persuasive essay on e cigarettes

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Smoking tobacco is probably one of the worst habits humankind has developed. Originating as a tradition of the Native Americans, practiced mostly on special occasions, smoking has gradually become a kind of mass addiction. Due to the efforts of tobacco companies seeking to increase their sales, people started smoking more and more often; the evolution of a more traditional pipe to a cigarette took some time, but eventually tobacco became more affordable and easier to use (you now simply need to light it up, instead of having to always carry a tobacco pouch, stuff a pipe, puff it, and so on). As a result, deaths and health issues connected to tobacco consumption became a worldwide concern.

A popular belief is that it is nicotine that kills. It is only partially true: although nicotine does harm one’s health (mostly affecting the cardiovascular system), it is the tar, carbon monoxide, hard particles contained in cigarette smoke, and a bunch of toxic emissions and heavy metals that deal the most damage. Nicotine causes addiction, and the smoke does the rest.

Nowadays, there are alternatives to analogue tobacco smoking: the widely popular electronic cigarettes. Although it is hotly debated whether e-cigarettes are harmful to smokers’ health or not, it is hard to argue that substituting cigarettes with these devices does more good than bad, since they possess a number of advantages that cannot be neglected easily. And whereas smoking still remains a dangerous and unacceptable addiction, e-cigarettes might be a decent way to break free of it.

Electronic cigarettes deliver nicotine to a smoker not through burning (which obviously implies inhaling harmful and toxic smoke), but through the evaporation of nicotine-containing liquids. An e-cigarette heats up the liquid in a special container called an atomizer; the liquid evaporates, and through this vapor a smoker receives their dose of nicotine. Thus, the process of nicotine consumption in this case should be called “vaping,” not “smoking.” These liquids usually comprise glycerol, propylene glycol, ethylene glycol, propanediol, and some other components ( NCBI ). Although some of them are not completely harmless, the chemical composure of e-cigarette liquids is definitely safer than the one of a regular cigarette. However, thorough control over the composure of these liquids should be established, and the usage of such components as ethylene glycol and propanediol should probably be banned. Still, if a smoker does not plan to quit, he or she might want to consider using e-cigarettes instead of real tobacco.

Another good reason for a smoker to start using e-cigarettes is that the aforementioned liquids can contain different amounts of nicotine. A heavy smoker might want to start vaping using liquids containing up to 24 milligrams of nicotine, and the good news for them is that it is possible to gradually decrease the dose until zero milligrams are present.

Although some smokers might experience physical symptoms when trying to quit smoking tobacco, in the majority of cases, it is a strong psychological component that does not let a smoker give up their addiction. It can be assumed that there are five main components of this psychological addiction: 1) believing in the relaxing/stimulating effect of nicotine that helps a smoker deal with stressful situations; 2) a smoker’s need to “keep hands busy” when bored, waiting for something, feeling nervous, and so on; 3) socializing with “fellow smokers”; 4) unconsciously and “automatically” following the habit; 5) the fear that if a smoker quits, he or she will lose something valuable, a source of psychological support or pleasure. In addition, some smokers find it aesthetic to inhale/exhale smoke, or have other reasons to continue tobacco consumption. Generally speaking, smoking is a behavioral pattern consisting of repeating situations and reactions. Without neglecting or challenging these reasons, it can be said that an e-cigarette is probably a safer alternative for a person who does not want to give up nicotine. They still deliver nicotine to a smoker’s body (thus fulfilling the reasons 1 and 5); they disrupt automatic smoking described in points 2 and 4 (since e-cigarettes function differently from their traditional analogues); they allow a person to continue socializing with other smokers during breaks at work, or on other occasions, as mentioned in point 3. But, while performing the same functions as regular cigarettes, electronic devices are safer and more socially acceptable.

In addition, a purely aesthetic reason to prefer e-cigarettes over their analogues: when evaporated, the liquids taste and smell better than tobacco. They are sold in a variety of flavors: melons, apples, cherry, tropical fruit, mint, blueberry, and so on. At the same time, regular tobacco smells and tastes awful not only for the non-smokers, but for a smoking person as well. So, why not stop poisoning oneself with toxic smoke, and at least substitute it with pleasantly smelling vapor?

Nicotine addiction in any of its forms, regardless of whether it is smoking or vaping, is a huge problem for addicts. It leads to a number of severe, chronic diseases and even to death. At the same time, there might be a healthier alternative for those smokers who realize the harm they cause to themselves, but who cannot yet give up their addiction. Electronic cigarettes are nowadays considered to be safer than regular cigarettes. Liquids used in these e-cigarettes contain fewer toxic elements, and do not include the products that are commonly burned in cigarettes. Vapor from e-cigarettes is mostly harmless to non-smokers; it tastes and smells better, which makes smoking e-cigarettes a less reproached habit. Finally, many smokers might discover that e-cigarettes do not obstruct their reasons to continue smoking, while making it possible to decrease the amounts of consumed nicotine and to eventually break the habit. Therefore, without praising or advertising e-cigarettes, it can still be stated that they are a more preferable alternative for smokers.

Works Cited

“Electronic Cigarettes: Overview of Chemical Composition and Exposure Estimation.” NCBI . BioMed Central, 2014. Web. 14 Nov. 2016.

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Personal Health

The Risks of Another Epidemic: Teenage Vaping

“We’re stepping backward from all the advances we’ve made in tobacco control,” one investigator said.

By Jane E. Brody

While most of us strive to avoid inhaling aerosols that could harbor a deadly virus, millions of teens and young adults are deliberately bathing their lungs in aerosols rich in chemicals with known or suspected health hazards.

I’m referring to vaping (or “ juuling ”): the use of e-cigarettes that is hooking young people on a highly addictive drug — nicotine — and will be likely to keep them hooked for decades. Meanwhile, e-cigarettes and other vaping devices are legally sold with few restrictions while producers and sellers reap the monetary rewards. Although many states prohibit e-cigarette sales to persons younger than 18 or 21, youngsters have little trouble accessing the products online or from friends and relatives.

In just one year, from 2017 to 2018, vaping by high school seniors increased more than “for any substance we’ve ever monitored in 45 years, and the next year it rose again almost as much,” said Richard Miech, principal investigator for the national survey Monitoring the Future.

By 2019, a quarter of 12th graders were vaping nicotine, nearly half of them daily. Daily vaping rose in all three grades surveyed — eighth, 10th and 12th — “with accompanying increases in the proportions of youth who are physically addicted to nicotine,” Dr. Miech and colleagues reported in The New England Journal of Medicine last year.

Although self-reported use of e-cigarettes by high school and middle school students decreased over the past year, Dr. Robert R. Redfield, director of the Centers for Disease Control and Prevention, cautioned, “Youth e-cigarette use remains an epidemic.”

“We’re stepping backward from all the advances we’ve made in tobacco control,” Dr. Miech, professor at the Institute for Social Research at the University of Michigan, said in an interview. “I’m worried that we will eventually return to the tobacco situation of yore. There’s evidence that kids who vape are four to five times more likely the next year to experiment with cigarettes for the first time.”

As someone who witnessed the persuasive tactics the tobacco industry used to get nearly half of American adults hooked on regular cigarettes in the 1950s, I see similar efforts being used today to promote these new delivery systems for nicotine: sex, glamour, endorsements by celebrities and doctors, and sponsorship of popular sports and musical events. Only now there are even more pervasive avenues of influence through websites and social media.

In 2016, ads for e-cigarettes reached nearly four in five middle and high school students in the United States, Dr. Ellen S. Rome noted.

As in decades past, the nation’s regulatory agencies have been slow — some say negligent — to recognize this fast-growing threat to the health and development of young Americans. Dr. Rome, a pediatrician who heads the Center for Adolescent Medicine at the Cleveland Clinic, explained that nicotine forms addictive pathways in the brain that can increase a youngster’s susceptibility to addiction throughout life. The adolescent brain is still developing, she told me, and e-cigarette use is often a gateway to vaping of marijuana, which can affect the brain centers responsible for attention, memory, learning, cognition, self-control and decision-making.

