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Prevention of smoking initiation in children and adolescents

Marianna Sockrider, MD, DrPH
Joseph B Rosen, MD
Section Editors
Gregory Redding, MD
Martin I Lorin, MD
Deputy Editor
Alison G Hoppin, MD


Tobacco smoking often starts during adolescence but can have important health effects throughout life. Because of nicotine dependence and social factors, initiation of smoking during adolescence is closely associated with persistent smoking in adulthood and with the many adverse health effects associated with chronic smoking. The long-term consequences of smoking and the benefits of smoking cessation in adults are discussed in separate topic reviews. (See "Patterns of tobacco use" and "Cigarette smoking and other possible risk factors for lung cancer", section on 'Smoking'.)

While there is good consensus on the importance of preventing smoking initiation, techniques for doing so are not standardized or adequately studied. Nonetheless, some general principles arise, extrapolated from health provider interventions for other risk behaviors or from smoking interventions in adults.

Preventing smoking initiation in children and adolescents will be reviewed here, focusing on interventions that can be performed in the primary care setting. Management of smoking cessation in adolescents is discussed separately. (See "Management of smoking cessation in adolescents".)


It is vital that pediatric health care providers routinely address tobacco use among patients and their families. In addition to evaluating for smoking and promoting smoking cessation among their adolescent patients, pediatric health care providers should systematically aim to prevent smoking initiation among all of their patients, as detailed in policy statements from many pediatric health care groups in the United States and elsewhere [1-7]. As stated in a comprehensive review on Preventing Tobacco Use Among Youth and Young Adults that was released by the US Surgeon General in 2012: "The tobacco epidemic continues because youth and young adults begin to use – and become addicted to – cigarettes and smokeless tobacco products" [8]. The report clearly highlights the health consequences of tobacco use by youth, high risk of addiction, and the need to intervene early to prevent onset and use of tobacco.

About 80 percent of individuals who start smoking during adolescence will continue to smoke in adulthood, and one-third of these individuals will die prematurely due to smoking-related disease [8]. (See 'Persistence of smoking into adulthood' below.)


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