Preventing Tobacco Use Among Youth

Cigarette smoking and other uses of tobacco is the single largest preventable cause of disease and premature death in the U.S. Smoking cigarettes kills more Americans than alcohol, car accidents, suicide, AIDS, homicide, and illegal drugs combined. About half of all Americans who keep smoking will die because of the habit. Cigarette smoking is estimated to kill more than 480,000 Americans each year, with about 160,000 of these deaths from many different forms of cancer. Up to 1 in 5 deaths in the US each year are from illnesses related to tobacco use and about 30% of cancer deaths are smoking related.

The non-cancer deaths caused by smoking relate to a variety of diseases, predominantly cardiovascular diseases and chronic obstructive pulmonary disease (COPD), a disease that includes emphysema and chronic bronchitis. In addition, smoking-related illness in the United States costs more than $300 billion a year, including nearly $170 billion in direct medical care for adults and $156 billion in lost productivity.

Cigarette smokers die younger than non-smokers. According to a study done in the late 1990s by the Centers for Disease Control and Prevention (CDC), smoking shortened male smokers' lives by 13.2 years and female smokers' lives by 14.5 years. Men and women who smoke are much more likely to die between the ages of 35 and 69 than those who have never smoked. Stopping smoking by age 40 reduces loss of life from tobacco related causes by about 90%, but quitting at any age is likely to reduce the risk of premature death.

The prevalence of use of tobacco

In 2014, an estimated 16.8% (40.0 million) U.S. adults were current cigarette smokers. Unfortunately, among U.S. youth, smoking cigarettes, cigars, e-cigarettes, and hookahs, using chew and snuff, remains common. In spite of restrictions on tobacco advertising targeting youths and widespread anti-smoking educational efforts, in 2014 more than 1 in 4 male high school students (28.3%) and 1 in 5 female high school students (20.9%) were found in surveys to be current users (as defined by any use in the past 30 days) of some type of tobacco. Among high school students 13.4% reported in 2014 that they used electronic cigarettes in the past 30 days—an increase from 1.5% in 2011; and 5.5% of high school students reported current use of smokeless tobacco.

Use of tobacco by young people in any form is unsafe. 

If smoking continues at the current rate among youth in this country, 5.6 million of today's Americans younger than 18 will die early from a smoking-related illness. That's about 1 of every 13 Americans aged 17 years or younger alive today. Nearly 9 out of 10 cigarette smokers first tried smoking by age 18, and 99% first tried smoking by age 26, so preventing tobacco use among youth is critical to ending the tobacco epidemic in the United States because tobacco use is started and dependence occurs primarily during adolescence.

The health effects of tobacco

Smokers are more likely than nonsmokers to develop heart disease, stroke, and lung cancer.

Smoking and Respiratory Disease:

  • Smokers are 12 to 13 times more likely to die from COPD than nonsmokers;
  • If you have asthma, tobacco smoke can trigger an attack or make an attack worse.

Tobacco tops the list of avoidable risks for cancer

If nobody smoked, about one of every three cancer deaths in the United States would be avoided. Tobacco smoke contains more than 7000 chemical compounds, with some 250 known to be harmful and at least 69 known to be carcinogens. For example, tobacco smoke contains radioactive polonium, a known carcinogen. Smokeless tobacco is not safe, it contains more than 3000 chemical compounds including at least 28 known carcinogens. Because most of the carcinogens in tobacco smoke reach all parts of the body through the bloodstream, it is not surprising that the risk of cigarette smoking can increase the risk of many types of cancer almost anywhere in your body.

Cancers caused by smoking

The parts of the body in direct contact with smoke have the greatest increase in risk of developing cancer. Tobacco and alcohol, especially in combination, increase the risk for cancers of the mouth, larynx, and throat. Smoking increases the risk of cancers of the mouth and pharynx by eight times. One or two packs of cigarettes a day increase the risk of lung cancer about 20 to 25 times over that of non-smokers and accounts for 87% of lung cancer deaths in men and 70% in women. Even secondhand smoke increases the risk of lung cancer by 20 to 30 percent. Lung cancer is not the most frequent cause of cancer but it is the leading cause of cancer death in both men and women, and is one of the hardest cancers to treat. More women in the US die from lung cancer than from breast cancer.

According to the CDC, the risk of cancer in these parts of the body are increased by tobacco use:

  • Lung (by 23 times among men and 13 times among women)
  • Acute myeloid leukemia
  • Bladder
  • Cervix
  • Colon and rectum (colorectal)
  • Esophagus
  • Kidney and ureter
  • Larynx
  • Liver
  • Nose and sinuses
  • Oropharynx (includes parts of the throat, tongue, soft palate, and the tonsils)
  • Ovary (a type called mucinous ovarian cancer)
  • Pancreas
  • Stomach
  • Trachea and bronchus

Other major health problems caused by smoking

Smoking contributes to many other important health problems other than cancer:

  • More than half of the deaths related to smoking are caused by diseases other than cancer, among them are coronary heart disease (increased by 2 to 4 times), aneurysms, bronchitis, emphysema, and stroke (increased by 2 to 4 times). Smoking has a generalized adverse effect on health by causing inflammation and impairing immune function.
  • Cigarette smoking makes asthma and pneumonia worse and causes chronic obstructive pulmonary disease (COPD). About 90% of all deaths from COPD are caused by smoking.
  • Smoking causes gum disease and loss of teeth.
  • Smoking can increase the risk of erectile dysfunction (ED).
  • Tobacco use is linked with a broad variety of reproductive health problems including reduced fertility, increased risk of ectopic pregnancy, miscarriage, premature birth, stillbirth, low birth-weight, birth defects and sudden infant death syndrome (SIDS).
  • Women past childbearing years who smoke have a greater risk for osteoporosis and bone fractures.
  • Smoking can increase the risk for cataracts and age-related macular degeneration.
  • Smoking is a cause of type 2 diabetes mellitus and can make it harder to control. The risk of developing diabetes is 30–40% higher for active smokers than nonsmokers.
  • Smoking is a cause of rheumatoid arthritis.

A recent study indicates that the excess mortality caused by smoking is underestimated. It found additional smoking related causes of mortality beyond the 21 formally established as caused by smoking, including two common types of cancer. According to the study, approximately 17% of the excess mortality among current smokers was due to associations with causes that are not currently established as attributable to smoking. These included associations between current smoking and deaths from:

  • renal failure (relative risk, 2.0; 95% confidence interval [CI], 1.7 to 2.3)
  • intestinal ischemia (relative risk, 6.0; 95% CI, 4.5 to 8.1)
  • hypertensive heart disease (relative risk, 2.4; 95% CI, 1.9 to 3.0)
  • infections (relative risk, 2.3; 95% CI, 2.0 to 2.7)
  • various respiratory diseases (relative risk, 2.0; 95% CI, 1.6 to 2.4)
  • breast cancer (relative risk, 1.3; 95% CI, 1.2 to 1.5)
  • prostate cancer (relative risk, 1.4; 95% CI, 1.2 to 1.7)

The study found that among former smokers, the relative risk for each of these outcomes declined as the number of years since quitting increased.

The implications of all of these grim statistics are clear: Do not start smoking, it is a true addiction. Avoid secondhand smoke and smokeless tobacco their risks are proven too. Although there is, so far, little data on e-cigarettes and cancer, the dangerous cardiovascular effects of nicotine are sure to remain.

And of course if you use tobacco now is the time to quit. Quitting smoking does not eliminate all of the increased risk of contracting all smoking-related diseases compared to non-smokers but the reductions are substantial. By one year after quitting, the risk for a heart attack drops 36-50%. Within 2 to 5 years after quitting smoking, the risk for stroke could fall to about the same level as that of a nonsmoker's. Quitting smoking decreases the risk for cancers of the mouth, throat, esophagus, and bladder by half within 5 years. Ten years after quitting smoking, the risk for lung cancer drops by half.

Factors associated with youth tobacco use

The CDC describes the factors associated with youth tobacco use to include the following:

  • Social and physical environments;
  • The way mass media show tobacco use as a normal activity can promote smoking among young people;
  • Youth are more likely to use tobacco if they see that tobacco use is acceptable or normal among their peers;
  • High school athletes are more likely to use smokeless tobacco than their peers who are non-athletes;
  • Parental smoking may promote smoking among young people;
  • Biological and genetic factors;
  • There is evidence that youth may be sensitive to nicotine and that teens can feel dependent on nicotine sooner than adults;
  • Genetic factors may make quitting smoking more difficult for young people;
  • A mother's smoking during pregnancy may increase the likelihood that her offspring will become regular smokers;
  • Mental health: There is a strong relationship between youth smoking and depression, anxiety, and stress;
  • Personal perceptions: Expectations of positive outcomes from smoking, such as coping with stress and controlling weight, are related to youth tobacco use.

Other influences that affect youth tobacco use include:

  • Lower socioeconomic status, including lower income or education
  • Lack of skills to resist influences to tobacco use
  • Lack of support or involvement from parents
  • Accessibility, availability, and price of tobacco products
  • Low levels of academic achievement
  • Low self-image or self-esteem
  • Exposure to tobacco advertising

Reducing Youth Tobacco Use

The CDC describes the following national, state, and local program activities that have been shown to reduce and prevent youth tobacco use when implemented together. They include the following:

  • Higher costs for tobacco products (for example, through increased taxes)
  • Prohibiting smoking in indoor areas of worksites and public places
  • Raising the minimum age of sale for tobacco products to 21 years, which has recently emerged as a potential strategy for reducing youth tobacco use11
  • TV and radio commercials, posters, and other media messages targeted toward youth to counter tobacco product advertisements
  • Community programs and school and college policies and interventions that encourage tobacco-free environments and lifestyles
  • Community programs that reduce tobacco advertising, promotions, and availability of tobacco products

Some social and environmental factors have been found to be related to lower smoking levels among youth. Among these are:

  • Religious participation
  • Racial/ethnic pride and strong racial identity
  • Higher academic achievement and aspirations

Continued efforts are needed to prevent and reduce the use of all forms of tobacco use among youth.

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