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Cancer Trends Progress Report – 2011/2012 Update

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Summary Tables
> Smoking Initiation
Youth Smoking
Adult Smoking
Quitting Smoking
Clinicians’ Advice to Quit Smoking
Medicaid Coverage of Tobacco Dependence Treatments
Fruit and Vegetable Consumption
Red Meat Consumption
Fat Consumption
Alcohol Consumption
Physical Activity
Sun Protection
Secondhand Smoke
Tobacco Company Marketing Expenditures
Early Detection
Life After Cancer
End of Life

Smoking Initiation
Prevention: Behavioral Factors

The percentage of people who initiated smoking has declined among the youngest cohort (those aged 12 to 17 years) but has risen among young adults (those aged 18 to 25 years).

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Smoking Initiation and Cancer

The younger a person starts smoking, the greater their lifelong risk of developing smoking-related cancers. This is because young smokers are more likely to become addicted, and the more years a person smokes, the greater the risk of cancer.

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Percentage of individuals in the groups aged 12 to 17 years and 18 and 25 years who said they had initiated smoking during the past 12 months.

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Period – 2002–2010

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Initiation of Cigarette Use:

Age 12–17: Significantly decreased from 2002 to 2010 (data shown only for this period given change in methodology).
Age 18–25: Significantly increased from 2002 to 2010 (data shown only for this period given change in methodology).
Although there were no trend differences by sex in the group aged 18 to 25 years from 2002 to 2008 (years data are available), there were trend differences by sex for the age group 12 and 17 years for the period 2002 and 2010. Females’ rates fell between 2002 (7.4 percent) and 2010 (6.0 percent), while males exhibited stable rates of smoking initiation over the same time.

From 2002 to 2008 (years data are available), there were no trend differences by race/ethnicity or poverty level in either age group.

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Most Recent Estimates

In the 12 and 17 age group, males and females had similar smoking initiation rates in 2010 (males, 5.7 percent; females, 6.0 percent).

In the 12+ age group, males and females initiated smoking at similar rates in 2010 (males, 3.1 percent; females, 2.3 percent).

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Healthy People 2020 Targets

Decrease the percentage to initiate cigarette smoking to:

  • 4.2 percent to initiate cigarette smoking in the 12 to 17 age group
  • 6.3 percent to initiate cigarette smoking in the 18 to 25 age group

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Groups at High Risk for Beginning Smoking

Overall, blacks have lower smoking initiation rates during adolescence than whites and Hispanics. Blacks begin regularly smoking primarily after the age of 18. Hispanics have an earlier onset of cigarette smoking compared to Asians/Pacific Islanders and blacks, but have a similar age of initiation compared to whites.

Young people who come from low-income families or families with less education are more likely to smoke. Young people are also more likely to smoke when they have less success and involvement in school and fewer skills to resist the pervasive pressures to use tobacco. Tendencies to take risks and rebel are among the other risk factors for beginning smoking.

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Key Issues

Nine out of 10 daily smokers try their first cigarette before the age of 18 and become addicted during adolescence, with 99 percent of first use by 26 years of age. In fact, in 2010 most new smokers were younger than 18 when they first smoked cigarettes (60 percent or 1.4 million).. Studies of smokers have indicated that the younger the age of smoking initiation, the greater the risk for developing nicotine dependence. People in adolescence and young adulthood are highly susceptible to initiating tobacco use because they are more willing to take risks, are more influenced by social pressures, and are highly susceptible to advertising. Tobacco companies spend more than $1 million dollars an hour to market their products, and tobacco product advertising, including depictions of smoking in movies and promotions, entice many young people to start using tobacco. However, the recent Surgeon General report predicts youth smoking initiation can be significantly curtailed by instituting comprehensive anti-smoking programs and increasing cigarette prices. Efforts to help young people delay or, even better, avoid smoking would help to prevent many cancers, as well as other adverse side effects associated with smoking.

A study examining high school graduates one year after graduation found that, among those who were "never smokers" in 12th grade, 25 percent had begun smoking. Among 12th-grade smokers, 39 percent had increased their cigarette use. Efforts to reduce smoking among adolescents should be extended to young adults because smoking initiation extends into young adulthood. Particular attention needs to be paid to those young adults not enrolled in college because they have higher smoking rates compared to those enrolled in college.

Research suggests that menthol cigarettes help adolescents and young adults begin smoking (see FDA-CTP-TPSAC report on menthol). Emerging smokeless and other non-cigarette tobacco products such as hookahs/water pipes are also of future concern.

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Additional Information on Smoking Initiation

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