Background According to the 2014 Surgeon General’s Report (SGR), ‘5.6 million (American) youth currently aged 0–17 years of age will die prematurely of a smoking-related illness.’ Advocates cite this number as evidence that smoking will exact an enormous toll for decades to come. This paper examines whether the projected toll accurately portrays smoking’s likely future burden.

Methods The SGR estimate, using 2012 state-specific data, can be closely approximated using national data by multiplying the population ages 0–17 by 2012 smoking prevalence among adults ages 18–30, and multiplying that by 32%, the 1996 estimate by the Centers for Disease Control and Prevention of the probability of future smoking-attributable mortality among young adult smokers. Repeating this process using 2018 data estimates the number of future deaths of youth ages 0–17 in 2018. A hypothetical estimate for 2024 assumes continuation of the 2012–2018 smoking prevalence decrease.

Findings Based on 2012 data, the estimated number of youth alive in 2012 who will die prematurely from smoking is 5.31 million. With lower young adult smoking prevalence in 2018, the future smoking-related mortality estimate is 3.66 million. For 2024, the estimate is 2.54 million.

Conclusions The SGR estimate depended on assumptions that no longer held a few years later. Yet advocates for youth smoking prevention cite it frequently today. Considerations such as this paper’s calculations, decreasing smoking initiation rates, increasing cessation, better screening for and treatment of smoking-related diseases, and smoking’s increasing social unacceptability suggest that smoking’s death toll for today’s youth will be far lower than contemporary estimates. How much lower is virtually impossible to estimate.