Risk & Protective Factors

More than six million adolescents and young adults who were born between 1983 and 2000 will eventually die of smoking-related illnesses.[1] There are several characteristics and risks associated with tobacco use and with difficulty quitting – many of these factors are applicable not only to adolescents but to all individuals, regardless of age.[2]

  • Factors associated with likelihood to smoke or use tobacco (read more)
  • Factors making it difficult to stop smoking (read more)

Factors associated with likelihood to smoke or use tobacco

Numerous factors influence adolescents’ decisions to start smoking or use other tobacco products. These factors include some individual characteristics, such as stress and low self-esteem, but also social characteristics, such as smoking by parents,[3] siblings, and friends.[4] Exposure and susceptibility to tobacco advertising can also affect smoking initiation among adolescents.[5] 

Certain characteristics increase the likelihood that an adolescent will smoke:

  • Older age. Rates of regular cigarette smoking and other tobacco use are higher among older adolescents than they are among younger adolescents (although the rate of smoking initiation is higher among younger adolescents).[4],[6]
  • Being male. Females tend to smoke fewer cigarettes a day, use cigarettes with lower nicotine content, and inhale cigarette smoke less deeply, than do males.[7]
  • Being white. White adolescents are more likely to use tobacco than are black or Hispanic adolescents. However, adolescents who are multi- ethnic, as well as American-Indian and Alaska Natives, are more likely than are any other race or ethnicity to use tobacco.[8]
  • Lacking college plans. Adolescents who plan to attend four years of college are much more likely to be nonsmokers than are their peers who lack such plans.[6]
  • Having parents who are not college educated. Adolescents whose parents had little or no college education are much more likely to smoke than are those whose parents have a college education or more.[6]
  • Experiencing highly stressful events. Having experienced numerous highly stressful events in childhood is linked with a greater risk of starting smoking by age 14 and with ever smoking. Among these stressors are being a witness or victim of abuse, experiencing a parental separation, or growing up in a household in which a family member is mentally ill or incarcerated.[9]

Factors making it difficult to stop smoking

Research points to multiple factors that lead to tobacco addiction in adolescence, from genetic patterns, to influences of parents and peers, to difficult life circumstances.[4],[9],[10] First and foremost, nicotine is a highly addictive drug that affects individuals on a cellular level—that addiction is difficult to overcome for adolescents, as well as adults.

Factors that make it difficult to stop smoking include:

  • Physical effects. The effects of nicotine, including the “reward” feeling, quickly wear off, motivating the user to keep using tobacco to recapture that feeling and to prevent withdrawal symptoms. Those withdrawal symptoms are unpleasant and include irritability, craving, attention problems, disturbed sleep, and increased appetite.[11]
  • Behavioral factors. In addition to the physical factors that make it harder for adolescents to quit smoking, behavioral factors also come into play: adolescents frequently associate smoking, its smell and feel, with a number of behaviors, including using alcohol and hanging out with friends who smoke.[7], [11] The influence of peers on adolescents’ smoking behavior seems to decline with age, [12] but is an important factor in whether adolescents begin smoking, and whether their smoking escalates to daily use.[13]
  • Smoking early in adolescence. Research shows that the earlier adolescents begin smoking cigarettes, the more likely they are to become addicted to nicotine.[14] According to results from a nationally representative health survey, nearly 90 percent of adults who smoke became regular smokers during adolescence or earlier.[15]
  • Concerns about weight gain. For some adolescents, concerns about weight gain may be associated with the decision to begin smoking or with a reluctance to quit.[7], [16] Females are less likely to try to quit smoking and are more likely to relapse if they do quit.[7]
  • Genetics. A half-a-dozen genes, among the thousands that a person inherits, can affect how the brain reacts to nicotine, including the likelihood of becoming addicted.[10]

Footnotes>>

[1]Hahn, E. J., Rayens, M. K., Chaloupka, F. J., Okoli, C. T. C., & Yang, J. (2002). Projected smoking-related deaths among U.S. youth: A 2000 update.  ImpacTeen Research Paper Series, No. 22. Retrieved June 11, 2014, from http://www.impacteen.org/generalarea_PDFs/Hahn_researchpaper22_May2002.pdf
[2]National Institue on Drug Abuse. (2012). Tobacco addiction: U.S. Department of Health and Human Services. Retrieved June 11, 2014, from http://www.drugabuse.gov/sites/default/files/tobaccorrs_v16.pdf
[3]Gilman, S. E., Rende, R., Boergers, J., Abrams, D. B., Buka, S. L., Clark, M. A., et al. (2009). Parental smoking and adolescent smoking initiation: An intergenerational perspective on tobacco control. Pediatrics, 123(2), e274-e281.
[4]O’Loughlin, J. O., Karp, I., Koulis, T., Paradis, G., & DiFranza, J. (2009). Determinants of first puff and daily cigarette smoking in adolescents.American Journal of Epidemiology, 170(5), 585-597.
[5]Hanewinkel, R., Isensee, B., Sargent, J. D., & Morgenstern, M. (2011). Cigarette advertising and teen smoking initiation. Pediatrics, 127(2), e271-e278.
[6] Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2014). Monitoring the Future national survey results on drug use, 1975-2013: Overview of key findings on adolescent drug use. Ann Arbor, MI: Institute for Social Research, The University of Michigan. Retrieved June 11, 2014 from, http://www.monitoringthefuture.org//pubs/monographs/mtf-overview2013.pdf
[7]National Institute on Drug Abuse. (2009). Tobacco addiction.  Research Report Series. NIH publication number 09-4342. Washington, DC: National Institutes of Health, U.S. Department of Health and Human Services. Retrieved June 11, 2014, from http://www.drugabuse.gov/sites/default/files/tobaccorrs_v16_0.pdf
[8]Substance Abuse and Mental Health Services Administration. (2011). Results from the 2010 National Survey on Drug Use and Health: Summary of national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved June 11, 2014, from http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm#4.4
[9]Anda, R. F., Croft, J. B., Felitti, V. J., Nordenberg, D., Giles, W. H., Williamson, D. F., et al. (1999). Adverse childhood experiences and smoking during adolescence and adulthood. Journal of the American Medical Association, 282(17), 1652-1658.
[10]Whitten, L. (2009). Studies link family of genes to nicotine addiction. NIDA Notes, 22(6). Retrieved June 11, 2014, from http://www.nida.nih.gov/NIDA_notes/NNvol22N6/Studies.html
[11]National Institute on Drug Abuse. (2011). Facts on drugs: Tobacco addiction.  NIDA for Teens. Retrieved June 11, 2014, from http://teens.drugabuse.gov/facts/facts_nicotine1.php
[12]Villanti, A., Boulay, M., & Juon, H.-S. (2011). Peer, parent, and media influences on adolescent smoking by developmental stage. Addictive Behaviors, 36, 133-136.
[13]Kim, J., Fleming, C. B., & Catalano, R. F. (2009). Individual and social influences on progression to daily smoking during adolescence. Pediatrics, 124(3), 895-902.
[14]U.S. Department of Health and Human Service. (2012). Preventing tobacco use among youth and young adults: A report of the Surgeon General. Rockville, MD. Retrieved June 11,  2014, from http://www.cdc.gov/tobacco/data_statistics/sgr/2012/consumer_booklet/pdfs/consumer.pdf
[15]National Survey on Drug Use and Health cited by Campaign for Tobacco-Free Kids. (2010). Tobacco use among youth. Retrieved June 11, 2014, from http://tobaccofreekids.org/research/factsheets/pdf/0002.pdf
[16]Potter, B. K., Pederson, L. L., Chan, S. S., Aubut, J. A. L., & Koval, J. J. (2004). Does a relationship exist between body weight, concerns about weight, and smoking among adolescents? An integration of the literature with an emphasis on gender. Nicotine & Tobacco Research6(3), 397-425.
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Last updated: October 24, 2014