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Youth Smoking Rates and the Risk of DiseaseResearch Paper

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Smoking and Disease Risk

In 2015, the U.S. Census Bureau (2014) predicts that 17 million adolescents between the ages of 14 and 17 will be residing in the United States, compared to 250 million adults aged 18 and over. The rate of tobacco use among high school students in the U.S. is estimated to be 6% based on data provided by the U.S. Centers for Disease Control and Prevention (CDC, 2014). This rate reflects students who smoked cigarettes at least 20 days out of the last 30; therefore, there are close to a million high school students who are frequent tobacco users. The percentage increases substantially if less frequent use is considered, including the use of cigars and smokeless tobacco. By comparison, nearly 19% of all adults aged 18 and over were currently smokers in 2010, with a slightly higher concentration of smokers in the Midwest and the South (CDC, 2013). This translates into almost 50 million smokers in the U.S. today.

The reason tobacco use is such a concern is because researchers have shown that tobacco users suffer from an increased risk of cardiovascular disease, cancer, lung disease, and reproductive problems (reviewed by CDC, 2013). The direct medical costs that have been attributed to smoking are $96 billion, with an additional $97 billion in lost productivity. This essay will examine the prevalence of smoking among youth and adults, in addition to the smoking-related causes for heart disease and cancer.

Smoking and the Risk of Cardiovascular Disease/Cancer

Worldwide, cardiovascular disease (CVD) accounts for 30 to 40% of all deaths, of which 10% has been attributed to tobacco use (reviewed by Kim, Han, & Lee, 2014). Among smokers, 31% of all smoking related deaths are caused by CVD. The threat of stroke and coronary heart disease has been estimated to increase by 2- to 4-fold if the person is a smoker; therefore, there is a close, strong relationship between smoking and CVD prevalence.

The etiology of CVD risk due to smoking is very complex and research studies have revealed a number of likely causes, including endothelial dysfunction, induction of a prothrombic state, chronic inflammation, changes in lipid metabolism, and hypoxia (reviewed by Kim, Han, & Lee, 2014). Among the most well-studied and major causes is the induction of reactive oxygen species (ROS), which in turn leads to oxidative stress, reduced nitric oxide bioavailability, induced prothrombic state, inflammation, and lipoprotein oxidation. Although cigarette smoke contains ROS species, these tend to be so short lived that the overall impact is minor by comparison.

Smoking by children and adolescents increases the risk of lifelong smoking, due largely to the development of a physical dependence on nicotine (Dratva et al., 2013). While the vast majority of research studies investigating the risk of disease due to smoking has focused on adult populations, a recent study looked at predictors of CVD risk in children, adolescents, and young adults between the ages of 8 and 20 (Dratva et al., 2013). An early indicator of atherosclerosis, the thickness of the carotid artery intima media, was found to be significantly increased in smokers compared to non-smokers within this age group. This finding is important because CVD risk begins in childhood, due in part to arterial changes that take place in childhood. Based on the findings of this study, youth who begin smoking substantially increase the risk of CVD development later in life.

Lung cancer was linked to smoking more than 50 years ago (reviewed by Caffrey, 2014). Since then, a number of other cancers have been linked to smoking, including colorectal and breast cancer. Recent support for this connection comes from a number of studies that have found that smoking cessation is at least as effective as the best chemotherapy drug in bringing about cancer remission. Given that the cost of a chemotherapy treatment can sometimes be in excess of $100,000 for an individual patient, smoking cessation makes a lot of economic sense. The risk of cancer due to smoking comes from the fact that tobacco smoke contains 69 different carcinogens. Unfortunately, changes in the way cigarette are manufactured decades ago have increased the risk of cancer. For women, the relative risk rose to 25.66 in 2010. In men, the relative risk was slightly less for the same year, at 24.97. This translates into a 26- and 25-fold increase in the risk of cancer for women and men, respectively, due to smoking. Smoking increases the risk of other cancers, including oropharyngeal, oesophageal, stomach, pancreatic, laryngeal, trachea, cervical, urinary, renal, bladder, and leukemia (Baliunas et al., 2007).

Geographic Factors

As mentioned in the introduction, there are significant geographic differences in the prevalence of smokers in the U.S. In Massachusetts, the prevalence of youth smokers declined to 14% by 2011, a 60% decrease since 1999 (Department of Public Health, 2013a). The prevalence of adult smokers in Massachusetts was 16.4% in 2012, with young adults leading the way at 23.8% (Department of Public Health, 2013b). Males represent the majority of smokers among youth (15.2 vs. 11.7%) and adults (18.0 vs. 14.8%). The CVD prevalence within Massachusetts is low compared to the rest of the U.S. In Boston and the surrounding cities, CVD risk ranges between 274.5 and 295.9 deaths per 100,000 residents (CDC, 2011a).

