The good news: The number of younger Americans who smoke has been going down since the late 1990s.

The bad news: The rates of cigarette smoking among high school juniors and seniors are still higher than those of adults. By 12th grade, more than half the smokers had tried to quit at least once in the past year. On top of that, about 1 in 7 high school boys uses some form of spit or other type of smokeless tobacco. More than 2% of high school girls use spit or smokeless tobacco. And cigars are also commonly used by high school teens.

Children and teens are easy targets for the tobacco industry. They’re often influenced by TV, movies, advertising, and by what their friends do and say. They don’t realize what a struggle it can be to quit. And having cancer, emphysema, blindness, or impotence may not seem like real concerns – children and teens don’t think much about future health outcomes.

Here we talk about tobacco use among children and teens. We also give some tips for parents, teachers, and other adults who want to keep their kids tobacco-free.

Facts about kids and tobacco

Almost all smokers start while they’re young

Nearly all first use of tobacco takes place before high school graduation. A 2009 survey from the US Centers for Disease Control and Prevention (CDC) found that nearly half of high school students had tried cigarette smoking at some point. In 2009, more than 1 out of 4 high school kids were current tobacco users.

The American Lung Association analyzed a CDC survey from 2008. Looking at adults who were regular smokers, they found 85% started smoking regularly at age 21 or younger. And 68% started at age 18 or younger.

The younger you are when you begin to smoke, the more likely you are to be an adult smoker.. And people who start regular smoking at younger ages are more likely to have trouble quitting than people who start later in life.

Kids who smoke have smoking-related health problems

Cigarette smoking causes serious health problems among children and teens. Regular teen smokers report problems such as:

• Coughing spells
• Shortness of breath, even when not exercising
• Wheezing or gasping
• More frequent headaches
• Increased phlegm (mucus)
• Respiratory illnesses
• Worse cold and flu symptoms
• Reduced physical fitness
• Poor lung growth and function
• Worse overall health
• Addiction to nicotine

As they get older, teens who continue to smoke can expect problems like:

• Gum disease and tooth loss
• Chronic lung diseases, like emphysema and bronchitis, which limit exercise and activity
• Hearing loss
• Vision problems, such as macular degeneration, which can lead to blindness
• Blood vessel disease, which can lead to heart attacks or strokes at a young age

Each day, nearly 4,000 kids under the age of 18 try their first cigarette and another 1,000 become regular, daily smokers. About one third of these kids will die prematurely from a smoking-related disease.

Most young smokers are addicted and find it hard to quit

Most young people who smoke regularly are already addicted to nicotine. In fact, they have the same kind of addiction as adult smokers. One research group studied regular smokers during high school and after graduation. While they were in high school, only 5% thought they would still be smoking in 5 years. But 7 to 9 years later, 63% were still smoking

Most teen smokers say that they would like to quit and many have tried to do so without success. Those who try to quit smoking report withdrawal symptoms much like those reported by adults.

Tobacco use is linked to other harmful behaviors

Research has shown that teen tobacco users are more likely to use alcohol and illegal drugs than are non-users. Cigarette smokers are also more likely to get into fights, carry weapons, attempt suicide, suffer from mental health problems such as depression, and engage in high-risk sexual behaviors.

Spit or smokeless tobacco use is also a big problem among kids

Spit or smokeless tobacco is a less lethal, but still unsafe, alternative to cigarettes. There are many terms used to describe tobacco that is put into the mouth, such as spit, spitless, oral tobacco, and chewing or snuff tobacco.

The use of spit or smokeless tobacco by any name can cause:

• Cancers of the mouth
• Cancers of the pharynx (throat) and larynx (voice box)
• Cancers of the esophagus (swallowing tube) and stomach
• Cancer of the pancreas
• Receding gums and gum disease, which can worsen to the point that the teeth fall out
• Pre-cancerous spots in the mouth, called leukoplakia
• Nicotine addiction

There is also a link to heart disease and stroke. And research has shown that teens who use spit or other oral tobacco are more likely to become cigarette smokers than non-users.

Smoking bans mean more promotion of spit or smokeless tobacco

Unfortunately, the new smoking bans in effect in many states may have an unintended effect on the use of spit and other smokeless tobacco. As recommended by the CDC, many schools no longer allow students, staff, parents, or visitors to smoke on school grounds, in school vehicles, or at school functions. In light of bans like this, tobacco companies are more strongly marketing their smokeless tobacco products. Many of these new tobacco products are being advertised as more discreet alternatives to cigarettes in places where smoking is not allowed.

Using spit or smokeless tobacco to quit smoking

Some companies promote using spit or smokeless tobacco as a way to help quit smoking, but there is no proof that spit tobacco or any other oral tobacco products help smokers quit smoking. Unlike FDA-approved standard treatments that have been proven to work, such as nicotine replacement, anti-depressants, nicotine receptor blockers, and behavioral therapy, oral tobacco products have not been tested to see if they can help a person stop smoking.

Look at the numbers

Tobacco use in middle school students

The most recent numbers on tobacco use among US middle school students come from a 2009 survey by the CDC. (Middle school includes children in grades 6, 7, and 8.)

• More than 8% of middle school students reported using some form of tobacco – cigarettes, spit or other oral tobacco, cigars, pipes, and flavored cigarettes like bidis or kreteks – at least once in the past 30 days.
• Over 5% of the students had smoked cigarettes, and 4% had smoked cigars. About 3% had used spit or other smokeless tobacco. Around 2% had smoked pipes and the same number had smoked bidis (about 2%). A little over 1% had smoked kreteks.
• Boys (about 10%) were more likely than girls (about 7%) to use some form of tobacco. Unlike previous years, boys were more likely to smoke cigarettes as well as use smokeless tobacco, bidis, kreteks, pipes, or cigars.

Tobacco use in high school students

The most recent tobacco numbers for high school students come from the 2009 CDC Youth Risk Behavior Survey and other CDC surveys. Keep in mind that these studies are done with students who are still in school. Those who drop out have higher rates of smoking and tobacco use.

• Nationwide, about 26% of high school students reported using some type of tobacco (cigarette, cigar, pipe, bidi, kretek, or smokeless tobacco) on at least 1 of the 30 days before the survey.
• On average, about 1 out of 5 students (20%) smoked cigarettes. Girls were almost as likely to smoke as boys. White students (23%) were more likely to smoke than black (10%), or Hispanic/Latino (18%) students.
• About 14% of high school students had smoked cigars in the last 30 days. Male students (19%) were more likely to smoke cigars than female students (9%).
• About 9% of high school students reported using spit or other smokeless tobacco at least once in the 30 days before the survey. About 15% of all the boys and more than 2% of all the girls surveyed had used some form of smokeless tobacco.
• In a 2007 survey, 61% of all the high school students who reported that they smoked or had smoked in the past had tried to quit at least once during the year before, but only 12% were successful.
• Other tobacco use among high school students included pipes (about 2%), bidis (about 2%), and kreteks (about 1%).