In 2007, more than 3 million American adolescents (aged 12–17) reported using a tobacco product in the month prior to the survey. In that same year it was found that nearly 60 percent of new smokers were under the age of 18 when they first smoked a cigarette. Of smokers under 18, more than 6 million will likely die prematurely from a smoking-related disease.

Tobacco use in teens is not only the result of psychosocial influences, such as peer pressure; recent research suggests that there may be biological reasons for this period of increased vulnerability. There is some evidence that intermittent smoking can result in the development of tobacco addiction in some teens. Animal models of teen smoking provide additional evidence of an increased vulnerability. Adolescent rats are more susceptible to the reinforcing effects of nicotine than adult rats, and take more nicotine when it is available than do adult animals.

Adolescents may also be more sensitive to the reinforcing effects of nicotine in combination with other chemicals found in cigarettes, thus increasing susceptibility to tobacco addiction. As mentioned above, acetaldehyde increases nicotine’s addictive properties in adolescent, but not adult, animals. A recent study also suggests that specific genes may increase risk for addiction among people who begin smoking during adolescence. NIDA continues to actively support research aimed at increasing our understanding of why and how adolescents become addicted, and to develop prevention and treatment strategies to meet their specific needs.

Are There Gender Differences in Tobacco Smoking?

Large-scale smoking cessation trials show that women are less likely to initiate quitting and may be more likely to relapse if they do quit.

Several avenues of research now indicate that men and women differ in their smoking behaviors. For instance, women smoke fewer cigarettes per day, tend to use cigarettes with lower nicotine content, and do not inhale as deeply as men. However, it is unclear whether this is due to differences in sensitivity to nicotine or other factors that affect women differently, such as social factors or the sensory aspects of smoking.

The number of smokers in the United States declined in the 1970s and 1980s, remained relatively stable throughout the 1990s, and declined further through the early 2000s. Because this decline in smoking was greater among men than women, the prevalence of smoking is only slightly higher for men today than it is for women. Several factors appear to be contributing to this narrowing gender gap, including women being less likely than men to quit.

Smoking cessation can have immediate health benefits. For example, within 24 hours of quitting, blood pressure and chances of heart attack decrease.

Large-scale smoking cessation trials show that women are less likely to initiate quitting and may be more likely to relapse if they do quit. In cessation programs using nicotine replacement methods, such as the patch or gum, the nicotine does not seem to reduce craving as effectively for women as for men. Other factors that may contribute to women’s difficulty with quitting are that withdrawal may be more intense for women or that women are more concerned about weight gain.

Although postcessation weight gain is typically modest (about 5–10 pounds), concerns about this may be an obstacle to treatment success. In fact, NIDA research has found that when women’s weight concerns were addressed during cognitive-behavioral therapy, they were more successful at quitting than women who were in a program designed only to attenuate postcessation weight gain. Other NIDA researchers have found that medications used for smoking cessation, such as bupropion and naltrexone, can also attenuate postcessation weight gain and could become an additional strategy for enhancing treatment success.

It is important for treatment professionals to be aware that standard regimens may have to be adjusted to compensate for gender differences in nicotine sensitivity and in other related factors that contribute to continued smoking.