Youth smoking is an issue that affects countries worldwide. While the extent to which smoking is viewed as a negative health behavior may vary across different nations, it remains an issue regardless of how it is perceived by different societies. The United States has taken numerous measures—ranging from changes in national policy surrounding youth cigarette access to changes in media campaigns—in attempts to eliminate the use of tobacco products among adolescents. Approximately 90% of smokers begin smoking prior to the age of 18.
History By the late 19th century, youth smoking in the United States and the United Kingdom became linked to "physical deterioration". A great number of prominent medical figures argued that smoking caused the British population to degenerate physically, as it was believed to interfere with the strength of growing boys.
The children's act of 1908, often called the "Children's Charter", was one of the earliest government measures to regulate youth smoking. By law it became a criminal offence to sell cigarettes, tobacco, or cigarette papers to anyone under the age of 16. The act also expanded police powers, constables and park-keepers in uniform were authorized to seize tobacco from any person "apparently under the age of sixteen" smoking in a public place.
Statistics
While the rates of cigarette smoking among adults and adolescents have declined in the past ten years in the United States, a considerable number of adolescents continue to smoke cigarettes. The Surgeon General's Warning released in 1964 was a major impetus for this change. In 1965, approximately 45% of Americans smoked, however by 2022, an estimated 11.6% of adults (about 28.8 million people) were current cigarette smokers, reflecting a substantial decline over time. The pattern of smoking among youth has had a slightly different trajectory, such that smoking rates for high school students began to increase in the early 1990s and did not begin to decrease until the end of the decade. If the current smoking trends continue, 5.6 million youths alive today will die prematurely.General, S. (2014). The health consequences of smoking—50 years of progress: a report of the surgeon general. In US Department of Health and Human Services. According to economist Kenneth Warner, Ph.D., the tobacco industry needs 5,000 new young smokers every day to maintain the total number of smokers.
In 2020, the Center for Disease Control and Prevention (CDC) estimated that upwards of 4 million middle school and high school students in the United States currently used tobacco products.
Survey data from the National Youth Tobacco Survey from 2015–2024 show that e-cigarettes were the most commonly reported tobacco product among both middle school and high school students throughout the period. E-cigarette use rose sharply in the late 2010s and reached a peak in 2019, when 27.5% of high school students and 10.5% of middle school students reported current (past 30-day) use. After 2019, e-cigarette use declined overall, falling to 7.8% among high school students and 3.5% among middle school students by 2024.The same survey data also show a substantial decline in cigarette smoking over the 2015–2024 period. Among high school students, cigarette use decreased from 9.3% (2015) to 1.7% (2024). Among middle school students, it declined from 2.3% (2015) to 1.1% (2024), with rates remaining near or below roughly one to two percent in the early 2020s.
National epidemiological surveys often deliver key findings on the proportion of youth that are consuming tobacco. The National Youth Tobacco Surveys (NYTS) was designed to provide data on middle school and high school students tobacco behaviors, as well as attitudes, beliefs, and exposure to pro- and anti- tobacco influences. Results from the 2011-2016 NYTS revealed that approximately 20.2% of high school students (grades 9-12) reported current tobacco use, which was defined as having used any tobacco product in the past 30 days. In further support of these findings, the National Survey on Drug Use and Health (NSDUH) is a prominent epidemiological survey that assesses national and state-level information on alcohol, tobacco, illicit drug use, as well as mental health, in the United States. The NSDUH defines current cigarette smoking as smoking all or part of a cigarette over the past 30 days. The 2012 NSDUH survey revealed that 6.6% of youth between the ages of 12 and 17 were current cigarette smokers. Females and males had similar prevalence estimates, 6.3% and 6.8% respectively. The demographic breakdown was such that Caucasian youth exhibited the greatest prevalence of smoking (8.2%), followed by Hispanic or Latino youth (4.8%) and African-American youth (4.1%). Breakdown by age revealed the age range between 16 and 17 had highest prevalence (13.6%), followed by the 14 to 15 age range (4.6%), and the 12 to 13 age range (1.2%). In terms of socioeconomic status, there was a greater prevalence of youth currently smoking below the poverty level (7.6%) than at or above the poverty level (6.2%). An examination of regional differences across the United States demonstrated the highest prevalence of smoking among adolescents in the Midwest (7.8%) and South (7.2%) regions, followed by the Northeast (5.7%) and West (5.1%) regions. Results from these epidemiological studies underscore the continued prevalence of cigarette smoking among adolescents. Prevention and control measures that reduce smoking in among adolescents can improve the nation's short- and long-term health.
