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

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 71756 young adults aged 22 to 23 years (38226 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