Risk & Protective Factors

Approximately 5.6 million adolescents who are currently under the age of 18 will die prematurely due to a 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.

Factors associated with likelihood to smoke or use tobacco

Numerous factors influence adolescents’ decisions to start smoking or to use other tobacco products. These factors include some individual characteristics, such as stress and low self-esteem, but also social characteristics, such as having parents,[3] siblings, or friends who smoke.[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.[2]

Being white, multi-ethnic, American-Indian, or Alaska Native. White adolescents are more likely to smoke cigarettes than black or Hispanic adolescents (though black adolescents are more likely to smoke cigars).[7] However, adolescents who are multi-ethnic, as well as American-Indian and Alaska Natives, are more likely than any other race or ethnic group 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 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.[4,8,9] First and foremost, nicotine is a highly addictive drug that affects individuals on a cellular level, meaning 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.[10]

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.[2,11] 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.[2,16] Females are less likely to try to quit smoking and are more likely to relapse if they do quit.[2]

Genetics. A half-dozen genes, among the thousands that a person inherits, can affect how the brain reacts to nicotine, including the likelihood of becoming addicted.[7]

Footnotes »


American Lunch Association. (2011). Trends in Tobacco Use. Washington, DC: American Lung Association, Research and Program Services, Epidemiology and Statistics Unit. Retrieved February 12, 2016, from http://www.lung.org/assets/documents/research/tobacco-trend-report.pdf


National Institute on Drug Abuse. (2009). Research report series: Tobacco addiction. Washington, DC: National Institutes of Health, U.S. Department of Health and Human Services. Retrieved February 12, 2016, from http://www.drugabuse.gov/publications/research-reports/tobacco/letter-director.


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.


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.


Hanewinkel, R., Isensee, B., Sargent, J. D., & Morgenstern, M. (2011). Cigarette advertising and teen smoking initiation. Pediatrics, 127(2), e271-e278.


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: Institute for Social Research, The University of Michigan. Retrieved February 12, 2016 from, http://www.monitoringthefuture.org//pubs/monographs/mtf-overview2013.pdf.


Arrazola, R. A., Neff, L. J., Kennedy, S. M., Holder-Hayes, E., & Jones, C. D. (2014). Tobacco use among middle and high school students – United States, 2013. Morbidity and Mortality Weekly Report, 63(45), 1021-1026.


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 February 12, 2016, from http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm#4.4.


Pampel, F.C., Boardman, J. D., Daw, J., Stallings, M. C., Smolen, A., Haberstick, B. C., Widaman, K. F., Neppl, T. K., & Conger, R. D. (2015). Life events, genetic susceptibility, and smoking among adolescents. Social Science Research, 54, 221-232.


U.S. Department of Health and Human Services. Do I have nicotine withdrawal? U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. Retrieved on February 12, 2016, http://smokefree.gov/withdrawal.


National Institute on Drug Abuse. (2011). Facts on drugs: Tobacco, nicotine, & e-cigarettes. Retrieved February 12, 2016, from http://teens.drugabuse.gov/facts/facts_nicotine1.php.


Villanti, A., Boulay, M., & Juon, H.-S. (2011). Peer, parent, and media influences on adolescent smoking by developmental stage. Addictive Behaviors, 36, 133-136.


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.


U.S. Department of Health and Human Services. (2012). Preventing tobacco use among youth and young adults: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Retrieved on February 12, 2016, from http://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/full-report.pdf.


National Survey on Drug Use and Health cited by Campaign for Tobacco-Free Kids. (2010). Tobacco use among youth. Retrieved February 12, 2016, from http://tobaccofreekids.org/research/factsheets/pdf/0002.pdf.


Hong, T., & Johnson, C. (2013). A longitudinal analysis of adolescent smoking: Using smoking status to differentiate the influence of body weight measures. Journal of School Health, 83(5), 314-321. 

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Last updated: April 11, 2016