Tobacco Use Initiation

Because cigarette smoking typically begins during adolescence, smoking is often described as a “pediatric disease.”  Nearly 90 percent of adults in the United States who smoke daily began smoking by age 18, and 98 percent first smoked by age 26. Nicotine is highly addictive; initiation of smoking during adolescence is linked to persistent smoking in adulthood and the many adverse health effects caused by smoking. Further, exposure to nicotine during adolescence may harm normal brain development, which continues until about age 25.  Specifically, nicotine exposure during adolescence may impair development of brain regions involved in attention, learning, and impulse control, and it may prime the brain for addiction to other drugs.

Cigarettes are not the only tobacco products taken up during adolescence. Reports show use of other tobacco products, such as electronic cigarettes, also begins in adolescence. Understanding   trends in youth initiation of tobacco products – including cigarettes, electronic cigarettes, cigars, nicotine pouches, and smokeless tobacco – helps policy makers determine how to allocate prevention resources more effectively. Effective strategies to reduce youth initiation of tobacco use include federal regulation of tobacco products; comprehensive smokefree and tobacco-free policies; increasing excise taxes; 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, legislation was enacted 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.