Youth Smoking

Special Populations > Youth Smoking

Adolescents and teen smokers can be more susceptible to nicotine addiction and face unique developmental challenges in the initiation and cessation of cigarette smoking. They are an important group to target with regard to both prevention and cessation efforts.

Youth Smoking

Cigarette smoking continues to be the leading cause of preventable morbidity and mortality worldwide.10,12,18 In the U.S., there are currently over 60 million daily smokers and this number is increasing by approximately 1 million people each year.15 Every day, more than 4000 adolescents under the age of 18 experiment with their first cigarette and over 1300 of them go on to become daily smokers.7,8,16,17 In fact, over 90% of adults who ever smoked daily tried their first cigarette before age 21, with a mean initiation age of 10.7 years for boys and 11.4 years in girls.1,14,17 The CDC has also reported that young adults aged 18–24 and 25–44 continue to have the highest prevalence of smoking of all age groups—22.2% and 22.8%, respectively.12 These statistics illustrate why smoking needs to be prioritized as a major public health concern among today's youth.

Social Influences and Risk Factors

A number of studies have been dedicated to better understanding and hopefully predicting smoking initiation in young adults. These studies have found many potential predictors of young adult daily smoking although parents' baseline smoking consistently emerged as the strongest long-term predictor followed closely by peer baseline smoking.12,13 It is well established that exposure to family members and peers who smoke significantly increases the likelihood of adolescent smoking, but the impact of parental behaviors is not limited to simply the action of smoking.4,12,15 Studies have found that adolescents are less likely to smoke when parents:11,15

  • Restrict exposure to smoking (e.g., not permitted indoors)
  • Practice nonsmoking behaviors (e.g., sitting in nonsmoking sections)
  • Engage in antismoking socialization
  • Communicate openly with adolescents regarding smoking behavior

The quality and frequency of communication plays a significant role in predicting youth smoking independent of adult smoking behavior. The literature suggests that parents and their children have different perceptions regarding each other’s feelings about smoking and any anti-smoking communication that may have occurred in the household.19 This is significant as the research shows that even when a parent smokes, adolescents who expect negative consequences from parents for smoking have a lower rate of initiation than those who expect neutral or positive consequences.11,16 Studies found that youth whose parents did not smoke were more likely to disagree with their parents on:18

  • The presence of specific rules about smoking
  • Parent’s acceptance of youth smoking
  • Parent’s concern for youth’s health related to smoking

These findings suggest that many nonsmoking parents may believe that their children abstaining from cigarettes is understood, so the need to make explicit rules or conversation with their children is unnecessary.2,11 In addition to communication, certain other parenting practices have been found to be associated with current smoking in adolescents, including:3,11

  • Lack of parental concern and social support
  • Lack of parent-child closeness
  • Parent-child conflict
  • Weak or excessive controls
  • Inconsistent discipline
  • Ineffective parental monitoring

Reasons for Smoking

Poor parental practices tend to increase the likelihood of adolescent smoking, but are not the sole factor contributing to initiation. In response to these practices, some adolescents tend to rebel against their parents in the form of smoking cigarettes, but most initiate smoking for a variety of other reasons such as:5,8

  • Social norms
  • Advertising
  • Popular media
  • Peer influence
  • Parental smoking
  • Weight control
  • Curiosity

Understanding why adolescents initiate smoking is simpler than understanding why they continue despite countless negative consequences. Adolescents are just as motivated as adults to quit and are often faced with more difficult challenges. Over 82% of 11 to 19 year olds who smoke contemplate quitting and over 70% have made a serious attempt within the first year. 8,9,19 However, of those who quit, 34% relapse within the first week and up to 92% relapse within the first year; both higher rates than seen in adults.8,19 Research attributes these patterns to a number of factors facing adolescents including:8

  • Underestimation of addictive potential of nicotine
  • Overconfidence in ability to quit anytime desired
  • Nicotine dependence establishing even more rapidly among adolescents on the biological level
  • Tendency to choose unassisted cessation methods, decreasing likelihood of success by 50%, compared to assisted methods

The culminating effect of these factors plays a major role in the struggle adolescents face when attempting to quit. In the United States, only 4% of smokers aged 12 to 19 successfully quit each year and less than 2% do so unassisted.8 Many adolescents have misguided perceptions about cigarettes that without a doubt influence their decisions to smoke or continue to smoke. Most of these misperceptions relate to the health-related effects of tobacco use. A recent study found that adolescents are roughly three times more likely to smoke if they:16

  • Believe smoking-related long-term risks are less likely to occur
  • Believe smoking-related short-term risks are less likely to occur
  • Believe smoking-related benefits are more likely to occur.

Providers and Youth

Perception of health risks is evidently a crucial factor that can affect an adolescent’s decision to smoke. Initially forming in early childhood, these perceptions continuously develop in response to external influences from interactions with peers, educators, professionals and advertisements.8,11,12 Numerous health education programs in elementary and middle schools teach students about the effects of tobacco and other drugs, but these programs are being removed from schools at an alarming rate, mainly due to budget cuts.14,16 With the decreasing influence of teachers, medical professionals need to accept an increasing role to educate the youth on the dangers of tobacco. Unfortunately, recent studies highlight a concerning trend that adolescent smokers are identified and counseled to quit in only:8,16,19

  • 33% of physician visits
  • 25% of otolaryngologist visits
  • 20% of dental visits
  • < 1% of other specialized visits (e.g. optometrist, gynecologists, etc.)

