Tobacco Use Is Still the Leading Cause of Preventable Death

Tobacco use continues to be the number one cause of preventable death in the United States and around the world. Tobacco killed one hundred million people worldwide in the 20th century and is on track to kill one billion people in the 21st century.1

In the US, tobacco use kills about 480,000 people per year — more than AIDS, alcohol, car accidents, illegal drugs, homicides, and suicides combined.2

Tobacco Graph

Tobacco Use Is Typically Started & Established During Adolescence

  • Approximately 90% of adult smokers tried their first cigarette before age 18 and nearly 700 children become regular smokers each day.3
  • Each day in the United States, more than 3,800 youth aged 18 years or younger smoke their first cigarette, and an additional 2,100 youth and young adults become daily cigarette smokers.4
  • E-cigarettes, including vapes, e-pens, e-pipes, and e-hookah, are known collectively as electronic nicotine delivery systems (ENDS). While cigarette use is on the decline, middle and high school students’ use of ENDS tripled from 2013 to 2014.5

School-Based Health Centers Can Help Reduce Youth Tobacco Use

School-based health centers (SBHCs) can help prevent tobacco use in students through health education and are well-positioned to provide tobacco cessation services.

  • One of the unique advantages of a SBHC is its ability to go beyond the provision of clinical medical services and engage in public health activities at the schoolwide level.
  • SBHC staff provide health education in classrooms, conduct schoolwide screenings, hold youth and parent education groups, and work with school staff to identify high-risk students.
  • This ability of SBHCs to fuse clinical care and public health makes them well-suited for many prevention activities, such as tobacco prevention and cessation.

Peer Education + SBHCs = An Effective Combination

Peer education programs have demonstrated effectiveness in preventing youth tobacco use.

  • Young people are more receptive to tobacco prevention messages delivered by their peers than those delivered by their teachers.7,8
  • For the peer educators, providing tobacco prevention education to their friends provides an opportunity for positive youth development.8
  • SBHCs who are already providing group education should consider peer programs as a way to enhance the effectiveness of their prevention education.

Resources for Practice

For tools that will help you start and run school tobacco programs, see Tobacco Resources.

(1) Campaign for Tobacco Free Kids. (2015).
(2) Ziedonis, Douglas M., et al. “Barriers and solutions to addressing tobacco dependence in addiction treatment programs.” (2007).
(3) US Department of Health and Human Services. “Preventing tobacco use among youth and young adults: a report of the Surgeon General.” Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health 3 (2012).
(4) US Department of Health and Human Services.
(5) Centers for Disease Control and Prevention. E-cigarette use triples among middle and high school students in just one year, MMWR. Morbidity and Mortality. (2015, April 16).
(6) Black, David R., Nancy S. Tobler, and John P. Sciacca. “Peer helping/involvement: an efficacious way to meet the challenge of reducing alcohol, tobacco, and other drug use among youth.” Journal of School Health 68.3 (1998): 87-93.
(7) Klepp, Knut‐Inge, Andrew Halper, and Cheryl L. Perry. “The efficacy of peer leaders in drug abuse prevention.” Journal of School Health 56.9 (1986): 407-411.
(8) Valente, Thomas W., et al. “Effects of a social-network method for group assignment strategies on peer-led tobacco prevention programs in schools.” American journal of public health 93.11 (2003): 1837-1843.