Approximately 90% of individuals who will become cigarette smokers initiate the behavior during adolescence. Factors that promote adolescent initiation are parental or older generation cigarette smoking, tobacco advertising and promotional activities, the availability of cigarettes, and the social acceptability of smoking. The need for an enhanced self-image and to imitate adult behavior is greatest for those adolescents who have the least external validation of their self-worth, which may explain in part the enormous differences in adolescent smoking prevalence by socioeconomic and school performance strata.

Prevention of smoking initiation must begin early, preferably in the elementary school years. Physicians who treat adolescents should be sensitive to the prevalence of this problem. Physicians should ask all adolescents whether they have experimented with tobacco or currently use tobacco, reinforce the facts that most adolescents and adults do not smoke, and explain that all forms of tobacco are both addictive and harmful.

Nicotine Addiction

• Disease Manifestations of Cigarette Smoking
• Lower Tar and Nicotine Cigarettes
• Nicotine Addiction: Cessation
• Nicotine Addiction: Introduction
• Nicotine Addiction: Other Forms of Tobacco Use
• Nicotine Addiction: Pharmacologic Interactions
• Nicotine Addiction: Physician Intervention