The rate of smoking in the United States has been reduced by approximately one-half since the 1960s. However, the rate of smoking among teenagers increased in the 1980s and 1990s, especially among teenage females. This raised concerns that young women would continue smoking during pregnancy. In addition, it was found that nearly 90% of those who smoked started before the age of 18, and in many cases at a considerably younger age.
In the 1980s and most of the 1990s, cigarette smoking was advertised to teenagers and even preteens, or “tweens,” through campaigns by companies such as Joe Camel. In recent years, a series of interventions directed at teenagers and tweens was put into effect. These included elimination of cigarette vending machines, penalties for those who sell cigarettes to those under 18, and elimination of most cigarette advertising aimed at those under 18. In addition, the Truth® campaign aimed to convince adolescents, who often see smoking as a sign of independence from their parents, that not smoking is actually a sign of independence from the tobacco companies who seek to control their behavior. Evaluation studies concluded that these interventions have worked to reduce adolescent smoking by about one-third.
Despite the successes of the early years of the 2000s in lowering the rates of cigarette smoking among adolescents, the rates have now stabilized at over 20%. Evidence indicates that adolescents who smoke generally do not participate in athletics, more often live in rural areas, and are more often white and less often African American. Males and females smoke about the same amount overall, but white females smoke more and Asian females smoke less than their male counterparts.
New drugs have recently been shown to increase the rates of success in smoking cessation among adults with few side effects. Evidence that the benefits are greater than the harms in adolescents is insufficient to recommend them for widespread use because of increased potential for adverse effects, including suicide. A series of interventions has been suggested for addressing the continuing problem of adolescent smoking. These include:
• Expulsion from school for cigarette smoking
• Focus on adolescents in tobacco warning labels
• Selective use of prescriptions for cigarette cessation drugs
• No smoking rules for sporting events, music concerts, and other adolescent-oriented events
• Fines for adolescents who falsify their age and purchase cigarettes
• Higher taxes on tobacco products
• Rewards to students in schools with the lowest smoking rates in a geographic area
• Higher auto insurance premiums for adolescents who smoke
• Application of technology to reduce the quantity of nicotine allowed in tobacco products to reduce the potential for addiction
• Testing of athletes for nicotine and exclusion from competition if they test positive
• Encouragement of the use of e-cigarettes, which utilize smokable nicotine but not cancer-causing components of cigarettes
• Provision of tobacco counseling as part of medical care covered through insurance