Cancer Trends Progress Report

Tobacco use is initiated and established primarily during adolescence: nearly 90 percent of adult smokers in the United States began smoking by age 18, and 98 percent first smoked by age 26. Each day in the United States, more than 3,800 youth 18 years of age or younger smoke their first cigarette, and more than 1,000 become daily cigarette smokers.

Teen smoking rates reached a peak in 1996 and have been declining since then, but previously observed steep rates of decline have stalled in recent years. In addition, a substantial proportion of youth use other tobacco products, including cigars, smokeless tobacco, pipes, hookahs, and electronic cigarettes. In fact, between 2011 and 2012 there were significant increases in the use of nonconventional tobacco products such as electronic cigarettes and hookahs. Monitoring and preventing youth tobacco use needs to incorporate other products, including new and emerging products.

There are many factors associated with youth tobacco use, including social influences and physical environment, and cognitive, affective, biological, and genetic factors. Because of nicotine dependence and social factors, initiation of smoking during adolescence is closely associated with persistent smoking in adulthood and with the many adverse health effects associated with chronic smoking. It is therefore critical to prevent smoking very early.

Understanding trends in the prevalence of tobacco use among youth enables policy makers to target prevention resources more effectively. To decrease tobacco use and susceptibility to use among youth, restrictions on advertising, promotion, and availability of tobacco products to youth should be combined with full implementation of evidence-based, community-wide, comprehensive tobacco control policies such as product taxes and smoke-free air laws.