Understanding the problem

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

The bad news: The rates of tobacco smoking among teenagers are still higher than those of adults. On top of that, about 1 in 7 high school boys use some form of spit or other type of smokeless tobacco. More than 2% of high school girls use spit or smokeless tobacco.

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 2007 survey from the U.S. Centers for Disease Control and Prevention (CDC) found that 50% of high school students had tried cigarette smoking at some point. In 2008, more than 1 out of 4 kids age 12 or older were current tobacco users -- this comes out to about 71 million American teens. Studies have shown that, for the most part, people who do not start using tobacco when they are teens never start using it.

The younger you are when you begin to smoke, the more likely you are to be an adult smoker. Almost 90% of adults who are regular smokers started at or before the age 19. And people who start smoking at younger ages are more likely to develop long-term nicotine addiction 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, including:

• coughing
• shortness of breath
• 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:

• early heart disease and stroke
• gum disease and tooth loss
• chronic lung diseases, like emphysema and bronchitis
• hearing loss
• vision problems, such as macular degeneration

Each day, more than 3,500 people under the age of 18 try their first cigarette and another 1,100 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. Almost 3 out of every 4 regular smokers in high school have already tried to quit but failed. Yet out of 100 high school smokers, only 3 think they will still be smoking in 5 years. Studies show that about 60 of them will still be smoking 7 to 9 years later.

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 progress 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 U.S. middle school students come from a 2006 survey by the CDC.

• About 10% of 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.

• About 6% 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 11%) were slightly more likely than girls (about 8%) to use some form of tobacco. Although girls were slightly more likely to smoke cigarettes, boys were more likely to use spit or other 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 2007 CDC survey. Some of these numbers are slightly lower than they were in 2005. Keep in mind that these studies are done with students that 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 spit 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 (12%), Hispanic/Latino (17%), or Asian (11%) students.

• About 8% of high school students reported using spit or other smokeless tobacco at least once in the 30 days before the survey. More than 13% of all the boys and more than 2% of all the girls surveyed had used some form of smokeless tobacco.

• 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 (8%).

• Of all the high school students who reported that they smoked, 61% had tried to quit at least once during the year before the survey but only 12% were successful.

• Other tobacco use among high school students included pipes (about 4%), bidis (about 3%), and kreteks (about 3%).

Other forms of tobacco favored by young people

Kreteks and bidis

Clove and other flavored cigarettes are used mostly by younger smokers. They are nearly ideal in design as a "trainer cigarette" -- giving kids another way to experiment with tobacco and get addicted to nicotine. The false image of these products as clean, natural, and safer than regular cigarettes seems to attract some young people who may otherwise not start smoking. But they are not safer than cigarettes, and each has its own additional problems.

New federal laws have banned flavored cigarettes as of October 2009 -- it is not illegal to have or smoke them, but it is illegal to sell them in the U.S. Tobacco companies are already working around this by making flavored small cigars (see the next section) as a replacement product.

Clove cigarettes (kreteks)

Clove cigarettes, also called kreteks ("kree-teks"), are a tobacco product with the same health risks as cigarettes. They are imported mainly from Indonesia or other Southeast Asian countries. Kreteks contain 60% to 70% tobacco and 30% to 40% ground cloves, clove oil, and other additives. They deliver more nicotine, carbon monoxide, and tar than regular cigarettes.

Kretek smokers have higher risks of asthma and other lung diseases than non-smokers. Regular kretek smokers have up to 20 times the risk for abnormal lung function compared with non-smokers. But kretek users often have the mistaken notion that smoking clove cigarettes is a safe alternative to smoking tobacco -- this is not true.

Flavored cigarettes (bidis)

Flavored cigarettes, called "bidis" or "beedies," are imported mainly from India or other Southeast Asian countries. They have become popular among young people in the United States in recent years. This is in part because they are sold in candy-like flavors such as chocolate, cherry, strawberry, licorice, and orange. Some people think they are safer and more natural than regular cigarettes. They tend to cost less than regular cigarettes and they give the smoker an immediate buzz.

