Study finds young people are now more likely to start smoking after they turn 18, not before; calls for more prevention efforts

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The celebration in recent years about lower smoking rates among teenagers could end up being all for naught, as a new study shows that more people are likely to now start smoking after they turn 18, not before.

The study at the University of Texas Health Science Center at Houston, looked at data from the National Survey on Drug Use and Health from 2006 to 2013. It found that the start of cigarette smoking among young adults was more than three times higher than that among teens: 6.3 percent and 1.9 percent respectively.

“Historically, it used to be that nearly everything started by age 18. That’s no longer the case, as young adults are experimenting with things once more common during high school years. Young adults are starting to act like adolescents,” said Cheryl Perry, senior author of the study, said in the news release.

Like the rest of the nation, smoking rates among Kentucky teens have dropped recently, to 14.3 percent in 2017 from 47 percent in 1997. Nationally, the teen smoking rate dropped to 8.8 percent from 36.4 percent respectively. Kentucky ranks second highest for adult smoking rates, 24.5 percent.

Perry, a professor and regional dean at UT's School of Public Health in Austin, was the senior scientific editor of the 1994 Surgeon’s General Report on Preventing Tobacco Use among Young People, which said, "Tobacco use primarily begins in early adolescence, typically by age 16; almost all first use occurs before the time of high-school graduation."

Perry called the shift toward later starts of smoking a “potentially watershed situation, which could have very alarming health implications.”

A news release about the study said, “In all cases, young adults were significantly more likely than youth to both have ever tried and be a current user of cigarettes, cigars, e-cigarettes and hookah.”

The research report, published in the Journal of Adolescent Health, also cited three other studies, including the national Population Assessment of Tobacco and Health Study and two in Texas that included not only cigarettes, but also e-cigarettes, cigar products and hookah.

“The fact that Texan cohorts looked the same nationally makes this evidence of later onset more compelling,” Perry said. “It indicates a massive cultural shift, relating to a behavior that still kills half of its regular customers.

The researchers note that one reason for later onset of smoking could be that adolescents are putting off activities that have been traditionally associated with being a teenager, like hanging out with friends, drinking alcohol, dating and driving.

Another possible reason: Policies to reduce tobacco use among teens have been highly effective, like banning various flavors of cigarettes, banning sponsorship at entertainment and sports events and stricter guidelines around youth marketing of these products..

The report notes that retailers' compliance with bans on sale of tobacco to minors increased to more than 90 percent by 2012, according to the U.S. Department of Health and Human Services.

But that apparently led to tobacco companies marketing more explicitly toward their youngest legal target group -- young adults, according to research cited in the study.

“According to the Federal Trade Commission cigarette report, price discounts accounted for the vast majority (80 percent) of cigarette marketing dollars in 2014 as tobacco companies try to attract price-sensitive young adults,” the study report says.

With young adults putting off starting a career, getting married and having children, the authors noted that this “could create a window of opportunity for risky behavior.”

The researchers warn that more needs to be done to prevent this behavior in young adults, but notes that there are few programs or policies that focus directly on the age group.

Perry adds that more research is needed, including on adults into their 30s, “to see whether this is a part of seismic change.”

“Just when we thought we were nearing the end game, we might have been outsmarted,” Perry said. “It’s a challenge, which will demand new ways of trying to communicate with and influence young adults who may be much harder to reach than adolescents.”