Are young people smoking more? Penn experts say it’s too early to tell

It may seem like smoking has made a comeback in popular culture, but Penn experts say combustible tobacco use remains low among adults in the United States.

Previously, research has indicated that youth exposure to tobacco-related content on social media is associated with greater susceptibility to using cigarettes. In interviews, Penn professors said that studying the issue is complicated by limitations in data availability and discussed concerns over the negative health impacts of nicotine and tobacco products.

“Perception and data often are out of sync,” Psychiatry professor James Loughead said. “The best data that we have doesn’t show an uptick.”

Loughead said though he has received anecdotal reports that smoking “is back in vogue,” there are no scientific reports to confirm a meaningful statistical increase across the country.

“Data always lags behind what’s actually happening on the street,” he acknowledged.

Psychiatry professor Robert Schnoll, who also serves as the Abramson Cancer Center’s associate director for population science, echoed a similar sentiment.

“Our surveillance tools are limited,” Schnoll said. “There’s often a delay of upwards of 12 to 18 months.”

Based on the most recent data, “the use of combustible tobacco is continuing to go down across almost every group in the United States,” according to Schnoll.

“We’ve never seen the U.S. rate of adult use lower than 10%, and it’s 9.9% now,” he added.

Schnoll said, however, that “data suggests that the greater the number of depictions of tobacco use in media, the more likely it is that people will smoke.”

In 2021, a study sampling over 5,000 U.S. youths showed that those exposed to tobacco-related content by celebrities or influencers were 30% more likely to be susceptible to smoking. According to a different study published this year, “long-established tobacco industry marketing strategies” have “historically used third-party endorsements and leveraged sex appeal and social status to promote cigarettes to young people.”

In May, the American Cancer Society Cancer Action Network and its coalition partners sent a letter to Vanity Fair’s global editorial director, expressing “disappointment” with a magazine cover photo depicting media personality Kylie Jenner lighting a cigarette.

“Influential media like yours should not glamorize a product that remains the leading preventable cause of death in the United States,” the letter read. “With nearly 90% of adult daily smokers using their first cigarette by the age of 18, ensuring that young people never start using tobacco or nicotine to begin with remains essential.”

“There is this recent shift toward analog marketing,” Director of the Biobehavioral Smoking Laboratory Andrew Strasser said. The “push” toward returning to objects that are “less wired” and “electronic” could be a part of why combustible tobacco is more appealing to young adults, he explained.

“I do think if the tobacco companies see an opportunity, they’ll wedge in there and try to market cigarettes as an analog way of acquiring nicotine,” Strasser added.

According to Schnoll, “the typical reason for why young kids smoke is certainly seeing characters in film and people around them” smoke.

When young adults do begin smoking, Loughead said, the numbers of quitting and relapse are “terrible." 

“If you look at unaided quitting — and most people quit unaided, cold turkey — there’s maybe, optimistically, a 5% success rate one year later,” he explained.

Loughead also expressed concern about whether “data will continue to be available” due to the elimination of the Centers for Disease Control and Prevention’s Office of Smoking and Health.

“We had the tools to understand what’s happening in youth smoking, but, surprise, a lot of this has been cut,” he said. “Now there’s litigation about whether the reallocated funding is being used to restart and rehire. My understanding is that the office is still closed.”

Meanwhile, the Food and Drug Administration’s Center for Tobacco Products, Schnoll said was “under the influence of this current administration,” and making decisions that “may not be evidence-based.”

“It is true that nicotine pouches have been approved as a harm reduction tool,” he said, referring to the FDA’s list of Modified Risk Tobacco Products. “I’m not so sure I agree with that perspective.”

Schnoll clarified that while he sees non-combustible alternatives as a “useful tool for cessation among adult combustible tobacco users,” they can also be “an easy way of facilitating addiction to young adults in a way that we hadn’t seen before.”

For the time being, he added, he is “much more worried” about electronic cigarettes and nicotine pouches than he is about combustible tobacco use.

“The product sales for Zyn have exploded maybe 20- or 30-fold in the last couple of years,” Schnoll said. 

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