Health care professionals have the unique opportunity to counsel youth on the benefits of tobacco cessation from the perspective of a certified health expert in order to help eliminate common misconceptions. Increasing the rates of professional counseling during visits is a relatively easy task that involves patience and discipline. Applying the  Five A’s Model, or the abbreviated Two A’s and R Model, is highly recommended for all health-service providers. The model serves as a basic platform for all tobacco cessation services because it allows the provider to acknowledge and assess cigarette smoking in youth as well as provide expert advice and professional references in a timely fashion without requiring full commitment from the patient. For more information on the Five A’s Model as well as treatment plans, please click here.

 

Last updated: December 07, 2011
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References
  1. American Lung Association. Adolescent smoking statistics 2003 Available at: http://www.lungusa.org/site/apps/s/content.asp?c=dvLUK9O0E&b=34706&ct=66697
  2. Andersen, M. R., Leroux, B. G., Marek, P. M., Peterson, A. V., Jr., Kealey, K. A., Bricker, J., et al. (2002). Mothers’ attitudes and concerns about their children smoking: Do they influence kids? Preventive Medicine, 34(2), 198–206.
  3. Aquilino, W. S., & Supple, A. J. (2001). Long-term effects of parenting practices during adolescence on well-being outcomes in young adulthood. Journal of Family Issues, 22(3), 289–308.
  4. Audrain-McGovern, J., Rodriguez, D., Tercyak, K. P., Neuner, G., & Moss, H. B. (2006). The impact of self-control indices on peer smoking and adolescent smoking progression. Journal of Pediatric Psychology, 31, 139–151.
  5. Baker T.B., Brandon T.H., Chassin L. (2004) Motivational influences on cigarette smoking. Annual Review of Psychology, 55,463-91.
  6. Burton, D., Graham, J. W., Johnson, C., Uutela, A., Vartiainen, E., & Palmer, R. F. (2010). Perceptions of smoking prevalence by youth in countries with and without a tobacco advertising ban. Journal Of Health Communication, 15(6), 656-664.
  7. Centers for Disease Control and Prevention. Youth and tobacco use: current estimates. 2006. Available at: http://www.cdc.gov/tobacco/youth/index.htm.
  8. Fiore, M. C., Jaen, C. R., Baker, T. B., & al., e. (2008). Treating Tobacco Use and Dependence 2008 Update.  Clinical Practice Guideline. In U.S. Department of Health and Human Services (Ed.). Rockville, MD: U.S. Department of Health and Human Services. http://www.ahrq.gov/path/tobacco.htm
  9. Hollis J.F., Polen M.R., Lichtenstein E, et al. (2003). Tobacco use patterns and attitudes among teens being seen for routine primary care. American Journal of Health Promotion, 17, 231-9.
  10. Kaufman, N., & Yach, D. (2000). Tobacco control: Challenges and prospects. Bulletin of the World Health Organization, 78, 867.
  11. Mahabee-Gittens, E., Ding, L., Gordon, J. S., & Huang, B. (2010). Agreement between parents and youths on measures of antismoking socialization. Journal Of Child & Adolescent Substance Abuse, 19(2), 158-170.
  12. Otten, R., Bricker, J. B., Liu, J., Comstock, B. A., & Peterson, A. V. (2011). Adolescent psychological and social predictors of young adult smoking acquisition and cessation: A 10-year longitudinal study. Health Psychology, 30(2), 163-170.
  13. Otten, R., Engels, R. C., van de Ven, M. O., & Bricker, J. B. (2007). Parental smoking and adolescent smoking stages: The role of parents’ current and former smoking, and family structure. Journal of Behavioral Medicine, 30, 143–154.
  14. Pingree, S., Boberg, E., Patten, C., Offord, K., Gaie, M., Schensky, A., & ... Ahluwalia, J. (2004). Helping Adolescents Quit Smoking: A Needs Assessment of Current and Former Teen Smokers. Health Communication, 16(2), 183-194.
  15. Rodriguez, D., Tscherne, J., & Audrain-McGovern, J. (2007). Contextual consistency and adolescent smoking: Testing the indirect effect of home indoor smoking restrictions on adolescent smoking through peer smoking. Nicotine & Tobacco Research, 9(11), 1155-1161.
  16. Song, A. V., Morrell, H. R., Cornell, J. L., Ramos, M. E., Biehl, M., Kropp, R. Y., & Halpern-Felsher, B. L. (2009). Perceptions of smoking-related risks and benefits as predictors of adolescent smoking initiation. American Journal Of Public Health, 99(3), 487-492.
  17. Substance Abuse and Mental Health Services Administration. Results from the 2005 National Survey on Drug Use and Health. Office of Applied Studies, NSDUH Series H-27, DHHS Publication No. SMA -5-4061. Rockville, MD, 2005.
  18. Sussman, S., Sun, P., & Dent, C. W. (2006). A meta-analysis of teen cigarette smoking cessation. Health Psychology, 25(5), 549-557.
  19. Van Zundert, R. M., Ferguson, S. G., Shiffman, S., & Engels, R. (2011). Dynamic effects of craving and negative affect on adolescent smoking relapse. Health Psychology, Advanced online publication, doi: 10.1037/a0025204.