Cancer Trends Progress Report

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: nearly 90 percent of adult cigarette smokers in the United States first tried cigarettes by age 18, and 98 percent first tried cigarettes by age 26. Each day in the United States, around 2,000 youth 18 years of age or younger smoke their first cigarette and another 300 become daily cigarette smokers.

Teen cigarette smoking rates reached a peak around 1996/1997 and have been declining since then. In addition, a substantial proportion of youth use other tobacco products, including cigars, smokeless tobacco, pipes, hookahs, and electronic cigarettes (e-cigarettes). Monitoring and preventing youth tobacco product 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 initiation as early as possible.

Understanding trends in the prevalence of tobacco product use among youth enables policy makers to more effectively target prevention resources. To decrease tobacco product 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, population-based, comprehensive tobacco control policies such as product taxes and smoke-free air laws.

Special note on e-cigarettes: A new e-cigarettes measure on 2011-2018 trends was added to the report in September 2019 due to the availability of data from the Centers for Disease Control and Prevention’s (CDC) and U.S. Food and Drug Administration’s (FDA) National Youth Tobacco Survey (NYTS).  The NYTS provides data on an annual basis, rather than every other year as provided by the CDC’s Youth Risk Behavior Surveillance System (YRBSS). Because of the rapidly changing usage of e-cigarettes, annual monitoring is important; having multiple sources of estimates can be useful as well.