Tobacco Use by Children and Adolescents

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Abstract
Cigarette smoking is the chief single avoidable cause of death in our society and the most important health issue of our time.1 Despite increased public awareness of the long-term morbidity associated with the initiation of cigarette smoking during childhood and adolescence, the 1979 US Surgeon General's report on the health consequences of smoking estimated that 6 million teenagers smoke, and there are another 100,000 youngsters less than 13 years of age who smoke.2 In 1979, the National Institute of Education reported a fivefold increase in the number of smokers between junior high school- and senior high school-aged students.3 In 1983, Johnston et al4 found that 21% of high school seniors were regular daily smokers. Although there has been a general decline of cigarette smoking among male adolescents, there has been no parallel decline in the rate of cigarette smoking among young women, particularly those 17 and 18 years of age (J. A. Califano, Jr, unpublished remarks, 1968, 1974, 1979). Young women who use oral contraceptives are at higher risk of cardiovascular complications if they smoke. Among women who smoke during pregnancy, there is increased risk of poor fetal growth, spontaneous abortion, fetal death, and neonatal death.5,6 In addition to the use of cigarettes, the use of "smokeless tobacco," eg, chewing tobacco and snuff, is becoming more common among young people, particularly rural youth. It is estimated that between 10% and 20% of high school students use smokeless tobacco.7 Its use has been associated with leukoplakia, oral cancer, tooth abrasion, and loss of teeth.8

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