Adolescent Tobacco Use

Smoking rates have declined steadily over the years,yet more than one in five Americans still smoke. In 2007, 28.5 percent of high school and 9.2 percent of middle school students smoked (1). Everyday, approximately 4,000 American youth aged 12-17 try their first cigarette (2).  If current patterns of smoking behavior continue, an estimated 6.4 million of today’s children can be expected to die prematurely from a smoking-related disease (3).

While all states have laws making it illegal to sell cigarettes to anyone under the age of 18, 49% of students surveyed were able to purchase  cigarettes in a store or gas station (4). The ease of access, coupled with aggressive marketing tactics by tobacco companies, has led to a  significant health risk for our youth. Smoking at an early age increases the risk of heart disease, stroke, chronic lung disease and for cancers of the lung, mouth, pharynx,esophagus and bladder (5,6).

The younger people begin using tobacco, the more likely they are to become strongly addicted to nicotine. Several studies have found nicotine to  be addictive in similar ways to heroin, cocaine and alcohol. Of all addictive behaviors, cigarette smoking is the one most likely to become established during adolescence (5).  Early identification and intervention are the key to reducing this alarming trend.

The most significant predictor of youth smoking is parental tobacco use; therefore, clinicians should screen both the adolescent and parent for  tobacco use. It is important to provide a strong, unified message regarding cessation and the serious health implications for both parties. In addition, clinicians need to offer developmentally appropriate cessation counseling and behavioral interventions shown to be effective with adults.

In 2007, the New York State Department of Health, Division of Managed Care and Program Evaluation, introduced an Adolescent Preventive Care-Screening Questionnaire to identify tobacco use and other risk  behaviors. The measures are based on recommendations of national organizations such as the American Medical  Association’s Guidelines for Adolescent Preventive Services (AMA GAPS) and the American Academy of Pediatrics. The health survey is an excellent tool to help facilitate cessation efforts. Of the high school students who smoke, 54.4 percent want to quit (1).

The Health Survey for Adolescents is not intended to replace existing comprehensive health assessments. It is meant as a brief tool to help address high priority risk behaviors and allow for dialog between the adolescent and their health care provider. Tobacco Cessation Physician Practice Guidelines are also available to help outline treatment strategies and identify educational  resources for adolescents with a positive tobacco response.

In early July, we will be hosting a Continuing Medical Education (CME) titled Adolescent Tobacco Counseling to address specific techniques for this patient population. Details will be posted on our web site shortly.

Patients who express a willingness to quit should be encouraged to call the New York State Quit line at 1-866-NY-QUITS for more information and  referral to the appropriate cessation program.

Health Survey for Adolescents
Health Survey for Adolescents Provider Information

  1. Children and Adolescents. U.S.Public Health Service, 2007
  2. Substance  Abuse and Mental Health Services Administration. Results from the 2004  National Survey on Drug Use and Health: (Office of Applied Studies). Rockville,Maryland: U.S. Department of Health and Human Services, 2005;NSDUH Series H-27;DHHS publication no. (SMA) 05-4061.
  3. CDC.Office of Smoking and Health, 2002 calculations based upon: Smoking attributable mortality and years of potential life lost—United States,1984. Morbidity and Mortality Weekly Report 1997;46:444-451.
  4. CDC.Youth Risk Behavior Surveillance—United States, 2005 Morbidity & Mortality Weekly Report 2006;55(SS-5):1–108.
  5. CDC.Preventing Tobacco Use Among Young People, A Report of the Surgeon General. Atlanta, GA: U.S.Department of Health and Human Services, 1994.
  6. DC.The Health Consequences of Smoking, A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, 2004.

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