In a review published last December in the Cleveland Clinic Journal of Medicine, Dr. Rome and her co-author, Perry Dinardo, challenged the public perception that vaping is harmless, or “at least less harmful than cigarette smoking.”

While it’s likely to be true that vaping may be less hazardous than tobacco cigarettes, since the vaped aerosols that reach the lungs are devoid of the thousands of tobacco-derived toxic and carcinogenic substances inhaled by cigarette smokers, vaping still introduces a fair share of potentially harmful chemicals. In addition to nicotine, some of the chemicals, like the carcinogen formaldehyde, are created when the nicotine-rich liquid in some vaping devices is heated to high temperatures.

“E-cigarettes might have their own unique health effects we haven’t discovered yet,” said Theodore L. Wagener, director of the Center for Tobacco Research at Ohio State University. “Although compared to tobacco cigarettes, e-cigarettes without a doubt expose users to much lower levels of harmful chemicals , we still don’t know how the body handles them and what their long-term effects might be.”

Remember, it took many decades of smoking by tens of millions of people before the deadly hazards of tobacco cigarettes were recognized.

The surge in the use of electronic cigarettes was tied to a game-changing product, Juul, a cartridge device introduced in 2017 in a slew of enticing flavors. Flavors especially attractive to youngsters are now banned from use in closed-system devices like Juul , which now is sold only in tobacco and menthol flavors, but can still be used in the open-system products sold in vape shops. And now, taking advantage of a loophole in regulations, a disposable product called Puff Bar , which comes in more than 20 flavors, has replaced Juul as the vape of choice among young people.

Concerns about vaping grew after a 2019 outbreak of severe lung injuries , which were subsequently linked to vitamin E acetate, an additive found in some vaping devices that deliver THC, the psychoactive ingredient in marijuana. Juul pods are not designed to be refillable with substances like THC or other chemicals.

Producers of Juul introduced changes that enhanced the palatability and safety of vaping, but at the same time “made it easier for kids to start using nicotine,” Dr. Wagener said. Instead of freebase nicotine that is very harsh to inhale, Juul contains a nicotine salt, “a very palatable form of nicotine that makes inhaling high doses of nicotine easy,” he explained. And Juul doesn’t require the high temperatures that produce toxic substances like formaldehyde. A single pod contains the nicotine equivalent of a pack of conventional cigarettes.

“Juul made it cool, and young people who had never smoked cigarettes are becoming addicted to nicotine ,” said Erika R. Cheng, a public health epidemiologist at Indiana University School of Medicine. In addition to nicotine, Juul pods contain a mix of glycerol, propylene glycol, benzoic acid and flavoring agents, the long-term health effects of which have yet to be determined , she said.

“E-cigarettes were initially advertised as a means to help people transition from harmful tobacco smoking,” Dr. Cheng said. “A lot of early users didn’t even know they contained nicotine.” Although a small minority of smokers have used e-cigarettes to help them quit or reduce their dependence on tobacco, most who use the devices vape to get their nicotine fix when they can’t smoke regular cigarettes.

Although there have been calls for bans on e-cigarettes, Abigail S. Friedman, a health economist at Yale University School of Public Health, cautioned that “bans can push people into the black market looking for something that can be acutely dangerous.”

Dr. Friedman said that rather than outright bans that can have unanticipated costs, she favors better regulations. Currently, other than flavors, what is inhaled from e-cigarettes is unregulated. Still, she and other experts are very concerned about the explosive uptake of vaping by young people. In the 2019 Youth Risk Behavior Survey of 4.9 million high school students, she said, 6 percent reported smoking conventional cigarettes while 33 percent puffed e-cigarettes in the past 30 days. In December 2018, the U.S. Surgeon General, Dr. Jerome Adams, declared e-cigarette use by youth an epidemic .

Jane Brody is the Personal Health columnist, a position she has held since 1976. She has written more than a dozen books including the best sellers “Jane Brody’s Nutrition Book” and “Jane Brody’s Good Food Book.” More about Jane E. Brody

EssayEmpire

Persuasive essay example: electronic cigarettes.

Electronic cigarettes deliver nicotine to a smoker not through burning (which obviously implies inhaling harmful and toxic smoke), but through the evaporation of nicotine-containing liquids. An e-cigarette heats up the liquid in a special container called an atomizer; the liquid evaporates, and through this vapor a smoker receives their dose of nicotine. Thus, the process of nicotine consumption in this case should be called “vaping,” not “smoking.” These liquids usually comprise glycerol, propylene glycol, ethylene glycol, propanediol, and some other components (NCBI). Although some of them are not completely harmless, the chemical composure of e-cigarette liquids is definitely safer than the one of a regular cigarette. However, thorough control over the composure of these liquids should be established, and the usage of such components as ethylene glycol and propanediol should probably be banned. Still, if a smoker does not plan to quit, he or she might want to consider using e-cigarettes instead of real tobacco.

Although some smokers might experience physical symptoms when trying to quit smoking tobacco, in the majority of cases, it is a strong psychological component that does not let a smoker give up their addiction. It can be assumed that there are five main components of this psychological addiction: 1) believing in the relaxing/stimulating effect of nicotine that helps a smoker deal with stressful situations; 2) a smoker’s need to “keep hands busy” when bored, waiting for something, feeling nervous, and so on; 3) socializing with “fellow smokers”; 4) unconsciously and “automatically” following the habit; 5) the fear that if a smoker quits, he or she will lose something valuable, a source of psychological support or pleasure. Besides, some smokers find it aesthetic to inhale/exhale smoke, or have other reasons to continue tobacco consumption. Generally speaking, smoking is a behavioral pattern consisting of repeating situations and reactions. Without neglecting or challenging these reasons, it can be said that an e-cigarette is probably a safer alternative for a person who does not want to give up nicotine. They still deliver nicotine to a smoker’s body (thus fulfilling the reasons 1 and 5); they disrupt automatic smoking described in points 2 and 4 (since e-cigarettes function differently from their traditional analogues); they allow a person to continue socializing with other smokers during breaks at work, or on other occasions, as mentioned in point 3. But, while performing the same functions as regular cigarettes, electronic devices are safer and more socially acceptable.

“Electronic Cigarettes: Overview of Chemical Composition and Exposure Estimation.” NCBI. BioMed Central, 2014. Web. 14 Nov. 2016.
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Persuasive Essay About Smoking - Making a Powerful Argument with Examples

What You Need To Know About Persuasive Essay

A persuasive essay is a type of writing that aims to convince its readers to take a certain stance or action. It often uses logical arguments and evidence to back up its argument in order to persuade readers.

It also utilizes rhetorical techniques such as ethos, pathos, and logos to make the argument more convincing. In other words, persuasive essays use facts and evidence as well as emotion to make their points.

A persuasive essay about smoking would use these techniques to convince its readers about any point about smoking. Check out an example below:

Simple persuasive essay about smoking

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Persuasive Essay Examples About Smoking

Smoking is one of the leading causes of preventable death in the world. It leads to adverse health effects, including lung cancer, heart disease, and damage to the respiratory tract. However, the number of people who smoke cigarettes has been on the rise globally.

A lot has been written on topics related to the effects of smoking. Reading essays about it can help you get an idea of what makes a good persuasive essay.

Here are some sample persuasive essays about smoking that you can use as inspiration for your own writing:

Persuasive speech on smoking outline

Persuasive essay about smoking should be banned

Persuasive essay about smoking pdf

Persuasive essay about smoking cannot relieve stress

Persuasive essay about smoking in public places

Speech about smoking is dangerous

Persuasive Essay About Smoking Introduction

Persuasive Essay About Stop Smoking

Short Persuasive Essay About Smoking

Stop Smoking Persuasive Speech

Check out some more persuasive essay examples on various other topics.

Argumentative Essay About Smoking Examples

An argumentative essay is a type of essay that uses facts and logical arguments to back up a point. It is similar to a persuasive essay but differs in that it utilizes more evidence than emotion.

If you’re looking to write an argumentative essay about smoking, here are some examples to get you started on the arguments of why you should not smoke.

