adolescents | 95% Confidence Interval | ||
![]() ![]() |
All Races![]() |
8.0 | 7.2 - 8.9 |
Non-Hispanic White![]() |
9.0 | 7.8 - 10.3 | |
Non-Hispanic Black![]() |
7.4 | 6.0 - 9.1 | |
Hispanic![]() |
6.4 | 5.3 - 7.5 |
E-cigarettes
By Sex
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
---|---|---|---|
Percent of adolescents | 95% Confidence Interval | ||
![]() ![]() |
Both Sexes![]() |
27.5 | 25.3 - 29.7 |
Male![]() |
27.6 | 25.1 - 30.3 | |
Female![]() |
27.4 | 25.0 - -29.9 |
By Race/Ethnicity
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
---|---|---|---|
Percent of adolescents | 95% Confidence Interval | ||
![]() ![]() |
All Races![]() |
27.5 | 25.3 - 29.7 |
Non-Hispanic White![]() |
32.4/td> | 29.8 - 35.2 | |
Non-Hispanic Black![]() |
17.7 | 14.5 - 21.4 | |
Hispanic![]() |
23.2 | 20.6 - 26.0 |
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 Youth Tobacco Use
For the public
- Smokefreeteen.gov. National Cancer Institute.
- SmokefreeTXT. National Cancer Institute.
- Tobacco. National Cancer Institute.
- Tobacco and Cancer. American Cancer Society.
- 2012 Surgeon General’s Report—Preventing Tobacco Use Among Youth and Young Adults. Centers for Disease Control and Prevention.
- Quick Facts on the Risks of E-Cigarette’s for Kids, Teens, and Young Adults. Centers for Disease Control and Prevention.
- Youth Tobacco Prevention. Centers for Disease Control and Prevention.
- 50 Years of Progress: A Report of the Surgeon General, 2014. U.S. Department of Health and Human Services.
- Youth and Tobacco. U.S. Food and Drug Administration.
For tobacco users
- Cigarette Smoking: Health Risks and How to Quit (PDQ®)–Patient Version. National Cancer Institute.
- Smokefree.gov. National Cancer Institute.
- Where To Get Help When You Decide To Quit Smoking. National Cancer Institute.
- How to Quit Smoking or Smokeless Tobacco. American Cancer Society.
- How to Quit Smoking. Centers for Disease Control and Prevention.
- North American Quitline Consortium.
For health professionals
- Cigarette Smoking: Health Risks and How to Quit (PDQ®)–Health Professional Version. National Cancer Institute.
- Treating Tobacco Use and Dependence: 2008 Update. Agency for Healthcare Research and Quality.
- Best Practices for Comprehensive Tobacco Control Programs—2014. Centers for Disease Control and Prevention.
- Youth and Tobacco. Food and Drug Administration.
Scientific reports
- Monograph 19: The Role of the Media in Promoting and Reducing Tobacco Use.. National Cancer Institute. Smoking and Tobacco Control Monographs.
- 2012 Surgeon General’s Report—Preventing Tobacco 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.
- 2016 Surgeon General’s Report—E-cigarette Use Among Youth and Young Adults. Centers for Disease Control and Prevention.
- 2018 Surgeon General’s Advisory on E-cigarette Use Among Youth. Office of the U.S. Surgeon General and Centers for Disease Control and Prevention.
- Tobacco Use in Top-Grossing Movies-United States, 2010-2018. Center for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep 2019. 68(43);974-978.
- 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.
- Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students — United States, 2011–2018.. Cullen KA, Ambrose BK, Gentzke AS et al. MMWR Morb Mortal Wkly Rep 2018;67(45):1276-1277.
- Quantifying the effect of changes in state-level adult smoking rates on youth smoking. Farrelly MC, Arnold KY, Juster HR, Allen JA. J Public Health Manag Pract 2014 Mar-Apr; 20 (2):E1-6.
- 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.
- Vital Signs: Tobacco Product Use Among Middle and High School Students – United States, 2011-2018. Andrea S. Gentzke; MeLisa Creamer; Karen A. Cullen, et al. MMWR Morb Mortality Wkly Rep 2019 68(6);157-164.
- Monitoring the Future: National Survey Results on Drug Use, 1975–2017. Johnston LD, O'Malley PM, Bachman JG, et al. (2018) Ann Arbor: Institute for Social Research, The University of Michigan.
- 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.