In the many efforts to prevent people from taking up smoking, most initiatives have focused on kids.  As the consumer advocacy group the American Council on Science and Health has long phrased it, "smoking is a pediatric disease." Prevent uptake in the young, and addiction rarely occurs.

But that has led to governments with a big blind spot about young adults, according to a paper in the Canadian Journal of Public Health by Thierry Gagné, a doctoral student at Université de Montréal's School of Public Health.

Over the last two decades, use of tobacco by high-school students has dropped dramatically but smoking by young people aged 18 to 25 has stayed relatively unchanged, with many young adults taking up the habit in college or on their first job.

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This delayed onset of smoking needs similar prevention campaigns from teens to young adults, Gagné argues. While he is speaking discussing Canada, the situation is no different in the US or worldwide.  Here are some questions he answered.

Q: How is the trend in smoking among young Canadian adults different from smoking among teenagers?

A: Smoking prevalence and initiation rates has been steadily decreasing among Canadian youth (ages 11-17) since the mid 1990's, with prevalence rates dropping by half between 1994 and 2004 and again by half between 2004 and 2014. According to the Canadian Student Tobacco, Alcohol and Drugs Survey, initiation to a first cigarette fell from 45% to 8% between 1994 and 2014 among 11- to 14-year-olds. Among 15-17 years old, it fell from 48 to 29% between 2006 and 2014. On the other hand, using the Canadian Community Health Survey, the largest of its kind in the country, we found that trends in initiation to a first cigarette, as well as in daily smoking have not changed significantly. Between 2001 and 2013, about 14 to 16% said they experimented with a first cigarette during their young adulthood and 8 to 9% went on to daily smoking.

Q: How have anti-tobacco campaigns failed young adults?

A: We've known for some time that young adults have had the highest prevalence of smoking. But back in the mid-1990s they simply weren't targeted. Instead, public-health experts directed their interventions and policies (restricting access based on age and location, for instance) at teenage smokers, since that was the demographic that was trending up. The experts didn't take into account that laws preventing marketing to youth would push tobacco companies to target young adults. They also didn't take into account the very different social and physical environments young adults are in, whether at school or at work or in their leisure activities. 

Q: What do you recommend the public health authorities do now?

A: The same things that Stéphanie Gaudet, a University of Ottawa sociology professor, recommended 10 years ago; they're still very à propos to tobacco control today. a) Adapt our surveillance infrastructure to monitor young adults’ smoking. b) Integrate young adults into current teen tobacco-control initiatives. c) Develop a global young-adult public health strategy. d) Include the voice of young adults in these developments. e) Work with other institutions that focus on young adulthood in education, employment and family matters. f) Work with other institutions that focus on disadvantaged young adults in health care, foster care, social services and other areas.

Citation: Thierry Gagné, Gerry Veenstra, "Trends in smoking initiation in Canada: Does non-inclusion of young adults in tobacco control strategies represent a missed opportunity?"
Canadian Journal of Public Health, Vol. 108, No. 1 (2017). DOI: