Tobacco Use Initiation

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In 2018, 2.3% of children and adolescents aged 12 to 17 began smoking cigarettes in the past year.

Summary graph for Tobacco Use Initiation, Click to see detailed view of graph

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Introduction

Because cigarette smoking typically begins during adolescence, tobacco use is often described as a “pediatric disease.” Nearly 90 percent of adult daily smokers in the United States began smoking by age 18, and 98 percent first smoked by age 26. Initiation of smoking during adolescence is linked to persistent smoking in adulthood and the many adverse health effects caused by smoking.

Understanding trends in youth initiation of tobacco products – including cigarettes, electronic cigarettes, cigars, and smokeless tobacco – enables policy makers to target prevention resources more effectively. Effective strategies to reduce youth initiation of tobacco use include federal regulation of tobacco products; significant increases in tobacco prices, including excise taxes; smokefree air laws; restrictions on tobacco advertising and promotion; restricting the availability of tobacco products to youth; mass-media public education campaigns; and full implementation of comprehensive state and community tobacco control programs. On December 20, 2019, the President signed legislation to amend the Federal Food, Drug, and Cosmetic Act, and raise the federal minimum age of sale of tobacco products from 18 to 21 years.

Measure

The percentage of individuals among those aged 12 to 17 years and 18 to 25 years who said they had initiated cigarette smoking during the past 12 months.

The percentage of individuals among those aged 12 to 17 years and 18 to 25 years who said they had initiated cigar smoking during the past 12 months.

The percentage of individuals among those aged 12 to 17 years and 18 to 25 years who said they had initiated smokeless tobacco use during the past 12 months.

The percentage of individuals among those aged 12 to 17 years and 18 to 25 years who said they had initiated use of any of these tobacco products during the past 12 months.

Note: Cigars include premium cigars, little filtered cigars, and cigarillos.

Note: E-cigarettes are not included in the tobacco-related questions of the National Household Survey on Drug Use and Health that is used for the data source of these measures.

Healthy People 2020 Target

  • Reduce the initiation of the use of tobacco products by children and adolescents aged 12 to 17 years to 5.8 percent.
  • Reduce the initiation of the use of cigarettes by children and adolescents aged 12 to 17 years to 4.3 percent.
  • Reduce the initiation of the use of smokeless tobacco products by children and adolescents aged 12 to 17 years to 0.6 percent.
  • Reduce the initiation of the use of cigars by children and adolescents aged 12 to 17 years to 2.9 percent.
  • Reduce the initiation of the use of tobacco products by young adults aged 18 to 25 years to 8.9 percent.
  • Reduce the initiation of the use of cigarettes by young adults aged 18 to 25 years to 6.4 percent.
  • Reduce the initiation of the use of smokeless tobacco products by young adults aged 18 to 25 years to 0.2 percent.
  • Reduce the initiation of the use of cigars by young adults aged 18 to 25 years to 4.3 percent.

Healthy People 2020 is a set of goals set forth by the Department of Health and Human Services.
Note: Goals are indicated as blue line on Detailed Trend Graphs.

Data Source

Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Use and Health, 2002-2018.

Trends and Most Recent EstimatesHelp with navigating the graphs and data tables

By Type of Tobacco Product, Excluding E-cigarettes

Ages 12-17
Initiation of the use of cigarettes, cigars, or smokeless tobacco among children and adolescents aged 12-17 years by type of tobacco product, 2002-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigarettes, cigars, or smokeless tobacco among children and adolescents aged 12-17 years by type of tobacco product, 2002-2018 Cigarettes, Cigars and Smokeless TobaccoClick to see the detailed trend graph for Cigarettes, Cigars and Smokeless Tobacco 4.6 4.2 - 5.0
CigarettesClick to see the detailed trend graph for Cigarettes 2.3 2.0 - 2.6
Smokeless TobaccoClick to see the detailed trend graph for Smokeless Tobacco 1.2 1.0 - 1.4
CigarsClick to see the detailed trend graph for Cigars 2.0 1.7 - 2.2
Ages 18-25
Initiation of the use of cigarettes, cigars, or smokeless tobacco among young adults aged 18-25 years by type of tobacco product, 2002-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigarettes, cigars, or smokeless tobacco among young adults aged 18-25 years by type of tobacco product, 2002-2018 Cigarettes, Cigars and Smokeless TobaccoClick to see the detailed trend graph for Cigarettes, Cigars and Smokeless Tobacco 7.1 7.1 - 6.6
CigarettesClick to see the detailed trend graph for Cigarettes 3.4 3.0 - 3.7
Smokeless TobaccoClick to see the detailed trend graph for Smokeless Tobacco 1.2 1.0 - 1.4
CigarsClick to see the detailed trend graph for Cigars 3.7 3.3 - 4.0

