Tobacco industry advertising and promotional activities
cause youth and young adults to start smoking, and
nicotine addiction keeps people smoking past those ages
(Chapter 14) (USDHHS 2012). Each year, for every adult
who dies prematurely from a smoking-related cause, more
than two youth or young adults become replacement
smokers (Chapter 13) (USDHHS 2012). Although the
prevalence of current smoking among high school-aged
youth has declined, the total number of youth and young
adults who started smoking increased from 1.9 million
in 2002 to 2.3 million in 2012 (Figure 3). However, progress
has been made in reducing initiation among youth
younger than 18 years of age, with the total number of
youth who initiated smoking before age 18 declining from
1.5 million in 2009 down to 1.2 million in 2012.
While attention has focused primarily on cigarette
smoking, this and recent Surgeon General’s reports review
health risks and emphasize the need to monitor patterns
of use of all combusted tobacco products, particularly the
use of cigarette-like cigars and roll-your-own cigarettes
using pipe tobacco. Most commonly, these products are
used along with cigarettes. According to recent trends,
the percentage of adults, 18 years of age and older—who
smoke either cigarettes, cigars, or roll-your-own cigarettes
made with pipe tobacco—has remained relatively
steady (25–26%) since 2009 and has declined only a small
amount since 2002 (Table 2).
Although recent trends emphasize the need for continued
and vigorous tobacco control efforts, significant