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Age of tobacco use initiation and association with current use and nicotine dependence among US middle and high school students, 2014–2016
  1. Saida Sharapova1,
  2. Carolyn Reyes-Guzman2,
  3. Tushar Singh1,3,
  4. Elyse Phillips1,
  5. Kristy L Marynak1,
  6. Israel Agaku1
  1. 1 Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2 Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
  3. 3 Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Dr Saida Sharapova, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta GA 30341, USA; ssharapova{at}


Introduction Tobacco use mostly begins in adolescence and young adulthood. Earlier age of initiation of cigarette smoking is associated with greater nicotine dependence and sustained tobacco use. However, data are limited on the age of initiation of non-cigarette tobacco products, and the association between using these products and nicotine dependence and progression to established use.

Methods Combined 2014–2016 National Youth Tobacco Survey data, a nationally representative cross-sectional survey of US students in grades 6–12 yielded 19 580 respondents who reported ever using any of five tobacco products: electronic cigarettes, cigarettes, cigars, smokeless tobacco and hookah. Analyses assessed age of reported first use of each product among ever-users, overall and by sex and race/ethnicity. Current daily use, past 30-day use, feelings of craving tobacco and time to first tobacco use after waking were assessed by age of first use.

Results Among ever-users, weighted median age for first use was 12.6 years for cigarettes, 13.8 years for cigars, 13.4 years for smokeless tobacco, 14.1 years for hookah and 14.1 years for e-cigarettes. First trying these tobacco products at age ≤13 years was associated with greater current use of the respective product and nicotine dependence compared with initiating use at age >13 years.

Conclusions First tobacco use at age ≤13 years is associated with current daily and past 30-day use of non-cigarette tobacco products, and with the development of nicotine dependence among youth ever-users. Proven tobacco prevention interventions that reach early adolescents are important to reduce overall youth tobacco use.

  • surveillance and monitoring
  • non-cigarette tobacco products
  • addiction

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  • Contributors All authors have substantially contributed to the conception of the work, interpretation of data for the work and drafting and critical revisions of the work for important intellectual content; have approved the final version for publication and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SS has analysed the data and has full responsibility for the work and decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.