Argumentative essay about smoking pdf

Argumentative essay about smoking in public places

Argumentative essay about smoking introduction

Check out the video below to find useful arguments against smoking:

Tips for Writing a Persuasive Essay About Smoking

You have read some examples of persuasive and argumentative essays about smoking. Now here are some tips that will help you craft a powerful essay on this topic.

Choose a Specific Angle

Select a particular perspective on the issue that you can use to form your argument. When talking about smoking, you can focus on any aspect such as the health risks, economic costs, or environmental impact.

Think about how you want to approach the topic. For instance, you could write about why smoking should be banned.

Check out the list of persuasive essay topics to help you while you are thinking of an angle to choose!

Research the Facts

Before writing your essay, make sure to research the facts about smoking. This will give you reliable information to use in your arguments and evidence for why people should avoid smoking.

You can find and use credible data and information from reputable sources such as government websites, health organizations, and scientific studies.

For instance, you should gather facts about health issues and negative effects of tobacco if arguing against smoking. Moreover, you should use and cite sources carefully.

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Make an Outline

The next step is to create an outline for your essay. This will help you organize your thoughts and make sure that all the points in your essay flow together logically.

Your outline should include the introduction, body paragraphs, and conclusion. This will help ensure that your essay has a clear structure and argument.

Use Persuasive Language

When writing your essay, make sure to use persuasive language such as “it is necessary” or “people must be aware”. This will help you convey your message more effectively and emphasize the importance of your point.

Also, don’t forget to use rhetorical devices such as ethos, pathos, and logos to make your arguments more convincing. That is, you should incorporate emotion, personal experience, and logic into your arguments.

Introduce Opposing Arguments

Another important tip when writing a persuasive essay on smoking is to introduce opposing arguments. It will show that you are aware of the counterarguments and can provide evidence to refute them. This will help you strengthen your argument.

By doing this, your essay will come off as more balanced and objective, making it more convincing.

Finish Strong

Finally, make sure to finish your essay with a powerful conclusion. This will help you leave a lasting impression on your readers and reinforce the main points of your argument. You can end by summarizing the key points or giving some advice to the reader.

A powerful conclusion could either include food for thought or a call to action. So be sure to use persuasive language and make your conclusion strong.

To conclude,

By following these tips, you can write an effective and persuasive essay on smoking. Remember to research the facts, make an outline, and use persuasive language.

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Persuasive Essay on Vaping and E-cigarettes Should Be Banned

Nicotine is a highly addictive substance which is as hard to give up as heroin. 2.06 million teens are using nicotine on a daily basis across America. Nicotine is commonly used in vaping and e-cigarettes, and the dosage is either lower or the same as in cigarettes and tobacco products.Some believe vapes lead to drug addictions, while others say they do nothing wrong and have no effect. Vaping and E-cigarettes should be banned. Vaping is unbenefictial to a person’s health and rather targets their packaging towards young children and gives them a higher risk of developing a nicotine addiction.

The number of kids who vape is increasing, addicting new generations to nicotine and cigarettes, and introducing them to smoking. The percentage of kids who vape has gone up throughout the years, For example, "As of 2020, 19.6% of high school students used e-cigarettes, the most-used tobacco product among the age group, followed by cigars (5%)" (ProCon 1). 19.6% of high school students rely on nicotine. The nicotine in the vapes is the same as the one in cigarettes that can lead to them turning to cigarettes. Many of the students can get their friends addicted to nicotine as well, increasing the number of students who use e-cigarettes. The site also mentions that "One JUULpod contains as much nicotine as a pack of cigarettes, both of which last for about 200 puffs" (ProCon 1). Vaping can be just as bad and addictive as cigarettes. It may take longer to use the whole vape rather than a pack of cigarettes, but it's still the same amount of nicotine consumed. It is not a healthier option if it's not as different as cigarettes. Matthew Myers, who campaigns against tobacco, stated, "Like cigarette companies, e-cigarette makers claim they don’t market to kids. But they’re using the same themes and tactics tobacco companies have long used to market regular cigarettes to kids (Exploring Issues 1). E-cigarettes and vape companies tend to rely on the same marketing used to get kids into cigarettes. They use the same techniques as tobacco companies that try to get kids to buy their products. They use a confident and good looking person to say vaping is cool and desirable. Vaping attracts many new people into smoking and opens many opportunities for health issues.

Nicotine can lead to many problems regarding health. Nicotine is a very addictive substance and can damage a person's body. One way it can affect a person is "Nicotine used by young people may increase the risk of addiction to other drugs and impair prefrontal brain development, which can lead to ADD and disrupt impulse control"(ProCon 1). Nicotine can cause cravings and cause impulsive behavior if a person becomes addicted. Nicotine can lead to more drugs and can cause brain damage to a person. Brain damage can lead to disorders like ADD. Not only does it lead to brain disorders, but also long-term diseases and strokes. The article states, "People who use e-cigarettes have a 71% increased risk of stroke and a 40% higher risk of heart disease, as compared to nonusers" (ProCon 1). People who use e-cigarettes or vapes have a higher chance of having a stroke or heart disease, which could kill them. The chemicals in the products can expose a person to life-long struggles because of a stroke. Heart disease is a long-term disease that can result from vaping and is the leading cause of death in America. A main contributor to these injuries and illnesses is the chemicals inside the vape. An example of what the chemicals can do is "Some ingredients in the liquids used in e-cigarettes change composition when they are heated, leading to inhalation of harmful compounds such as formaldehyde, which is carcinogenic" (ProCon 1). The liquids can change when heated, changing the compounds in the liquid. The liquid compounds could become dangerous and turn into chemicals like formaldehyde, which can lead to irritations all over the body and sometimes even cancer. Some health conditions and problems can cause problems for the rest of a person's life, but some argue it helps people with smoking.

E-cigarettes help people stop smoking. Studies have been done many times on this topic. One study states, "A July 2019 study found that cigarette smokers who picked up vaping were 67% more likely to quit smoking" (ProCon 1). That may be true, but people can still face health issues and still ingest an equal amount of nicotine found in a pack of cigarettes. Vapes can be safer than cigarettes because of the fact that they use vapor, not smoke. The website says, "However, most scientists agree that ESDs are much less harmful to health than tobacco cigarettes" (Exploring Issues). Vapes can be much safer than tobacco with items inside, but they can also expose a person to the same health problems as tobacco. Vaping can even heat up and change the liquid compound inside of it, creating formaldehyde, which can lead to cancer and irritations. The heat in the vapes can burn holes in the lungs as well, just like cigarettes.

Vaping can cause many problems regarding health and contributes to attracting more children to turn to vaping. Vapes can be marketed the same as cigarettes and can be just as harmful. Vaping can lead to a gateway of health issues like strokes, heart attacks, ADD, nausea, and more. The liquid in the vapes can create dangerous compounds when heated up and can burn holes into the lungs. It may be different than smoking and a healthier option, but the risks are still present.

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Should Cigarettes Be Banned? Essay

Introduction.

Arguments against the Issue
Arguments for the Issue

For the recognition of whether or why cigarettes should be banned, this essay should start with a bit of history.

Cigarettes are made from tobacco leaves. Their use started in Central America around 6,000 B.C. After 5,000 BC, the Mayan community started chewing and smoking tobacco leaves and used them for medicinal purposes like healing wounds. Later on, people invented pipe smoking, which was followed by the manufacturing of cigarettes in the mid-1800s (Smoking, 2010).

On this page, the author won’t explore why smoking should be banned. The essay will evaluate arguments for and against cigarettes in particular. Many people smoke them to lighten up and enhance their concentration at places of work. Meanwhile, some claim that this relaxation method is too harmful to enjoy.

So, should cigarettes be banned? This essay attempts to find out.

Why Cigarettes Should Be Banned: Arguments against

Smoking cigarettes helps people to relax and get better concentration. Mental illness symptoms such as anxiety and Schizophrenia are alleviated by smoking (Russo, 2011); this has been medically proven. Smoking cigarettes helps in socialization as it sets the mood of a smoker into being jovial.

Governments obtain huge amount of money from cigarette manufacturing industries in form of taxes. These industries also create employment opportunities for many people. Banning of cigarette smoking would mean loss of thousands of jobs as well as revenue for the government (Fix, n.d.).

