Adolescents and Cigarette Smoking
Teens Appear to Be Using Tobacco at an Increasing Rate
Dec 8, 2008
Every day, approximately 4,400 American teenagers try their first cigarettes. Currently, three million adolescents under age 18 smoke cigarettes. 25% of adolescents smoke before they graduate from high school, and 90% of adults who smoke report having started before the age of 18. (Centers for Disease Control and Prevention. Cigarette use among high school students—United States, 1991-2005. MMWR 2006;55(26):724-726)
While teen smoking steadily declined between 1997 and 2003, that trend has stabilized—and may be reversing. The percentage of 10th and 12th graders who smoke actually increased between 2003 and 2005.
The Tobacco Master Settlement Agreement reached in 1998 was one of the factors responsible for a transient decline in teen smoking: Advertising targeted toward adolescents decreased, and tobacco costs increased due to industry efforts to recover financial losses.
Risk Factors for Teen Smoking
Risk factors for smoking—and responses to intervention—differ between adolescent and adult populations:
- Race: White teens consistently smoke more than their Hispanic and African-American counterparts
- Educational goals: Students who plan to attend college have lower smoking rates than those who have no such plans
- Psychiatric disorders: Attention-deficit disorder and depression have been linked to higher rates of adolescent smoking
- Stress: Home and school stressors contribute to adolescent smoking tendencies
- Peer pressure: Adolescents are particularly susceptible to encouragement from friends who smoke
- Parental smoking: Teens whose parents use tobacco are much more likely to do so themselves
- Media advertising: When advertising targeted toward adolescents was banned in 1998, teen smoking declined. There is a direct relationship between the number of exposures to advertising and teens’ abilities to recall ads
- Personal beliefs: Teens are less likely to fear the long-term adverse consequences of tobacco use
(Adapted from Sunday SR, et al. Smoking in adolescence: what a clinician can do to help. Med Clin North Am 2004;88(6):1495-1515)
Smoking Cessation Interventions for Teens
Smoking cessation techniques for adolescents include formalized programs, community interventions, and medications. Since adolescents are somewhat mistrustful of adult authority figures—and since they don’t typically volunteer information about smoking unless specifically asked—their cooperation should be elicited through age-appropriate review of program goals and expectations and an explanation of medications’ side effects and benefits.
- Counseling: Cognitive behavioral therapy improves smoking cessation rates. (McDonald P, et al. Better practices for youth tobacco cessation: evidence of review panel. Am J Health Behav 2003:27(supp 2):S144-158)
- Medications: Nicotine replacement therapy (patch, lozenges, inhaler or gum) appears to decrease the number of cigarettes smoked, but doesn’t necessarily improve abstinence at 12 months. (Smith TA, et al. Nicotine patch therapy in adolescent smokers. Pediatrics 1996;98(4pt1):659-667). Although no psychoactive drugs are currently licensed by the FDA for adolescent smoking cessation, studies show that bupropion (Zyban, Wellbutrin) is safe and effective, providing abstinence rates of up to 27% at six months. Chantix is not currently labeled for adolescent use.
- Combination therapy: The use of counseling along with medications results in improved abstinence rates. However, the use of nicotine replacement in conjunction with bupropion does not significantly improve cessation rates.
- Community-based programs: School-based prevention programs typically only have short-term effects on teens. Those programs that are most successful focus on the immediate consequences of smoking. School-enforced smoking bans decrease smoking rates by up to 40%.
- Access to tobacco is another important variable. Prior to passage of the PACT Act in 2003, children as young as 11 could easily obtain cigarettes online.
Tobacco remains the leading cause of preventable death in the US. Adolescents who avoid initial pressures to smoke are far less likely to smoke as adults.
