Decline in Tobacco Use Among Children, Young Adults Stalled, According to Surgeon General Report

Tobacco is the leading cause of preventable and premature death in the United States, according to a new report from the surgeon general's office. Tobacco kills more than 1,200 Americans every day, and for every tobacco-related death, two people younger than age 26 begin smoking regularly. Nearly 90 percent of these "replacement" smokers try their first cigarette by age 18, and approximately three out of four high-school smokers continue to smoke well into adulthood.

"Nearly one in three young adults between the ages of 18 and 26 smokes," said U.S. Surgeon General Regina Benjamin, M.D., at a recent news conference to introduce the report Preventing Tobacco Use Among Youth and Young Adults. "This is a higher rate than for any other age group."

Smoking early in life has substantial health risks that begin immediately in young smokers, including serious early cardiovascular damage and a reduction in lung functionality, according to the report. In addition, the younger a child is when he or she starts using tobacco, the more likely he or she is to become addicted and the more heavily addicted he or she likely will become.

But, said Benjamin, who is a family physician, comprehensive, sustained, multicomponent programs can cut youth tobacco use in half within six years.

"We know prevention is the key," she said. "Ninety-nine percent of smokers begin before the age of 25. We want to prevent our next generation from ever starting to smoke. If we can just get them to remain smoke-free 'til age 26, less than 1 percent of them will ever start."

That is why Benjamin is asking family physicians and others to help educate their younger patients to try to curb the large number of teens and young Americans who smoke or chew tobacco. "Primary care physicians … are well-respected by their patients," Benjamin said. "We always need to talk to our patients about smoking and ways to quit smoking, particularly in the primary care arena where we are dealing with adolescents and this age group. We can have a very strong effect."

Many successful tobacco cessation programs and related efforts prevent young people from starting to use tobacco, said Benjamin. These include mass media campaigns; higher tobacco prices; smoke-free laws and policies; evidence-based school programs, such as the AAFP's Tar Wars program; and sustained community efforts.

"We know what works," Benjamin said. "We know when we enact smoke-free policies, we reduce exposure to secondhand smoke, prompt smokers to quit, change social norms and support healthy decisions. When we increase the price of tobacco, smoking rates decline."

"When we educate the public with aggressive media campaigns, we inform them of the risk, encourage tobacco users to quit and prevent youth from starting," she said. "Science tells us that sustained, multicomponent programs prevent young people from starting to use tobacco."

Although the United States has made progress in reducing smoking rates during the past 10 years, including in young people, decreases in tobacco use rates have leveled off recently, according to the report. "The efforts of the early 21st century need to be reinvigorated, and additional strategies considered, to end the tobacco epidemic," says the report. "Providing and sustaining sufficient funding for comprehensive community programs, statewide tobacco control programs, school-based policies and programs, and mass media campaigns must be a priority."