Bidis are tobacco hand-rolled in a tendu or temburi leaf (plants native to Asia) and tied with colorful strings on the ends. Even though bidis contain less tobacco than regular cigarettes, they deliver more nicotine (the addictive chemical in tobacco) and tar, and other harmful substances such as carbon monoxide and ammonia. They are unfiltered. And because they are thinner than regular cigarettes, they require about 3 times as many puffs per cigarette.

Bidis appear to have all of the same health risks of regular cigarettes, if not more. Bidi smokers have much higher risks of heart attacks, chronic bronchitis, and some cancers than non-smokers.

Small cigars

Cigars are often thought to be less harmful, less addictive, and more stylish than cigarettes -- though this is not true. Since 1998, small cigars have been the fastest growing product on the cigar market. They look much the same as cigarettes and are also sold in packs. But because they are cigars, at this time they are not taxed or regulated the way cigarettes are. This makes them cheaper and easier for kids to get. In fact, in recent years, the number of kids who try smoking cigars has been close to or even higher than the number of those who try cigarettes.

Another appeal to youth is the flavorings commonly used in small cigars. Fruit, candy, and chocolate flavors attract kids. And U.S. laws have recently made flavored cigarettes illegal, which may prompt some to use flavored small cigars instead. It is expected that the small and flavored cigar problem will get even worse as tobacco companies take advantage of the lack of regulation of these products.

Small cigars are as addictive and deadly as cigarettes. They are often smoked the same way as cigarettes and cause many of the same types of cancer and other illnesses.

Hookahs (water pipes)

Hookah is also called narghile (nar-guh-lee) smoking. It started in Asia and the Middle East. It involves burning tobacco that has been mixed with flavors such as honey, molasses, or dried fruit in a water pipe and inhaling the flavored smoke through a long hose. Charcoal is usually used to heat the tobacco mixture, which is called shisha (she-shuh). Hookah smoking is usually a social event which allows the smokers to spend time together and talk as they pass the pipe around. It has recently become popular among younger people in Western countries.

Hookahs are marketed as being a safe alternative to cigarettes. This claim is false. The water does not filter out many of the toxins. In fact, hookah smoke has been shown to contain concentrations of toxins, such as carbon monoxide, nicotine, tar, and heavy metals, that are as high or higher than are seen with cigarette smoke.

Several types of cancer, including lung cancer, have been linked to hookah smoking. Hookah is also linked to other unique risks not associated with cigarette smoking. For example, infectious diseases including tuberculosis (which can infect the lungs or other parts of the body), aspergillus (a fungus that can cause serious lung infections), and helicobacter (which can cause stomach ulcers) may be spread by sharing the pipe or through the way the tobacco is prepared.

What parents and other concerned adults can do

Keep kids from starting

Concerned parents may have more power over whether their children start using tobacco than they think they do. In a recent study, teens whose parents often talked to them about the dangers of smoking were about half as likely to smoke as those who didn't have these discussions with their parents. This held true no matter whether or not the parents were smokers themselves.

Here are some tips for parents to help them keep their kids tobacco-free:

• Remember that despite the impact of movies, music, and TV, parents can be the greatest influence in their kids' lives.

• Talk to your children about the risks of tobacco use -- studies have shown that this works! If loved ones suffer with or died from tobacco-related illnesses, let your kids know. Let them know, for instance, that tobacco use strains the heart, damages the lungs, and can cause a lot of other problems, including cancer. Also mention what it can do to the way a person looks and smells: smoking makes hair and clothes stink, causes bad breath, and stains teeth and fingernails. Spit and smokeless tobacco cause bad breath, stained teeth, tooth decay, tooth loss, and bones loss in the jaw.

• The children of parents who smoke are much more likely to smoke themselves. But if you use tobacco, you can still make a difference. Your best move, of course, is to try to quit. Meanwhile, don't use tobacco around your children, don't offer it to them, and don't leave it where they can easily get it.

• Start talking about tobacco use when your children are 5 or 6 years old and continue through their high school years. Many kids start using tobacco by age 11. And many are addicted by age 14.

