Teens and smoking

DEFINITION: Tobacco smoking includes the use of cigarettes, cigars, pipes, hookahs, and e-cigarettes. Tobacco smoking often begins early in the teenage years. Most adults who smoke cigarettes report they first tried smoking before the age of eighteen.

Prevalence of Smoking

According to 2024 data from the Centers for Disease Control and Prevention (CDC), 10.1 percent of high school students and 5.4 percent of middle school students used a tobacco product at least once in the previous month. Moreover, 23.6 percent of high schoolers and 12.9 percent of middle schoolers reported trying tobacco products at least once in their lifetime. Electronic cigarettes, or e-cigarettes, have become the most common tobacco product used by youth. Beginning in 2014, e-cigarette use by middle- and high-school students surpassed their use of traditional tobacco products for the first time. That trend continued over the next decade. In 2024, 7.8 percent of high schoolers used electronic cigarettes within the last month. This was a drastic increase from the 1.5 percent reported in 2010, though rates have declined from their peak in 2015 at 16 percent. Among middle schoolers, 3.5 percent smoked an e-cigarette within the last month in 2024.

By comparison, 1.7 percent of high schoolers and 1.1 percent of middle schoolers reported smoking cigarettes in the last month in 2024, according to the CDC. Other forms of tobacco products also declined in popularity during the twenty-first century. A survey conducted by Monitoring the Future in 2015 found that among high school seniors, 20 percent had smoked hookah within the previous year; however, statistics from 2019 show that hookah smoking had declined by about 75 percent among high school seniors. By 2024, the CDC found that less than 1 percent of high school students reported smoking hookah.

Initiation and Continuation

Tobacco smoking typically begins around age eleven to thirteen years, although some youths start even earlier. Many factors influence whether a nonsmoking teen will experiment with cigarettes, including one’s genetic makeup and whether parents or other adults in the household smoke; whether friends or acquaintances smoke; exposure to tobacco marketing or to tobacco use in films or video games; psychological factors such as anxiety, depression, poor coping skills, attention deficit disorder, and low self-esteem; and beliefs about tobacco use (for example, that smoking helps kids fit in or smoking makes a person look “cool”).

One factor that has received considerable attention is the effect of exposure to tobacco marketing or to portrayals of tobacco use in the media, both of which have been found to be at least as influential in getting teens or young adults to smoke as are family, friends, or psychological factors. These factors are particularly important because avoiding such exposure is difficult. Further, the marketing of flavored e-cigarettes and other tobacco products, which often use flavors particularly appealing to teens, have led to increased use among youth. In 2024, 88.2 percent of high schoolers who used e-cigarettes reported using flavored e-cigarettes during the past month.

Simply puffing on a cigarette does not mean that a person will continue to smoke or become addicted to tobacco. Research indicates that the strongest predictors of a person’s continuing to smoke and eventually becoming addicted are low self-esteem; being impulsive and seeking novelty; feeling depressed; smoking being permitted in the home; lower socioeconomic status; and being exposed to tobacco product advertising in various media outlets, including the internet, television, and magazines.

Becoming Addicted

It was once thought that a person had to smoke daily to become addicted, but research has shown this assumption to be false. Smokers can be said to be autonomous over their tobacco use if they can quit without experiencing discomfort or without expending effort.

Analogously, most people could give up eating broccoli or liver without difficulty or without suffering any ill effects, but the majority of people who smoke more than a few cigarettes in their lifetime go on to develop symptoms of diminished autonomy (that is, they become physically and psychologically addicted). They find it difficult to quit or to cut down their smoking because they experience unpleasant symptoms. Often this occurs within only weeks of first inhaling cigarette smoke. A sizeable percentage of teens experience one or more symptoms of diminished autonomy after smoking fewer than five cigarettes in their lives, and more than 75 percent of teens experienced symptoms while smoking only a cigarette or two each week. Girls tend to become addicted more easily than boys, although the reasons for this are unknown.

Nicotine (the major ingredient in tobacco smoke), even in low doses, causes the brain to remodel itself. In response to nicotine, neurons (the basic building blocks in the nervous system) change their physical characteristics and the ways in which they communicate with each other through neurotransmitters (the chemicals that carry signals from one neuron to another). While this happens throughout the nervous system, the effects are particularly marked in the reward system, the part of the brain that is responsible for the experience of good feelings and pleasure.

The first few doses of nicotine (the first few cigarettes) sensitize the brain so that it becomes more susceptible to later doses. Thus, the effects of nicotine make it easier for the brain to become accustomed to nicotine, which makes it more difficult for a person to remove nicotine from the body by cutting down or quitting smoking.

A medical diagnosis of tobacco dependence or addiction can be made when the number of symptoms reaches a threshold specified by either the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases (ICD). Factors that predict a teen smoker’s developing a sufficient number of symptoms to meet the ICD-10 threshold include a relaxed, dizzy, or light-headed sensation after the first puff or two on a cigarette, and feeling depressed. The earlier a person begins to smoke, the greater the likelihood of that person becoming dependent and the worse the addiction (that is, the harder it becomes to quit).

Risks of Smoking

The US surgeon general has repeatedly warned of serious risks incurred by people who smoke tobacco. In a 2004 report, smoking was identified as a cause of twenty-nine diseases or serious medical conditions, including various cancers, cardiovascular and respiratory diseases, and reproductive or fertility related effects.

Cigarette smoking is considered the primary preventable cause of death, with approximately one in every five deaths in the United States (about 480,000 per year, or 1,300 per day) attributable to smoking. The diseases caused by smoking produce chronic disability in many people and are estimated to cost more than $600 billion per year in health care expenses and lost productivity in the United States alone.

It takes years of continued smoking to be affected by many of these diseases, but even teens and young adults suffer some serious consequences. For example, young women who smoke are more likely than their nonsmoking peers to experience infertility or delays in trying to become pregnant. If they become pregnant, their babies are at increased risk of low birth weight or sudden infant death syndrome (SIDS). Young adults who smoke incur the risk of early onset reductions in lung function, which would make it difficult, for example, to exercise, dance, or sing. Smoking also increases asthma-related symptoms, and children and young adults are particularly susceptible to asthma and other respiratory diseases.

All available evidence suggests that avoiding smoking is one of the best steps a person can take to remain healthy, and that quitting smoking if one has started is also beneficial. The US surgeon general has concluded that there is no safe level of exposure to tobacco smoke; secondhand smoke, or smoke in one’s immediate environment, is almost as dangerous as smoking itself.

Cessation

There are many effective ways to stop smoking. Every US state and every Canadian province has a free “quitline,” and many offer help online. Hospitals and other health care facilities offer support groups and one-on-one help, and school and college health services usually provide information and support. For persons who need additional help, various over-the-counter nicotine-replacement products (such as patches, gum, and lozenges) are available, as are prescription medications.

Bibliography

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