Smoking cigarettes helps in weight management due to the reduced appetite induced in the body by cigarettes. Therefore, smoking is a good and effective weight loss aid (Auctions, 2010).

Why Cigarettes Should Be Banned: Arguments for

Smoking cigarettes is one of the major causes of deaths. About 443, 000 people die out of cigarette smoking related illnesses in the U.S. every year (CDC, 2011 ). Cigarettes contain many harmful chemicals; it was found that cigarettes have more than 4,000 chemicals. Most of these components are known to cause cancer.

Smoking is known to cause lung cancer, bladder cancer, stomach Cancer, kidney cancer, cancer of oral cavity and cancer of the cervix. Ammonia, Tar and Carbon Monoxide are found in cigarettes and are very harmful to human body (Society, 2010).

Cigarette smoking has great effects on reproductive health. It is known to cause infertility, still births, low birth weight and sudden infant death syndrome (SIDS). In addition, it affects the bones by reducing their densities. Hip fractures in female cigarette smokers are higher than in female non smokers (CDC, 2011 ).

Banning of cigarette smoking would come with many benefits. First people’s health would be improved. Health benefits of stopping to smoke are more than the emotional or psychological comfort that are brought by smoking. Banning cigarette smoking would be of great benefit to the young people.

Those in their thirties, in terms of age in years, would still benefit from the reduced risks caused by cigarettes. Old people who would wish stop smoking cigarettes would not be late to do so. Banning of cigarette smoking will be beneficial to all smokers regardless of their age (Society, 2010).

Many cigarette smokers are at higher risk of being infected with different types of cancer. These include: “Lung, Larynx, Oral cavity, Esophagus, Kidney, Cervix, Bladder, stomach among other cancers” (Society, 2010, p. 1).

Smoking induces stress. A research in London showed that a group of people who stopped smoking had reduced stress than those who had continued to smoke after one year; this was because those who continued to smoke greatly depended on cigarettes.

A smoker is more prone to be stressed if he/she is not in a position to quench a thirst for smoking therefore failure to smoke will subjected smokers to stress (Benson, 2010). Banning of cigarette smoking would therefore reduce stress levels in people. Peer groups will be made of non smokers. People will look for other ways to cope with stress and anxiety other than smoking.

Economic burden on countries will be reduced by banning of cigarette smoking: “in the year 2000, 8.6 million people in U.S suffered from at least one chronic disease that was associated with cigarette smoking” (CDC, 2011, p. 1). Majority of these people ailed from more than one of the diseases caused by cigarette smoking (Society, 2010).

Though smoking cigarettes creates employment and contributes to government’s revenues, it causes more harm than good. The quality of life led by cigarette smokers is lowered. Furthermore, their quality of work is decreased because they might not attend to their duties regularly in extreme cases of being affected by ailments caused by cigarettes (Society, 2010).

Banning of cigarette smoking would eliminate exposure of the human body to harmful substances. Tar is carcinogenic. Nicotine is the addictive substance in cigarette that causes mental and emotional dependence on cigarettes (Society, 2010). Nicotine also elevates cholesterol levels in the body.

Carbon Monoxide takes oxygen from the body of the user and this may cause Chronic Obstructive Pulmonary Disorder (Netdoctor, 2005). Banning of cigarette smoking will reduce the above risks which are the main causes of poor health in cigarette smokers.

Reproductive health of people will to some extent be guaranteed by banning of cigarette smoking. Tobacco related infertility in women and impotence in men would be no more. Risks of miscarriage, premature births and still births would be reduced thus saving lives of babies (Society, 2010).

Cigarette smoking is a major health challenge. It causes many health problems including reproductive disorders, cancer, stress, heart diseases and stroke. Banning of cigarette smoking would largely benefit people’s health.

Auctions, G. (2010). Advantages and Disadvantages of Smokinng . Web.

Benson, J. (2010). Smoking increases stress levels . Web.

CDC. (2011). Smoking and Tobacco Use . Web.

Fix, W. Should Smoking be Banned . Web.

Netdoctor. (2005). Smoking Health Risks . Web.

Russo, J. (2011). Health Benefits of Smoking Cigarettes . Web.

Smoking, H. (2010). The History of Smoking . Web.

Society, A. C. (2010). Cigarette Smoking . Web.

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IvyPanda. (2018, October 10). Should Cigarettes Be Banned? Essay. https://ivypanda.com/essays/should-cigarette-smoking-be-banned/

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Health Effects of Vaping

At a glance.

Learn more about the health effects of vaping.

No tobacco products, including e-cigarettes, are safe.
Most e-cigarettes contain nicotine, which is highly addictive and is a health danger for pregnant people, developing fetuses, and youth. 1
Aerosol from e-cigarettes can also contain harmful and potentially harmful substances. These include cancer-causing chemicals and tiny particles that can be inhaled deep into lungs. 1
E-cigarettes should not be used by youth, young adults, or people who are pregnant. E-cigarettes may have the potential to benefit adults who smoke and are not pregnant if used as a complete substitute for all smoked tobacco products. 2 3 4
Scientists still have a lot to learn about the short- and long-term health effects of using e-cigarettes.

Most e-cigarettes, or vapes, contain nicotine, which has known adverse health effects. 1

Nicotine is highly addictive. 1
Nicotine is toxic to developing fetuses and is a health danger for pregnant people. 1
Acute nicotine exposure can be toxic. Children and adults have been poisoned by swallowing, breathing, or absorbing vaping liquid through their skin or eyes. More than 80% of calls to U.S. poison control centers for e-cigarettes are for children less than 5 years old. 5

Nicotine poses unique dangers to youth because their brains are still developing.

Nicotine can harm brain development which continues until about age 25. 1
Youth can start showing signs of nicotine addiction quickly, sometimes before the start of regular or daily use. 1
Using nicotine during adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control. 1
Adolescents who use nicotine may be at increased risk for future addiction to other drugs. 1 6
Youth who vape may also be more likely to smoke cigarettes in the future. 7 8 9 10 11 12

Other potential harms of e-cigarettes

E-cigarette aerosol can contain substances that can be harmful or potentially harmful to the body. These include: 1

Nicotine, a highly addictive chemical that can harm adolescent brain development
Cancer-causing chemicals
Heavy metals such as nickel, tin, and lead
Tiny particles that can be inhaled deep into the lungs
Volatile organic compounds
Flavorings such as diacetyl, a chemical linked to a serious lung disease. Some flavorings used in e-cigarettes may be safe to eat but not to inhale because the lungs process substances differently than the gut.

E-cigarette aerosol generally contains fewer harmful chemicals than the deadly mix of 7,000 chemicals in smoke from cigarettes. 7 13 14 However, this does not make e-cigarettes safe. Scientists are still learning about the immediate and long-term health effects of using e-cigarettes.

Dual use refers to the use of both e-cigarettes and regular cigarettes. Dual use is not an effective way to safeguard health. It may result in greater exposure to toxins and worse respiratory health outcomes than using either product alone. 2 3 4 15

Some people who use e-cigarettes have experienced seizures. Most reports to the Food and Drug Administration (FDA ) have involved youth or young adults. 16 17

E-cigarettes can cause unintended injuries. Defective e-cigarette batteries have caused fires and explosions, some of which have resulted in serious injuries. Most explosions happened when the batteries were being charged.

Anyone can report health or safety issues with tobacco products, including e-cigarettes, through the FDA Safety Reporting Portal .

Health effects of vaping for pregnant people

The use of any tobacco product, including e-cigarettes, is not safe during pregnancy. 1 14 Scientists are still learning about the health effects of vaping on pregnancy and pregnancy outcomes. Here's what we know now:

Most e-cigarettes, or vapes, contain nicotine—the addictive substance in cigarettes, cigars, and other tobacco products. 18
Nicotine is a health danger for pregnant people and is toxic to developing fetuses. 1 14
Nicotine can damage a fetus's developing brain and lungs. 13
E-cigarette use during pregnancy has been associated with low birth weight and pre-term birth. 19 20

Nicotine addiction and withdrawal

Nicotine is the main addictive substance in tobacco products, including e-cigarettes. With repeated use, a person's brain gets used to having nicotine. This can make them think they need nicotine just to feel okay. This is part of nicotine addiction.

