Tobacco Use in Youth and Adolescents

The negative health effects of active and passive tobacco exposure are well-documented. Cigarette smoking is the primary cause of preventable death and morbidity in the United States, causing atherosclerosis with associated heart disease and stroke, cancer of the lung and other organs, emphysema, and other serious health problems. Passive exposure to cigarette smoke increases the risk of sudden infant death syndrome, asthma and middle ear disease.[Metsios: 2009] [Cook: 1999] Exposure to tobacco in-utero is associated with intrauterine growth restriction[Reeves: 2008] as well as obesity during adulthood.[Power: 2010] Recent evidence suggests that maternal smoking during pregnancy may also adversely effect auditory functioning during infancy.[Peck: 2010]
Most smokers begin smoking as adolescents.[Giovino: 1995] The risk of initiating smoking during adolescence increases if there is a parent in the home that smokes,[Gilman: 2009] but the risk returns to baseline if the parent successfully quits smoking. Daily smoking during adolescence is a strong predictor of nicotine dependence during adulthood[Patton: 2006], and quitting smoking during adolescence reduces the future risk of nicotine dependence.[Van: 2010] Emphasis within the community should thus be directed toward the prevention of smoking in adolescents and on cessation in those who have initiated smoking, along with their family members who smoke. A review of the efficacy of smoking cessation programs for young people supports the use of behavioral programs that incorporate the patient's stage of readiness for change (e.g., motivational interviewing); there is little evidence to support the use of nicotine replacement systems in adolescents.[Grimshaw: 2006]
The Monitoring the Future (MTF) survey is a series of annual classroom surveys of eighth, 10th, and 12th graders conducted by researchers at the University of Michigan. The data collected through the MTF surveys showed a peak prevalence of teen smoking in 1996 and 1997 followed by a gradual decline. In 1996, for example, 21% of 8th graders surveyed reported smoking during the past month. In 1997, 37% of 12th graders reported recent use of cigarettes. In 2009, teen smoking reached its lowest prevalence since 1975, with 7% of 8th graders and 20% of 12th graders reporting smoking during the past month. [Johnston: 2009]
Individuals that use smokeless tobacco (snuff, dipping tobacco, chewing tobacco) are at increased risk for developing cancer of the oral cavity,[Critchley: 2003] [Lee: 2009] and an increased risk of cancers of the pancreas, esophagus, and stomach has been suggested.[Boffetta: 2008] In addition, smokeless tobacco use has been associated with an increased risk of myocardial infarction and stroke.[Boffetta: 2009] The use of smokeless tobacco declined in youth from the mid-1990s through the early 2000s. In recent years, however, there has been a gradual increase with 3.7% of 8th graders and 8.4% of 12th graders using smokeless tobacco in the 30 days prior to survey in 2009.[Johnston: 2009] This increase in prevalence is accompanied by a decrease in the perceived risk of smokeless tobacco use among youth, suggesting a role for increased public health education regarding the dangers of these products.


Information & Support

For Professionals

Youth Tobacco Prevention (CDC)

For Parents and Patients


Americans for Nonsmokers' Rights

American Lung Association
The American Lung Association works to fight lung disease in all forms, with a special emphasis on asthma, tobacco control, and environmental health. This site offers up-to-date information on asthma for children, teens, and adults with asthma. It also provides research information for physicians.


Quit Smoking (CDC)
Compilation of resources related to smoking cessation; Centers for Disease Control and Prevention.

Youth Tobacco Prevention (CDC)

Smokeless tobacco and how to quit (American Cancer Society)

Keeping Your Natural Beauty: A Smoker's Guide to Quitting
A commercial webpage with a number of links to reputable sites with good information on quitting smoking.


Author: Catherine Jolma, MD - 5/2010

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