In New York City, 16.1% of all residents smoke (NYC Coalition for a Smoke-Free City, n.d.). This includes close to 21,000 public high school students (NYC Coalition for a Smoke-Free City, n.d.), who represent just under 9% of the student population (NYC Department of Education, 2015). The rates of CVD for Manhattan and the surrounding boroughs range from 339.7 to 620.5 deaths per 100,000 residents (CDC, 2011b). In Los Angeles, the overall prevalence of smoking is 14.8%, but ranges between 9.8 and 19.0% depending on City Council District (County of Los Angeles Public Health, 2010). The prevalence of smoking deaths in Los Angeles ranges between 305 and 357.4 (CDC, 2011c). The prevalence of teen smokers in Los Angeles County, grades 9 through 12, was about 12% in 2005 (County of Los Angeles Public Health, 2010).

In summary, the percentage of youth smokers in Massachusetts, New York City, and Los Angeles was 14, 9, and 12, percent respectively. Adult smokers for the same locations were 16.4, 16.1, and 14.8%, respectively. Based on these statistics, the rate of smoking among youth is a poor predictor of the rate of smoking among adults. The rough average of CVD deaths in Boston, New York City, and Los Angeles were 285, 480, and 331, respectively, statistics which do not show a correlation with smoking rates among youth or adults.


Tobacco use continues to represent a significant risk factor for the development of CVD and cancer. Although smoking rates have declined among youth and adults, the disease burden due to smoking continues to be a significant public health concern. This analysis did not reveal a clear association between smoking and CVD-associated mortality by geographic location, but clearly smoking remains a significant health issue among youth and adults in the three major metropolitan areas examined. Based on the statistics discussed above, smoking rates range between 10 and 20% in major metropolitan cities. In a nation of over 300 million people, and given the risk of CVD and cancer for smokers, somewhere between 30 and 60 million Americans have a 2- to 4-fold increase in the risk of CVD and a 25-fold increase in the risk of cancer; therefore, smoking continues to represent a major health problem in this country and deserves continued public investment in anti-smoking programs.


Baliunas, D., Patra, J., Rehm, J., Popova, S., Kaiseman, M., & Taylor, B. (2007). Smoking-atributable mortality and expected years of life lost in Canada 2002: Conclusions for prevention and policy. Chronic Diseases in Canada, 27(4), 154-62.

Caffrey, M.K. (2014). 50th Anniversary Report: Even more known about smoking, cancer connections. American Journal of Managed Care, 20(5 Spec. No.), SP157-9.

CDC. (2011a). Interactive Atlas of Heart Disease and Stroke. Massachusetts: Heart disease death rate per 100,000, 35+, all race, all gender, 2008-2010. Retrieved from http://nccd.cdc.gov/DHDSPAtlas/viewer.aspx?extent=-8943237.334815212,-7438140.311229159,4701721.791948178,5393592.15682184&mode=county&state=MA&thematicType=health&filterIds=4,3,2,7,10,9&filterOptions=1,1,1,1,1,1&themeSubClassId=1&overlays=Streets:0,1;cdc_base:0,1,2,3,4,5,6,15;.

CDC. (2011b). Interactive Atlas of Heart Disease and Stroke. New York: Heart disease death rate per 100,000, 35+, all race, all gender, 2008-2010. Retrieved from http://nccd.cdc.gov/DHDSPAtlas/viewer.aspx?extent=-8317927.638699902,-8058139.9427192025,4894004.935549973,5013425.414888645&mode=county&state=NY&thematicType=health&filterIds=4,3,2,7,10,9&filterOptions=1,1,1,1,1,1&themeSubClassId=1&overlays=Streets:0,1;cdc_base:0,1,2,3,4,5,6,15;.

CDC. (2011c). Interactive Atlas of Heart Disease and Stroke. California: Heart disease death rate per 100,000, 35+, all race, all gender, 2008-2010. Retrieved from http://nccd.cdc.gov/DHDSPAtlas/viewer.aspx?extent=-13375169.75521075,-12869839.815274304,3924801.498434898,4157094.038016434&mode=county&state=CA&thematicType=health&filterIds=4,3,2,7,10,9&filterOptions=1,1,1,1,1,1&themeSubClassId=1&overlays=Streets:0,1;cdc_base:0,1,2,3,4,5,6,15;.

CDC. (2013). Vital Signs: Current cigarette smoking among adults aged ?18 years -- United States, 2005-2010. MMWR. Morbidity and Mortality Weekly Report, 60(35), 1207-12.

CDC. (2014). Tobacco use and United States students: What is the problem? Retrieved from http://www.cdc.gov/healthyyouth/yrbs/pdf/us_tobacco_combo.pdf.

County of Los Angeles Public Health. (2010). Cigarette smoking in Los Angeles County: Local data to inform tobacco policy. Retrieved from http://publichealth.lacounty.gov/ha/reports/habriefs/2007/Cigarette_Smoking_Cities_finalS.pdf.

Department of Public Health. (2013a). Youth Tobacco Use in Massachusetts: Survey Results from 1993 to 2011. Retrieved from http://www.mass.gov/eohhs/docs/dph/tobacco-control/youth-tobacco-report-2011.pdf.

Department of Public Health. (2013b). Who smokes: Massachusetts fact sheet. Retrieved from http://www.mass.gov/eohhs/docs/dph/tobacco-control/adults-who-smoke.pdf.

Dratva, J., Probst-Hensch, N., Schmidt-Trucksass, A. Caviezel, S. de Groot, E., Bettschart, R. et al. (2013). Atherogenesis in youth --… [END OF PREVIEW]

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