Signs of nicotine addiction include craving nicotine, being unable to stop using it, and developing a tolerance (needing to use more to feel the same). Nicotine addiction can also affect relationships with family and friends and performance in school, at work, or other activities.

When someone addicted to nicotine stops using it, their body and brain have to adjust. This can result in temporary symptoms of nicotine withdrawal which may include:

Feeling irritable, jumpy, restless, or anxious
Feeling sad or down
Having trouble sleeping
Having a hard time concentrating
Feeling hungry
Craving nicotine

Withdrawal symptoms fade over time as the brain gets used to not having nicotine.

Nicotine addiction and mental health

Nicotine addiction can harm mental health and be a source of stress. 21 22 23 24 More research is needed to understand the connection between vaping and mental health, but studies show people who quit smoking cigarettes experience: 25

Lower levels of anxiety, depression, and stress
Improved positive mood and quality of life

Mental health is a growing concern among youth. 26 27 Youth vaping and cigarette use are associated with mental health symptoms such as depression. 22 28

The most common reason middle and high school students give for currently using e-cigarettes is, "I am feeling anxious, stressed, or depressed." 29 Nicotine addiction or withdrawal can contribute to these feelings or make them worse. Youth may use tobacco products to relieve their symptoms, which can lead to a cycle of nicotine addiction.

Empower Vape-Free Youth ad featuring a brain graphic and message about the connection between nicotine addiction and youth mental health.

U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General . Centers for Disease Control and Prevention; 2016. Accessed Feb 14, 2024.
Goniewicz ML, Smith DM, Edwards KC, et al. Comparison of nicotine and toxicant exposure in users of electronic cigarettes and combustible cigarettes . JAMA Netw Open. 2018;1(8):e185937.
Reddy KP, Schwamm E, Kalkhoran S, et al. Respiratory symptom incidence among people using electronic cigarettes, combustible tobacco, or both . Am J Respir Crit Care Med. 2021;204(2):231–234.
Smith DM, Christensen C, van Bemmel D, et al. Exposure to nicotine and toxicants among dual users of tobacco cigarettes and e-cigarettes: Population Assessment of Tobacco and Health (PATH) Study, 2013-2014 . Nicotine Tob Res. 2021;23(5):790–797.
Tashakkori NA, Rostron BL, Christensen CH, Cullen KA. Notes from the field: e-cigarette–associated cases reported to poison centers — United States, April 1, 2022–March 31, 2023 . MMWR Morb Mortal Wkly Rep. 2023;72:694–695.
Yuan M, Cross SJ, Loughlin SE, Leslie FM. Nicotine and the adolescent brain . J Physiol. 2015;593(16):3397–3412.
National Academies of Sciences, Engineering, and Medicine. Public Health Consequences of E-Cigarettes . The National Academies Press; 2018.
Barrington-Trimis JL, Kong G, Leventhal AM, et al. E-cigarette use and subsequent smoking frequency among adolescents . Pediatrics. 2018;142(6):e20180486.
Barrington-Trimis JL, Urman R, Berhane K, et al. E-cigarettes and future cigarette use . Pediatrics. 2016;138(1):e20160379.
Bunnell RE, Agaku IT, Arrazola RA, et al. Intentions to smoke cigarettes among never-smoking US middle and high school electronic cigarette users: National Youth Tobacco Survey, 2011-2013 . Nicotine Tob Res. 2015;17(2):228–235.
Soneji S, Barrington-Trimis JL, Wills TA, et al. Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: a systematic review and meta-analysis . JAMA Pediatr. 2017;171(8):788–797.
Sun R, Méndez D, Warner KE. Association of electronic cigarette use by U.S. adolescents with subsequent persistent cigarette smoking . JAMA Netw Open. 2023;6(3):e234885.
U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease . Centers for Disease Control and Prevention; 2010. Accessed Feb 13, 2024.
U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General . Centers for Disease Control and Prevention; 2014. Accessed Feb 12, 2024.
Mukerjee R, Hirschtick JL, LZ Arciniega, et al. ENDS, cigarettes, and respiratory illness: longitudinal associations among U.S. youth . AJPM. Published online Dec 2023.
Faulcon LM, Rudy S, Limpert J, Wang B, Murphy I. Adverse experience reports of seizures in youth and young adult electronic nicotine delivery systems users . J Adolesc Health . 2020;66(1):15–17.
U.S. Food and Drug Administration. E-cigarette: Safety Communication - Related to Seizures Reported Following E-cigarette Use, Particularly in Youth and Young Adults . U.S. Department of Health and Human Services; 2019. Accessed Feb 14, 2024.
Marynak KL, Gammon DG, Rogers T, et al. Sales of nicotine-containing electronic cigarette products: United States, 2015 . Am J Public Health . 2017;107(5):702-705.
Regan AK, Bombard JM, O'Hegarty MM, Smith RA, Tong VT. Adverse birth outcomes associated with prepregnancy and prenatal electronic cigarette use . Obstet Gynecol. 2021;138(1):85–94.
Regan AK, Pereira G. Patterns of combustible and electronic cigarette use during pregnancy and associated pregnancy outcomes . Sci Rep. 2021;11(1):13508.
Kutlu MG, Parikh V, Gould TJ. Nicotine addiction and psychiatric disorders . Int Rev Neurobiol. 2015;124:171–208.
Obisesan OH, Mirbolouk M, Osei AD, et al. Association between e-cigarette use and depression in the Behavioral Risk Factor Surveillance System, 2016-2017 . JAMA Netw Open. 2019;2(12):e1916800.
Prochaska JJ, Das S, Young-Wolff KC. Smoking, mental illness, and public health . Annu Rev Public Health. 2017;38:165–185.
Wootton RE, Richmond RC, Stuijfzand BG, et al. Evidence for causal effects of lifetime smoking on risk for depression and schizophrenia: a Mendelian randomisation study . Psychol Med. 2020;50(14):2435–2443.
Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: systematic review and meta-analysis . BMJ. 2014;348:g1151.
Centers for Disease Control and Prevention.   Youth Risk Behavior Survey Data Summary & Trends Report: 2011–2021 . U.S. Department of Health and Human Services; 2023. Accessed Dec 15, 2023.
U.S. Department of Health and Human Services. Protecting Youth Mental Health: The U.S. Surgeon General's Advisory . Office of the Surgeon General; 2021. Accessed Jan 5, 2024.
Lechner WV, Janssen T, Kahler CW, Audrain-McGovern J, Leventhal AM. Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents . Prev Med. 2017;96:73–78.
Gentzke AS, Wang TW, Cornelius M, et al. Tobacco product use and associated factors among middle and high school students—National Youth Tobacco Survey, United States, 2021 . MMWR Surveill Summ. 2022;71(No. SS-5):1–29.

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National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2012.

Cover of Preventing Tobacco Use Among Youth and Young Adults

Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.

1 introduction, summary, and conclusions.

Introduction

Tobacco use is a global epidemic among young people. As with adults, it poses a serious health threat to youth and young adults in the United States and has significant implications for this nation’s public and economic health in the future ( Perry et al. 1994 ; Kessler 1995 ). The impact of cigarette smoking and other tobacco use on chronic disease, which accounts for 75% of American spending on health care ( Anderson 2010 ), is well-documented and undeniable. Although progress has been made since the first Surgeon General’s report on smoking and health in 1964 ( U.S. Department of Health, Education, and Welfare [USDHEW] 1964 ), nearly one in four high school seniors is a current smoker. Most young smokers become adult smokers. One-half of adult smokers die prematurely from tobacco-related diseases ( Fagerström 2002 ; Doll et al. 2004 ). Despite thousands of programs to reduce youth smoking and hundreds of thousands of media stories on the dangers of tobacco use, generation after generation continues to use these deadly products, and family after family continues to suffer the devastating consequences. Yet a robust science base exists on social, biological, and environmental factors that influence young people to use tobacco, the physiology of progression from experimentation to addiction, other health effects of tobacco use, the epidemiology of youth and young adult tobacco use, and evidence-based interventions that have proven effective at reducing both initiation and prevalence of tobacco use among young people. Those are precisely the issues examined in this report, which aims to support the application of this robust science base.

