Two-Thirds of Vocational Students Smoked Heavily by Age 13, With Strong Links to Alcohol and Marijuana Use | Research

The takeaway

Among 154 vocational school students, 65% smoked at least 10 cigarettes daily, most starting by age 13, and smokers had significantly higher rates of alcohol and marijuana use alongside poorer grades.

Read this if you work with adolescents and want to understand how tobacco, alcohol, and marijuana use cluster together in this age group.

65% smoked 10+ cigarettes daily, most starting by age 13

What the researchers found

Researchers surveyed 154 students aged 14 to 20 at two vocational high schools about their smoking habits, with objective laboratory verification.

Sixty-five percent of the sample smoked at least 10 cigarettes daily and had begun by age 13. They easily purchased tobacco over-the-counter. The strongest predictors of smoking were having a close friend, parent, or sibling who smoked.

Smokers had significantly poorer academic performance and higher rates of alcohol and marijuana use compared to non-smokers. Despite knowing the health risks (awareness exceeded 95%), 70% of smokers were unconcerned. More than half had tried to quit multiple times and failed, with rapid relapse common. However, one-third remained motivated to try quitting.

Exhaled carbon monoxide proved more immediate, sensitive, and cost-effective than salivary cotinine for detecting smokers.

Why it matters

This study documented the clustering of substance use in adolescents, with tobacco, alcohol, and marijuana use co-occurring alongside academic problems. The finding that most adolescent smokers had tried and failed to quit by their mid-teens underscores how quickly dependence develops.

The numbers in context

154 students surveyed. 65% smoked 10+ cigarettes/day. Most started by age 13. Health knowledge exceeded 95%. 70% were unconcerned about health risks. More than 50% had tried to quit and failed. 33% remained motivated to quit.

How the study worked

Cross-sectional survey of 154 vocational school students aged 14-20. A 23-item questionnaire for all students; smokers (N=99) completed an additional 55-item questionnaire on patterns, addiction criteria, health concerns, and quitting experiences. Exhaled CO and salivary cotinine were measured.

What this study cannot tell us

Vocational school students may not represent all adolescents. The sample was relatively small. Cross-sectional data cannot determine whether smoking led to marijuana/alcohol use or vice versa. The study did not control for socioeconomic factors.

How to read the evidence

A cross-sectional school survey with objective biomarker verification. Useful for describing patterns but limited to vocational school students.

When this study was published

Published in 1996. Adolescent substance use patterns have shifted, with vaping largely replacing cigarette smoking among teens.

The bigger picture

The co-occurrence of tobacco, alcohol, and marijuana use documented here reflects a broader pattern now well-established in adolescent research: substance use tends to cluster rather than occurring in isolation, and addressing one substance without considering others may be insufficient.

Questions still open

Does addressing marijuana and alcohol use alongside tobacco improve cessation outcomes in adolescents? Why does health knowledge have so little impact on adolescent smoking behavior? Would early intervention targeting the 13-and-under age group prevent progression?

Common questions

Were the students aware smoking was harmful?

Yes. Over 95% demonstrated knowledge of health risks, but 70% of smokers said they were not concerned. Knowledge alone did not prevent or reduce smoking.

How was marijuana involved?

Smokers had significantly higher marijuana use than non-smokers. The study documented co-occurring substance use but could not determine which came first.

Read the original research

A survey of adolescent smoking patterns.

The Journal of the American Board of Family Practice, 9(1), 7-13

View on PubMed ↗

Citation

Dappen, A; Schwartz, R H; O'Donnell, R. (1996). A survey of adolescent smoking patterns.. The Journal of the American Board of Family Practice, 9(1), 7-13.