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Comparative Study
. 2020 Oct 1;3(10):e2019022.
doi: 10.1001/jamanetworkopen.2020.19022.

Trends in the Age of Cigarette Smoking Initiation Among Young Adults in the US From 2002 to 2018

Jessica L Barrington-Trimis  1   2 , Jessica L Braymiller  1 , Jennifer B Unger  1   2 , Rob McConnell  1   2 , Andrew Stokes  3 , Adam M Leventhal  1   2   4 , James D Sargent  5 , Jonathan M Samet  6 , Renee D Goodwin  7   8
Affiliations
Comparative Study

Trends in the Age of Cigarette Smoking Initiation Among Young Adults in the US From 2002 to 2018

Jessica L Barrington-Trimis et al. JAMA Netw Open. .

Abstract

Importance: Success in reducing the prevalence of adolescent smoking could reflect complete prevention of smoking initiation or a shift in the age of cigarette smoking initiation from adolescence into early adulthood.

Objective: To assess trends in early adult (ages 18-23 years) vs adolescent (age <18 years) cigarette smoking initiation and transition to daily cigarette smoking from 2002 to 2018.

Design, setting, and participants: Ages at initiation of smoking and the transition to daily smoking were ascertained from the National Survey on Drug Use and Health (2002-2018), an annual, population-based, repeated cross-sectional study representative of the US population. This cross-sectional analysis was restricted to young adults who completed the survey at ages 22 to 23 years during survey years 2002 to 2018 to limit potential age-related recall bias. Retrospectively collected age of cigarette smoking initiation was assessed among ever cigarette smokers; age of transition to daily smoking was assessed among ever daily cigarette smokers. Data analysis was performed from June 2019 to July 2020.

Exposures: Calendar year of survey (2002 to 2018).

Main outcomes and measures: The main outcomes were population-weighted cigarette smoking prevalence and cigarette smoking initiation and transition to daily smoking in adolescence (age <18 years) vs early adulthood (ages 18-23 years).

Results: Among 71 756 young adults aged 22 to 23 years (38 226 women [50.5%]), ever cigarette smoking prevalence decreased from a population-weighted estimate of 74.6% (95% CI, 73.1%-75.9%) in 2002 to 51.4% (95% CI, 49.3%-53.5%) in 2018 (P < .001). Daily smoking prevalence rates similarly decreased from 41.1% (95% CI, 39.1%-43.1%) in 2002 to 20.2% (95% CI, 18.6%-21.8%) in 2018 (P < .001). However, among 48 015 ever smokers, the proportion initiating smoking in early adulthood (ages 18-23 years) increased over this time, from 20.6% (95% CI, 18.5%-22.8%) in 2002 to 42.6% (95% CI, 39.6%-45.7%) in 2018 (P < .001). Similarly, among 24 490 daily cigarette smokers, the proportion who transitioned to daily smoking in early adulthood increased from 38.7% (95% CI, 35.9%-41.6%) in 2002 to 55.9% (95% CI, 52.0%-59.8%) in 2018 (P < .001).

Conclusions and relevance: A substantial proportion of beginning smokers and most new daily smokers are now young adults, reflecting a shift from adolescence to early adulthood, a population segment once considered beyond the critical risk period for cigarette smoking onset. Expanding the long-standing emphasis on adolescent surveillance and prevention in adolescence to include the young adult population is warranted.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Sargent reported serving as a consultant to the program project that supports this work, which involves attending an annual meeting for which he is reimbursed for travel and expenses and receives a $1000 honorarium. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Proportion of Ever Cigarette Smokers Who Began Smoking at Ages 18 to 23 Years and Proportion of Ever Daily Smokers Who Began Smoking Daily at Ages 18 to 23 years by Year From 2002 to 2018, Among Participants Aged 22 to 23 Years at Survey Completion
Error bars denote 95% CIs.
Figure 2.
Figure 2.. Distribution of Age at Initiation Among Ever Cigarette Smokers in 2002 and 2018 and Age of Initiation of Daily Smoking Among Daily Smokers in 2002 and 2018 Among Participants Aged 22 to 23 Years at Survey Administration
Panels A and B show data for ever smokers in 2002 (A) and 2018 (B). Panels C and D show data for daily smokers in 2002 (C) and 2018 (D). Dashed lines indicate smoking initiation at age 18 years. aP < .001 for test of difference in mean age of initiation for 2002 vs 2018, adjusting for gender, race/ethnicity, education level, income, and marital status.
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Comment in

References

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