Youth and Tobacco

American Indian and Alaska Native youth have higher rates of commercial tobacco-use than other races/ethnicities in many regions of the U.S. Smoking initiation is often early for Native youth compared with other races, with initiation in the tween years and regular smoking in the teen years. The use of multiple tobacco and nicotine products—including cigarettes, e-cigarettes, cigars, and smokeless tobacco—is also common among young people. Messages and images that make commercial tobacco use “normal” and “appealing” can be found almost everywhere and the pressure is strong on today’s native youth.

While most commercial tobacco product companies claim not to target youth, tobacco industry documents showed that companies continue to market their products to youth. Youth are targeted as “replacement smokers,” as commercial tobacco use kills nearly 1,300 Americans every day. Each day more than 3,800 youth try smoking for the first time and another 2,100 youth and young adults become regular smokers.1 If smoking continues at the current rate among U.S. youth, 5.6 million of today’s youth will die early from smoking-related illness—that is 1 out of every 13 Americans aged 17 or younger alive today.2

Youth are particularly vulnerable to social and environmental influences to use commercial tobacco; young people who want to fit in with peers that use commercial tobacco products may begin smoking, chewing, or vaping as an experiment, but find themselves addicted as a teenager. While teenage commercial tobacco and nicotine product users may think they can quit, 3 of 4 high school smokers remain smokers as adults.

Positive environments and social norms free of commercial tobacco product use may help our youth avoid commercial tobacco abuse in the first place. Traditional teachings on respectful, cultural use of tobacco may help youth distinguish traditional tobacco from commercial tobacco abuse and avoid the misuse of tobacco. American Indian and Alaska Native cultural ways and Native languages can form the backbone of commercial tobacco use prevention among Native youth.

Native youth are working to keep tobacco sacred and to ‘Be An Original,’ not a replacement for tobacco companies, who lose commercial tobacco consumers to commercial tobacco related death each day.



Marketing, Advertisements, Movies and Media

Tobacco companies spend more than a million dollars per hour in the U.S. alone to market their products.3 In a lot of mass media, including movies and paid advertisements, smoking is portrayed as a normal part of life. Youth and young adults see smoking in their social circles, movies they watch, video games they play, websites they visit, and many communities where they live. Youth who get the most exposure to onscreen smoking are about twice as likely to begin smoking as those who get the least exposure.


About half of PG-13 movies contained images of smoking or commercial tobacco product use each year from 2010 to 2014. The percentage of PG-13 movies with tobacco incidents increased and the number of tobacco incidents in movies rated PG more than tripled from 2013 to 2014.4 The 2014 Surgeon General’s Report stated that youth rates of tobacco use would be reduced by 18% if tobacco incidents and impressions were eliminated in PG-13 films and movies with tobacco incidents received an R rating.5


Commercial tobacco companies have used native imagery to sell tobacco products for decades and continue to do so today. These companies mis-appropriate tribal cultural images for profit, including the image of a headdress and a Native American smoking a pipe. Native youth have taken a stand against this:


Point of Sale

Commercial tobacco product advertising and promotions entice far too many young people to start using commercial tobacco. Point of Sale advertising and promotions include signs on the inside and outside of gas stations and convenience stores, displays, coupons, and other price discounts. One way of targeting youth is the placement of commercial tobacco products and advertisements, especially including vibrant colors and candy flavors, at youth eye-level in gas stations and convenience stores. Point of sale marketing has been shown to influence the likelihood that youth begin smoking and the products and brands that youth use.6 For more information, see the Campaign for Tobacco Free Kids Factsheet.


Internet Marketing

Tobacco companies focus on advertising e-cigarettes, cigars and smokeless commercial tobacco through online media. E-cigarette ads in particular tend to appear on websites that focus on topics such as music and entertainment that are likely to have high youth traffic. The American Legacy Foundation found that advertisements for commercial tobacco or e-cigarettes were found on 180 of the 250 websites they monitored in a study on online tobacco advertisement. These ads often lead to company pages that did not provide commercial tobacco cessation information.


Role Models

Youth identify with peers they see as social leaders and may imitate their behavior; those whose friends or siblings smoke are more likely to smoke.


  1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 2015. Youth and Tobacco Use
  2. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2012. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General
  3. Campaign for Tobacco Free Kids. 2008. Tobacco Company Marketing to Kids
  4. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 2015. Smoking in the Movies
  5. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2014. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General

Health Effects of Tobacco and Nicotine on Youth

  • Tobacco impairs lung function and growth, causing lack of oxygen and shortness of breath, chronic coughing and wheezing
  • Tobacco can affect youth activities and athletic performance. Smokers run slower and can't run as far as nonsmokers
  • Every day in the United States, another 1,500 kids become daily smokers
  • Nicotine is highly addictive for youth. Most smokers start before finishing high school
  • Three out of four high school smokers become adult smokers
  • Kids who smoke 2 or 3 cigarettes a day can get hooked in as short as two weeks
  • Nicotine is poisonous—it’s used as a pesticide, and a drop of pure nicotine can kill a person
  • Nicotine in tobacco absorbs into the bloodstream within 10 seconds, causing the brain to release adrenaline and create a buzz of pleasure and energy
  • As the buzz quickly fades, a person feels tired, a little down, and wants to light up the next cigarette to get that buzz again
  • As tolerance builds, more and more cigarettes will be needed to get nicotine’s pleasure and prevent withdrawal symptoms
  • This up and down cycle repeats over and over, leading to addiction
  • 40% of teenagers who smoke daily have tried to quit and failed
  • Many people need more than one try in order to quit. Learn about quitting.
  • Smoking as few as 5 cigarettes a day can reduce teens' lung function growth, with teenage girls being especially vulnerable
  • Tobacco narrows blood vessels and puts a strain on the heart
  • Secondhand smoke increases sudden infant death syndrome and respiratory illness, cardiovascular disease, ear infections, allergies, bronchitis, pneumonia, and asthma
  • Older children whose parents smoke get sick more often
  • Girls who smoke are more likely to grow excess facial hair
  • Teens who smoke produce twice as much phlegm as teens who don't
  • Teens who smoke break out more and acne lasts longer for teens who smoke
  • Teens who smoke catch more colds and their symptoms are worse and last longer
  • Teenagers who smoke use more medications than those who do not smoke
  • Teenagers who smoke have significantly more trouble sleeping than those who don’t
  • About 2/3 of teen smokers say they want to quit smoking, and 70% say they would not have started if they could choose again
  • 44% of teens say they didn't know bidi cigarettes (thin, hand-rolled, often-flavored cigarettes imported from Asia that are blends of tobacco and locally available non-tobacco leaves) could lead to cancer. One bidi cigarette produces 3 times as much nicotine and carbon monoxide as a regular cigarette and 5 times as much tar. Find out about bidis
  • 1 of every 3 kids who become regular smokers will die of a smoking related disease
  • Learn more about Youth & Tobacco and Youth Tobacco Prevention from the Centers for Disease Control and Prevention