US teen smoking rates have plummeted, with fewer than 1% now daily smokers

The number of American teens who smoke or have even tried smoking has dropped dramatically compared to a generation ago, with less than 1% now saying they light up cigarettes daily.

Researchers tracked data on students in grades 9 through 12 from 1991 through to 2021. They report a 16-fold decline in daily cigarette use—from 9.8% of teens saying they smoked daily in 1991 to just 0.6% by 2021.

Even trying smoking is clearly unpopular now: Whereas about 70% of teens surveyed in 1991 said they had "ever" smoked, that number fell to less than 18% by 2021, a fourfold decline.

"The substantial decrease in cigarette use among U.S. adolescents spanning three decades is an encouraging public health achievement," said senior study author Panagiota Kitsantas, of Florida Atlantic University in Boca Raton.

"This decrease underscores the importance of continued vigilance, research and intervention to further reduce tobacco use and its associated harms," Kitsantas said in a university news release. She's chair of population health and social medicine at the university's Schmidt College of Medicine.

The findings are based on federal government surveys comprising more than 226,000 teens.

The study is published online in the winter 2023 issue of the Ochsner Journal.

Other findings from the study:

• "Frequent" smoking (on at least 20 days of the prior month) fell from 12.7% of teens in 1991 to 0.7% 30 years later.

• "Occasional" (at least 1 cigarette over the past month) smoking dropped from 27% of teens to 3.8% by 2021, a sevenfold decline.

• 12th graders were more likely to say they occasionally smoked versus kids in grades 9 through 11. That suggests that older teens may be more likely to at least experiment with smoking, the researchers said.
• Smoking rates have fallen most dramatically among Black teens, compared to whites or Hispanics.

Smoking-related illness is still responsible for one in every five U.S. deaths, killing about half a million Americans annually, the researchers noted.

And even though reductions in smoking among young people is welcome news, it may take time to show up in improved life spans.

"Quitting smoking significantly reduces risks of cardiovascular disease beginning within a matter of months and reaching the non-smoker status within a few years, even among older adults," explained study co-author Dr. Charles Hennekens.

"However, for lung and other cancers, reductions do not even begin to emerge for years after quitting, and even after 10 years, remain midway between the continuing smoker and lifelong nonsmoker," said Hennekens, who is a professor of medicine at Florida Atlantic.

"Thus, for reducing cardiovascular disease risks it's never too late to quit, but to reduce risks of cancer, it's never too early," he said.

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