Cigarettes, Cigars and Smokeless Tobacco

Ages 12-17 by Sex
Initiation of the use of cigarettes, cigars, or smokeless tobacco among children and adolescents aged 12-17 years by sex, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigarettes, cigars, or smokeless tobacco among children and adolescents aged 12-17 years by sex, 2008-2018 Both SexesClick to see the detailed trend graph for Both Sexes 4.6 4.2 - 5.0
MaleClick to see the detailed trend graph for Male 5.0 4.4 - 5.5
FemaleClick to see the detailed trend graph for Female 4.2 3.7 - 4.8
Ages 18-25 by Sex
Initiation of the use of cigarettes, cigars, or smokeless tobacco among young adults aged 18-25 years by sex, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigarettes, cigars, or smokeless tobacco among young adults aged 18-25 years by sex, 2008-2018 Both SexesClick to see the detailed trend graph for Both Sexes 7.1 7.1 - 6.6
MaleClick to see the detailed trend graph for Male 8.1 7.3 - 8.9
FemaleClick to see the detailed trend graph for Female 6.2 5.5 - 6.8
Ages 12-17 by Race/Ethnicity
Initiation of the use of cigarettes, cigars, or smokeless tobacco among children and adolescents aged 12-17 years by race/ethnicity, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigarettes, cigars, or smokeless tobacco among children and adolescents aged 12-17 years by race/ethnicity, 2008-2018 All RacesClick to see the detailed trend graph for All Races 4.6 4.2 - 5.0
Non-Hispanic WhiteClick to see the detailed trend graph for Non-Hispanic White 5.9 5.3 - 6.5
Non-Hispanic BlackClick to see the detailed trend graph for Non-Hispanic Black 3.2 2.3 - 4.1
HispanicClick to see the detailed trend graph for Hispanic 3.5 2.7 - 4.2
Ages 18-25 by Race/Ethnicity
Initiation of the use of cigarettes, cigars, or smokeless tobacco among young adults aged 18-25 years by race/ethnicity, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigarettes, cigars, or smokeless tobacco among young adults aged 18-25 years by race/ethnicity, 2008-2018 All RacesClick to see the detailed trend graph for All Races 7.1 7.1 - 6.6
Non-Hispanic WhiteClick to see the detailed trend graph for Non-Hispanic White 8.4 7.6 - 9.2
Non-Hispanic BlackClick to see the detailed trend graph for Non-Hispanic Black 4.4 3.3 - 5.5
HispanicClick to see the detailed trend graph for Hispanic 5.8 4.8 - 6.8
By Age
Initiation of the use of cigarettes, cigars, or smokeless tobacco among children, adolescents and young adults by age at initiation, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigarettes, cigars, or smokeless tobacco among children, adolescents and young adults by age at initiation, 2008-2018 Ages 12-17Click to see the detailed trend graph for Ages 12-17 4.6 4.2 - 5.0
Ages 18-25Click to see the detailed trend graph for Ages 18-25 7.1 7.1 - 6.6

