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Smoking by very young people continues to be widespread and is a growing problem in some countries. Globally, the estimated number of young teen males and females 13–15 years old who smoke cigarettes or use smokeless tobacco products is approximately 50 million.

From the beginning of the Global Youth Tobacco Survey in 1999 and through 2019, 198 countries completed the survey at some point, with 135 conducting it more than once. Of these countries, tobacco use prevalence among both male and female youth decreased in 72 countries but increased in 32 others. In the remaining countries, the trends for male youth and female youth were mixed. In other words, in nearly half of the surveyed countries, there was an increase in female youth’s or male youth’s smoking, or both.

Most countries with a reduction in tobacco use among male and female youth have a very high human development index (HDI). Currently, countries with the highest prevalence of tobacco use among youth generally have a lower HDI. In several of these countries, tobacco use among adolescent females is now more common than among adult females, indicating that the historically reliable lower prevalence of tobacco use among females in many populations worldwide may not continue in the near future.

It is also alarming that, in about two-thirds of countries, more than 30% of current young adult smokers started smoking daily before age 16. Most of these countries score high or very high on the HDI, suggesting that as economies develop tobacco may become more affordable to youth, allowing them to start smoking at an earlier age. Moreover, in more than a third of countries, one-quarter of young teen males and females aged 13–15 are likely to start smoking due to a peer effect.

Although cigarette smoking is the most common type of tobacco use among youth worldwide, the use of other tobacco products is very common. For example, smokeless tobacco was the most common tobacco product used by young teen males and females aged 13–15 in Nepal in 2011, with prevalence of 19.7% and 12.9%, respectively, while prevalence of any tobacco product use was 24.6% among male youth and 16.4% among female youth. Waterpipe smoking has historically been more common in some parts of Asia and north Africa, but it has become popular in some other countries among young adults, particularly university/college students. Prevalence of the use of newer nicotine-containing products (including e-cigarettes) among youth has substantially increased in some very high-HDI countries (see E-cigarettes & HTPs). In addition to cigarette smoking, tobacco control measures need to appropriately address the use of all these products.

Duration of tobacco use is more likely to be longer among those who start tobacco use at earlier ages than those who start it later in life. It has been shown that duration of smoking is a particularly important factor in increasing lung cancer risk. These dynamics further underscore the need for implementation of effective tobacco control policies to prevent youth initiation of tobacco use and provide help with cessation for those who already use tobacco. Tobacco taxation is one of the most effective interventions because youth are more sensitive to increases in tobacco price.


Trends in youth smoking prevalence and potential smokers among youth:

Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health, Global Tobacco Surveillance System Data (GTSSData) [online].

Adult versus youth smoking prevalence:

WHO report on the global tobacco epidemic 2021: Addressing new and emerging products. Geneva: World Health Organization; 2021.

Age at smoking initiation:

Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health, Global Tobacco Surveillance System Data (GTSSData) [online].

Use of alternative tobacco products among youth:

Drope J, Cahn Z, Kennedy R, Liber AC, Stoklosa M, Henson R, Douglas CE, Drope J. Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine. CA Cancer J Clin. 2017 Nov;67(6):449-471.

Salloum RG, Haider MR, Barnett TE, Guo Y, Getz KR, Thrasher JF, et al. Waterpipe tobacco smoking and susceptibility to cigarette smoking among young adults in the United States, 2012–2013. Prev Chronic Dis 2016;13:150505.

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