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, about half the smokers had tried to quit at least once in the past year. On top of that, about 1 in 8 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. Cigars and other forms of combustible tobacco (tobacco that is burned and smoked) are also commonly used by high school teens. (There’s more on this in the section called “Other forms of tobacco favored by young people.”)

Children and teens are easy targets for the tobacco industry. They’re often influenced by TV, movies, the Internet, 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 — kids 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

In 2011, 19% of high school girls and 28% of high school boys used some form of tobacco at least one day in the month before the survey. Studies have found that nearly all first use of tobacco takes place before high school graduation.

According to the 2012 Surgeon General’s Report, very few people start smoking after age 25. Nearly 9 out of 10 adult smokers started by age 18; 99% started by age 26.

The younger you are when you begin to use tobacco, the more likely you are to use it when you are an adult. And people who start regularly using tobacco when they are younger are more likely to have trouble quitting than people who start later in life.

This means if we can keep kids tobacco free until age 18, most will never start using it.

Kids who smoke have smoking-related health problems

Cigarette smoking causes serious health problems in 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 that are worse and happen more often
• 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. According to the 2012 Surgeon General’s Report:

“Of every three young smokers, only one will quit, and one of those remaining smokers will die from tobacco-related causes. Most of these young people never considered the long-term health consequences associated with tobacco use when they started smoking; and nicotine, a highly addictive drug, causes many to continue smoking well into adulthood, often with deadly consequences.”

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 smoking. 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 smokers than non-users.

Smoking bans mean more promotion of spit or smokeless tobacco

Unfortunately, the new smoking bans in many states may have an unintended effect on the use of spit and other smokeless tobacco. As recommended by the Centers for Disease and Prevention (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 smoking 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’s no proof that spit tobacco or any other oral tobacco products help smokers quit smoking. Unlike US Food and Drug Administration (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 2011 survey by the CDC. (Middle school includes children in grades 6, 7, and 8.)

• More than 7% 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 4% of the students had smoked cigarettes, and 3.5% had smoked cigars. About 2% 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.

Tobacco use in high school students

The most recent tobacco numbers for high school students come from the 2011 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 23% 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 (18%) smoked cigarettes. Girls (16%) were less likely to smoke than boys (20%). White students (22%) were more likely to smoke than black (14%), or Hispanic/Latino (15%) students.
• About 13% of high school students had smoked cigars in the last 30 days. Male students (18%) were more likely to smoke cigars than female students (8%).
• About 8% of high school students reported using spit or other smokeless tobacco at least once in the 30 days before the survey. About 13% of all the boys and about 2% of all the girls surveyed had used some form of smokeless tobacco.
• About half of all the school students who reported that they still smoked had tried to quit at least once during the year before.
• Other tobacco use among high school students included pipes (about 4%), bidis (about 2%), and kreteks (about 2%).