Cigarettes

Ages 12-17 by Sex
Initiation of the use of cigarettes among children and adolescents aged 12-17 years by sex, 2002-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigarettes among children and adolescents aged 12-17 years by sex, 2002-2018 Both SexesClick to see the detailed trend graph for Both Sexes 2.3 2.0 - 2.6
MaleClick to see the detailed trend graph for Male 2.1 1.7 - 2.5
FemaleClick to see the detailed trend graph for Female 2.5 2.1 - 2.9
Ages 18-25 by Sex
Initiation of the use of cigarettes among young adults aged 18-25 years by sex, 2002-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigarettes among young adults aged 18-25 years by sex, 2002-2018 Both SexesClick to see the detailed trend graph for Both Sexes 3.4 3.0 - 3.7
MaleClick to see the detailed trend graph for Male 3.4 3.4 - 2.9
FemaleClick to see the detailed trend graph for Female 3.3 3.3 - 2.8
Ages 12-17 by Race/Ethnicity
Initiation of the use of cigarettes among children and adolescents aged 12-17 years by race/ethnicity, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigarettes among children and adolescents aged 12-17 years by race/ethnicity, 2008-2018 All RacesClick to see the detailed trend graph for All Races 2.3 2.0 - 2.6
Non-Hispanic WhiteClick to see the detailed trend graph for Non-Hispanic White 2.9 2.4 - 3.3
Non-Hispanic BlackClick to see the detailed trend graph for Non-Hispanic Black 1.4 0.8 - 2.0
HispanicClick to see the detailed trend graph for Hispanic 1.9 1.3 - 2.6
Ages 18-25 by Race/Ethnicity
Initiation of the use of cigarettes among young adults aged 18-25 years by race/ethnicity, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigarettes among young adults aged 18-25 years by race/ethnicity, 2008-2018 All RacesClick to see the detailed trend graph for All Races 3.4 3.0 - 3.7
Non-Hispanic WhiteClick to see the detailed trend graph for Non-Hispanic White 3.6 3.6 - 3.1
Non-Hispanic BlackClick to see the detailed trend graph for Non-Hispanic Black 2.3 2.3 - 1.5
HispanicClick to see the detailed trend graph for Hispanic 3.5 3.5 - 2.7
By Age
Initiation of the use of cigarettes among children, adolescents and young adults by age at initiation, 2002-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigarettes among children, adolescents and young adults by age at initiation, 2002-2018 Ages 12-17Click to see the detailed trend graph for Ages 12-17 2.3 2.0 - 2.6
Ages 18-25Click to see the detailed trend graph for Ages 18-25 3.4 3.0 - 3.7

Smokeless Tobacco

Ages 12-17 by Sex
Initiation of the use of smokeless tobacco among children and adolescents aged 12-17 years by sex, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of smokeless tobacco among children and adolescents aged 12-17 years by sex, 2008-2018 Both SexesClick to see the detailed trend graph for Both Sexes 1.2 1.0 - 1.4
MaleClick to see the detailed trend graph for Male 1.7 1.3 - 2.0
FemaleClick to see the detailed trend graph for Female 0.8 0.6 - 1.0
Ages 18-25 by Sex
Initiation of the use of smokeless tobacco among young adults aged 18-25 years by sex, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of smokeless tobacco among young adults aged 18-25 years by sex, 2008-2018 Both SexesClick to see the detailed trend graph for Both Sexes 1.2 1.0 - 1.4
MaleClick to see the detailed trend graph for Male 1.7 1.4 - 2.1
FemaleClick to see the detailed trend graph for Female 0.7 0.5 - 1.0
Ages 12-17 by Race/Ethnicity
Initiation of the use of smokeless tobacco among children and adolescents aged 12-17 years by race/ethnicity, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of smokeless tobacco among children and adolescents aged 12-17 years by race/ethnicity, 2008-2018 All RacesClick to see the detailed trend graph for All Races 1.2 1.0 - 1.4
Non-Hispanic WhiteClick to see the detailed trend graph for Non-Hispanic White 1.7 1.4 - 2.0
Non-Hispanic BlackClick to see the detailed trend graph for Non-Hispanic Black 0.4 0.1 - 0.7
HispanicClick to see the detailed trend graph for Hispanic 1.0 0.5 - 1.4
Ages 18-25 by Race/Ethnicity
Initiation of the use of smokeless tobacco among young adults aged 18-25 years by race/ethnicity, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of smokeless tobacco among young adults aged 18-25 years by race/ethnicity, 2008-2018 All RacesClick to see the detailed trend graph for All Races 1.2 1.0 - 1.4
Non-Hispanic WhiteClick to see the detailed trend graph for Non-Hispanic White 1.7 1.3 - 2.0
Non-Hispanic BlackClick to see the detailed trend graph for Non-Hispanic Black 0.8 0.3 - 1.2
HispanicClick to see the detailed trend graph for Hispanic 0.4 0.2 - 0.6
By Age
Initiation of the use of smokeless tobacco among children, adolescents and young adults by age at initiation, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of smokeless tobacco among children, adolescents and young adults by age at initiation, 2008-2018 Ages 12-17Click to see the detailed trend graph for Ages 12-17 1.2 1.0 - 1.4
Ages 18-25Click to see the detailed trend graph for Ages 18-25 1.2 1.0 - 1.4

