Although uneven across social and ethnic groups, the decline in smoking is consistent among young Americans

Smoking among young people has been steadily declining since 2002, according to a recent study. However, the progress made varies greatly depending on individuals' social and ethnic factors, contributing to increasing health inequalities.

The study was conducted on a sample of more than 180,000 people, aged 21 to 25, between 2002 and 2019. Participants in this large-scale survey were asked to indicate their age, gender, ethnic origin, level of education, smoking status (daily smoker, occasional smoker, non-smoker), and, for those concerned, the age of their first cigarette, and the age at which they began smoking daily.[1].

The inexorable decline in smoking across all ethnic and social groups

The figures show a clear decrease in tobacco consumption among young people, whether in terms of the number of people who have already smoked a cigarette or tobacco product at least once, or the daily or occasional prevalence of smoking. Thus, the proportion of young people who started smoking fell considerably between 2002 and 2019 in all social and ethnic groups observed. However, this decrease was more marked among the population with a level at least higher than that of the diploma equivalent to the Bac, compared to young people with a low level of diploma.

Furthermore, there is a differentiated dynamic in the decline in smoking initiation depending on the ethnic groups of individuals. Thus, approximately 60% young Americans declaring themselves as belonging to the Asian ethnic group had already started smoking in 2002, compared to approximately 35% in 2019. This decrease is much less rapid among the Native American community : in 2002, more than 80% of them had already smoked at the time of the survey, compared to around 65% in 2019. This community is also the most affected by smoking, since more than 35% of 21-25 year-olds were still daily smokers in 2019, compared to less than 10% among African-Americans.

The first cigarette smoked later and later

Similarly, there has been a gradual increase in the age of smoking initiation over the period 2002-2019, although there is still inequality in dynamics based on social and ethnic background. Thus, in 2019, more than 60% of young people belonging to the Asian ethnic group who had already used tobacco reported having done so from the ages of 18 to 25, compared to only around 35% in 2002. Here again, Native Americans have the worst figures: around 30% of smokers in this age group started between the ages of 18 and 25. However, real progress has been observed among this community, since this proportion was only 10% around twenty years earlier. Here again, we find the same unequal situation depending on the educational level: the age of smoking initiation tends to rise as the level of education is high. Thus, in 2019, more than 50% of young smokers with at least a level equivalent to the Baccalaureate started smoking from the age of 18, a proportion twice as high as that observed among smokers who did not attend high school. This gradual increase in the age of initiation is good news for public health, because studies show that the earlier tobacco consumption occurs, the stronger the nicotine and tobacco addiction.

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[1] Harlow AF, McConnell R, Leventhal AM, Goodwin RD, Barrington-Trimis JL. Racial, Ethnic, and Educational Differences in Age of Smoking Initiation Among Young Adults in the United States, 2002 to 2019. JAMA Netw Open. 2023;6(3):e235742.doi:10.1001/jamanetworkopen.2023.5742