Nearly all tobacco use begins in childhood and adolescence ( U.S. Department of Health and Human Services [USDHHS] 1994 ). In all, 88% of adult smokers who smoke daily report that they started smoking by the age of 18 years (see Chapter 3 , “The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide”). This is a time in life of great vulnerability to social influences ( Steinberg 2004 ), such as those offered through the marketing of tobacco products and the modeling of smoking by attractive role models, as in movies ( Dalton et al. 2009 ), which have especially strong effects on the young. This is also a time in life of heightened sensitivity to normative influences: as tobacco use is less tolerated in public areas and there are fewer social or regular users of tobacco, use decreases among youth ( Alesci et al. 2003 ). And so, as we adults quit, we help protect our children.

Cigarettes are the only legal consumer products in the world that cause one-half of their long-term users to die prematurely ( Fagerström 2002 ; Doll et al. 2004 ). As this epidemic continues to take its toll in the United States, it is also increasing in low- and middle-income countries that are least able to afford the resulting health and economic consequences ( Peto and Lopez 2001 ; Reddy et al. 2006 ). It is past time to end this epidemic. To do so, primary prevention is required, for which our focus must be on youth and young adults. As noted in this report, we now have a set of proven tools and policies that can drastically lower youth initiation and use of tobacco products. Fully committing to using these tools and executing these policies consistently and aggressively is the most straight forward and effective to making future generations tobacco-free.

The 1994 Surgeon General’s Report

This Surgeon General’s report on tobacco is the second to focus solely on young people since these reports began in 1964. Its main purpose is to update the science of smoking among youth since the first comprehensive Surgeon General’s report on tobacco use by youth, Preventing Tobacco Use Among Young People , was published in 1994 ( USDHHS 1994 ). That report concluded that if young people can remain free of tobacco until 18 years of age, most will never start to smoke. The report documented the addiction process for young people and how the symptoms of addiction in youth are similar to those in adults. Tobacco was also presented as a gateway drug among young people, because its use generally precedes and increases the risk of using illicit drugs. Cigarette advertising and promotional activities were seen as a potent way to increase the risk of cigarette smoking among young people, while community-wide efforts were shown to have been successful in reducing tobacco use among youth. All of these conclusions remain important, relevant, and accurate, as documented in the current report, but there has been considerable research since 1994 that greatly expands our knowledge about tobacco use among youth, its prevention, and the dynamics of cessation among young people. Thus, there is a compelling need for the current report.

Tobacco Control Developments

Since 1994, multiple legal and scientific developments have altered the tobacco control environment and thus have affected smoking among youth. The states and the U.S. Department of Justice brought lawsuits against cigarette companies, with the result that many internal documents of the tobacco industry have been made public and have been analyzed and introduced into the science of tobacco control. Also, the 1998 Master Settlement Agreement with the tobacco companies resulted in the elimination of billboard and transit advertising as well as print advertising that directly targeted underage youth and limitations on the use of brand sponsorships ( National Association of Attorneys General [NAAG] 1998 ). This settlement also created the American Legacy Foundation, which implemented a nationwide antismoking campaign targeting youth. In 2009, the U.S. Congress passed a law that gave the U.S. Food and Drug Administration authority to regulate tobacco products in order to promote the public’s health ( Family Smoking Prevention and Tobacco Control Act 2009 ). Certain tobacco companies are now subject to regulations limiting their ability to market to young people. In addition, they have had to reimburse state governments (through agreements made with some states and the Master Settlement Agreement) for some health care costs. Due in part to these changes, there was a decrease in tobacco use among adults and among youth following the Master Settlement Agreement, which is documented in this current report.

Recent Surgeon General Reports Addressing Youth Issues

Other reports of the Surgeon General since 1994 have also included major conclusions that relate to tobacco use among youth ( Office of the Surgeon General 2010 ). In 1998, the report focused on tobacco use among U.S. racial/ethnic minority groups ( USDHHS 1998 ) and noted that cigarette smoking among Black and Hispanic youth increased in the 1990s following declines among all racial/ethnic groups in the 1980s; this was particularly notable among Black youth, and culturally appropriate interventions were suggested. In 2000, the report focused on reducing tobacco use ( USDHHS 2000b ). A major conclusion of that report was that school-based interventions, when implemented with community- and media-based activities, could reduce or postpone the onset of smoking among adolescents by 20–40%. That report also noted that effective regulation of tobacco advertising and promotional activities directed at young people would very likely reduce the prevalence and onset of smoking. In 2001, the Surgeon General’s report focused on women and smoking ( USDHHS 2001 ). Besides reinforcing much of what was discussed in earlier reports, this report documented that girls were more affected than boys by the desire to smoke for the purpose of weight control. Given the ongoing obesity epidemic ( Bonnie et al. 2007 ), the current report includes a more extensive review of research in this area.

The 2004 Surgeon General’s report on the health consequences of smoking ( USDHHS 2004 ) concluded that there is sufficient evidence to infer that a causal relationship exists between active smoking and (a) impaired lung growth during childhood and adolescence; (b) early onset of decline in lung function during late adolescence and early adulthood; (c) respiratory signs and symptoms in children and adolescents, including coughing, phlegm, wheezing, and dyspnea; and (d) asthma-related symptoms (e.g., wheezing) in childhood and adolescence. The 2004 Surgeon General’s report further provided evidence that cigarette smoking in young people is associated with the development of atherosclerosis.

The 2010 Surgeon General’s report on the biology of tobacco focused on the understanding of biological and behavioral mechanisms that might underlie the pathogenicity of tobacco smoke ( USDHHS 2010 ). Although there are no specific conclusions in that report regarding adolescent addiction, it does describe evidence indicating that adolescents can become dependent at even low levels of consumption. Two studies ( Adriani et al. 2003 ; Schochet et al. 2005 ) referenced in that report suggest that because the adolescent brain is still developing, it may be more susceptible and receptive to nicotine than the adult brain.

Scientific Reviews

Since 1994, several scientific reviews related to one or more aspects of tobacco use among youth have been undertaken that also serve as a foundation for the current report. The Institute of Medicine (IOM) ( Lynch and Bonnie 1994 ) released Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths, a report that provided policy recommendations based on research to that date. In 1998, IOM provided a white paper, Taking Action to Reduce Tobacco Use, on strategies to reduce the increasing prevalence (at that time) of smoking among young people and adults. More recently, IOM ( Bonnie et al. 2007 ) released a comprehensive report entitled Ending the Tobacco Problem: A Blueprint for the Nation . Although that report covered multiple potential approaches to tobacco control, not just those focused on youth, it characterized the overarching goal of reducing smoking as involving three distinct steps: “reducing the rate of initiation of smoking among youth (IOM [ Lynch and Bonnie] 1994 ), reducing involuntary tobacco smoke exposure ( National Research Council 1986 ), and helping people quit smoking” (p. 3). Thus, reducing onset was seen as one of the primary goals of tobacco control.

As part of USDHHS continuing efforts to assess the health of the nation, prevent disease, and promote health, the department released, in 2000, Healthy People 2010 and, in 2010, Healthy People 2020 ( USDHHS 2000a , 2011 ). Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of prevention activities. Each iteration of Healthy People serves as the nation’s disease prevention and health promotion roadmap for the decade. Both Healthy People 2010 and Healthy People 2020 highlight “Tobacco Use” as one of the nation’s “Leading Health Indicators,” feature “Tobacco Use” as one of its topic areas, and identify specific measurable tobacco-related objectives and targets for the nation to strive for. Healthy People 2010 and Healthy People 2020 provide tobacco objectives based on the most current science and detailed population-based data to drive action, assess tobacco use among young people, and identify racial and ethnic disparities. Additionally, many of the Healthy People 2010 and 2020 tobacco objectives address reductions of tobacco use among youth and target decreases in tobacco advertising in venues most often influencing young people. A complete list of the healthy people 2020 objectives can be found on their Web site ( USDHHS 2011 ).

