EDITORIAL
Tobacco Use During Adolescence and Young
Adulthood: The Battle is Not Over
This issue of the Journal focuses exclusively on tobacco
use during adolescence: predictors of use patterns,
cultural correlates of use, interventions, and mecha-
nisms for identification of habituated adolescents.
Tobacco remains the leading cause of death in the
United States, accounting for 435,000 deaths (18.1%
of the total deaths) [1]. The most recent Surgeon
General’s Report on The Health Consequences of
Smoking, published 40 years after the first Surgeon
General’s Report on Smoking, lends further support
to the negative health consequences of smoking. The
2004 Report documents the harmful effects of smok-
ing on almost every organ of the body [2]. This new
report provides an interactive scientific database of
more than 1600 key articles cited in the report and is
available through the Internet [2]. Even though very
few adolescents and young adults experience mor-
tality or significant morbidity from tobacco during
the second decade of life, the onset of tobacco use
often begins during this stage of life. Once the young
person has initiated use, it is often difficult to quit
and clinicians are derelict in their efforts to screen
youth during clinical visits.
In spite of the good news from the 2003 data from
the Centers for Disease Control and Prevention
Youth Risk Behavior Surveillance System (YRBSS)
and the Monitoring the Future Survey [3,4], far too
many adolescents are using tobacco. In 2003, the
lifetime prevalence of ever having smoked a cigarette
was 58.4% of high school students, down from 70.1%
in 1991 [3]. Twenty-two percent of high school stu-
dents report that they are current users (defined as
smoking at least one cigarette a day for the 30 days
prior to the survey)—this rate has also dropped from
27.5% in 1991. The Monitoring the Future Survey
supports these downward trends, with 26.7% of high
school seniors reporting that they have smoked in
the past 30 days during 2003. This prevalence rate is
the lowest that has been recorded since the survey
was started in 1976, down from a reported high of
36.5% in 1997 [4]. There is more good news from the
YRBSS, with 57.4% of adolescents reporting that they
have attempted to quit smoking [3].
Three papers in the Journal that utilize longitudi-
nal data sets give us an opportunity to further
understand trajectories and predictors of smoking
behavior. Van den Bree and her colleagues use data
from the National Longitudinal Study of Adolescent
Health (Add Health) to assess the correlates of smok-
ing behavior from the first to the second wave of data
collection, a one-year period of time [5]. Substance
use by peers and self, delinquency, and poor school
performance were all associated with initiation and
progression of smoking. Poor family relations pre-
dicted initiation of experimental tobacco use for girls,
and lack of involvement in active pastimes was
associated with failure to discontinue the experimen-
tation. Two additional papers reported in the Journal,
both from Finland, further add to our understanding
of the risk of initiation and continuation. Paavol and
her colleagues use a 13-year longitudinal study of
903 young people—15 years old at entry into the
study and 28 years old at the last data point in
1993—to report on smoking, alcohol use, and phys-
ical activity [6]. Smoking behavior tended to persist
over the 13-year time period—over half of the vari-
ance of the smoking behavior when the subjects
reached 28 is explained by their behavior at 21. In
addition, alcohol use at 15 was highly predictive of
smoking behavior during young adulthood. Those
individuals who consumed less alcohol and partici-
pated in more physical activity were more likely to
quit smoking over time. In the second Finish study,
Riala and her colleagues demonstrate that the most
powerful predictor for drunk driving during late
adolescence and early adulthood was smoking at the
age of 14 [7]. In addition, hospital-treated substance
abuse disorders were associated with male regular
smoking and female regular alcohol use and having
often been heavily drunk at the age of 14 years. Even
JOURNAL OF ADOLESCENT HEALTH 2004;35:169–171
© Society for Adolescent Medicine, 2004 1054-139X/04/$–see front matter
Published by Elsevier Inc., 360 Park Avenue South, New York, NY 10010 doi:10.1016/j.jadohealth.2004.06.001