Tobacco laws and regulation In most developed countries, the minimum age of tobacco usage and purchase is 18, or the age of majority. IThe Public Health Cigarette Smoking Act of 1969 banned all tobacco marketing advertising on television and radio, with many countries following in later years in the US. In 2012, Australia became the first country in the world to mandate standardized plain packaging intended to make cigarettes less appealing to new and existing smokers, especially adolescents and those focused on a personal brand image. Since then, more countries have adopted plain packaging and large warning labels, especially European countries like Belgium, France, and the United Kingdom, among others.
Stages in youth smoking Youth who begin smoking pass through various stages, each influenced by a variety of factors, before becoming a daily smoker. The stages can progress in any direction and stop or restart any number of times.
Stage 1: Pre-contemplation/preparation – Youth in this stage have never smoked and most likely have minimal desires to begin smoking. Adolescents in this stage are likely impervious to the effects of social pressures for smoking or do not view smoking in a positive light.
Stage 2: Contemplation/Preparation – An adolescent's beliefs about smoking are beginning to change as they begin to contemplate smoking. Youth will often develop attitudes or envision what smoking will be like before engaging initiating. Notably, these attitudes towards smoking may often be negative, but are not as salient nor impactful to the adolescent because of either positive media messages or role models (i.e. parents who are smokers). Adolescents in this stage begin to consider the function of smoking, with popular reasons including smoking to be cool or independent, reduce social anxiety, and regulate emotions.
Stage 3: Initiation – This stage consists of an adolescent trying an initial cigarette(s). Typically, there are stronger peer or familial influences motivating this initial behavior. Adolescents may also desire to improve their self-image if they are receiving minimal approval from their desired peers further increasing the chances of initiation.
Stage 4: Experimentation – During this stage, there is a steady increase in the frequency of cigarette use, as well as the various situations in which cigarettes are used. There is an imbalance between positive and negative values placed on cigarettes, such that an adolescent adopts increasingly positive views on cigarette smoking. An adolescent smoker in this stage is not guaranteed to be a regular smoker and still has the option of quitting. Among smokers in this category who are likely to become regular smokers, the negative aspects of smoking such as the burning sensation or heat are reduced, and more positive benefits are emphasized. While there can be acute initial positive effects from smoking (i.e. increased heart rate and nervous system stimulation), smoking during this and the subsequent stage may be associated with some of the more severe physiological consequences of smoking. Additionally, youth in this stage may begin to associate themselves with a personal identity of being a smoker as they are learning how to smoke (i.e. how to handle a cigarette, inhale correctly, etc.).
Stage 5: Regular Smoking – Smoking throughout this stage becomes less infrequent and more regular. Regular smoking in youth can vary from smoking at social gatherings or smoking on a majority of weekdays. Adolescents in this category are not characterized as smoking daily or in high rates.
Stage 6: Established/Daily Smoking – Not all adolescent smokers from the previous stage move to this stage, although a large proportion do progress to daily smoking. Adolescent smokers in this stage may begin to experience symptoms associated with nicotine dependence such as strong cravings or withdrawal symptoms. At this point, a combination of physiological and biological factors maintains the smoking behavior as part of the adolescent's self-regulation.
Previous research has examined the differential effects various influences can have at different stages of smoking. Connectedness to one's family, and being a member of a Hispanic or Asian ethnic group, were found to be protective against smoking across never smokers, experimenters, and regular smokers. Risk factors across all three smoking status' included maternal smoking or greater depressive symptoms. Maternal smoking may be a greater risk factor among daughters than sons. An additional major risk factor is alcohol use, which has been demonstrated as being more influential during the earlier stages of smoking. Research shows that smoking and alcohol use often co-occur in adolescents.
Causes Demographic factors
Research has shown that there are certain personal factors that are correlated with higher usage of cigarettes and other tobacco products. Age has been identified as a risk factor, such that older adolescents are more likely to have higher rates of regular cigarette and other tobacco product use than younger adolescents. However, older adolescents have a reduced risk of initiation smoking with reasoning stemming around an older adolescent being less susceptible than a younger adolescent in engaging in the initial smoking process. In terms of gender, males smoke more cigarettes per day, use cigarettes with higher nicotine content, and inhale smoke more deeply. Males have also demonstrated increased satisfaction from their cigarette, as well as shorter latency between the time they wake up in the morning and when they have their first cigarette, which are signs of greater nicotine dependence. Females continue to experience environmental pressure to smoke. In an examination of gender differences in adolescent smoking, Branstetter and colleagues (2012) found that females were more often surrounded by family members and romantic partners that smoked cigarettes.