• Know if your kids' friends use tobacco. Talk about ways to say "no" to tobacco.

• Talk to your kids about the false glamorization of tobacco in the media, such as movies, TV, and magazines.

If you use tobacco yourself and don't want your children to start, know that you can still influence their decisions. You may even have more power, because you've been there. You can speak to your child firsthand about:

• how you got started and what you thought about it at the time
• how hard it is to quit
• how it has affected your health
• what it costs you, financially and socially

If you can, keep your house smoke-free. Don't smoke indoors and don't allow indoor smoking by anyone else.

Help your child quit

If your child has already started using tobacco, the CDC offers these suggestions to help them kick the habit:

• Try to avoid threats and ultimatums. Find out why your child is smoking or using other forms of tobacco. Is he or she trying to get your attention? Or maybe trying to fit in with a peer group? You may find out that just going through the teen years is quite stressful to your child.

• Show interest. Ask a few questions. Find out what changes can be made in his or her life to help your child quit smoking.

• If you smoke, try to quit. If you did smoke and have already quit, talk to your child about what it was like for you. Personalize the little problems around smoking and the big challenge of quitting. Teens and pre-teens often believe they can quit smoking whenever they want, but research shows many teens never do. Try to share these facts with them in a non-threatening way.

• Support your child. Both you and your child need to prepare for the mood swings and crankiness that can come with nicotine withdrawal. Offer your teen the 5 Ds to get through the tough times:

• Delay: The craving will eventually go away.
• Deep breath: Take a few calming deep breaths.
• Drink water: It will flush out the chemicals.
• Do something else: Find a new, healthy habit.
• Discuss: Talk about your thoughts and feelings.

• Make a list with your teen or pre-teen of the reasons why they want to quit. Refer back to this list when your child is tempted.

• Finally, reward your child when he or she quits. Plan something special for you to do together.

Helping your child quit using tobacco is one of the best parenting activities you could ever do. If you're a smoker, the second best thing may be quitting yourself.

Additional resources

More information from your American Cancer Society

The following information may also be helpful to you and your child. These materials may be ordered from our toll-free number, 1-800-227-2345.

• Guide to Quitting Smoking (also available in Spanish)

• Helping a Smoker Quit: Do's and Don'ts

• Questions About Smoking, Tobacco, and Health (also available in Spanish)

• Quitting Smoking -- Help for Cravings and Tough Situations (also available in Spanish)

• Smokeless Tobacco and How to Quit (also available in Spanish)

National organizations and Web sites*

Along with the American Cancer Society, other sources of information and support include:

American Lung Association
Toll-free number: 1-800-548-8252
Web site: www.lungusa.org
Printed quit materials are available, some in Spanish. Also offers the tobacco cessation program "Freedom from Smoking Online" at www.ffsonline.org

Centers for Disease Control and Prevention
Office on Smoking and Health
Toll-free number: 1-800-232-4636 (1-800-CDC-INFO)
Free quit support line: 1-800-784-8669 (1-800-QUIT-NOW)
TTY: 1-800-332-8615
Web site: www.cdc.gov/tobacco

Environmental Protection Agency (EPA)
Telephone: 202-272-0167
Web site: www.epa.gov
Has advice on how to protect children from secondhand smoke, a Smoke-free Homes Pledge, and other tobacco-related materials on the direct Web site, www.epa.gov/smokefree

National Cancer Institute
Toll-free number: 1-800-422-6237 (1-800-4-CANCER) for cancer information
Toll-free tobacco line: 1-877-448-7848
Tobacco quit line: 1-800-784-8669 (1-800-QUITNOW)
Web site: www.cancer.gov
Direct tobacco Web site: www.smokefree.gov
Quitting information, cessation guide, and counseling is offered, as well as information on state telephone-based quit programs

QuitNet
Web site: www.quitnet.com
Offers free, cutting edge, effective tobacco cessation services to people worldwide

*Inclusion on this list does not imply endorsement by the American Cancer Society.

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org.

References

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Last Medical Review: 09/28/2009
Last Revised: 09/28/2009