In addition, the National Cancer Institute (NCI) of the National Institutes of Health has published monographs pertinent to the topic of tobacco use among youth. In 2001, NCI published Monograph 14, Changing Adolescent Smoking Prevalence , which reviewed data on smoking among youth in the 1990s, highlighted important statewide intervention programs, presented data on the influence of marketing by the tobacco industry and the pricing of cigarettes, and examined differences in smoking by racial/ethnic subgroup ( NCI 2001 ). In 2008, NCI published Monograph 19, The Role of the Media in Promoting and Reducing Tobacco Use ( NCI 2008 ). Although young people were not the sole focus of this Monograph, the causal relationship between tobacco advertising and promotion and increased tobacco use, the impact on youth of depictions of smoking in movies, and the success of media campaigns in reducing youth tobacco use were highlighted as major conclusions of the report.

The Community Preventive Services Task Force (2011) provides evidence-based recommendations about community preventive services, programs, and policies on a range of topics including tobacco use prevention and cessation ( Task Force on Community Preventive Services 2001 , 2005 ). Evidence reviews addressing interventions to reduce tobacco use initiation and restricting minors’ access to tobacco products were cited and used to inform the reviews in the current report. The Cochrane Collaboration (2010) has also substantially contributed to the review literature on youth and tobacco use by producing relevant systematic assessments of health-related programs and interventions. Relevant to this Surgeon General’s report are Cochrane reviews on interventions using mass media ( Sowden 1998 ), community interventions to prevent smoking ( Sowden and Stead 2003 ), the effects of advertising and promotional activities on smoking among youth ( Lovato et al. 2003 , 2011 ), preventing tobacco sales to minors ( Stead and Lancaster 2005 ), school-based programs ( Thomas and Perara 2006 ), programs for young people to quit using tobacco ( Grimshaw and Stanton 2006 ), and family programs for preventing smoking by youth ( Thomas et al. 2007 ). These reviews have been cited throughout the current report when appropriate.

In summary, substantial new research has added to our knowledge and understanding of tobacco use and control as it relates to youth since the 1994 Surgeon General’s report, including updates and new data in subsequent Surgeon General’s reports, in IOM reports, in NCI Monographs, and in Cochrane Collaboration reviews, in addition to hundreds of peer-reviewed publications, book chapters, policy reports, and systematic reviews. Although this report is a follow-up to the 1994 report, other important reviews have been undertaken in the past 18 years and have served to fill the gap during an especially active and important time in research on tobacco control among youth.

Focus of the Report

Young People

This report focuses on “young people.” In general, work was reviewed on the health consequences, epidemiology, etiology, reduction, and prevention of tobacco use for those in the young adolescent (11–14 years of age), adolescent (15–17 years of age), and young adult (18–25 years of age) age groups. When possible, an effort was made to be specific about the age group to which a particular analysis, study, or conclusion applies. Because hundreds of articles, books, and reports were reviewed, however, there are, unavoidably, inconsistencies in the terminology used. “Adolescents,” “children,” and “youth” are used mostly interchangeably throughout this report. In general, this group encompasses those 11–17 years of age, although “children” is a more general term that will include those younger than 11 years of age. Generally, those who are 18–25 years old are considered young adults (even though, developmentally, the period between 18–20 years of age is often labeled late adolescence), and those 26 years of age or older are considered adults.

In addition, it is important to note that the report is concerned with active smoking or use of smokeless tobacco on the part of the young person. The report does not consider young people’s exposure to secondhand smoke, also referred to as involuntary or passive smoking, which was discussed in the 2006 report of the Surgeon General ( USDHHS 2006 ). Additionally, the report does not discuss research on children younger than 11 years old; there is very little evidence of tobacco use in the United States by children younger than 11 years of age, and although there may be some predictors of later tobacco use in those younger years, the research on active tobacco use among youth has been focused on those 11 years of age and older.

Tobacco Use

Although cigarette smoking is the most common form of tobacco use in the United States, this report focuses on other forms as well, such as using smokeless tobacco (including chew and snuff) and smoking a product other than a cigarette, such as a pipe, cigar, or bidi (tobacco wrapped in tendu leaves). Because for young people the use of one form of tobacco has been associated with use of other tobacco products, it is particularly important to monitor all forms of tobacco use in this age group. The term “tobacco use” in this report indicates use of any tobacco product. When the word “smoking” is used alone, it refers to cigarette smoking.

Organization of the Report

This chapter begins by providing a short synopsis of other reports that have addressed smoking among youth and, after listing the major conclusions of this report, will end by presenting conclusions specific to each chapter. Chapter 2 of this report (“The Health Consequences of Tobacco Use Among Young People”) focuses on the diseases caused by early tobacco use, the addiction process, the relation of body weight to smoking, respiratory and pulmonary problems associated with tobacco use, and cardiovascular effects. Chapter 3 (“The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide”) provides recent and long-term cross-sectional and longitudinal data on cigarette smoking, use of smokeless tobacco, and the use of other tobacco products by young people, by racial/ethnic group and gender, primarily in the United States, but including some worldwide data as well. Chapter 4 (“Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth”) identifies the primary risk factors associated with tobacco use among youth at four levels, including the larger social and physical environments, smaller social groups, cognitive factors, and genetics and neurobiology. Chapter 5 (“The Tobacco Industry’s Influences on the Use of Tobacco Among Youth”) includes data on marketing expenditures for the tobacco industry over time and by category, the effects of cigarette advertising and promotional activities on young people’s smoking, the effects of price and packaging on use, the use of the Internet and movies to market tobacco products, and an evaluation of efforts by the tobacco industry to prevent tobacco use among young people. Chapter 6 (“Efforts to Prevent and Reduce Tobacco Use Among Young People”) provides evidence on the effectiveness of family-based, clinic-based, and school-based programs, mass media campaigns, regulatory and legislative approaches, increased cigarette prices, and community and statewide efforts in the fight against tobacco use among youth. Chapter 7 (“A Vision for Ending the Tobacco Epidemic”) points to next steps in preventing and reducing tobacco use among young people.

Preparation of the Report

This report of the Surgeon General was prepared by the Office on Smoking and Health (OSH), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), USDHHS. In 2008, 18 external independent scientists reviewed the 1994 report and suggested areas to be added and updated. These scientists also suggested chapter editors and a senior scientific editor, who were contacted by OSH. Each chapter editor named external scientists who could contribute, and 33 content experts prepared draft sections. The draft sections were consolidated into chapters by the chapter editors and then reviewed by the senior scientific editor, with technical editing performed by CDC. The chapters were sent individually to 34 peer reviewers who are experts in the areas covered and who reviewed the chapters for scientific accuracy and comprehensiveness. The entire manuscript was then sent to more than 25 external senior scientists who reviewed the science of the entire document. After each review cycle, the drafts were revised by the chapter and senior scientific editor on the basis of the experts’ comments. Subsequently, the report was reviewed by various agencies within USDHHS. Publication lags prevent up-to-the-minute inclusion of all recently published articles and data, and so some more recent publications may not be cited in this report.

Evaluation of the Evidence

Since the first Surgeon General’s report in 1964 on smoking and health ( USDHEW 1964 ), major conclusions concerning the conditions and diseases caused by cigarette smoking and the use of smokeless tobacco have been based on explicit criteria for causal inference ( USDHHS 2004 ). Although a number of different criteria have been proposed for causal inference since the 1960s, this report focuses on the five commonly accepted criteria that were used in the original 1964 report and that are discussed in greater detail in the 2004 report on the health consequences of smoking ( USDHHS 2004 ). The five criteria refer to the examination of the association between two variables, such as a risk factor (e.g., smoking) and an outcome (e.g., lung cancer). Causal inference between these variables is based on (1) the consistency of the association across multiple studies; this is the persistent finding of an association in different persons, places, circumstances, and times; (2) the degree of the strength of association, that is, the magnitude and statistical significance of the association in multiple studies; (3) the specificity of the association to clearly demonstrate that tobacco use is robustly associated with the condition, even if tobacco use has multiple effects and multiple causes exist for the condition; (4) the temporal relationship of the association so that tobacco use precedes disease onset; and (5) the coherence of the association, that is, the argument that the association makes scientific sense, given data from other sources and understanding of biological and psychosocial mechanisms ( USDHHS 2004 ). Since the 2004 Surgeon General’s report, The Health Consequences of Smoking , a four-level hierarchy ( Table 1.1 ) has been used to assess the research data on associations discussed in these reports ( USDHHS 2004 ). In general, this assessment was done by the chapter editors and then reviewed as appropriate by peer reviewers, senior scientists, and the scientific editors. For a relationship to be considered sufficient to be characterized as causal, multiple studies over time provided evidence in support of each criteria.