Cigars

Ages 12-17 by Sex
Initiation of the use of cigars among children and adolescents aged 12-17 years by sex, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigars among children and adolescents aged 12-17 years by sex, 2008-2018 Both SexesClick to see the detailed trend graph for Both Sexes 2.0 1.7 - 2.2
MaleClick to see the detailed trend graph for Male 2.4 2.0 - 2.7
FemaleClick to see the detailed trend graph for Female 1.6 1.3 - 1.9
Ages 18-25 by Sex
Initiation of the use of cigars among young adults aged 18-25 years by sex, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigars among young adults aged 18-25 years by sex, 2008-2018 Both SexesClick to see the detailed trend graph for Both Sexes 3.7 3.3 - 4.0
MaleClick to see the detailed trend graph for Male 4.4 3.8 - 5.0
FemaleClick to see the detailed trend graph for Female 2.9 2.4 - 3.3
Ages 12-17 by Race/Ethnicity
Initiation of the use of cigars among children and adolescents aged 12-17 years by race/ethnicity, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigars among children and adolescents aged 12-17 years by race/ethnicity, 2008-2018 All RacesClick to see the detailed trend graph for All Races 2.0 1.7 - 2.2
Non-Hispanic WhiteClick to see the detailed trend graph for Non-Hispanic White 2.5 2.1 - 2.9
Non-Hispanic BlackClick to see the detailed trend graph for Non-Hispanic Black 1.7 1.1 - 2.4
HispanicClick to see the detailed trend graph for Hispanic 1.3 0.9 - 1.8
Ages 18-25 by Race/Ethnicity
Initiation of the use of cigars among young adults aged 18-25 years by race/ethnicity, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigars among young adults aged 18-25 years by race/ethnicity, 2008-2018 All RacesClick to see the detailed trend graph for All Races 3.7 3.3 - 4.0
Non-Hispanic WhiteClick to see the detailed trend graph for Non-Hispanic White 4.5 3.9 - 5.0
Non-Hispanic BlackClick to see the detailed trend graph for Non-Hispanic Black 2.1 1.3 - 2.8
HispanicClick to see the detailed trend graph for Hispanic 2.6 1.9 - 3.3
By Age
Initiation of the use of cigars among children, adolescents and young adults by age at initiation, 2008-2018
Overview Graph Detailed Trend Graphs Most Recent Estimates (2018)
Percent 95% Confidence Interval
Thumbnail of graph for Initiation of the use of cigars among children, adolescents and young adults by age at initiation, 2008-2018 Ages 12-17Click to see the detailed trend graph for Ages 12-17 2.0 1.7 - 2.2
Ages 18-25Click to see the detailed trend graph for Ages 18-25 3.7 3.3 - 4.0

Evidence-based Resources

The Cancer Control P.L.A.N.E.T. web portal contains tobacco control resources that support collaboration, identify evidence-based approaches, and list research-tested interventions. To identify high-risk populations and prioritize cancer control efforts, state and county-level tobacco data can be found on State Cancer Profiles.

Additional Information on Tobacco Use Initiation

For the public

For health professionals

Scientific reports

Year Range

2002-2018

Recent Summary Trend Year Range

2014-2018

Summary Tables

Smoking

Recent Summary Trend

Falling

Desired Direction

Falling