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Gen Z — largely comprised of middle- and high-school students — reported the lowest smoking rates on record in 2024, according to CDC and FDA data, but that trend may be in jeopardy.
“Overall, the decline in smoking in the U.S., [down] to about 11.9% of the population overall, is a great public health success story that has occurred over the past 20 years,” Dr. Neil W. Schluger, dean of the School of Medicine of New York Medical College and pulmonologist, told Fox News Digital.
Some experts, however, fear that the “cool factor” could be making a comeback, hooking a new generation on smoking.
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In certain populations, there is reportedly a movement to re-glamorize cigarette smoking, Schluger said.
One Instagram account, @Cigfluencers, posts photos of celebrities with cigarettes to its more than 83,000 followers.
“SMOKING HOT!” reads a caption for a provocative image of Sabrina Carpenter smoking over a bathroom sink. “Also, Smoking = Hot.”
Additional celebrities who have been open about their cigarette use — and are also pictured on @Cigfluencers — include Ben Affleck, Jeremy Allen White and Natalie Portman, among others.
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“Influencers can be influenced by marketing dollars and can attract younger generations, particularly if the channels used are popular among younger people, such as with social media,” said Judith J. Prochaska, Ph.D., professor in the Department of Medicine at Stanford University in California, whose research focuses on developing effective treatments for tobacco dependence.
Multiple studies show that adolescents and young adults who watch smoking-related content are more likely to begin using tobacco products in the future, but those risks are magnified when they engage with tobacco content on social media.
“It’s confusing and a dangerous contradiction for young people who take their cues from pop culture and celebrity influencers, and are especially vulnerable to believe that smoking is more popular than it really is,” said Truth Initiative CEO and President Robin Koval in a news article on the organization’s website.
In a recent opinion piece published in The BMJ, the author wrote that smoking is experiencing a “pop-culture revival” that is an “unwelcome throw-back for public health.”
“This normalization of smoking risks is re-igniting a harmful cultural association between cigarettes and coolness, to which young people are particularly vulnerable,” the article says.
Smoking trends among youth
In the mid- to late-90s, around one-third of high-schoolers smoked cigarettes. That has dropped to less than 3% today, according to the American Lung Association.
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“It is harder to track trends in youth and young adults, because they tend to be less connected to survey efforts, and behaviors can change quickly,” Dr. Daniel J. Boffa, vice chair of the American College of Surgeons Commission on Cancer and division chief of thoracic surgery at Yale School of Medicine, told Fox News Digital.
“The signals we do have suggest that tobacco smoking rates are much lower in Gen Z than for some earlier generations.”
Boffa noted, however, that around 8% of Gen Z teens use e-cigarettes — “which is important because we really don’t know the long-term effect of e-cigarettes yet, and some young adults will switch over from e-cigarettes to smoking tobacco.”
The U.S. saw a surge in vaping rates in 2019, largely due to the popularity of the brand JUUL, which resonated among youth because of its high nicotine delivery, discreet design, kid-friendly flavors and appealing marketing tactics, Prochaska noted.
E-cigarettes are also on the rise among young adults — in part due to adolescents aging into young adulthood, she added.
Health risks of smoking
Over 90% of long-term smokers started before the age of 18, Boffa noted.
“The problem with tobacco smoking in the teenage and young adult years is that the most severe health-related consequences won’t appear for a few decades, making it easier to ignore the warnings,” he warned.
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When someone smokes over time, the inhaled combusted tobacco and paper damage the tiny air sacs in the lungs called alveoli, which facilitate the exchange of oxygen and carbon dioxide. This damage could lead to chronic obstructive lung disease, according to Mayo Clinic.
The habit can also increase cancer risk, health experts warn. Humans produce random mutated cells that can potentially become cancerous, but a healthy immune system usually eliminates those cells.
When someone smokes, however, toxic substances enter the body and depress the immune system, giving those mutated cells a chance to grow and become cancerous.
Repeated exposure can also increase the risk of oral health problems, pregnancy harms, sexual dysfunction and even mental health effects, Prochaska warned.
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Smoking is also a risk factor for coronary artery disease, aneurysms in the aorta (the main artery of the heart), peripheral vascular disease, and heart attacks and strokes, according to the FDA.
“The reduction in tobacco use in the U.S. is a huge advance in public health, and we should be vigilant not to slide backwards,” Schluger said.
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To maintain this progress, the doctor is a proponent of banning smoking in public places, raising tobacco taxes, increasing funding for cessation programs, and cracking down on illegal advertising and sales to minors.
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