Four-level hierarchy for classifying the strength of causal inferences based on available evidence.

When a causal association is presented in the chapter conclusions in this report, these four levels are used to describe the strength of the evidence of the association, from causal (1) to not causal (4). Within the report, other terms are used to discuss the evidence to date (i.e., mixed, limited, and equivocal evidence), which generally represent an inadequacy of data to inform a conclusion.

However, an assessment of a casual relationship is not utilized in presenting all of the report’s conclusions. The major conclusions are written to be important summary statements that are easily understood by those reading the report. Some conclusions, particularly those found in Chapter 3 (epidemiology), provide observations and data related to tobacco use among young people, and are generally not examinations of causal relationships. For those conclusions that are written using the hierarchy above, a careful and extensive review of the literature has been undertaken for this report, based on the accepted causal criteria ( USDHHS 2004 ). Evidence that was characterized as Level 1 or Level 2 was prioritized for inclusion as chapter conclusions.

In additional to causal inferences, statistical estimation and hypothesis testing of associations are presented. For example, confidence intervals have been added to the tables in the chapter on the epidemiology of youth tobacco use (see Chapter 3 ), and statistical testing has been conducted for that chapter when appropriate. The chapter on efforts to prevent tobacco use discusses the relative improvement in tobacco use rates when implementing one type of program (or policy) versus a control program. Statistical methods, including meta-analytic methods and longitudinal trajectory analyses, are also presented to ensure that the methods of evaluating data are up to date with the current cutting-edge research that has been reviewed. Regardless of the methods used to assess significance, the five causal criteria discussed above were applied in developing the conclusions of each chapter and the report.

Major Conclusions
Cigarette smoking by youth and young adults has immediate adverse health consequences, including addiction, and accelerates the development of chronic diseases across the full life course.
Prevention efforts must focus on both adolescents and young adults because among adults who become daily smokers, nearly all first use of cigarettes occurs by 18 years of age (88%), with 99% of first use by 26 years of age.
Advertising and promotional activities by tobacco companies have been shown to cause the onset and continuation of smoking among adolescents and young adults.
After years of steady progress, declines in the use of tobacco by youth and young adults have slowed for cigarette smoking and stalled for smokeless tobacco use.
Coordinated, multicomponent interventions that combine mass media campaigns, price increases including those that result from tax increases, school-based policies and programs, and statewide or community-wide changes in smoke-free policies and norms are effective in reducing the initiation, prevalence, and intensity of smoking among youth and young adults.
Chapter Conclusions

The following are the conclusions presented in the substantive chapters of this report.

Chapter 2. The Health Consequences of Tobacco Use Among Young People

The evidence is sufficient to conclude that there is a causal relationship between smoking and addiction to nicotine, beginning in adolescence and young adulthood.
The evidence is suggestive but not sufficient to conclude that smoking contributes to future use of marijuana and other illicit drugs.
The evidence is suggestive but not sufficient to conclude that smoking by adolescents and young adults is not associated with significant weight loss, contrary to young people’s beliefs.
The evidence is sufficient to conclude that there is a causal relationship between active smoking and both reduced lung function and impaired lung growth during childhood and adolescence.
The evidence is sufficient to conclude that there is a causal relationship between active smoking and wheezing severe enough to be diagnosed as asthma in susceptible child and adolescent populations.
The evidence is sufficient to conclude that there is a causal relationship between smoking in adolescence and young adulthood and early abdominal aortic atherosclerosis in young adults.
The evidence is suggestive but not sufficient to conclude that there is a causal relationship between smoking in adolescence and young adulthood and coronary artery atherosclerosis in adulthood.

Chapter 3. The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide

Among adults who become daily smokers, nearly all first use of cigarettes occurs by 18 years of age (88%), with 99% of first use by 26 years of age.
Almost one in four high school seniors is a current (in the past 30 days) cigarette smoker, compared with one in three young adults and one in five adults. About 1 in 10 high school senior males is a current smokeless tobacco user, and about 1 in 5 high school senior males is a current cigar smoker.
Among adolescents and young adults, cigarette smoking declined from the late 1990s, particularly after the Master Settlement Agreement in 1998. This decline has slowed in recent years, however.
Significant disparities in tobacco use remain among young people nationwide. The prevalence of cigarette smoking is highest among American Indians and Alaska Natives, followed by Whites and Hispanics, and then Asians and Blacks. The prevalence of cigarette smoking is also highest among lower socioeconomic status youth.
Use of smokeless tobacco and cigars declined in the late 1990s, but the declines appear to have stalled in the last 5 years. The latest data show the use of smokeless tobacco is increasing among White high school males, and cigar smoking may be increasing among Black high school females.
Concurrent use of multiple tobacco products is prevalent among youth. Among those who use tobacco, nearly one-third of high school females and more than one-half of high school males report using more than one tobacco product in the last 30 days.
Rates of tobacco use remain low among girls relative to boys in many developing countries, however, the gender gap between adolescent females and males is narrow in many countries around the globe.

Chapter 4. Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth

Given their developmental stage, adolescents and young adults are uniquely susceptible to social and environmental influences to use tobacco.
Socioeconomic factors and educational attainment influence the development of youth smoking behavior. The adolescents most likely to begin to use tobacco and progress to regular use are those who have lower academic achievement.
The evidence is sufficient to conclude that there is a causal relationship between peer group social influences and the initiation and maintenance of smoking behaviors during adolescence.
Affective processes play an important role in youth smoking behavior, with a strong association between youth smoking and negative affect.
The evidence is suggestive that tobacco use is a heritable trait, more so for regular use than for onset. The expression of genetic risk for smoking among young people may be moderated by small-group and larger social-environmental factors.

Chapter 5. The Tobacco Industry’s Influences on the Use of Tobacco Among Youth

In 2008, tobacco companies spent $9.94 billion on the marketing of cigarettes and $547 million on the marketing of smokeless tobacco. Spending on cigarette marketing is 48% higher than in 1998, the year of the Master Settlement Agreement. Expenditures for marketing smokeless tobacco are 277% higher than in 1998.
Tobacco company expenditures have become increasingly concentrated on marketing efforts that reduce the prices of targeted tobacco products. Such expenditures accounted for approximately 84% of cigarette marketing and more than 77% of the marketing of smokeless tobacco products in 2008.
The evidence is sufficient to conclude that there is a causal relationship between advertising and promotional efforts of the tobacco companies and the initiation and progression of tobacco use among young people.
The evidence is suggestive but not sufficient to conclude that tobacco companies have changed the packaging and design of their products in ways that have increased these products’ appeal to adolescents and young adults.
The tobacco companies’ activities and programs for the prevention of youth smoking have not demonstrated an impact on the initiation or prevalence of smoking among young people.
The evidence is sufficient to conclude that there is a causal relationship between depictions of smoking in the movies and the initiation of smoking among young people.

Chapter 6. Efforts to Prevent and Reduce Tobacco Use Among Young People

The evidence is sufficient to conclude that mass media campaigns, comprehensive community programs, and comprehensive statewide tobacco control programs can prevent the initiation of tobacco use and reduce its prevalence among youth.
The evidence is sufficient to conclude that increases in cigarette prices reduce the initiation, prevalence, and intensity of smoking among youth and young adults.
The evidence is sufficient to conclude that school-based programs with evidence of effectiveness, containing specific components, can produce at least short-term effects and reduce the prevalence of tobacco use among school-aged youth.
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Cite this Page National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2012. 1, Introduction, Summary, and Conclusions.
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