Strategy 1.3 - Youth

    • May 25, 2010

About 1,200 children and adolescents become daily smokers each day. In 2006, an estimated 3.3 million U.S. adolescents had used tobacco within the previous month. Compared to older populations in the United States, adolescents and young adults have the highest smoking prevalence.

Although quitting benefits are greatest for those who quit at younger ages, numerous studies conducted in the 1990s found that counseling approaches and medications effective for adult quitters are not as effective for youth. A 2006 national survey funded by the Robert Wood Johnson Foundation (RWJF) and the Center for Disease Control and Prevention's Office on Smoking and Health found that more than 60 percent of adolescent and young adult smokers had tried to quit within the previous year.

Since RWJF first entered the tobacco-cessation field in the early 1990s, reducing tobacco among youth has been one of its major goals. The cessation effort has focused on identifying how and why youth begin smoking and how they progress from occasional smokers to daily smokers and on developing the best treatment methods for helping youth quit.

What Is Known About Smoking Among Youth and Young Adults

  • Influences on youth quitting. Peers, family, individual attributes and external environment all influence the likelihood that kids will quit. (This factsheet from the Youth Tobacco Cessation Collaborative details the research on youth tobacco influences.)
  • Young smokers try to quit as often or more often than adult smokers. The RWJF-funded National Youth Smoking Cessation Survey found that more than 80 percent of young smokers want to quit. About three-quarters have tried to quit at least once and failed. (See this factsheet from the collaborative for more information on young smokers' quit attempts.)
  • Most young smokers don't use effective treatments when they try to quit. (See news brief on a summer 2007 article in the American Journal of Public Health about a study of young adult smokers' quit attempts.)
  • Treatments that are effective for adult smokers are not as appealing and effective for teen and young adult smokers. The 1996 and 2001 USPHS clinical practice guidelines panels did not recommend any counseling or pharmacotherapeutic treatment methods for youth.

Key RWJF-Sponsored Initiatives: Research

  • Substance Abuse Policy Research Program (SAPRP) (1994–2010) and its predecessor, the Tobacco Policy Research and Evaluation Program (TPREP) (1992–96) have supported policy relevant, peer-reviewed research that increases understanding of policies for reducing harm caused by substance abuse, including tobacco use. These programs provided seminal findings showing the beneficial effects of tobacco tax and price increases, especially on young smokers, as well as on anti-smoking media campaigns and smoke-free air laws on smoking prevention and cessation. They also documented the synergistic effects of comprehensive and combined public health tobacco-control policies on population and treatment use. Results for youth smoking initiation and cessation can be found in SAPRP knowledge assets and reports ("Increasing the Use of Smoking Cessation Treatments," "Cigarette Taxes and Pricing" and "Research Agenda for Achieving a Smoke-Free Society"). (See Program Results on SAPRP, Program Results on TPREP and SAPRP Knowledge Assets.)
  • Tobacco Etiology Research Network (TERN) (1996–2006) was a transdisciplinary research network that focused on the causes and progression of tobacco use and dependence and on processes of tobacco use initiation and cessation in youth and young adults. TERN brought researchers together from a variety of fields to study the origins of tobacco dependence.
  • Bridging the Gap/ImpacTeen (1997–2012) co-directed by Frank Chaloupka, P.H., and Lloyd Johnson, Ph.D., is an interdisciplinary research program that has examined the links between youth behavior (including smoking) and national state and local policy, economic and social factors.
  • Helping Young Smokers Quit (2001–09) was a two-phase program that surveyed the growing number of existing adolescent tobacco-cessation programs to identify major program offerings, both promising and potentially harmful treatment practices, and the resources/resource constraints in the real world settings in which they are offered. While a growing number of teen cessation programs are available, little has been known about:
    • How many programs exist
    • Where they are located
    • What services they offer
    • What populations they serve
    • How they provide treatment
    Moreover, only a handful of such programs have been evaluated. In its second phase, the program disseminated effective, developmentally appropriate cessation programs for adolescent smokers. (See Advocacy & Communications, below.)
  • The National Youth Smoking Cessation Survey (started in July 2003, findings released in July 2006) co-led by Gary Giovino, PhD, and Dianne Barker, MPA, and co-funded by RWJF, the Centers for Disease Control and Prevention, and the National Cancer Institute, was a two-year longitudinal telephone survey that asked smokers aged 16 to 24 about their cessation activity. Findings have provided national estimates of quitting activity, have clarified factors associated with quitting among adolescents and young adults, and clarified youth preferences for different types of treatment. (See the report on rwjf.org.)

Key RWJF-Sponsored Initiatives: Action to Put Research Into Practice

  • The Campaign for Tobacco-Free Kids (started by RWJF in 1996 and ongoing) advocates for policies and programs that prevent tobacco use initiation and promote cessation among youth and young adults. (See Program Results and the campaign's website.)
  • The Youth Tobacco Cessation Collaborative (YTCC) (1998–2008). In 1998, the major U.S. funders of tobacco-control research, program and policy initiatives (the U.S. Centers for Disease Control and Prevention, the Legacy Foundation, National Cancer Institute, National Institute on Drug Abuse and RWJF) joined forces to establish and fund the YTCC to accelerate progress in helping young people quit tobacco use. The ambitious goal of the YTCC was to ensure that every young tobacco user (aged 12 to 24) had access to appropriate and effective cessation interventions by the year 2010. The YTCC was formed to eliminate unplanned duplication of effort and to ensure, through their collective efforts, that the full range of key gaps would be addressed. (See Program Results and an RWJF abstract about the YTCC and its National Blueprint for Action.)

Key RWJF-Sponsored Initiatives: Advocacy & Communications Around What Works

  • After conducting research on effective, developmentally appropriate cessation programs for adolescent smokers, Helping Young Smokers Quit (2001–09) (see above), in its second phase, addressed the critical need to disseminate information about them. In addition, researchers developed evaluation tools for use by any youth-oriented quit-smoking program.
  • A meeting of experts explored how regulations affect youth smoking-cessation research. (See Program Results.)
  • A meeting of tobacco-control donors to explore new ways to involve philanthropies in tobacco-control initiatives targeted at youth. (See Program Results.)

Other Related Resources Funded by RWJF

  • A study comparing the use of smoking-cessation treatments among young adult smokers and older adults smokers. (See RWJF abstract; journal article in the American Journal of Public Health available from the abstract.)
  • Research that found that young adults do not take advantage of proven smoking-cessation treatments that can double their chances of quitting. (See RWJF news brief.)
  • A pilot study examined the efficacy of a motivational interviewing intervention for adolescent smokers. (See Program Results.)
  • A study that found that bupropion, an FDA-approved cessation medication is effective in helping teen smokers quit. (See Program Results.)
  • A study that indicates that evidence-based tobacco-cessation treatments are underused by young adult smokers. (See RWJF Research Highlight.)
  • A conference whose participants considered methodological issues in studying adolescent use of tobacco-cessation treatment. (See Program Results.)

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