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Smoking in Young Age and Its Impacts

Introduction 

Smoking, especially when initiated during adolescence or early adulthood, is a critical public health concern that continues to threaten global health security. Youth smoking often leads to long-term nicotine addiction, chronic disease, and increased mortality, with a massive burden on healthcare systems. The tobacco industry has long targeted younger populations through marketing and flavored products, making them more susceptible to early initiation. 

Early initiation of smoking before the age of 18 significantly raises the risk of long-term dependency and reduces the likelihood of successful cessation later in life. The adolescent brain, still in development, is more vulnerable to the addictive effects of nicotine. This early exposure lays the groundwork for various physiological, psychological, and social complications across the lifespan

Globally, the prevalence of tobacco use among youth remains high despite strict regulations in many countries. According to the WHO Global Youth Tobacco Survey (GYTS) 2023, which sampled adolescents aged 13–15 in over 150 countries: 

  • Approximately 10% of adolescents worldwide use tobacco in some form. 
  • In low- and middle-income countries (LMICs), the prevalence reaches up to 17% in males and 9% in females. 
  • Over 80% of adult smokers began smoking before age 18. 

In the United States, data from the CDC’s 2023 National Youth Tobacco Survey (NYTS) showed: 

  • 16.5% of high school students and 4.5% of middle school students reported current tobacco use. 
  • E-cigarettes are now the most common product, used by 14% of high school students. 

These numbers are especially alarming given the extensive efforts in tobacco control policies worldwide, suggesting that newer forms of tobacco (e.g., vaping, flavored products) are undermining existing prevention frameworks. 

Although adolescents may not immediately show overt symptoms of smoking-related diseases, several early signs and physiological changes may appear, including: 

  • Persistent cough 
  • Shortness of breath during physical exertion 
  • Fatigue and decreased stamina 
  • Increased frequency of respiratory infections 
  • Bad breath, tooth discoloration, and gum disease 
  • Decreased immune function 
  • Reduced sense of smell and taste 
  • Early signs of cardiovascular stress (elevated blood pressure, heart rate) 
  • Psychological dependence, mood swings, and irritability linked to nicotine 

Long-term smoking from a young age also alters lung development, causing a permanent reduction in lung capacity by early adulthood. 

The consequences of early tobacco use are often lifelong and multifaceted: 

a. Respiratory and Pulmonary Damage 

  • Increased risk of chronic bronchitis, asthma exacerbations, and early-onset COPD 
  • Reduced lung function growth trajectory, leading to permanent impairment 
  • Increased susceptibility to pneumonia and tuberculosis 

b. Cardiovascular Risks 

  • Early smoking causes vascular endothelial damage 
  • Higher risks of hypertension, atherosclerosis, and early myocardial infarction 
  • Elevated long-term risk of stroke and cardiovascular mortality 

c. Cancer Risk 

  • Youth smokers are 4–6 times more likely to develop cancers of the lungs, esophagus, mouth, throat, and bladder 
  • Cumulative exposure beginning early dramatically increases DNA damage over time 

d. Neurodevelopmental and Psychological Effects 

  • Nicotine impacts adolescent brain development, especially in regions responsible for decision-making, impulse control, and mood regulation 
  • Increased risks of anxiety, depression, ADHD, and poor academic performance 

e. Social and Behavioral Consequences 

  • Smoking correlates with increased likelihood of substance abuse (alcohol, marijuana, opioids) 
  • Associated with risk-taking behaviors and lower socioeconomic status in adulthood 
  • Often leads to social isolation, peer pressure, and bullying 

a. Lifestyle-Based Interventions 

  • School-based prevention programs focusing on peer resistance, assertiveness, and media literacy 
  • Family engagement programs targeting parental smoking behavior and communication 
  • Promoting sports, arts, and community engagement to reduce susceptibility to smoking initiation 

b. Pharmacologic Options (for adolescents under supervision) 

  • Nicotine Replacement Therapy (NRT): patches, gums, lozenges in selected high-dependence cases 
  • Bupropion SR and varenicline: limited evidence in adolescents; typically reserved for adults 
  • Must always be coupled with behavioral therapy and motivational interviewing 
  • U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. 2020. https://www.hhs.gov/sites/default/files/consequences-smoking-exec-summary.pdf 
  • Goriounova NA, Mansvelder HD. Short- and long-term consequences of nicotine exposure during adolescence for prefrontal cortex neuronal network function. Cold Spring Harb Perspect Med. 2012;2(12):a012120. doi:10.1101/cshperspect.a012120 

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