Most people who use tobacco started during adolescence, and those who begin at a younger age are more likely to develop nicotine dependence and have trouble quitting.67 According to the 2017 Monitoring the Future Survey, 9.7 percent of 12th graders, 5.0 percent of 10th graders, and 1.9 percent of 8th graders used cigarettes in the past month.12 Analyses of the 2012 National Youth Tobacco Survey (NYTS) found that 20.8 percent of current adolescent tobacco users reported wanting to use tobacco within 30 minutes of waking—a classic symptom of nicotine dependence. This study also found that 41.9 percent reported strong cravings for tobacco.68 Other research has found that light and intermittent smoking among adolescents is associated with the same level of difficulty quitting as daily smoking.69
Any exposure to nicotine among youth is a concern. The adolescent brain is still developing, and nicotine has effects on the brain’s reward system and brain regions involved in emotional and cognitive functions.70 Research suggests that the nicotine-related changes to these areas of the brain during adolescence may perpetuate continued tobacco use into adulthood.71 These changes also contribute to a higher rate of other substance use disorders among people who use tobacco during adolescence, sometimes referred to as a "gateway" effect.70,72
Mental health, beliefs about smoking, perception of schoolmates’ smoking, and other substance use are additional factors that can influence an adolescent’s risk for smoking and nicotine dependence.73 Emotional problems—including depression74 and recent negative life events75—are associated with tobacco use among adolescents. Smoking among peers and within social groups is a major environmental factor that influences adolescent smoking; social smoking is a more important motivator for adolescents compared to adult smokers.76
It is common for adolescent smoking to follow an intergenerational pattern, which has genetic, epigenetic, and environmental influences.73,77 Data from parents and adolescents suggests that current parental nicotine dependence is strongly linked with adolescent smoking and dependence. Other factors—such as parents’ education, marital status, and parenting behavior also influence teen smoking.